NHS Digital Data Release Register - reformatted
Methods Analytics Ltd
Opt outs honoured: N
Basis: Health and Social Care Act 2012
Format: Anonymised - ICO code compliant Sensitive
How often: Ongoing
When: unknown — 11/2016
HSCIC Id: DARS-NIC-09519-D5G0R-v0.4
Data: Hospital Episode Statistics Outpatients
Data: Hospital Episode Statistics Admitted Patient Care
Data: Hospital Episode Statistics Accident and Emergency
Data: Standard Monthly Extract : SUS PbR A&E
Data: Standard Monthly Extract : SUS PbR APC Episodes
Data: Standard Monthly Extract : SUS PbR APC Spells
Data: Standard Monthly Extract : SUS PbR OP
Data: Hospital Episode Statistics Critical Care
Data: Bridge file: Hospital Episode Statistics to Diagnostic Imaging Dataset
Data: Diagnostic Imaging Dataset
Data: Bridge file: Hospital Episode Statistics to Mental Health Minimum Data Set
Data: Mental Health and Learning Disabilities Data Set
Output: Outputs for the data will be as follows and are related back to the above objectives. All outputs are still live and on-going.
1) Stethoscope. Tool developed as Ruby on Rails bespoke web tool combined with Qlikview 11 dashboards
https://stethoscope.methods.co.uk.
2) Ad hoc reports and bespoke tools ongoing. Created using MS Office Suite , Excel 2013, Word 2013, Qlikview and Tableau and also rendered as .PDF format for final reports on highly aggregate data. These include multiple reports on Emergency care are for CCGs, providers and NHS England regions to support understanding of causes of failure and direct service improvement initiatives. Methods are also supporting the NHS Improvement Getting it Right First Time (GIRFT) programme, a wide ranging programme to improve secondary care quality and outcomes, with bespoke analysis and reporting for every provider in England.
3) Royal College of Surgeons Live dashboards and tool developed in Qlikview11 called the Procedures Explorer Tool (http://rcs.methods.co.uk/pet.html) and have recently produced surgical deep dive reports for every CCG and provider in England.
4) The output is an application, SWORD, at https://sword.methods.co.uk
Activities: For all purposes above the data is made available to Methods Analytics through NHS Digital's secure file transfer programme (ftp), after which it is imported into directly into Methods Analytics SQL data warehouse that is hosted as discrete physical servers by Redcentric.
Only users who are substantively employed by Methods Analytics will have access to the data.
The process is handled by a single Data Base Administrator, as per NHS Digital guidance, who has the password for the secure ftp. This process means the individual will set off a set of automatic instructions to import the data into SQL via an SSIS package. The package itself handles the data import process. Redcentric provide rack space, power, internet connectivity (controlled by physical firewalls) and high level server management support (such as server system software patching).
Methods Analytics will install, maintain and operate all non-operating system software and have sole access to the servers. The installed software for hosting and managing the data will be MS SQL Server 2014. Methods Analytics users will have to complete a Data Centre Access request form which is signed off by their line manager before being granted access the server. Using 2 factor authentication, encrypted, VPN. The VPN supports the use of both SafeNet Software based tokens and hardware based tokens each of these types requires a pin-code in order to generate a one-time password for the VPN. Each token is only usable on one device. The use of tokens restricts each Methods Analytics user to a single computer, with a drive encrypted using Microsoft Bitlocker.
With the unique token issued to each member of Methods Analytics staff who need access, this identifies them discretely and incorporates user level access control limiting access to tables and data at a per user level. Data on the servers is encrypted using XTS AES 256-bit encryption at rest. All processing will be undertaken within the server environment. No episode level data will leave the secure environment. Once the record level data has been processed, only anonymous, aggregated data (subject to disclosure control rules in line with NHS Digital rules), is transferred out of the secure Redcentric environment, as described in individual sections below. No record level data is provided to any third party, and all record level or aggregated data (subject to disclosure control rules in line with NHS Digital rules) is held at RedCentric. The reporting tool (Tableau and Qlikview) are hosted and run only in the secure Redcentric environment.
1) NHS Digital Data is processed into indicators within the Redcentric environment and the resulting aggregated data (with small numbers unsuppressed) dataset is transferred to a reporting server which is also within Redcentric over a secure internal connection initiated from the secure server. Disclosure control rules in line with NHS Digital rules are applied by the reporting server product (Tableau or Qlikview) as the application is used, and thus ensures that no small number unsuppressed data is available to the user.
Stethoscope’s functionality built in the web for providing indicator Alerts and MyView uses a different data model to Qlikview. The data is still processed in Redcentric and subject to disclosure control rules in line with NHS Digital rules. Whilst the NHS Digital disclosure control rules do permit small numbers at certain geographical levels, Methods Analytics apply small number suppression to any low numbers in the data table regardless of the level of aggregation (i.e. Regional, Provider etc.) before it is transferred to an Amazon Web Service instance (in the EU Ireland region), where the data is restored to a SQL database which serves the web product. To be clear, only aggregated data subject to disclosure control rules in line with NHS Digital rules (anonymous data therefore) is held or processed within Ireland.
2) NHS Digital Data is processed into indicators and counts within the Redcentric environment and undergo a process to create an anonymous, small number suppressed tabulation. Those tabulations, which are suppressed in line with the HES Analysis Guide, are transferred via encrypted VPN to encrypted PCs/laptops in order to build reports using a suite of business intelligence software consisting of MS Office, MS PowerBI, Qlikview or Tableau. Reports are also rendered as Adobe PDF documents before being distributed.
3) NHS Digital Data is processed into indicators and counts within the Redcentric and the resulting aggregated (small numbers unsuppressed) dataset is transferred to a Qlikview server which is also within Redcentric over a secure internal connection initiated from the source server. Disclosure control rules in line with NHS Digital rules are applied at the application layer (Qlikview) and ensures that small numbers are not available to the user.
4) NHS Digital Data is processed into indicators and counts within the server environment and the resulting
pseudonymised dataset is transferred to a Qlikview server which is also within Redcentric over a secure internal connection initiated from the source server. Disclosure control rules in line with NHS Digital rules are applied at the application layer (Qlikview) and ensures that no numbers <=5 are available to the user at this time, except where expressly permitted above in section 5a.
Objective: The data will be used to support the NHS either directly through the delivery of tools and bespoke analysis or indirectly through non-NHS organisations, where analytics are provided to the NHS as the end beneficiary via a non-NHS organisation.
The organisations who would be considered as supporting the NHS directly are:
Department of Health
Monitor
NHS Trust Development Agency
NHS Improvement
NHS England
National Institute for Health and Care Excellence (NICE)
Clinical Commissioning Groups (CCGs)
Commissioning Support Units (CSUs)
Local Authorities (for Public Health purposes only)
Providers of NHS-funded care
Professional bodies
This list is referred to as “Healthcare Organisations” below.
Organisations who would be considered as supporting the NHS indirectly only where they are providing analysis/analytics to one of the “Healthcare Organisations”.
Such organisations work within the healthcare space and have access to analysis solely for the purpose of assisting NHS organisations. Such organisations will only be provided with aggregated data, subject to NHS Digital disclosure control rules. Disclosure control will be carried out in line with the HES Analysis Guide where the data is from the HES/SUS datasets. Where the data includes Mental Health data (either on its own, or linked to HES and/or SUS), then the Mental Health disclosure control rules will apply (see Special Conditions for details). Throughout this application/agreement, the combination of these rules is stated as “…subject to disclosure control rules in line with NHS Digital rules”.
Methods Analytics' target audience is NHS organisations, however the NHS is increasingly looking to industry to support it in the provision of evidence and implementation support for service improvement, and hence Methods Analytics wish to offer the tool services to a limited number of non-NHS organisations based on their agreeing to license terms and conditions, which include submitting and evidencing training in information governance and the restriction of the use of the tool to the uses outlined in this document, with this purpose statement flowed down as a contract schedule.
For clarity, the schedule will state that:
• Only aggregated small number suppressed data may be used from the tool.
• No data is to be used for direct marketing to individuals or organisations.
• No data is to be used for direct sales activities
New / renewed agreements that Methods Analytics Ltd put in place with customers (following the commencement of this agreement) in relation to purposes (1) and (2) will permit Methods Analytics Ltd to audit their customers to ensure that data is used in compliance with this data sharing agreement. Such agreements will also request additional detail on the benefits achieved by using such tools and data. Methods Analytics Ltd will make all such detail available to NHS Digital. At least one audit of a non-NHS organisation must be carried out in 2017.
There are five uses of data requested (and each is discussed further within the processing, outputs and benefits section). The specific uses are :-
1) For Stethoscope - a quality variation tool which provides national benchmarking of Hospital Episode Statistics (HES) based indicators that is made available free to the public at an organisation roll up level, and more granular information to subscribing Healthcare Organisations, as listed above, and non-NHS organisations undertaking service improvement support for NHS benefit. Such organisations work within the healthcare space and have access to the system solely for the purpose of assisting NHS organisations. Such organisations will only be provided with aggregate data subject to disclosure control rules in line with NHS Digital rules on their agreeing to license terms and conditions, which include submitting and evidencing training in information governance and the restriction of the use of the tool to the uses outlined in this document, with this purpose statement flowed down as a contract schedule. For clarity, this will state that:
• No record level data is provided to any third party organisation in any format.
• No data is to be used for direct marketing to individuals or organisations.
• No data is to be used for direct sales activities.
Non-NHS organisations to be included are: Healthcare Organisations, charity and not-for-profit organisations , academic researchers, companies that specialise in providing commissioning support and service improvement services to the NHS and life science companies. No other non-NHS organisations are permitted.
Consultant Code will also provide a further level of drilldown in the Stethoscope product to provide Trusts only to explore and understand the variation in care between their own consultants across Method Analytics indicator set. Access to the more granular tool is provided securely to named subscribers only, with individual surgeons able to compare themselves to a national cohort of surgeons. Access controls restrict access to consultant identifiable data so that only authorised staff at an individual Trust can only see data for their own employees, and such data is subject to disclosure control rules in line with NHS Digital rules. No access to servers containing HES data is possible through Stethoscope as the Stethoscope servers are not linked in any way to the secure environment.
Only aggregated data (suppressed in line with the HES Analysis Guide) is surfaced through Stethoscope.
2) For bespoke tools and analysis for individual NHS clients (Healthcare Organisations, as listed above) and non-NHS organisations (as listed above) undertaking service improvement support for NHS benefit. Such organisations work within the healthcare space and receive analysis solely for the purpose of NHS benefit. All such organisations will only be provided with aggregate, small number suppressed data in line with the HES Analysis Guide. The majority of these reports contain data items from Stethoscope but are reported as dashboards for individual organisations. They also contain bespoke metrics generated from HES data presented as aggregated (subject to disclosure control rules in line with NHS Digital rules) tabulated data and/or charts and graphics, and can have accompanying narrative interpretation. Methods Analytics may choose to place tabulations in the public domain (via Methods website or partner website) where a tabulation has been produced to support academic work or for other analysis under the terms of this agreement where there is public benefit in be a provider of open data. All such tabulations will be aggregated, subject to disclosure control rules in line with NHS Digital rules.
3) For creating and hosting dashboards and an explorer tool developed with the surgical associations working group under a NICE accredited methodology. This is work for the National Surgical Commissioning Centre, hosted by the Royal College of Surgeons of England and part of the NHS England Rightcare programme. These tools show activity rates and simple outcomes for CCG populations and care providers using HES/SUS Payment by Results (PbR) data. These tools are free to the public.
4) Surgical Workload Outcomes Audit Database (SWORD) is a project for a number of the specialist surgical societies to develop an intelligence tool for only their Consultant Surgeons members to access measures and metrics about their own performance, which will be accessible via the associations’ member’s portals (therefore password protected). Only consultant surgeon members of the associations can access the SWORD tool. Access is further restricted so that surgeons can only access pathways developed with and for their specialist association and not those pertaining to other specialties. This is further secured by the request for access being generated by the association and sent to Methods Analytics, with Consultant name, General Medical Council (GMC) number and nhs.net email address that is used for communication with the individual. Method Analytics creates an account for that consultant with access granted only to pathways developed with and for the requesting association. When the user logs in, the system validates a link between their user name and GMC number, so when they click the ‘consultant view’ they see only their own data with a national mean. At this level only data for the named consultant is visible. As requested and previously recommended by Data Access and Advisory Group, the surgical associations individual consultants may see their own activity and outcomes without suppression, and national mean data to enable local discussion amongst surgeons of low volume activity and outcomes. There is no option to view other consultants’ data in this view. If the user does not have a valid GMC number linked to their user account, then when a user clicks on consultant view no information is presented.
The other use case for SWORD is ‘pathway view’ where a user looks at an organisation level comparative (benchmarking) data for an individual surgical pathway, such as cholecystectomy, groin hernia etc. with the ability to drill in and investigate how behaviour varies for groups of patients (grouped by a common theme e.g. treatment pathway, not by identifiers). The surgical associations have now requested that Methods Analytics do not undertake suppression in this view either as to do so compromises the quality and accuracy of data, meaning too much data is missing to form a complete and accurate picture of what is going on clinically for patients on these pathways and significantly reduces the value of tool to the surgical community. The ability to look at sub-cohorts of activity and understand variation in decision making and low volume activity is a core use case, as stated, the entire tool is only available to active consultant surgeons and they can only view pathways developed with and for their specialty association. The pathway view without suppression is deemed vital for clinical engagement, improvement of data quality and improvement in surgical decision making and patient outcomes by providing insight into clinical behaviours that it would be desirable to understand and potentially challenge, and identify if there are places in the country that are doing well and can peer support improvement in these pathways for those struggling.
Update to include HES Critical Care, Diagnostic Imaging Dataset (DIDS), Mental Health and Learning Disabilities Dataset (MHLDDS), and Bridge files:
Methods Analytics are applying for these new datasets (and bridging files) in response to requests from current NHS commissioner and provider clients of their services. There is significant interest from both commissioners and providers of NHS care to understand the complete end-to-end care pathway, informing users of ‘whole system’ behaviour. This is a strong current NHS focus, including cross-care sector integration. With these data sets, Methods Analytics will be able to create information on different pathway models, such as direct access, traditional pathways via an acute outpatient appointment or the impact of referral management and triage to diagnostic designs. These data can inform an understanding of variation in total pathway duration, number of contacts required and total cost. This will enable the realisation of direct benefits to both commissioners and providers through improved evidence for design, monitoring and managing more efficient and effective care pathways, increasing value to both the NHS and patients. The new data sets will be used across purposes 1- 4 above.
Benefits: Benefits relating to each of the purpose statements is listed below:
1) Stethoscope Free (formerly Acute Trust Quality Dashboard) free to the NHS and the public is information tool showing aggregated indicator data across the domains of the NHS operating framework. This has significant usage across the NHS with hundreds of visits each period and users can download a free PDF report, with approximately 7000 views and 30 free PDF downloaded by users each month. The free public Stethoscope website was used as input for the Keogh mortality reviews and is visited by Monitor, Care Quality Commission (CQC) and NHS Trust Development Authority (NTDA) among many others. Methods are aware that the free PDF download is used to inform Trust boards, having been asked for permission by Trust secretaries.
Stethoscope Subscriber a password protected secure service offered with an annual subscription to cover the costs of data hosting and processing, licensing for Qlikview, development of the tool and hosting user groups. This offers users much more frequently than publicly available sources updated indicator data with the ability to drill into the data and filter by different options to provide insight and understanding of the quality of care. Users would be assigned access to the tool by an administrator in their organisation and examples of users include Trust Chief Executives, Medical and Nursing Directors, Specialty Managers, Clinicians and Information Departments. CCG, Local Area Team and commissioning region subscribers may grant access to the tool for use by Quality Managers, Public Health analysts, Commissioning Managers and Executives.
It is important for Methods Analytics to work with their customers to ensure they can interpret the data and use it to take appropriate actions to improve the quality of care where possible. Many indicators are available dealing with Quality and Safety issues NHS Organisations face to allow decision makers to take actions based on up to date information. Methods have CCG, provider and NHS England regions as subscribers with over 100,000 page views per year and 100% contract renewal from subscribers indicating the value of the system to NHS users. The Stethoscope subscriber system has been used to support Quality Surveillance Groups, Quality Summits, and board to board oversight meetings
This application/agreement provides Stethoscope access to non-NHS organisations solely where they are working for NHS benefit by providing service improvement support to NHS organisations. As some NHS organisations require additional specialist resource to deliver the benefits of using benchmarking information, therefore subscription to Stethoscope is required by the non-NHS organisations as:
1. This enables the non-NHS organisation to have people equipped to provide immediate support to NHS organisations.
2. Providing them with aggregate level information via the tool is the most efficient way of disseminating information in support of this work – the alternative described directly below would clearly create large inefficiencies.
3. It allows such organisations to be autonomous in undertaking work that requires a level of independence and is beneficial to the NHS and negates the risk associated with further raw data dissemination these organisations directly.
Allowing select non-NHS healthcare focused organisations to access aggregate level analytics is beneficial to the NHS as it enable the NHS to quickly access additional specialist resource when it is required. This allows the timely delivery of improvements in clinical quality and/or operational efficiency. Without this option it would be necessary for them to increase or upskill their internal resource. To do so would require longer timescales and prove more costly for the organization and therefore the NHS in the long run if there is primarily a short term need.
This application/agreement will extend Methods’ ability to inform providers and commissioners of NHS care and other interested parties (as described) by broadening the scope and coverage of data sets that can be used to understand the health care system and so improve their ability to help users of their services understand behaviour, activity and outcomes in the health care system, so supporting service, efficiency and quality improvement efforts.
Mental Health and Learning Disability is not well served by healthcare intelligence intermediaries and the ability to respond to direct requests from providers, commissioners and other interested parties such as local authorities for information and analysis will be welcomed. The expected benefits from MHLDDS data that have been considered in discussion with clients (current CCG clients and prospective clients) include: broadening the use of the platform from pure secondary care to a more population health focus and understanding the complex relationship between physical and mental health through linked health sector data, which will enable the design, monitoring and management of care pathways for individuals using this multi-sector set of services. This will improve patient experience, improving population management and so efficiency, capacity and cost.
The expected benefits from DIDs data that have been considered in discussion with clients include: ability to understand patient flows and pathway duration prior to secondary care and so inform care pathway redesign, potentially reducing delay, shortening journeys, reducing the need for multiple outpatient appointments and secondary care visits, so reducing cost to the NHS and also negating the need for patients to make multiple journeys.
2) Methods Analytics work with Trusts and CCGs, and wider programmes such as the DH NHS Improvement GIRFT team to provide ad hoc reporting matching their requirements, using HES/SUS and SUS PbR data as appropriate to derive insight into a specific topic or issue. The ability to extend the reporting, particularly for the GIRFT programme by using DIDs and MHLDDS linked data is desirable as it means that more of the patient pathway and scope of care delivery can be considered in the program and greater quality improvement and efficiency gains sought.
A real life example is a review of urgent care within an NHS Trust: Methods Analytics used HES data to build a picture of issues around urgent care including where patients are flowing from, how referral patterns are changing over time and conversion rates that was used by the organization to initiate a transformation programme and improve urgent care timeliness and outcomes. Similar projects focusing on mortality have resulted in large and lasting reductions in hospital mortality. Projects include a large amount of clinical engagement to ensure that data in the reports is used in the best way possible to make changes to services that benefit patients in any organisation working with Methods Analytics. The Analytics team includes clinicians and consultants to provide the right expertise when discussing any insight with Methods Analytics NHS clients.
Methods are also working with the DH GIRFT programme, generating report across 12 specialty areas under Lord Carters NHS efficiency programme. These detailed data rich reports are shaped by national lead clinicians for each specialty and they then visit every provider in England to discuss their data with them in order to improve the quality and efficiency of care. This programme is currently being rolled out. Methods Analytics have recently produced a programme update for the GIRFT team, using HES analysis to demonstrate the early impact the GIRFT programme has had across the NHS and supporting policy development, such as, realising over £4m of cashable saving and releasing over 50,000 bed days of surgical occupancy while improving the quality of care. The ability to bring DIDs data to bear on the GIRFT programme will enhance Methods’ ability to support them by bringing an additional area of NHS activity and so cost into scope, enabling greater scrutiny and discussion of potential quality and efficiency opportunities.
Enabling Methods Analytics to place tabulations as described for free in the public domain will deliver benefit to the NHS and wider public as aggregate, anonymous, low volume suppressed data that we have created as part of the input to published academic work (e.g. http://www.iaas-med.com/files/Journal/21.4/Swift_et_al.pdf) and public reports (e.g. the NHS England surgical deep dive reports referred to in 3 below) will enable further local analysis, research and understanding of improvement science in healthcare, ultimately benefitting healthcare and the public purse.
3) The NSCC dashboards and PET tool was developed in partnership with the Royal College of Surgeons and NHS England Rightcare programme to support the work of the National Surgical Commissioning Centre
http://www.rcseng.ac.uk/healthcare-bodies/nscc. They developed commissioning guides for CCGs on specific interventions which all have NICE accreditation. As part of this work, Methods Analytics developed the PET tool to allow commissioners to access data to support the guidelines. The commissioning Guides are approved by the National Institution for Clinical Excellence and together with the data tools are used by commissioners across England to improve services for patients and monitor those improvements. RCSE has made the guidelines publically available and also the data tools in line with the requirements of the governments transparency agenda. Therefore there are no ‘customers’ as the tool is available to all. This tool has been live since 2012 and Methods Analytics has been recontracted again for 2016/17, to maintain and enhance these tools. The tool receives of the order of 350 hits per month from NHS and wider public. Methods Analytics has recently produced a ‘surgical deep dive’ report for the RCSE and NHS England Rightcare programme that uses HES analysis to produce a detailed report for every NHS provider and CCG detailing variation across 29 surgical care pathways that will be available for free to the public and NHS on the NHS England web site.
4) SWORD is a tool developed with ALS and AUGIS to provide to their consultant surgeon members detailed, clinically valid metric that report activity, quality and outcome metrics for surgical pathways. The tool is now live following user validation and testing, with consultant surgeons starting to request, and being provided with, access. Wider roll out is ongoing, including developing relationships with other surgical specialties, where the Association of Coloproctologists Great Britain and Ireland and the British Association of Paediatric Surgery are working with us to develop pathways.
By allowing surgeons to see how their quality of care varies from other surgeons performing the same operations they can work to improve the levels of care they are able to offer and improve the safety for patients they are operating on, in order to get a full understanding it is important they are able to identify themselves in the tool. Surgeons can also use the data could also be used for revalidation purposes therefore ensuring patient safety by providing evidence a surgeon is up to date and fit for practice. There is significant interest from other specialist societies based on the work done in upper GI and laparoscopic surgery and developmental work is underway with the Association of colorectal surgeons, British Association of Pediatric Surgeons and support from the over-arching Federation of Surgical Specialist Associations.
The ability to bring DIDs data to bear on the SWORD programme will enhance Methods’ ability to support them by bringing additional areas of NHS activity and so cost into scope, enabling greater scrutiny and discussion of potential quality and efficiency opportunities.
Source: NHS Digital.