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NHS Wales Informatics Service Outpatient Activity Project Closure Report

NHS WALES INFORMATICS

SERVICE

OUTPATIENT ACTIVITY

Project Closure Report

Version: 2.1 (Final) Date: 9th May 2012

____________________________________________________________________________________________________ Document: Outpatient Activity Project Closure Report Date Created: 11/04/2012 Programme: NWIS Date Printed: 23/10/2012 Author: David Hawes / Paul Fletcher Version: 2.1 Status: Final

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____________________________________________________________________________________________________ Document: Outpatient Activity Project Closure Report Date Created: 11/04/2012 Programme: NWIS Date Printed: 23/10/2012 Author: David Hawes / Paul Fletcher Version: 2.1

Document History Document Location The source of the document will be found on the Programme’s folder under: T:\DQS\IS-03 Data Quality\IS-03-005 Official Documents\2. Outpatients Revision History Date of this revision: 9/5/2012

Version No.

Revision Date Summary of Changes Changes

Marked 1.0 n/a First draft n/a

2.0 9/5/12 Incorporating David Hawes review comments and additional LHB responses

2.1 10/5/12 LHB/Trust summary tables removed

Approvals This document requires the following approvals:

Name Date of Approval

Version

Distribution This document has been distributed to: Name Date of

Issue Version

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Contents 1. PURPOSE ............................................................................................................ 4

2. BACKGROUND .................................................................................................... 4

3. THE APPROACH .................................................................................................. 4

4. FINDINGS ............................................................................................................. 5

5. CONCLUSION / IMPLEMENTATION ................................................................... 6

6. SUMMARY / NEXT STEPS .................................................................................. 8

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1. PURPOSE The purpose of this document is to report on the closure of the Outpatient Activity project and to outline any outstanding issues / requirements.

2. BACKGROUND The Outpatient Activity Minimum Data Set (OPA MDS) is a long established, secondary use (and secondary care) information standard. WHC(98)60 mandated the flow of the OPA MDS across the Welsh NHS and required all Trusts to make this available to the then Health Authorities (HAs) on a monthly basis (in many former HA areas OPA MDS flows were long established prior to 1998). The process for capturing the MDS in a more efficient manner was refined following the publication of a series of circulars (WHC(2003)48, WHC(2003)80 and WHC(2004)81) which detailed arrangements for the processing of the OPA MDS via the NHS Wales Data Switching Service (NWDSS), now managed by the NHS Wales Informatics Service (NWIS) The data has a range of uses and can be used to support the management, and planning of healthcare services, evaluation of NHS performance trends and can be a valuable source of epidemiological data at both a national and local level. High quality data is essential if it is to be relied upon to support such processes in NHS Wales. In 2006, the Outpatient Activity Comparative Project was established, with the aim of examining the validity and completeness of the data contained within the OPA MDS, with the overall aim being to utilize the OPA MDS as the definitive source of OPA data for performance and reporting purposes. At the time of the establishment of the project, outpatient activity information was available via a number of different sources, most notably the national database itself, QS1, Trust Financial Returns (TFRs), Commissioning Reports (LTA) and CHKS. An initial scoping exercise was undertaken to ascertain what information was included within the scope of each data source and ongoing work has been undertaken ever since with the aim of improving the data quality of all the data sets, with the overall aim of utilising the OPA MDS as the definitive source of outpatient activity data. This document details the concluding elements of this work and seeks to close the project, outlining the range of final validation of the OPA MDS undertaken by Welsh LHBs and Trusts. 3. THE APPROACH

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The requirement for a NHS Wales OPA MDS mandate stemmed from:

- The demand from the then Welsh Information Managers Group (WIMG) for a national, corporate, OPA MDS standard, together with a more rationalised process for the sourcing and processing of the dataset (to replace the then varying local standards and processes);

- The growing demand from senior users, both locally and nationally, to replace

the official source of national OP statistics, the QS1 (Quarterly Statistics 1 aggregate return) with a more effective data source capable of supporting key business processes (commissioning, planning, performance management and outcome analysis). The QS1, whilst a return of considerable history (the capture of simple aggregate OP stats in NHSW commenced in 1958) was limited in several key regards here:

o Poor timeliness and frequency of submission (quarterly) o Failure to support analysis by key variables (e.g. patient demographics,

LHB area of residence, referring GP practice etc.) o No process to enable the capture of potential new data items of interest

(e.g. procedure, outcome, clinician type) o Inability to health event link to other data sources (e.g. admitted patient

care, referral) o Lack of audit trail or means to enable subsequent data validation (other

than just simple ‘consistency checking’ with figures submitted in previous quarters).

In spite of this history, the resource expended by Trusts and LHBs in ensuring the delivery of the OPA MDS, and the fact that the utility of the data has been frequently demonstrated both locally and nationally, QS1 remains the official source of national outpatient statistics and reporting. In order to understand the quality of data contained within the OPA MDS as opposed to the more ‘trusted’ QS1 data source, a number of comparative exercises were carried out between the two sets of data, with subsequent pieces of work being undertaken in order to minimise any issues and discrepancies found. 4. FINDINGS Data providers and national agencies have been required to ‘double run’ and manage both data flows. The National Data Flows Review Final Report, June 2010, described this diseconomy of scale and the lack of a single, definitive, ‘version of the truth’ for which NHS organisations are responsible are the inevitable consequences of such a situation. Following the receipt of the National Data Flows Review, The Information Requirements Board thus proposed the cessation of QS1 derived outpatient activity

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data and, where possible, the derivation of outpatient activity information using the OPA MDS. Furthermore, in April 2011, Richard Bowen (Director of Operations, Department for Health, Social Services and Children, Welsh Government) issued a letter that made the commitment to monitoring outpatient activity performance (e.g. Productivity & Efficiency measures) using the OPA MDS from 2011/12 onwards. The AQF for 2011/12 also seeks to reduce the burden of national reporting whilst at the same time introducing more sophisticated quality and outcome measures, for OP activity using data derived from MDS’s. A copy of the letter can be found in Appendix 1. In response to this mandate, in October 2011, a final proposal was submitted to WISB seeking approval on the utilisation of the OPA MDS as the definitive source of data for national reporting of outpatient activity data. The proposal outlined some of the ongoing actions being taken to address any immediate and longer term issues associated with the data quality and associated data definitions of the OPA MDS. The data set comparison and data validation work resulted in a gradual reduction in the differences between reported outpatient activity in QS1 and the MDS, The latest comparison exercises show a difference of around 1.95% on an all Wales basis, for the period April 2011 – October 2011. It is noted however, that greater variances can be found when looking at the data on an individual Health Board / Trust and / or specialty basis. Over a number of submissions, the outstanding issues that were causing significant discrepancies between QS1 and the OPA MDS on an individual Health Board basis were outlined to WISB. On the condition that LHBs demonstrate action to correct those discrepancies, it was agreed to proceed with the implementation of the OPA MDS with effect from 1st April 2012. Individual letters, along with a detailed log of the issues / actions to be addressed by each organisation, were issued to LHBs / Trust in December 2011. The letters, issued by Pam Hall (then Head of Information, NWIS) required them to ensure corrective action was taken, and for it to be completed by 31st March 2012. A generic copy of the letter can be found in Appendix 2. The responses provided by each LHB / Trust can be found in Appendix 3. 5. CONCLUSION / IMPLEMENTATION The utilisation of the OPA MDS as the definitive source of outpatient activity data for NHS Wales will not necessitate any immediate changes to the current information requirements associated with the OPA MDS return. In light of Richard Bowen’s letter (see Appendix 1), the national reporting of performance information using the OPA MDS has already been tested and implemented

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HSA currently publish annual figures relating to outpatient activity using data sourced from QS1. The switch to utilising the OPA MDS as the source of this data will require NWIS to provide a revised data extract routine to HSA. Given the simplistic nature of the current data flow, there are no significant technical barriers to updating the data extract process to source the data from the OPA MDS. There is currently no data extract specification for the provision of outpatient activity data to the Financial Information Strategy (FIS) in support of the end-of-year financial costing process. FIS collate OPA data directly from LHBs / Trusts in support of the financial costing returns. However, the Admitted Patient Care (APC) data set is currently utilised for financial costing, having already been deemed to be the definitive source of APC activity data. Therefore, no significant barriers are envisaged in enabling the sharing of outpatient activity data using the OPA MDS using the similar processes adopted for APC. Appropriate testing and development will be undertaken by NWIS, in conjunction with FIS and LHBs / Trusts to ensure the data provided meet their requirements. A summary of the LHB / Trust responses to the final data validation process is set out below: Abertawe Bro Morgannwg ULHB: The LHB have identified the reasons for the differences and are taking corrective action accordingly. Aneurin Bevan LHB The LHB have committed to submitting mental health service activity to the OPA MDS by year end 2011/12, with the data being backdated to April 2011. Other small discrepancies have been addressed as a result of manual collection being phased out during 2011/12. Betsi Cadwaladr LHB The LHB have committed to implementing changes to systems and processes, to ensure that a number of issues highlighted to them are corrected, e.g. to ensure the correct and accurate recording of obstetrics activity and nurse-led activity. A timeframe has not been set for this work to be completed. They will undertake a review of manual activity across the LHB, pending further discussions with NWIS on how this should be recorded and reported. A timeframe has not been set for this work to be completed. They have requested further guidance from NWIS with regards to the recording of such things as genitor-urinary medicine activity and non-traditional activity. Cardiff and Vale ULHB: The LHB have confirmed that they are addressing the issues highlighted and are currently signing off a new extract which will provide the new updated compliant data set.

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It is envisaged that they will be using the new extract with effect from May 2012 for April 2012 data. Cwm Taf LHB: The LHB have confirmed that the difference in the figures relates to manual activity that is included in the QS1 return but not captured on Myrddin. They are rolling out Myrddin into more areas now and the ‘missing’ activity is being captured as times goes by. They have also recently implemented a number of procedures in order to resolve some of the other issues highlighted. Hywel Dda LHB: The LHB have identified the reasons for the differences and are taking corrective action accordingly. Powys Teaching LHB: The LHB have identified the reasons for the differences and are looking into the way in which they classify certain types of activity in order to make the recording and reporting of the activity more accurate. They are also looking at their processes for producing both sets of figures to ensure that they are consistent. 6. SUMMARY / NEXT STEPS This Project Closure Document seeks to formally close the Outpatient Comparative Project, and marks the official introduction of the Outpatient Activity MDS as the definitive source of outpatient activity for reporting and performance purposes. Latest data comparative exercises have shown that the difference in figures between QS1 and the MDS has been reducing, with latest analysis showing a difference of around 1.95% on an all Wales basis. LHBs / Trusts have been provided with the data analysis relevant to their organisation, and have been asked to produce an action plan to address the outstanding areas of concern that have been identified. The LHBs / Trusts have responded positively, and have initiated the necessary data validation work required in order to address the issues that have been highlighted to them. The provision of the annual extract of outpatient activity data to HSA, using the OPA MDS as the source, will take mid-2013.

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Historically, data in support of the end-of-year financial costing process is made available to FIS and LHBs / Trusts in July / August. NWIS will make OPA MDS data available, subject to the development and approval of an appropriate specification between FIS, NWIS and LHBs / Trusts. For the purpose of reporting of performance against the productivity & efficiency measures, NWIS is already has already tested and implemented the reporting of outpatient activity performance against the Efficiency & Productivity indicators using the OPA MDS as its source. The impact on NWIS in needing to update the annual data extract of outpatient activity data for HSA, using the OPA MDS as the source data is regarded as minimal and achievable. HSA will be kept up-to-date of ongoing progress against the LHB / Trust actions plans associated with the correction of any remaining data quality or inconsistency issues associated with the OPA MDS so that these can be reflected on any national publications as required.


APPENDIX 1 LETTER FROM RICHARD BOWEN To: Chief Executives – NHS Health Boards

Chief Executive WAST Ein cyf / Our ref: RB/ AQF.1.4.11 Dear Colleague, Update on Performance Reporting linked to the AQF The AQF for 2011/12 introduces a number of new quality and outcome measures as described in the published document and covering letter of the 18th January 2011 however the consistent collection, measurement and reporting of the new indicators require further development and will take time to implement. My team have met to discuss the implications of the AQF with LHB performance and information leads and explored the potential impact on LHB systems. Outcomes from this work will determine the timescale for reporting on these new metrics and what could be reasonably published on a monthly, quarterly or annually basis. Where we require IT infrastructure changes or data standards and definitional support, we will be reliant on support of NWIS colleagues and the implementation timescales of any change will be reflected accordingly to ensure a gradual and smooth transition over time. We will formally communicate our findings in Quarter 1 however in the meantime, LHBs should continue reporting against the existing national performance metrics until further notice. As part of this process, we will also be looking to reduce the burden of national reporting and Appendix A details the work that has been done with Information leads on the outpatient data set and our collective intention to move from two reporting systems to one. We must continue to drive the improvement in reporting outcomes within the NHS and evidence the quality of our patient care and I appreciate your support during this transition period. Yours sincerely

Richard Bowen Director of Operations ____________________________________________________________________________________________________ Document: Outpatient Activity Project Closure Report Date Created: 11/04/2012 Programme: NWIS Date Printed: 23/10/2012 Author: David Hawes / Paul Fletcher Version: 1

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Appendix A Notice: From 1st April 2011 Outpatient (OP) performance will be measured using outpatient minimum data set (MDS) Outpatient data is currently collected through two sources an aggregated QS1 return each quarter and through a monthly out-patient minimum data set (MDS). Both have been mandated with supporting DSCN’s; however the quality and variability in data across the two sources would indicate that there inconsistencies in the data that is reported. For the first quarter both systems will continue to run while alternative ways of collecting sensitive data like GUM services are addressed and while you set up systems to capture any remaining manual processes. Staff at NWIS have been holding meetings with your information teams through out 2009/10 to identify and address these differences. It is anticipated that this work will carry on as your staff focus on areas where there are current difficulties. The move to the OP MDS allows for a more responsive and timely set of data which will support both local and national review of efficiency and productivity. Over the first quarter of 2011/12 a more robust measure based on the principle of outcomes, will be developed for OP data this is being sponsored by the acute productivity board. DNA and new to review rates by speciality codes will continue to be collected to support ongoing focus on this area. While the AQF has moved away from centrally driven targets this is still an expectation that locally and nationally that a reduction in waste, harm and variation will be key drivers for change. A new efficiency and productivity document to support this has been developed with the OPA areas using the OP MDS as their data source. This will be issued shortly to support your ongoing work in improving efficiency across your services It is planned that throughout 2011/12 there will be opportunities for joint meetings between information and performance leads to meet to discuss information flow and performance monitoring. OP data will be one such topic

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APPENDIX 2 INDIVIDUAL HEALTH BOARD LETTERS Generic Letter sent to each Health Board:

Friday 23rd December 2011 To: LHB / Trust Associate Director of Informatics

LHB / Trust Head of Information Services CC: Director of Operations, Department of Health & Social Services, Welsh Government

Head of Information Standards, Welsh Government Information Standards Team, NHS Wales Informatics Service Dear Colleagues, Outpatient Activity Reporting In April 2011, Richard Bowen (Director of Operations, Department for Health & Social Services, Welsh Government) issued a letter that committed to monitoring outpatient activity performance (e.g. via the Efficiency & Productivity measures) using the Outpatient Activity Minimum Data Set (OPA MDS) from 2011/12 onwards. The Annual Quality Framework (AQF) for 2011/12 also seeks to reduce the burden of national reporting, whilst at the same time introducing more sophisticated quality and outcome measures for OP activity using data derived from MDS’. A project entitled the Outpatient Comparative project was set up some time ago to identify, understand and correct discrepancies and inconsistencies in the way outpatient activity data are reported between the OPA MDS and the Quarterly Statistical Returns, which are colloquially known as QS1. Significant improvements in the consistency of reported outpatient activity data have been achieved since the projects inception – in the most recent comparative analysis of OPA MDS and QS1 data, which compared reported activity for 2010/11, the all-Wales difference in the number of outpatient attendances stood at just 1.95%, within the 5% tolerance set for the purposes of seeking to define the OPA MDS as the definitive source of outpatient activity data in Wales. Within Local Health Boards, however, differences of greater than 5% are seen across a number of specialties. The reasons for these differences are known, with many due to simple data quality errors that need to be addressed. These ongoing concerns need to be addressed in order to assure Stakeholders, such as the Performance Division and Health Statistics & Analysis Unit (HSA) of the Welsh Government, that the OPA MDS is fit for purpose for secondary use. Annex 1 of this letter sets out the outstanding areas of concern in respect of the reporting of outpatient activity by insert health board name. The expectation is that corrective action is taken to ensure all consultant (including independent nurse) led outpatient activity undertaken in hospital and health care settings is submitted within the OPA MDS. This data will be the outpatient activity that is used for all

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national analyses of outpatient activity. Any activity data which is submitted which doesn’t match the consultant (or independent nurse) led definition will not be used for national analyses subject to further clarification of the requirement to provide this activity information. There is no requirement for the LHB to update any activity reporting within QS1. There is also no requirement to incorporate Genitourinary Medicine (GUM) activity into the OPA MDS. NWIS is currently in the process of investigating whether ‘sensitive’ information (e.g. GUM, sexually transmitted diseases) such as this can be reported centrally via patient-level data sets. The LHB is therefore asked to immediately review the issues with a view to providing a detailed plan outlining the actions to be taken with appropriate timescales for completion. All organisations are required to ensure all corrective action has been completed by the 31st March 2012 at the latest. Should you have any queries, please contact David Hawes, Information Standards Manager, NWIS on 029 2050 2571 or via email – [email protected]. Yours sincerely,

Pam Hall Head of Information NHS Wales Informatics Service

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mailto:[email protected]



APPENDIX 3 HEALTH BOARD RESPONSES Response from Betsi Cadwaladr LHB: BCU Health Board Analysis of Outpatient Activity Recording Issues

Area of Activity Issue Proposed Solution Obstetrics Incorrect Specialty Code is

being used in Myrddin (East) and Pims (West)

The Organisation will implement a change to ensure this is corrected in the source system.

Nurse-led Activity Significant amounts of nurse-led activity is not being submitted in the MDS (East and West). Some Nurse-led activity is recorded in joint diaries on Myrddin, and not easily split into separate specialties

The Organisation will ensure that nurse-led activity is submitted in the MDS. Plans will be developed to overcome any issues relating to joint diaries.

Manual Activity Some sites not on PAS systems and therefore not reported in MDS

A review of all this activity will be undertaken across BCU. Depending on the outcome of this and the scale of work involved we would welcome a discussion with NWIS around where this might fit into wider priorities. It may not be realistic to have implemented all of this by 1st April. If that is the case BCU would wish to continue submitting this manually via a shortened version of QS1, whilst a programme of work was developed during 12/13.

Clinical Genetics Data is collected manually and at present cannot be submitted in MDS format.

At present this is not deemed a high priority area to move onto Myrddin. The organisation would favour being able to continue to submit this manually in shortened version of QS1.

Genito-Urinary Medicine

Data not recorded on PAS systems so not reported in MDS

Awaiting further guidance from NWIS on how to proceed. Would favour this

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remaining on departmental system with manual submission of figures.

Activity not at Hospital Site

This activity is dispersed across a number of other sites. QS1 guidance has told us to “bucket” these together when in fact they do have a site code. There may be some manual activity included here also.

No further action. The organisation is happy that this information is being submitted to the MDS via the correct site codes. Issue regarding manual activity addressed under previous point

2 site codes in the same grounds

Glantraeth is on the same Hospital site as the Royal Alex. Bryn Hesketh is on the same site as Colwyn Bay. This has led to discrepancies in recording between the 2 sites.

No action required. The MDS gives the correct level of granularity.

External Providers

There are a range of clinics where BCU is the host site but the Provider is external. Eg. Alderhey. These are submitted with a different provider code (the correct one) in the MDS hence the apparent discrepancy in numbers.

No further action required. The data is submitted in the MDS however will appear against a different provider. Analysis by site code only would see this activity correctly recorded if that analysis was required.

North Wales Cancer Treatment Centre

The NWCTC is attached to YGC but does have its own site code. Historically a number of the clinics that take place there were set up with the YGC site code and this remains the case.

Strictly speaking these clinics should be mapped to NWCTC. As any changes to templates are made this will implemented. In the meantime, this is not considered a high priority as the activity is still submitted in the MDS and will show against YGC. Please confirm if this is acceptable.

Comments

• The responses above reflect the comment in the original letter regarding the need to submit all consultant (including independent nurse) led outpatient activity within the MDS. This is taken to include specialist nurse activity too. The Central area of BCU (former Conwy & Denbighshire) has always submitted all nurse-led activity, however this has not been the case in the East and West areas. This was on the basis of clear guidance from Anthony Tracey during his time at CHIP that specialist nurse activity was no different to

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that of an SHO or a registrar. i.e. part of the Consultant “firm”. It is apparent from this exercise (and others we have undertaken internally) that former organisations applied definitions in a different manner. It is therefore likely that a similarly inconsistent picture will be evident across Wales. We would request that explicit guidance is given on how this activity should be submitted that makes reference to specialist and independent nurses. This should also feed through to documentation from Welsh Government on how efficiency measures in the AQF should be calculated. This should reflect the ability to distinguish between these activity types to allow reporting to be undertaken with them in or out.

• The organisation would also welcome continued discussions on a range of other related outpatient activity issues that have arisen throughout the course of this project. There is a range of other activity that does not fit the traditional definitions that is not being submitted across Health Boards in Wales.

• As noted in some of the responses there is need for agreement on how we should continue to submit specialties not recorded on PAS systems in the short term.

• BCU would welcome the cessation of QS1 for the core outpatient activity recording after Q4 has been submitted in April, without the need to continue submitting during the next financial year.

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Response from Aneurin Bevan LHB: By year end we will be submitting an OPMDS for our mental health services, backdated to April 2011. The other small service numbers have already been addressed as manual collection has been phased out during 2011-12.

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Response from Powys Teaching LHB: The differences between our QS1 data and MDS data are mostly due to the way we define activity as either consultant or nurse. The reports we’ve been using for QS1 are using different criteria to the Indigo extract that produces our MDS and this is also adding the discrepancies. We’ve been able to reconcile the 2 data sets against each other after removing the ‘nurse’ activity and came to a difference of 4 records. We’re currently looking at how best we can re classify some of the nurse activity within certain specialties e.g. Urology, by placing it under a new specialty code where it can be easily identified in our reports. We’re also looking at our processes for producing both sets of figures to ensure they’re consistent.

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Response from Cardiff and Vale ULHB: As discussed this is in hand and we currently signing off a new extract which will provide the new updated compliant data set. If all goes to plan we will be using the new extract from this month for April 2012 data.

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Response from Cwm Taf LHB: I have looked at this previously and the explanation is relatively straightforward: The difference in the figures relates to manual activity that is included in the QS1 return but not captured on Myrddin. We are rolling out Myrddin into more areas now and this ‘missing’ activity is being captured as times goes by. The significant CAMHS activity relates to the SEW network which Cwm Taf is the host organisation for and I have submitted a file recently to cover this for the whole of last year, this activity is captured on the ABMU Myrddin system as it relates to the Neath/Port Talbot area but we now have an agreement with ABMU to supply us with a monthly file for submission. With Myrddin being rolled out across the HB to capture the missing activity and a regular CAMHS data being available the decommissioning of the QS1 should be able to proceed without delay.

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Response from Hywel Dda LHB:

Ein cyf/Our ref:

Gofynnwch am/Please

ask for:

Rhif Ffôn /Telephone:

Ffacs/Facsimile:

E-bost/E-mail:

Outpatient Activity Reporting

Anthony Tracey

01267 227901

[email protected]

Ysbyty Cyffredinol Glangwili Heol Dolgwili, Caerfyrddin Sir Gaerfyrddin. SA31 2AF Rhif Ffôn: 01267 235151 Glangwili General Hospital Dolgwilli Road, Carmarthen, Carmarthenshire, SA31 2AF. Tel: 01267 235151

09th February 2012

Dear Paul Re: Outpatient Activity Reporting Please find within Annex 1 the completed action plan with the corrective actions identified. If you wish to discuss any of the content of Annex 1 then please feel free to contact me. Yours sincerely

Anthony Tracey Head of Information Services

mailto:[email protected]


Annex 1 Outpatient Activity (OPA) MDS – Issues To Be Addressed A comparative analysis of OPA MDS v QS1 data for Financial Year 2010/11 highlighted the following issues that need to be addressed by the LHB: Issue Corrective Action Required LHB Comments / Actions Activity Only Reported within QS1:

e.g. activity reported as being undertaken ‘not at a hospital site’ and ‘outside the trust’ Report activity within OPA MDS

The large proportion of this activity (Ophthalmology) is undertaken at North Road Clinic and is included within MDS activity, and is assigned to the correct site within the MDS.

Activity Reported Inconsistently within the OPA MDS (some only reported within QS1):

e.g. Mental Illness (some sites), Old Age Psychiatry (some sites), Learning Disabilities (some sites)

Report activity consistently within OPA MDS

We are currently investigating this issue and any remedial actions required will be completed by April 2012.

The following table provides a more detailed summary of the remaining issues that are to be addressed, whereby there are significant differences between the activity reported in QS1 compared to the activity reported to the OPA MDS. The LHB is required to review the differences set out in the table below and undertake action to ensure activity currently being under-reported within the OPA MDS is correctly reported by 1st April 2012.

____________________________________________________________________________________________________ Document: Outpatient Activity Project Closure Report Date Created: 11/04/2012 Programme: NWIS Date Printed: 23/10/2012 Author: David Hawes / Paul Fletcher Version: 1 Status: Draft

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Summary of Issues to be Addressed Site Code Site Name

Spec Code Specialty Name QS1 MDS Difference

% Difference

LHB Comments

7A2AG West Wales General Hospital 120 ENT 9208 8126 1082 11.75%

QS1 includes Audio Medicine, whereas this is split out as a main specialty within the Outpatient MDS.

320 Cardiology 3814 3372 442 11.59%

Heart Failure Nurse clinics in surgeries included under main hospital for QS1, however is not included within the MDS.

510Obstetrics - AN (outpatients) 5337 3570 1767 33.11%

QS1 includes Midwifery Led Care, but is split out as a main specialty within Outpatient MDS.

7A2AJ Bronglais General Hospital 300 General Medicine 5857 5441 416 7.10%

A consultant’s data was omitted from the MDS, but included within QS1. This has now been rectified and will flow from April 2012 onwards.

361 Nephrology 462 429 33 7.14% Timing issues with manual clinics 400 Other Neurology 24 18 6 25.00% Timing issues with manual clinics

430 Geriatric Medicine 212 0 212 100.00%

This activity is shown as General Medicine on MDS. It is proposed that we will discontinue the use of Geriatric Medicine and add to General Medicine for future submissions.


QS1 is inclusive of Family Planning data, which is excluded during the extract of MDS information as it is included within the GUM specialty.

7A2AK Cardigan And District Memorial Hospital 430 Geriatric Medicine 30 0 30 100.00%



QS1 is inclusive of Family Planning data, which is excluded during the extract of MDS information as it is included within the GUM



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Site Code Site Name


% Difference

LHB Comments

specialty.

520Obstetrics - PN (outpatients) 5 0 5 100.00%

These are Withybush patients and will be therefore included within the Withybush figures.

7A2AL Prince Philip Hospital 120 ENT 3819 3530 289 7.57%

QS1 includes Audio Medicine, whereas this is split out as a main specialty within the Outpatient MDS

320 Cardiology 2948 2753 195 6.61%

Heart Failure Nurse clinics in surgeries included under main hospital for QS1, however is not included within the MDS

7A2BL Withybush General Hospital 180Accident & Emergency 262 0 262 100.00%

Never been included in the MDS as they are all follow up appointments, which are included within Emergency Department Dataset

510Obstetrics – AN (outpatients) 2546 1417 1129 44.34%

There is a data quality issue here. The QS1 includes outpatient contacts which are being recorded under “Obstetric IP” MDS. Work has been instigated to rectify this issue.

7A2D6 Aberaeron Hospital 130 Ophthalmology 781 708 73 9.35% Timing issues with manual clinics

300 General Medicine 99 55 44 44.44%

A consultant’s data was omitted from the MDS, but included within QS1. This has now been rectified and will flow from April 2012 onwards.

430 Geriatric Medicine 26 0 26 100.00%



QS1 is inclusive of Family Planning data, which is excluded during the extract of MDS information as it is included within the GUM specialty.

7A2E1 Amman Valley Hospital 101 Urology 459 431 28 6.10% Timing issues with manual clinics 7A2EF S. Pembs Hosp. Health & 510 Obstetrics - AN 377 235 142 37.67% There is a data quality issue here. The QS1



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Site Code Site Name


% Difference

LHB Comments

Social Care Res Centre (outpatients) includes outpatient contacts which are being recorded under “Obstetric IP” MDS. Work has been instigated to rectify this issue.

620GP Other than maternity 425 0 425 100.00%

This has always been an issue due to the fact that we separate out this element from our A&E data for QS1 purposes.

7A2JA New Tenby Cottage Hospital Outpatients 510

Obstetrics - AN (outpatients) 597 313 284 47.57%

There is a data quality issue here. The QS1 includes outpatient contacts which are being recorded under “Obstetric IP” MDS. Work has been instigated to rectify this issue.

7A2NB Hywel Dda Activity not at a hospital site 101 Urology 1 0 1 100.00%

Nurse led activity, and is included within MDS activity.

130 Ophthalmology 11193 0 11193 100.00%

This is activity is undertaken with North Road Clinic and is included within MDS activity.

143 Orthodontics 524 0 524 100.00%

This is activity is undertaken with North Road Clinic and is included within MDS activity.

420 Paediatrics 84 0 84 100.00%Nurse led activity, and is included within MDS activity.


Community Ante Natal data and Family Planning data for Lampeter and Cardigan Health Centre, which is included within the MDS activity.

7A2RM Hywel Dda activity outside the Trust 100 General Surgery 103 0 103 100.00%

Tywyn Hospital Data which is included within MDS activity 110

Trauma & Orthopaedic 150 0 150 100.00%

130 Ophthalmology 737 0 737 100.00% 300 General Medicine 93 0 93 100.00% 320 Cardiology 65 0 65 100.00% 420 Paediatrics 77 0 77 100.00% 502 Gynaecology 140 0 140 100.00%



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Response from Abertawe Bro Morgannwg ULHB: Summary of Issues to be Addressed Site Code Site Name

Spec Code Specialty Name QS1 MDS Difference % Difference

LHB Comments

7A3B7 Princess Of Wales Hospital 100 General Surgery 14061 9345 4716 33.54%

QS1 figure includes Pre-assessment activity which

is recorded under 9901 and 9902 on the MDS

510 Obstetrics - AN (outpatients) 3461 0 3461 100.00%

All obstetric outpatients on PIMS are seen under the

inpatient specialty code of 501 instead of the outpatient

codes 510 and 520

822 Chemical Pathology 440 0 440 100.00%

The QS1 figure for Chemical Pathology actually represents

the patients seen under the General Pathology code - 820

7A3B9 Maesteg General Hospital 710 Mental Illness 502 0 502 100.00%

? if this is recorded as Maesteg Health Clinic 7A34U

on MDS 7A3C4 Singleton Hospital 191 Pain Management 552 240 312 56.52% QS1 = 552 & MDS =554

300 General Medicine 12337 6218 6119 49.60%

ABM include spec codes 301 & 302 & 320 as part of

medicine 430 Geriatric Medicine 1163 582 581 49.96% QS1 = 1143 & MDS =1156 510 Obstetrics - AN (outpatients) 12243 3872 8371 68.37% QS1 = 8064 & MDS =8031

711 Child & Adolescent Psychiatry 5550 2357 3193 57.53%Trehafod activity added to

Singleton in QS1 7A3C7 Morriston Hospital 141 Restorative Dentistry 5745 5215 530 9.23% QS1 = 5526 & MDS = 5232

150 Neurosurgery 3295 2000 1295 39.30%Change of Specialty Code 150000 + 110700 = 3354



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Site Code Site Name


LHB Comments

191 Pain Management 308 261 47 15.26%All activity should be in total

404

300 General Medicine 8717 5072 3645 41.81%ABM include spec codes 301

& 302 as part of medicine 314 Rehabilitation 503 451 52 10.34% QS1 = 444 & MDS = 353 400 Other Neurology 11932 4207 7725 64.74% Manual returns for this spec

502 Gynaecology 355 234 121 34.08%

Previously allocated to wrong site code correct number =

234

7A3C8 Clydach War Memorial Hospital 710 Mental Illness 1912 1700 212 11.09%

QS1 Data reported as 7A3C8 included patients who were

seen at other sites

715 Old Age Psychiatry 462 93 369 79.87%


seen at other sites 7A3CJ Neath Port Talbot Hospital 100 General Surgery 9552 6360 3192 33.42% Site code issue 510 Obstetrics - AN (outpatients) 3330 0 3330 100.00% See Singleton Response 800 Clinical Oncology 665 0 665 100.00% Manual figures

7A3EJ Ystradgynlais Community Hospital 700 Learning Disabilities 5 0 5 100.00%

Needs validation

710 Mental Illness 255 108 147 57.65% Needs validation 715 Old Age Psychiatry 528 386 142 26.89% Needs validation7A3EM Gorseinon Hospital 100 General Surgery 4 0 4 100.00% Should be Null

120 ENT 1844 136 1708 92.62%

Manually assign to Gorseinon Hospital as clinics were

incorrectly set-up

191 Pain Management 264 0 264 100.00%


incorrectly set-up

314 Rehabilitation 28 0 28 100.00%


incorrectly set-up 400 Other Neurology 1624 946 678 41.75% As above



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Site Code Site Name


LHB Comments

430 Geriatric Medicine 132 80 52 39.39% As above

7A3FJ Cefn Coed Hospital 141 Restorative Dentistry 372 0 372 100.00%Manual QS1 returns, no data

on Information Systems

7A3FL Tonna Hospital 710 Mental Illness 620 0 620 100.00%? if data is recorded under

correct code – Tonna is KB

715 Old Age Psychiatry 923 0 923 100.00%? if data is recorded under

correct code – Tonna is KB 7A3GD Llwyneryr Hospital 700 Learning Disabilities 641 0 641 100.00%

7A3KC Westfa Day Hospital 715 Old Age Psychiatry 1881 1480 401 21.32%


seen at other sites 7A3LA Coity Clinic 715 Old Age Psychiatry 1672 1524 148 8.85%

7A3P7 The Forge Mental Health Resource Centre 700 Learning Disabilities 134 0 134 100.00%

Needs validation

710 Mental Illness 1571 0 1571 100.00%Manuall assigned to Forge

Centre as set up under NPT

7A3PC Children's Orthopaedic Clinic 110 Trauma & Orthopaedic 1831 0 1831 100.00%

Needs validation

7A3PP Central Clinic 710 Mental Illness 5878 3572 2306 39.23%


seen at other sites – 7A3RE

NHS WALES INFORMATICS SERVICE OUTPATIENT ACTIVITY Project … Project... · NHS Wales Informatics...

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