Change Request
 
NHS Information Authority

Data & Information Standards Programme

Reference: Change Request 485
Version No: 1.7
Subject: HES Extraction of Out-Patient and Accident and Emergency CDS
Type of Change: Change to Supporting Information
Effective Date: Immediate
Reason for Change: The Hospital Episode Statistics (HES) data warehouse is a record level database of hospital admissions populated by taking a sub-set of the data submitted to the NHS Wide Clearing Service (NWCS). The scope of the data warehouse has been increased to include the Out-Patient Attendance and Accident and Emergency Attendance Commissioning Data Set Types. This paper updates the supporting information in the NHS Data Dictionary about the uses of NWCS data.

Background:

Hospital Episode Statistics (HES) provide information on admitted patient care in England. This is used to provide wide-ranging analysis for the NHS, Government and many other organisations and individuals who have an interest in health and healthcare administration.

The Department of Health HES Service gained approval from the Review of Central Returns Steering Committee (ROCR), NHS Security and Confidentiality Advisory Group (SCAG) and Patient Information Advisory Group (PIAG) for the inclusion of Out-Patient Attendance and Accident and Emergency Attendance Commissioning Data Sets in the HES data warehouse. The extraction of out-patient data commenced in September 2004 with the backload of 2003-04 data from NHS Wide Clearing Service (NWCS). Accident and Emergency extracts are planned to follow.

Although transmission of the Accident and Emergency Attendance CDS is not currently mandated, the existing records from NWCS provide a useful starting point for analysis. Trusts are not expected to backload data to the NWCS.

Further information can be found on the HES website:
http://www.dh.gov.uk/PublicationsAndStatistics/Statistics/HospitalEpisodeStatistics/fs/en

Summary of changes:

Supporting Information
CDS HES CONTEXTUAL    Change to Supporting Information
HOSPITAL EPISODE STATISTICS    Change to Supporting Information
 

Date: 8 October 2004
Sponsor: Department of Health HES Service

Note: Additions shown in highlighted with a blue background. Deletions are shown using strikeout. Within the Diagrams deleted classes and relationships are shown as red in colour, blue is used for changed items and green is used for created items.

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CDS HES CONTEXTUAL

Change to Supporting Information: Change to Supporting Information
CDS, CMDS and HES
 

Contextual Overview

A. Information Requirements
  1. Information on care provided by NHS hospitals and Primary Care Trusts for all patients, and Independent Sector providers (for NHS patients only) is required to:


    • monitor and manage Service Agreements;
    • develop commissioning plans;
    • monitor Health Improvement Programmes;
    • underpin clinical governance;
    • understand the health needs of the population.

    Main commissioners need access to data to monitor OUT OF AREA TREATMENT activity as part of the management of their Service Agreements. PRIMARY CARE TRUSTS also need to monitor in-year referrals to investigate the sources and reasons for Out of Area Treatments.

    Independent Sector Treatment Centres (TC) are responsible for providing Admitted Patient Care and Out-Patient Attendance CDS and may submit it on their own behalf or via a third party. Other Independent Sector activity for NHS patients is the responsibility of the NHS commissioning body for the provision of the appropriate central returns and datasets.

  1. The Department of Health (DH) needs a complete record of all patients admitted to NHS hospitals and Primary Care Trusts, including patients receiving private treatment. Hospital Episode Statistics (HES) are derived from the Admitted Patient Care CDS Types submitted via the NHS-wide Clearing Service (NWCS). These records provide information about hospital and patient management and epidemiological data on patient diagnoses and operative procedures. The HES database has already been used to support every aspect of the new Performance Framework.

  1. The Department of Health (DH) needs a complete record of all patients admitted to or treated as out-patients by NHS hospitals and Primary Care Trusts including patients receiving private treatment. The record also includes NHS patients treated electively in the independent sector and overseas. Hospital Episode Statistics (HES) are derived from the Admitted Patient Care CDS Types, Out-Patient Attendance and Accident and Emergency Attendance CDS Types submitted via the NHS-wide Clearing Service (NWCS). These records provide information about hospital and patient management and epidemiological data on patient diagnoses and operative procedures. The HES data warehouse has already been used to support many aspects of the new Performance Framework.

    B. Data Flows
  1. HES records are extracted from the NWCS database quarterly. The timely provision of Admitted Patient Care (APC) records to the NWCS, complete with clinical information, is now a performance issue for Trusts.

  1. The strategic direction set out within Information for Health is to develop comprehensive and consistent electronic health records for patients from clinical information flows. In the short term, access to and the analysis of CDS Types will remain important, and the exchange of these data sets should continue on at least a monthly basis.

  1. To determine who receives CDS Types, NHS Trusts and Primary Care Trusts need to take all of the following factors into account, not necessarily in the order specified here:


    • identifying the patient's registered GP - to establish the responsible Primary Care Trust;

    • determining where the patient is resident - necessary when the patient is not registered with a GP;

    • assigning the correct type of NHS SERVICE AGREEMENT for the treatment provided;

    • identifying an overseas visitor and whether the patient is a private patient.

    The information data flows are shown in the Tables below.
    C. CDS Data Flow Definitions
  1. The exchange of individual CDS Types may be mandatory or optional. All Admitted Patient Care and Out-Patient Attendance CDS Type exchanges are mandatory, but exchanges of individual CDS Types for accident and emergency attendances are not, and require local agreement between the parties concerned.

  1. The exchange of individual CDS Types may be mandatory or optional. All Admitted Patient Care and Out-Patient Attendance CDS Type exchanges are mandatory, but exchanges of individual CDS Types for accident and emergency attendances are not, and require local agreement between the parties concerned. Where CDS information is collected, it should always be exchanged via the NHS Wide Clearing Service.

  1. Where CDS Types are exchanged, the data items within the CDS Type have a mandatory or optional status. A data item marked as mandatory (M) means that it must be included in the CDS Type; a data item marked as optional (O) means that the data item need only be included if both parties agree to its exchange. Although the exchange of the Accident and Emergency CDS Type may be optional, this does not apply to the status of the data items within this CDS Type.

  1. For records relating to CDS activity from the 1st April 2002 see REVISED CDS INFORMATION FLOW ADDRESSING GRID - Activity from 1st April 2002 below.

  1. For records relating to CDS activity up to 31st March 2002, see PREVIOUS CDS INFORMATION FLOW ADDRESSING GRID - Activity up to 31st March 2002 below.

    REVISED CDS INFORMATION FLOW ADDRESSING GRID - Activity from 1st April 2002

      CDS PRIME RECIPIENT
    Patient/Service Agreement PCT OF RESIDENCE PCT responsible Main Comm-issioner Organisa-tion to which costs of treatment accrue
    Patient registered with GP with PCT Service Agreement * *    
    Patient not registered with a GP but resident in an area covered by a PCT with a PCT Service Agreement * *    
    Patient registered with a GP treated as an Out Of Area Treatment (OAT) * * *  
    Patient not registered with a GP treated as an Out Of Area Treatment (OAT) * * *  
    Overseas visitor exempt from charges and not registered with a GP *
    (TDH00)
      *  
    Overseas visitor exempt from charges and registered with a GP *
    (TDH00)
    * *  
    Overseas visitor liable for NHS charges and not registered with a GP *
    (VPP00)
         
    Overseas visitor liable for NHS charges and registered with a GP *
    (VPP00)
    *    
    Patient registered with GP with a Specialised Services & Other Commissioning Consortia Service Agreement * *   *
    Patient not registered with GP with a Specialised Services & Other Commissioning Consortia Service Agreement * *   *
    Private Patient * *    

    Notes:

    a. Some flows will be sent for unfinished episodes. For example, a consultant episode may be in progress when a data flow is sent. In such cases the end date is not known and the patient has not been discharged. These data items will therefore not be included in that data flow.

    b. Note that if two recipients are identical (PCT of Residence is the same as the Main Commissioner only one data set should be sent to that recipient.

    c. For further information please refer to DSCN 46/2002.

    PREVIOUS CDS INFORMATION FLOW ADDRESSING GRID - Activity up to 31st March 2002

  1. All records relating to CDS activity up to 31st March 2002, including unfinished episodes on that date, will use the previous data flow addressing grid irrespective of when the records are actually sent to the NWCS. For example, an admitted patient episode which ended in March 2002 should be addressed to the appropriate HA or PCG/PCT in existence in March 2002 even though the record may not be sent until 1st April 2002 or later.

Patient/Service Agreement PCG/PCT HA responsible for PCG: HA to which PCT is accountable PCG OR PCT OF RESIDENCE HA responsible for PCG OR PCT OF RESIDENCE; Main Comm-issioner Organisa-tion to which costs of treatment accrue HA of Residence Agency acting on behalf of DH
Patient registered with GP with PCG/PCT Service Agreement * *         *  
Patient not registered with GP but resident in area covered by PCG/PCT with PCG/PCT Service Agreement     * *     *  
Patient registered with GP treated as Out of Area Treatment * *     *   *  
Patient not registered with GP treated as Out of Area Treatment     * * *   *  
Overseas visitor exempt from charges         *     *
(TDH00)
Overseas visitor - liable for NHS charges               *
(VPP00)
Patient registered with GP with Specialised Services & Other Commissioning Consortia Service Agreement * *       * *  
Patient not registered with GP with Specialised Services & Other Commissioning Consortia Service Agreement     * *   * *  
Private Patient * *         *  

Notes:

a. Some flows will be sent for unfinished episodes. For example, a consultant episode may be in progress when a data flow is sent. In such cases the end date is not known and the patient has not been discharged. These data items will therefore not be included in that data flow.

b. Note that if two recipients are identical (e.g. the HA of Residence is the same as the HA responsible for the patient's PCG) only one data set should be sent to that recipient.


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HOSPITAL EPISODE STATISTICS

Change to Supporting Information: Change to Supporting Information
HOSPITAL EPISODE STATISTICS (HES)
 

HOSPITAL EPISODE STATISTICS (HES)

Introduction

The data for the Department of Health Hospital Episode Statistics (HES) database are extracted from the CDS at the NHS-wide Clearing Service (NWCS). The data for the Department of Health Hospital Episode Statistics (HES) data warehouse are extracted from the CDS at the NHS-wide Clearing Service (NWCS).

HES and what they are used for

The Hospital Episode Statistics (HES) required by the DH cover every finished consultant episode and midwife episode in England (excluding regular day and night admissions) within the financial year, from 1 April to 31 March. The Hospital Episode Statistics (HES) required by the DH cover every finished consultant, nurse and midwife episode in England (including regular day and night admissions) within the financial year, from 1 April to 31 March. Finished episodes must contain all the relevant clinical data. They also include an Annual Census of episodes unfinished at midnight on 31 March, and the Psychiatric Census, a subset of the Annual Census, which contains additional data items. The database represents an invaluable national source of information about patterns of treatment in hospitals throughout England as well as providing epidemiological data about diseases and operative procedures. HES also includes an Annual Census of episodes unfinished at midnight on 31 March, and the Psychiatric Census, a subset of the Annual Census, which contains additional data items. HES will also cover out-patient and accident and emergency data backdated to 1 April 2003, extracted from the Out-Patient Attendance and Accident and Emergency Attendance Commissioning Data Set Types. The data warehouse represents an invaluable national source of information about patterns of treatment in hospitals throughout England as well as providing epidemiological data about diseases and operative procedures.

HES data are published annually and are also used to feed into other published statistics including the Compendium of Clinical and Health Indicators (formerly the Public Health Common Data Set) and the Performance Indicators. Within the DH, the main uses of the data include policy development, resource allocation, performance management, accountability to public and parliament and monitoring of health and healthcare variations. In addition, HES data are widely used by clinical and other researchers, both within and outside the DH. There is pressure to increase both the timeliness and completeness of the HES data set.

Further information can be obtained from the Hospital Episode Statistics (HES) website: http://www.doh.dh.gov.uk/hes/.uk/PublicationsAndStatistics/Statistics/HospitalEpisodeStatistics/fs/en.

How HES data are processed

Data records must be lodged with the NHS-wide Clearing Service contractors McKesson HBOC, not later than the last Friday of the month after the end of the data quarter (i.e. finished consultant episodes for 1 April-30 June by 27 July 2001) for their inclusion in the quarterly HES extract. Data records must be lodged with the NHS Wide Clearing Service regularly and routinely, preferably on a monthly basis.

An annual refresh of the data is taken approximately 9 weeks after the end of the data year (1 June 2001) when all the quarterly data is replaced. By the time the annual refresh of HES data is taken, all finished episodes are expected to include all relevant clinical data. Unfinished and psychiatric episodes for the data year are taken at the same time. Extracts for the HES data warehouse are taken at prearranged times each quarter and these dates are published on the ClearNET website and elsewhere.
http://clearnet.mhapp.nhs. uk/ iclearnet. html

Before being incorporated into the main HES database, all data are subject to a complex sequence of checks, as follows: These quarterly extracts are generally taken one month apart in order to reduce the burden on the NHS. A&E data will be extracted to a similar timetable, initially six months in arrears but moving to quarterly extracts.

Data is extracted as cumulative quarters throughout the period 1 April - 31 March and the entire year's data is taken again - as an 'annual refresh' - approximately eight weeks after the end of the year for admitted patient data and 12 weeks after the end of the year for out-patient data.

It is expected that at each of the extract dates the records are as complete as possible both in terms of the overall activity and the completion of the relevant data items. Unfinished and psychiatric census episodes for the whole year, which form part of the admitted patient data, are taken at the same time as the annual refresh.

Before being incorporated into the main HES data warehouse, all data are subject to a complex sequence of checks, as follows:

Verification
For finished episodes, McKesson HBOC selects episodes that contain an end date within the data year. For finished admitted patient episodes, the NWCS service provider selects episodes that contain an end date within the data year. To be accepted for HES, a record must contain an appropriate Hospital Provider Code relating to that data year. A record which fails this check will be rejected. Similar criteria apply for the extraction of out-patient and A&E CDS data in that the event must have occurred within the extract period.

Derivation
The data extracted is used singly or in combination to derive additional information, such as the patient's age group or the SHA of treatment to facilitate the interrogation and analysis of the data warehouse.

Manual Cleaning (Annual Data Only)
Under exceptional circumstances, the processing of the annual data can be halted to make manual changes to the data. This is carried out on a Trust specific basis and requires the agreement of the Trust(s) concerned, the HES section and usually the relevant Regional Office. This is carried out on a Trust specific basis and requires the agreement of the Trust(s) concerned and the HES section. Manual cleaning is extremely resource and time intensive and is only undertaken when there would otherwise be a significant impact on the integrity of the data set. The details of the manual cleaning process are on the HES website (see below for website address).

Autocleaning
Various fields within the record are analysed to see whether the entries make sense on their own, and with reference to related fields. In some cases it is possible to overwrite incorrect entries by deriving the data from other fields within the record. If this cannot be done, the incorrect entry may be overwritten with the accepted code for `not known/not applicable'.

Validation
This process tests the contents of individual records against a set of rules to identify errors after autocleaning which cannot be corrected. Records containing such anomalies are not excluded from the HES database, but the validation process generates a report which is useful in analysing data quality.

Further information

If you want to find out more on HES processing, the HES department at the DH publish a number of documents including 'An Introduction to HES' and 'How HES Data is Processed', the latter includes detail concerning autocleaning and validation routines outlined above. These can be obtained from the Hospital Episode Statistics DH Website - HES If you want to find out more on HES processing, the HES team at the Department of Health publish a number of documents, one of which details the autocleaning and derivation routines outlined above.

The HES team can be contacted at:

Department of Health HES Service
Skipton House - Room 430B
80, London Road
London
SE1 6LH
Tel: 020 7972 5529
Fax: 020 7972 5662

Fax: 020 7972 5662

DH Website - HES


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