Mental Health Information NHS Trust Forum Thursday 28

Mental Health Information NHS Trust Forum Thursday 28 th January 2010

Introduction • Latest release and use of MHMDS • MHMDS Approvals – where we are • New datasets –IAPT –Community, Maternity, Child Health, CAMHS • ICs new role

Plan (Hope) • • Approvals – soon Only issue – what goes to commissioners ISN – February / March Q 4 P / Q 3 R submission as normal Annual submission as normal No Q 4 R submission Q 1 P submission – v 4 IDB Fall back – no Q 1 P (but not agreed with DH or anyone else) and mapping

Payment by Results • V 3. 5 – any time • Ho. NOS 65+ any time (if you’re on the list) • Guidance Transitions And Algorithms Product Review Group Costing Outcomes Mental Health Clustering Tool Clinical: LD Secure IAPT

Summary of changes • Clusters: – Can flow - now – Should flow – from April 2011 – Must flow – by December 2011 • New data items – Can flow – Q 1, 2011/12 – Should flow – as soon as possible – Must flow – April 2012/13

Tables removed • Community episode of Community Psychiatric Nursing • Inpatient Episode (IPEP replaced by INPATEP and PROVSPELL) • Professional Staff Episode • Care Co-ordinator • Responsible Clinician • CPN Contact • Consultant Outpatient Attendance • Professional Staff Group Contact • Contact with Care Co-ordinator • Spell Suspensions

Unchanged tables • • • • Master Patient Index Day Care Episode Consultant Outpatient Episode Acute Home-Based Care Episode Mental Health Care Home Stay Episode Day Care Facility Attendance Mental Health Clustering Tool Payment by Results Care Cluster Social Service Statutory Assessment SCT Recalls ECT Leave of Absence AWOL

Reconfigured tables • Disaggregated from Review table – – – Employment Accommodation Primary and secondary diagnoses Ho. NOS Intervention (not mandated) CPA Episode • Staff table – Replaces KWS and RC • Team Episode – Replaces CEP and PGEP • Hospital Provider Spell and Inpatient Episode – Replace IPEP • Healthcare Professional Contact – Replaces OPATT, KWCONT, CCONT and PGCONT

New to MHMDS • • • Psychosis details (previously recorded on FERN) Referral details Delayed Discharges (Unify 2) Crisis Plan Ho. NOS variants and PHQ 9 Home Leave Self Harm (Count Me In) Restraint (Count Me In) Seclusion (Count Me In)

Amended tables • Ward stays – Added Security Level, Ward Gender, Ward Age, extra Care Intensity • Clinical Team – Now for national use and better team list added • KWASS renamed to CCASS – Staff ID added to link to Staff table • RCASS – Assignment dates and Staff ID added • Review table – Just about reviews; abuse question indicator and data linkage items added • Mental Health Act event – Extra data items added to enable move to replace KP 90 • SCT – Expiry date added

Mental Health Bureau Service V 4 Gary Sargent – Bureau Services Manager

Why the change ? • V 3 v V 4 : – Standardisation – Development and support – Security • Storage • Access - Authentication – Ease – No installation

Open Exeter (OE)

OE Application Screen

Bureau Services Portal

MHMDS Homepage

MHMDS Homepage

Upload Screen

Upload Screen 2

View Results

Not For Submission

MHMDS Homepage

Submission History

Final Extracts

Contact Details Exeter Helpdesk, exeter. helpdesk@nhs. net, tel. 01392 251289 Gary Sargent, Bureau Services Manager, gary. sargent@nhs. net, tel. 01392 206916

Questions ?

Implementation and Submission Schedule Jo Simpson Gary Sargent

Implementation Plan for v 4 and Submission Schedule • Implementation timetable for v 4 processing – Subject to ISN – Mitigation actions in reserve • Way in which 2011/12 and 2012/13 submission timetable is structured

Implementation plan

Draft Submission Schedule Last v 3/3. 5 submission Annual file 2010/11 – July 2010 No Q 4 R submission for 2010/11 – agreed with DH

Improving Access to Psychological Therapies (IAPT) Nick Bridges Senior Business Analyst

Areas to be considered • • • Why is the data set needed ? Structure of the data set Submission process Status of the approval process Key dates Further planned developments • Note: Applies to all providers of NHS Services, including independent providers

Why is the data set needed ? Support the NHS in delivering: • NICE approved, evidenced-based psychological therapies for people with depression and anxiety disorders • Access to services and treatments for people experiencing depression and anxiety disorders from all communities within the local population, irrespective of age, gender, ethnicity, diagnosis, socio-economic status, sexuality, faith or disability • Increased health and wellbeing, measuring recovery and meaningful improvements

Why is the data set needed ? Continued Support the NHS in delivering: • Patient choice and satisfaction • Timely access to services • Improved employment, benefit, and social inclusion status including help for people to retain employment, return to work, improve their vocational situation and participate in the activities of daily living.

Structure of the data set • 50 item data set • A relational database containing four tables: – Person – Referral – Appointment – Disability • Called the ‘IAPT Intermediate Database (IDB)’

Submission process Data flow: – Provider data extract from local system – Format into required IDB format – Upload via Open Exeter web portal (using N 3 connection) – Central data processing – includes various derivations and calculations – Data made available for download to providers, commissioners and the NHS IC The is essentially the same as new MHMDS process, which will be discussed in detail this afternoon. But, are some differences from MHMDS processing: – IAPT system will be in place from ‘summer 2011. MHMDS system is being developed first – No “assembly” process, only derivations and calculations. – Commissioner data is pseudonymised – Monthly submission

Status of the approval process • Considered at ISB board yesterday ! • Outcome…. .

Key dates January 2011 ISB approval March 2011 ISN issued “Summer 2011” IAPT data flow system complete “Summer 2011” to March 2012 Voluntary data submission April 2012 onwards Mandated submission

Further planned developments • • Detailed data set documentation will be issued, including: Data set specification and guidance • Information Standards Notice • Specification of outputs of the processing, including extracts and rules for derivations / calculations undertaken • Bureau Service processes • KPI’s will initially run in parallel with data set and then cease in 2013/14

Further planned developments • Outcome based currency and tariff • Investigation to be undertaken to determine relationship between the IAPT data set and the mental health clusters: – What the requirements are for deriving an IAPT currency and tariff – Whether any requirement exists to change existing MH clusters / clustering tool to incorporate IAPT. • Additional items are likely to be added to the IAPT data set, such as patient experience, duration of problem and previous treatments. • Planned date for ISN is still to be finalised, but expectation is that development closely maps to Pb. R agenda • More details will be issued as the development progresses

Update on MHMDS Indicators and Validations Maria Short Senior Information Analyst

Performance Indicators from MHMDS… Results from IC http: //www. ic. nhs. uk/services/mhmds/quarterly Results from Department of Health http: //www. dh. gov. uk/en/Publicationsandstatistics/P ublications/Publications. Policy. And. Guidance/DH_109 146 Measures from CQC e. g. ‘Completeness’ of MHMDS (09/10) http: //www. cqc. org. uk/periodicreview/nationalcom mitmentsandpriorities 2009/10/mentalhealthtrusts. c fm

Performance Indicators from MHMDS… • Data produced from MHMDS for DH Performance Indicators and published on IC website • DH take data from here and publish with the rest of their performance framework • DH changed some of their definitions In Sept / Oct 2010 • MHMDS analysis NOT changed to reflect these changes • IC and DH working together to align these!

Performance Indicators from MHMDS… Main differences… • DH state ‘reference period’ • Ho. NOS has age restriction on DH definitions • AWOL definition counts ‘episodes’ rather than care spells in DH documentation We have been working with DH to change the definitions to align with the current analysis so that the indicators remain comparable for 2010/11. IC will change analysis for 2011/12.

CQC measures… • Quality and Risk Profiles: http: //www. cqc. org. uk/_db/_documents/QRP_data_so urces_-_MH_v 1. 6 b. pdf • Q 4 2009/10 • Measure ‘reversed’ compared to previous indicators i. e. Numerator counts invalid / missing / default records depending on data item • Have a read!

Performance Indicators from MHMDS… http: //www. ic. nhs. uk/services/mhmds/quarterly

Performance Indicators from MHMDS… http: //www. ic. nhs. uk/services/mhmds/quarterly **Detailed constructions on ‘Constructions tab’**

Performance Indicators from MHMDS… Just to clarify… • ALL denominators use quarterly data only • Numerators for 1, 1 a, 2 and 2 a look for the most recent non NULL record over the last 12 months (present and previous 3 quarters) for the people identified in the denominator • Numerators for 4 and 5 use quarterly data only because the data items themselves are derived during assembly (please see spec)

MHMDS Specification Assembler detail Derivations Input tables and data items

MHMDS Version 4 Quarterly Data Quality Reports • We need to review our MHMDS data quality reporting requirements (as part of the development and implementation of MHMDS Version 4) • Our review of the data quality reports is currently a work in progress • We are looking for your thoughts/feedback on: – New data items to report on – Data items to be removed from reports – Rules changes • Please Email us at MHMDS@IC. NHS. UK • Contact : Suzie Brown (Higher Information Analyst) Community and Mental Health Team at the IC

History • The MHMDS Data Quality Reports were originally published by DH • Reports were subsequently develop by us at the IC as an interim solution – pre SUS implementation (Developed to look like DH reports) • These reports were due to be produced within SUS (once MHMDS was properly flowing) • As such we were previously constrained by SUS rules. (We tried to keep the rules as consistent as possible with the SUS rules where possible) • Now in a position to take a fresh look at the reports (with implementation of V 4 and MHMDS no longer going into SUS)

Current Format Excel File with 5 Worksheets: 1. Introduction 2. Notes 3. Results (shown as a %) 4. Results (numbers) 5. Rules A reminder of what the reports currently look like:

Results (Shown as a %)

DQ Reporting Changes for MHMDS V 4 DQ Validation/Reporting will be a 2 Stage Process: 1. MHMDS Data Summary Report – produced on submission – – – Produced for every file submitted (both primary and refresh) Reports are produced as part of pre-deadline processing 3 Section at submission stage: 1. 2. 3. 2. Validation Warning - Highlights issues which suggest incomplete/poor data Diagnostics – reflect known information requirements Quarterly MHMDS reports - based on processed data – – More categories than the diagnostic reports As we currently produce but: • • • – With some data items removed Some new data items added Rules adapted as appropriate To reflect V 4 data changes and processing

Difference between Data Summary Reports and Data Quality Report • MHMDS Data Summary Reports – – • Produced for every file at point of submission Produced before any processing is done and any derivations are produced Can only report on Valid/Invalid/Missing Validates person identifiable data Quarterly Data Quality Report – Reports on data within the final refresh submission only – post processing and the production of derivations. – Will not directly validate person identifiable data (but may report on validity of such data where possible via derived data items e. g. Birthdate via Age derivations) – Reports on Valid/Other/Invalid/Default/Other (which is why we also call them VODIM reports) • There are likely to be differences in values shown in these reports for the same data items for the same reporting period, because: – Some people may end up with more than one MHMDS Record for the period – The denominator for the Quarterly Data Quality Reports is the MHMDS record, rather than individual patients. – Therefore, where a patient ends up with more than one record – because they had more than one care spell – or no record, because there was no activity – the denominators in the pre and post deadline extracts will be different.

Main Considerations • Maintain consistency with the rule/constructions for different data quality reports/indicators (a balancing act) – Keep rules consistent with data quality reporting on other datasets e. g. CDS – Try to maintain consistency with DH Performance Indicators and CQC Quality Indicators. – Maintain consistency between Data Summary Reports and MHMDS quarterly Data Quality Reports. • Need to focus on key data items

Proposed Data Items to Remove From the Quarterly Data Quality Reports • • • PCT of Residence Mental Health Care Spell End Code CPA Level (at end of reporting period) Occupation (CPA Care Co-ordinator) Legal Status Classification (End of Reporting Period PCT of GP Practice Outpatient Attendance Consultant All data items reporting on the number of ‘Contacts’ (e. g. with CPN, Clinical Psychologist etc) Employment Status Settled Accommodation Indicator

Quarterly Data Quality Reports Rules Changes • Rules need to be changed to account for how MHMDS v 4 will look • Other Changes – Rules for Validity Commissioner code • No longer validated against a ‘Commissioner List’ • It will be increasingly difficult to keep this list up to date (due to changes to commissioning structure within the NHS) • GP Practice Code will become more important • Valid will include any codes in the correct format and an appropriate 1 st character for a valid ODS organisation – Birth date (derived from age) • If the age is over 120 then the data will be categorised as invalid – Ethnic Category • Z (not stated) to be categorised as ‘Other’ and not ‘Default’ • To stay consistent with the definition of ‘other’ previously mentioned • Consistent with including Z in the numerator (valid/other) for other DQ indicators

New Data Items to Include in the MHMDS V 4 Data Quality Reports • We will need to include all the new HONOS scores which form part of MHMDS version 4 • We are looking for your input into what other new data items should be included.

Where To Find the Current and Historic Trust Level Data Quality Reports Please take a look and let us know your thoughts Friendly url: http: //www. ic. nhs. uk/services/mhmds/dq

Down to detail: MHMDS v 4 data processing Jo Simpson Senior Project Manager

Down to detail: v 4 processing • Why the change? – Automated – Transparent – More secure – No longer a temporary solution – Detail required to support PBR and replace other existing data collections (Fundamental Review of Returns)

V 3 v. v 4 processing • V 3 produces: – Flat file – Aggregate counts from input data – No reliable way of linking care pathways across reporting periods – Only outputs are pseudo data • V 4 will produce: – Full detail of input database in 3 linked tables – Enable linkage across reporting periods – Be capable of producing patient identifiable record level detail

Down to detail: v 4 processing • Populate IDB • Upload IDB • Validate IDB • Pre deadline processing SUBMISSION DEADLINE • Post deadline processing

Processing MHMDS • Populate IDB – 45 tables

Processing MHMDS • Populate IDB – inclusion rules for types of table – Single – Event – Episodes

Processing MHMDS • Populate IDB • Upload IDB • Validate IDB • Pre deadline processing SUBMISSION DEADLINE • Post deadline processing

Processing MHMDS • Validate IDB – Pass – Fail File rejected File is processed Report on failure – any of the following: • The following tables were empty: (either or both of) 1 - MPI 5 - REFER • X patients had an invalid NHS number (using v 3. 5 validation rules) • X patients had an invalid postcode (using v 3. 5 validation rules) • X patients had an invalid birth date (valid date, not in future and with derived age at start of RP not greater than 120) • X duplicate NHS numbers in MPI Table • X duplicate Local patient IDs (LPID) in MPI Table

Processing MHMDS • Populate IDB • Upload IDB • Validate IDB • Pre deadline processing SUBMISSION DEADLINE • Post deadline processing

Pre deadline processing • Extract data • Data item level derivations • Flatten data from x linked tables to 3

Pre deadline processing: Extract data different rules for different table types • Items that only appear once in MHMDS record: – NHS number – GP practice • Items that appear many times (or not) – Events – single date – Episodes – start and end dates

Eg: Contacts extracted for Q 1

Pre deadline processing… • Extract data • Data item level derivations – Team Type for each Team Episode – derived from unique Team ID (in Team Episode Table) and matching record with Team Type in CLINTEAM Table

…derivations

Pre deadline Processing… • Extract data • Data item level derivations – From data in IDB, eg for each Team Episode a Team Type derived from Unique Team ID and Team Type allocated to that ID in the Team Table – From reference data, eg LSOA from postcode • Flatten data from 45 linked tables to 3 – by type: single, event or episode

Flatten data – eg: episode tables

View outputs of pre deadline processing • Data summary reports • Test extract

Data Summary Reports • Validation results • Warnings eg: – X patients had an invalid gender code – X patients were shown to be aged Under 16 at the start of the RP – X patients had overlapping Referrals open during the RP • Diagnostics and other metrics

Data Summary Reports • Diagnostics and other metrics: – – – metrics to support the assurance of the data flow • Number of patients • Number of Event Dates data quality metrics for some key data items • x/y valid Gender • x/y valid Organisation code GP Practice (Where y = rows in record. csv) an indication of the number of patients that fell in to the denominator group for some known commonly used indicators: • • people on CPA aged 18 -69

Test extract • Record csv • Episode csv • Event csv

Recap - Processing MHMDS • Populate IDB • Upload IDB • Validate IDB • Pre deadline processing Review outputs and repeat until SUBMISSION DEADLINE • Post deadline processing

Post deadline processing • Derive for each MHMDS record* – – – MHMDS Person ID MHMDS Spell ID Spell Start Date Spell End Reason MHMDS Record Number * Consists of one row in record csv and multiple rows in episode and event csv, linked on MHMDS record id

Mental Health Care Spell The spell is a patient level summary of all the mental health care provided from the patient’s first referral into the provider’s adult mental health services and ending with a clinician’s decision to discharge the patient from these services, or death. The spell is unique to a provider / patient combination and may span days, months or years. • In version 4 MHMDS, the Spell Start and End dates will be derived from Table 5: Referrals – This table should contain a record for each external referral to the mental healthcare provider for the patient. This should include referrals that were not accepted by the provider. – Where there are overlapping external referrals a date of discharge from mental health service should be entered for the referral that finally closes the episode of care within the provider. – Internal referrals with the mental healthcare provider should not be included.

Some other familiar MHMDS concepts MHMDS record The MHMDS record describes that part of a patient’s care spell that occurred within a particular reporting period. The full record of a care spell may consist of more than one MHMDS record, if the spell has spanned more than one reporting period. Reporting period A regular period of time described by a start and end date. Each MHMDS record includes information relating to a discreet reporting period. For version 4 processing in 2011/12 the reporting period will to continue to be a quarter and quarter 1 is from 01/04/2011 – 30/06/2011.

Log on and retrieve final extract: • Record csv • Episode csv • Event csv

Documentation • Current: – Draft v 4 Data standard (v 0. 15 on web site: http: //www. ic. nhs. uk/services/mental-health-minimum-dataset- ) Updates on Changes to MHMDS processing (2) mhmds/specifications-and-guidance – • In preparation: – – Guidance IDB v 4 and Release Notes Mapping guide 3. 5 to 4 Data Manual to include data inclusion rules and derivation rules and specification for test and final extracts

Any questions? . . . Contact: mhmds@ic. nhs. uk www. ic. nhs. uk/services/mental-health