NHS Digital Data Release Register - reformatted


Project 1 — DARS-NIC-373563-N8Z9J

Opt outs honoured: No - data flow is not identifiable (Does not include the flow of confidential data)

Sensitive: Non Sensitive, and Sensitive

When: 2016/09 — 2020/05.

Repeats: Ongoing

Legal basis: Health and Social Care Act 2012, Health and Social Care Act 2012 – s261(1) and s261(2)(b)(ii)

Categories: Anonymised - ICO code compliant


  • Hospital Episode Statistics Outpatients
  • Hospital Episode Statistics Accident and Emergency
  • Hospital Episode Statistics Admitted Patient Care
  • Emergency Care Data Set (ECDS)
  • HES:Civil Registration (Deaths) bridge
  • Civil Registration - Deaths


IMS Health is a brand comprised of a number of legal entities which provide technology and services to healthcare. This application/agreement is a request for pseudonymised record-level HES data which will be controlled by two legal entities: • IMS Health TS • IMS Health UK ltd Hereafter, these two entities will be referred to collectively as IMS Health. IMS Health will use the HES data to perform two types of service: 1. Data visualisation and benchmarking tools which includes: i) Care Pathway Analyser (formerly visualise treatment pathways) ii) Hospital Feedback services iii) Visualise Healthcare Data 2) Advanced Statistical Analysis (formerly referred to as structured disease analysis) It should be noted that these services have been renamed from the previous application. 1) The data visualisation and benchmarking tools are described below: • Care Pathway Analyser (CPA). Presents users with simple views of aggregated care pathways. This allows investigation of the causes of variation in patient pathways and the subsequent impact on service delivery. • Hospital Feedback Services (HFS). A dashboard allowing chief pharmacists to optimise their use of medicines. It will also allow them to monitor their own performance against internal targets and benchmark against similar hospitals. This service is still in development. • Visualise Healthcare Data (VHD). A suite of tools/reports that allows users to perform queries on aggregated HES data then view graphs and tables. 2) Advanced Statistical Analysis includes: diagnostic algorithm development, epidemiology, health economics and outcomes research studies. Both services will only be provided to the following categories of types of organisation: - Providers of healthcare services • Clinical Commissioning Groups • Commissioning Support Units (CSU’s) • Hospital Trusts • Private secondary care providers • Mental Health trusts • Community Provider Trusts • Pharmacies • NHS England • Public Health England • Health and Wellbeing Boards - Universities - Life science industry • Pharmaceutical companies • Medical Device companies • Industry bodies – limited to the Association of the British Pharmaceutical Industry (ABPI), Ethical Medicines Industry Group (EMIG) and the Proprietary Associated of Great Britain (PAGB) Third parties will only see aggregated and small number suppressed data. The number of organisations to whom IMS Health provide products and services changes regularly. In the year to date IMS Health have worked on 31 Advanced Statistical Analysis projects and Data Visualisation and Benchmarking services using HES data held under this DSA. Of these projects, approximately half were for repeat customers (who had purchased at least one other tool or project from IMS Health within that period). When finalised, HFS will be given to all NHS Trusts. IMS Health understands the importance of data minimisation and outline IMS Health’s requirement for national, timely HES data in the following paragraphs. IMS Health requires national data to enable the end users of IMS Health’s tools to benchmark against organisations in their local area or with similar demographic characteristics. IMS Health also requires national data to inform economic analyses for inclusion in submissions to NICE, which makes decisions at a national level. HFS is intended for all chief pharmacists in NHS Trusts. The requirement for timely data is because the commissioners and providers to whom IMS Health provide IMS Health’s tools need to make decisions based on the most up-to-date information. IMS Health won an open tender to perform a medicines optimisation study for a group of cancer treatment providers. More detail on this project is given in later sections. Historic data is required to support Advanced Statistical Analysis projects, as historical data allows robust analysis of trends over time.

Yielded Benefits:

Examples of how previous projects have provided benefit to patient care are given below. Cancer Vanguard Medicines Optimisation Project IQVIA supported the NHS Cancer Vanguard (The Christie, UCLH and Royal Marsden NHS Foundation Trusts) to optimise the care and use of medicines for mCRC (Metastatic Colorectal Cancer) patients, whilst reducing the unnecessary variation in patient care. IQVIA used Advanced Statistical Analysis and the Care Pathway Analyser tools to deliver this project, involving a review of medicines usage at each centre and identification of avoidable variation in episodes of care. The output was a model to reduce the cost of treating cancer to ensure clarity around best practice processes. Patient reported outcomes also ensured that the relationship between best practice and improvement in patients’ quality of life is quantified. The analysis was developed alongside chief pharmacists and associated clinical teams with results shared with healthcare professionals in a way that allowed them to improve patients’ quality of life in a cost-effective manner. More information about the Cancer Vanguard can be found here - http://cancervanguard.nhs.uk/about/. Multi-Hospital Site DVT Treatment Variation Project Since their introduction novel oral anticoagulants (NOACS) have not experienced the uptake anticipated following their NICE recommendation. By utilising these new compounds, the NHS can alter the way Deep Vein Thrombosis (DVT) treatment pathways are delivered. The goals of this partnership project were: • Understand how DVT is currently treated (nationally utilising HES data assets) • Compare how individual Trusts treat patients with DVT Nationally and within Benchmark Trusts • Quantify the potential financial implications associated with a change in DVT treatment pathway • Outline potential change tactics and key messages that could be aligned to a shift in treatment approach The National analysis presented key observations associated with the current clinical management of DVT. DVT hospital treatment is resource intensive placing scarce hospital resources under further pressure with variation in current care pathways. Findings uncovered from the study identified key drivers that all impact on the financial sustainability of local DVT services. The choice of clinical pathway will impact on Trust financial performance, working with key stakeholders to implement alternative pathways can mitigate financial risk. A key outcome of the work presented to representatives from 90 UK Trusts was the need to understand how the clinical strategy adopted by a Trust can impact the level of financial risk the Hospital is exposed to. Greater Manchester Liver Disease Working with key NHS, academic and professional bodies from the Greater Manchester region IQVIA presented an overview of how liver disease, defined by a cohort of ICD.10 diagnosis codes, was currently being managed across the region. This overview of liver disease treatment pathways was delivered utilising National HES data assets with National Care Pathway Analytics technology deployed over the data. This provided IQVIA with treatment pathway visualisation at Clinical Commissioning Group level showing aggregated treatment pathway volumes, the cost associated with these pathways, the typical length of stay and the average number of treatment events per pathway. Isolating key performance indicators by each of the 12 Greater Manchester CCG’s highlighted the variation in both clinical management of the disease area, and the cost and capacity implications of that variation. A key outcome of the work will be the utilisation of the analysis to improve and standardise the management of patients’ within this disease cohort. Salford Royal Hospital – Unwarranted treatment pathway variation IQVIA presented the National Care Pathway Analytics solution (NCPA - based on care pathway technology applied to HES data assets) solution to Salford Royal NHSFT. However, when demonstrating the NCPA solution to the Trust, the Trust commented that; NCPA, provided an insight into the performance of Salford Royal NHSFT and allowed them to benchmark against other Trusts both nationally and within the Greater Manchester region and identified that there was an issue. In order to investigate further and allow for real change, deeper analysis on local Trust data, taking in additional datasets not available in HES was required. However without the initial NCPA analysis, these issues may have gone unnoticed. Instead of individual “APC – Admitted Patient Care Events” the Trust would ideally want to see more detailed event level granularity within the ‘hospital stay’ part of the treatment pathway, i.e. visualisation of a daily activity breakdown of the patients’ treatment The Trust have developed for 2017/18 a local programme between the ‘Better Care Lower Cost – BCLC’ team and ‘Quality Improvement - QI team’. The programme would utilise QI methodologies to be used on local projects which would benefit from this approach. The BCLC and QI teams are developing a 90-day cycle approach to service review with a view to identifying 10% gains in both quality and efficiency. Trust senior directors invited IQVIA to develop Care Pathway technology to support them in the delivery of this local improvement initiative. Because of the utilisation of National HES data delivered to the Trust in a unique and creative way has led to the development and delivery of a detailed local project that can enable the Trust to support the identification and reduction of unwarranted variation in patient treatment pathways. Outcome – Delivered to Client, Acute Care Pathway Analytics product that will enable and support the delivery of a reduction in clinical variation, improving Length of Stay (LOS), increase profitability and deliver improved operational efficiency UCLH – Trauma & Orthopaedics Clinical Productivity This Clinical Productivity Pilot aimed to understand the causes of clinical variation in the provision of T&O services at UCLH, using a combination of benchmarking (HES data), and “deep dive” analytical capabilities that IQVIA tested with Trust members including operational, financial and clinical stakeholders. From an overall analysis of clinical variation across the T&O speciality, knee replacement and hip replacement represented some of the biggest opportunities to reduce length of stay. To fully understand how actionable and feasible these opportunities were to the Trust, a detailed analysis around knee replacement elective procedures was completed. The results of the analysis into knee replacement indicated that: • Some of the LOS variation that could be reduced are patients that are currently being discharged on Thursdays and Fridays. Patients characteristics (including complexity measures) between key consultants is indicated to be comparable. Data highlighted that key consultants operate on a specific day from Wednesday to Friday, generating three types of “pathways” to compare against. • Further emphasis in ward rounds/discharges during Wednesdays could be worth investigating further (most of the capacity gaps were isolated to this day). • By targeting only 20% of the potential opportunity, a reduction of 107 Bed Days across a year could be achievable. The main purpose of this work was to provide actionable insights and support discussions that the Trust might undertake for further service transformation involving the provision of T&O services. Going further, the same data assets, methodologies and approaches used in this pilot study were suggested to be used to identify potential opportunities in other specific procedures, or specialties to inform wider a case for change and improve further operational and clinical performance. Greater Manchester breast cancer service analysis, a joint working project led by the Christie NHS FT, Novartis and IQVIA The principle of this joint working project is that the Greater Manchester (GM) secondary breast cancer service could be optimised and perceived variations in access to treatment addressed if an analytical approach to pathway optimisation was conducted. This can be achieved through the analysis of data generated by routine delivery of care, in particular Hospital Episode Statistics, for breast cancer services in GM involving The Christie. The project consists of two components, pathway analysis and patient pathway experience. The project, due to conclude summer 2018, will provide a visual representation of the secondary breast cancer service in order to understand the variation of access to breast cancer services that exist to the people of GM and build a case for change that can be shared with operational healthcare leaders in the GM region. This project is based around partnership working and the collaborative sharing of insights and expertise between the Christie/Greater Manchester and Novartis, with the support of IQVIA, in order to optimise the treatment of secondary breast cancer within Greater Manchester.

Expected Benefits:

IMS operates on a project by project basis. Each project using this data source must generate benefit to healthcare, for example by: • Providing detailed evidence based recommendations for how to improve care in specific organisations or therapy areas • Giving healthcare professionals (HCPs) the ability to understand their own organisation’s performance via dashboards and reports; enabling them to reduce cost whilst delivering best practice care • Providing analyses to decision making bodies such as the European Medicines Agency and the National Institute for Health and Care Excellence; in order to enable them to grant patients access to innovative medicines • Contributing to knowledge to the medical community in order to stimulate further research into improving patient care Examples of how previous projects have provided benefit to patient care are given below. Developing diagnostic pathways in Fabry Disease: IMS Health developed a diagnostic algorithm for patients with Fabry disease. In current ICD-10 coding the 4 characters code (E75.2 other sphingolipidosis) encompasses 5 different diseases: Gocher disease, Krabbe disease, Niemann-Pick disease and Metachromatic leukodystrophy. Despite the similarities in disease genesis the symptoms, treatment pathways, procedures and prognosis are different. By identifying the actual underlying disease patient would be put on the correct treatment pathway more quickly and better managed their condition. The project involved working with Lysosomal storage disorder (LSD) clinical experts to understand the different diseases, the epidemiology and the diagnosis and treatment pathway. Clinicians then worked with IMS to identify inclusion and exclusion criteria for Fabry disease based on the specialties visited by the patient, associated diagnosis codes (ICD-10 codes), procedures and treatments performed (OPCS codes), and LSD specialty centres visited (key specialist centres). The team also divided some of the variables by age of the patients to define patients for disease that typically affect certain age groups. The output was a logic-based algorithm which could be used to identify Fabry disease patients in routine clinical practice. This project was completed in March 2016, the expected benefit is an improvement in the speed and accuracy of Fabry disease diagnoses. Analysis and validation of musculoskeletal services for the NHS and Care UK: Working with Aylesbury Vale CCG, Chiltern CCG, Buckinghamshire NHS Trust & Care UK, IMS Health modelled the level of service in changing environments over the next five-year period in order to improve their long-term planning process. The analysis used HES data plus data supplied from 8 CCGs. The IMS Health team designed interventions to make the service more efficient and compiled forecasts to show the impact of these interventions on the forecast. The analysis was initially summarised in a presentation but subsequently delivered as dashboard that allowed the clients to model and understand the impact of pursuing different strategies for transformation and therefore inform decision making. For example, the model predicted that reducing the rate of inpatient spells with excess bed days had a low impact on overall MSK spend; however, reducing the rate of inpatient spells where the patient had complications or comorbidities or moving outpatient appointments to the community had a much greater potential to increase efficiency. The research proposal for this project was submitted in October 2014. The final analysis was delivered in February 2016. The expected benefit is that this tool will allow HCPs to understand how to deliver more effective cost saving programmes. Patient profiling and pathway analysis for University Hospital South Manchester: In response to a requirement from a senior clinician at the University Hospital of South Manchester (UHMS), IMS performed an exploratory analysis using VHD in pneumonia and cellulitis. In both diseases, the analysis showed that more than half of all admissions were in patients from the most deprived 20% of neighbourhoods. The analysis went on to benchmark UHSM against its peers and found it had the third highest readmissions ratio in the region. The UHSM project also included analysis of patient pathways. The analysis found that the average pneumonia pathway was 69% longer than the national average and cost the NHS 37% more. Further analysis showed 38% of pneumonia pathways in Manchester contained at least one COPD-related event; this was 10 percentage points more than the national average. On average, this group of pathways was more expensive and longer than the group without a recorded COPD event. The results of this work were presented to the Trust in February 2016. The Trust expects to reduce costs and improve patient outcomes by applying best practice from Trusts with a similar case mix. Analysis of cardiology pathways for the Heart of England NHS Foundation Trust: CPA and VHD were used to review the cardiology services in the Heart of England Foundation Trust. The analysis, combined with the Trust’s own data, aimed to improve the efficiency of care. The analysis was presented at various stages to a team from the Trust in early 2016. Following on from the analysis, IMS Health recommended providing care based on clusters of procedures as this would allow the Trust to monitor consistency more closely and improve demand forecasting. IMS Health expects that this analysis will allow the Trust to improve care by being better prepared for demand for cardiology services. Using CPA to streamline hip replacement pathways in Cambridge and Peterborough CCG: CPA in combination with HES and the CCG’s own local activity data was used to establish a gold standard pathway in Cambridgeshire and Peterborough for four providers in the region. Treatment pathway analysis and benchmarking against similar CCGs enabled them to envisage where the NHS’s Cost Improvement Programme (CIP) and the Quality, Innovation Productivity and Prevention (QIPP) programme could be delivered. In the words of the Local Chief Officer “IMS Health provided me the insight to see where CIP and QIPP could be delivered by commissioning shorter pathways in line with best practice” This work was presented in February 2016. The expected benefit is that this analysis will help HCPs deliver hip replacements safely and efficiently in line with best practice. Three further examples of projects under development and their expected benefits are: Cancer Vanguard Medicines Optimisation Project: IMS Health has won a tender with a group of NHS Trusts. The aim of the project is to optimise the use of cancer medicines and reduce the unnecessary variation in cancer care. IMS Health will use Advanced Statistical Analysis and the Care Pathway Analyser tool to deliver this project; it will involve a review of medicines usage in cancer, and identification of avoidable variation. The output will be a model to reduce the cost of treating cancer to ensure clarity around best practice processes. Patient reported outcomes will also ensure that the relationship between best practice and improvement in patients’ quality of life is quantified. This analysis is being developed alongside HCPs and the expected benefit is that the results will be presented back to HCPs in a way that will allow them to improve patients’ quality of life in a cost effective manner. Staffordshire CCGs and the Rightcare programme: IMS Health is working with the Director of Strategic Programmes for a group of CCGs including: Cannock and Chase CCG, Stafford and Surrounds CCG, South East Staffs and Seisdon Peninsula CCG. The Director would like to use CPA to support the implementation of the NHS Rightcare programme. The Director had the following to say about the initiative: “NHS Rightcare (http://www.rightcare.nhs.uk/) promotes the principle of eliminating unwarranted variation in healthcare. The IMS care pathway analysis tool allows commissioners and providers to see variation in care provided and benchmark compliance with best practice utilising national HES (Hospital Episode Statistics) data in conjunction with locally available data. It is therefore a potentially valuable tool in allowing commissioners and providers to redesign pathways to achieve high quality affordable care.” Hospital Feedback Services: IMS Health is committed to ensuring that the NHS chief pharmacists have accurate and up-to-date information in order to better manage their drug dispensing. The IMS medicines optimisation dashboard is designed to include IMS Health’s Hospital Pharmacy Audit data and National HES data. The ability to include HES data is a vital component in ensuring that the output accurately reflects the seasonal variation in hospital activity and medicines usage. For example, the antibiotic usage dashboard includes the following report: Ratio of Defined Daily Dose of all dispensed antibacterial (ATC J1) products per 1000 admissions. It is the HES data that ensures accuracy on the 1000 admissions and enables IMS Health to account for seasonal variation in the analysis. IMS Health will provide HFS to all hospital trusts. It is being designed in collaboration with the chief pharmacist community to ensure that it meets their needs. IMS Health expects HFS to benefit healthcare by allowing chief pharmacist to improve prescribing efficiency leading to a financial savings; it will also allow them to better forecast the amount of medicines required and therefore prevent waste:


For clarity services covered within this application only produce two types of output: • Dashboards • Aggregated tables In both cases outputs are aggregated and small numbers suppressed in line with the HES Analysis Guide. Details for each of the services are given below. Visualise Healthcare Data (VHD): VHD is an internet browser based application, an iPad application or a bespoke report. Users are given role based access to the applications. The applications allow users to produce graphical and tabular estimates of burden of disease, cost of care, common comorbidities and similar analyses. These analyses may be stratified by diagnosis, organisation and other similar parameters. Care Pathway Analyser (CPA): CPA is currently an internet browser based application and other delivery methods are in development. CPA will either be deployed directly to users or used to support consulting projects. In the former users are given role based access to the application which will allow them to analyse images of aggregated pathways. In the latter, outputs will be presentations and reports containing pathway images as well as IMS Health recommendations. Hospital Feedback Services (HFS): HFS will be delivered (expected in late 2016) as a browser-based application and other delivery methods are in development. Chief pharmacists will be given role-based access to a dashboard which will show them aggregated HES data, aggregated prescribing data and performance indicators. These data will be presented in graphs and tables. Advanced Statistical Analysis The data included in advanced statistical analysis are always aggregated and small number suppressed in line with the HES Analysis Guide. These outputs are produced to meet different objectives and delivered in different ways. A health economic analysis may require analysis of the data to estimate the cost of managing a given condition then used as an input in an economic model for a NICE submission. Developing a diagnostic algorithm will result in the production of a formula which may be presented to clinicians in an Excel based calculator with an explanatory report or presentation. Many of the outputs of advanced statistical analysis are reported in journal articles or conference presentations.


IMS Health will receive the data from HSCIC and will apply derivations. No linkage is carried out to other datasets. In the context of this application/agreement applying derivations does not mean linking to other patient-level information. In this application/agreement, applying derivations means that IMS Health will use non-identifiable data to derive new information. For example, length of stay is approximated using the relationship between admission and discharge dates and the cost of an admission is approximated using the NHS payment by results tariff. For data visualisation and benchmarking services, further derivations are applied to allow benchmarking and the data is presented in dashboards alongside other IMS Health and publically available data sources e.g. Quality Outcomes Framework data. All data visualisation and benchmarking tools are hosted by IMS Health. All data seen by end users is aggregated, small number are suppressed and are compliant with the HES Analysis Guide. Usage of these tools is auditable and role based access controls are applied. Customers using these tools are contractually prevented from using the data for solely commercial purposes. For advanced scientific analysis, IMS Health produce bespoke analysis for external organisations on a project by project basis. All requests for bespoke analysis are subject to review by an independent scientific advisory committee (ISEAC – details in the following paragraph) who review the proposed study design. If ISEAC approves the study, it is logged on an access control register and the IMS Health researchers are allowed to access the relevant subset of HES data. The researchers will present the results of their analysis to external organisations in the form of aggregated, small number suppressed tables compliant with the HES Analysis Guide. These outputs may also take the form of counts, proportions or formulae. Anonymised abstracts will be published on the IMS Health global bibliography 6-12 months after completion of the study. ISEAC is a group of medical and scientific advisors who are independent of IMS Health. For studies based on the HES data held under this Data Sharing Agreement the role of the committee is to ensure that will ensure that any study performed is compliant with this Data Sharing Agreement and by extension the Care Act 2014. All ISEAC decisions are binding, and any studies not approved will not be performed unless revised and subsequently approved. ISEAC records of decisions can be made available to NHS Digital under the caveat that they remain commercial in confidence.