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Better Information Means Better Care:The role of the CDO in improving Healthcare through
the better use of Data
Dr Geraint LewisChief Data Officer
The NHS in England before the reforms
Providers: regulation and accountability
NHS April 2013 onwards
New funding arrangements
High quality care for all, now and for future generations
Text Text
World class dataOpen Outcomes
Greater voice and insight for patients and clinicians
More choiceand control
Transparency
Participation
7
• Hospital Episode Statistics (HES) is a world-class data service containing details of all NHS hospital activity in England
• Records every inpatient ‘episode’ (1989 onwards), outpatient attendance (2003 onwards) and A&E attendance (2007 onwards)
• Invaluable research tool – tens of thousands of peer-reviewed articles and audits
Dame Edith Körner (1921-2000)
Our starting point forworld class data: HES
Year 1 Year 2
Two years of HES data for one individual patient
Describing: to describe patterns of hospital activity over time
Predicting: to build models that help plan services and reduce the risk of needing unplanned care
Evaluating: Using modern scientific methods to find out the success rate of preventive care
Uses of NHS Data
Comparing: to compare health needs and the use of services in different parts of the country
Auditing: to help assess the quality and safety of hospital care
Investigating: exploring what apparent links in the data are telling us
1. Variable data quality and completeness
1. Very difficult for patients to access their own data
1. Missing data:
a) No information about in-hospital prescribing, investigations, observations, etc.
b) No information about care outside hospital
c) No information about social care
Problems with HES
Questions that cannot yet
be answered using HES
• How many patients in England received chemotherapy last year?
• What proportion of patients in St. Mary’s hospital were reviewed by a consultant at least once a day?
• For patients in Birmingham versus Bristol, what was the average time between presenting to their GP with bowel symptoms to being diagnosed with colon cancer?
• What proportion of patients on Ward 20 who had highly abnormal nursing observations were reviewed by the intensive care outreach team within an hour?
UNCLASSIFIED
J F M A M J J A S O N D J F M A M J J A S O N D
Out-patient
In-patient
Emergency
Time
Le
ve
l o
f C
are
2011 2012
J F M A M J J A S O N D J F M A M J J A S O N D J F M A M
Out-patient
Primary Care
In-patient
Emergency
Social CareMental Health
Prescribing
TimeLeve
l of
Car
e
2011 2012 2013
× × × × × ×
J F M A M J J A S O N D J F M A M J J A S O N D J F M A M
Out-patient
Primary Care
In-patient
Emergency
Social CareMental Health
Prescribing
TimeLeve
l of
Car
e
2011 2012 2013
× × × × × ×
21:00 22:00 23:00 0:00 1:00 2 3 4 5:00 TimeLe
vel o
f Ev
ent
Pharmacy
Symptoms
Observations
Imaging
Tests
Results
Diagnoses
✚C ✚
★★ ★ ★ ★ ★✪ ✪
o oo o o
12-Jul-11
Procedures
Human Rights Act
NHS Constitution
Data Protection
Act
Health & Social
Care Act
2nd Caldicott Review
Protecting privacy
Safeguards
Identifiable data Potentially identifiable data
Non-identifiable data
Safeguards
Identifiable data Potentially identifiable data
Non-identifiable data
Contains identifiers such as
date of birth and postcode
Disclosed by the HSCIC
only where there is a legal
basis (e.g. section 251
approval) or with patient
consent.
Safeguards
Identifiable data Potentially identifiable data
Non-identifiable data
Contains identifiers such as
date of birth and postcode
Disclosed by the HSCIC
only where there is a legal
basis (e.g. section 251
approval) or with patient
consent.
Contains a unique
pseudonym for each person
Wide range of safeguards
as specified by the
information commissioner’s
office (e.g., purpose
limitation, prohibition of re-
identification, time limits for
destroying data, contractual
penalties)
Safeguards
Identifiable data Potentially identifiable data
Non-identifiable data
Contains identifiers such as
date of birth and postcode
Disclosed by the HSCIC
only where there is a legal
basis (e.g. section 251
approval) or with patient
consent.
Contains a unique
pseudonym for each person
Wide range of safeguards
as specified by the
information commissioner’s
office (e.g., purpose
limitation, prohibition of re-
identification, time limits for
destroying data, contractual
penalties)
Contains aggregated or
anonymous data
Safeguards to ensure
that the data are truly
anonymous in line with
ICO advice (e.g., small-
number suppression,
perturbation, rounding)
GP Practice
Health and Social Care Information
Centre
NHS Commissioners
& Providers, Public Health England etc.
Publication
Health Service Researchers &
analysts
PatientSection 251
Potential patient objection
Hospital, social care providers
etc.
Patients have a choice
GP Practice
Health and Social Care Information
Centre
NHS England, CCGs, Public Health teams
Publication
Health Service Researchers &
analysts
PatientSection 251
Role of the CDO
1. Information Governance
2. Information Standards
3.Strategic Intelligence
4.Open data and transparency
Further information
www.england.nhs.uk/caredata
