NHS Digital Data Release Register - reformatted
Lightfoot Solutions UK Ltd
Project 1 — DARS-NIC-359692-Q4X1C
Opt outs honoured: No - data flow is not identifiable
Sensitive: Non Sensitive
When: 2016/04 (or before) — 2018/12.
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 Accident and Emergency
- Hospital Episode Statistics Admitted Patient Care
- Hospital Episode Statistics Outpatients
A board of ambulance medical directors representing all trusts use the data dashboard and it informs improvement strategies by looking at the variation in acute trust HES data for arrival by ambulance, re-admissions, % that are admitted and acuity of patients conveyed by ambulance to A&E. The HES data is viewed along side ambulance data to form partial measures for patient outcomes. Some ambulance trusts have then gone on to apply SPC principles to local data and commission support for service improvement. The HES data has identified where there is an opportunity for an ambulance trusts to increase their “hear and treat” rate so patient are treated and remain in their home with community nurse support . Ambulance trusts are trying to move away from a target driven service to a patient centric service and they are reviewing the data collected to support this approach.
This agreement supersedes NIC-292299-D8B0C Lightfoot provide the Signals from Noise (sfn) statistical tool, which is used by or for All Lightfoot customers are either within the NHS (Providers, Commissioners), Medical Schools, NHS Professional Associations, or AHSNs. The specific objectives are stated below.1) To provide access to summary and statistical analysis of patient data to NHS Trusts to support greater understanding of patient activity and flow to support the following activities, using the statistical process control package: a. A view of current patient pathways and demonstrate the key constraints and points for improvement, supporting the opportunities for sharing of best practice between clinicians and providers b. Agree with clinicians work plans to address the key constraints identified in the pathways c. Monitor and evaluate the impact of the improvement actions d. Identify and embed the improvements and realise the benefits 2) To provide access to summary and statistical analysis of patient data to NHS commissioning organisations to support healthcare planning and service redesign, using SPC to : a. Provide a view of current patient pathways and to identify key constraints, variation and bottlenecks in the various patient pathways b. Monitor and evaluate the impact of the improvement actions 3) To provide access to summary and statistical analysis of patient data to Ambulance Trusts to support service improvement programmes 4) To provide access to summary and statistical analysis of patient data to the Association of Ambulance Chief Executives (AACE) to enable and support national improvement programmes by using HES data to demonstrate outcomes of patient cohorts taken to hospital via the Urgent & Emergency Care pathway and conveyed by ambulance. Lightfoot also support AACE’s national objective of improved benchmarking between the 10 ambulance trusts in England. The aim being to identify, using HES data, areas of good clinical practice between the 10 ambulance trusts and provide comparison KPIs. In addition the data is used to analyse variation across the region with the aim of identifying best practice and also areas of opportunity. Once the areas of best practice have been identified these can then be spread across the region to improve the health outcomes for the regional and national populations of the England Work streams are provided with Statistical Process Control (SPC) view of current pathways for patients and to identify key constraints, variation and bottlenecks in the various patient pathways which is used to monitor and evaluate the impact of the improvement actions and advise when necessary intervention should take place. Data is used to agree with clinicians work plans to address the key constraints identified in the pathways. Statistical process control to identify and embed the improvements and realise the benefits In all cases data is for use with operational staff and clinicians to support performance improvement work by presenting HES data in a unique and highly visual manner through the Signals From Noise (sfn) tool. The data is presented in dashboards, charts, mapping charts and in written reports as required by clients. In addition a client may require to use sfn SPC charts to demonstrate where improvements to service levels or patient experience have resulted in their initiatives. In these cases the results analysed through sfn are used in reports and client case studies. Lightfoot will also provide secure access for agreed analysts to complete their own analysis and prepare a range of reports including a summary dashboard. Only in aggregate form. All users will be made aware of compliance to the HSCIC Hospital Episode Statistics (HES) Analysis Guide. In all cases summary and statistical analysis will be automatically processed to suppress small numbers before being presented. Lightfoot confirm that no record level data will be provided to any third party. In addition the data will not be used for sales or marketing purposes or in compiling tender responses
Benefits from Section 5 Purpose/Methods/Outputs: 1) Analysis of patient data with Acute Trusts has allowed to identify best practice with peer group trusts and adopt similar practice to reduce length of stay or certain conditions or reduce time patients spend in A&E, thus improving the Trusts achievement of the 4 hour target for A&E. 2) Analysis of patient data with NHS commissioning organisations identified patients attending A&E and subsequently where admitted and whose initial diagnosis was considered an ambulatory care sensitive condition. This allowed commissioners to review pathways and in this particular case found significant numbers of patients with COPD who were then treated in a primary care setting, resulting in reduced attendances at A&E departments. 3) Analysis of patient data with ambulance trusts identified regions across the country where ambulance trusts delivering an enhanced clinical model which allowed increased rates of See and Treat therefore significantly reducing the number of “avoidable attendances” to A&E departments of patients transported by ambulance. In one region this established better outcomes for patients but also significant finical savings to the health economy when patients were treating at scene rather than be transported to hospital. This also helped commissioners to appropriately fund this level of service provided by the ambulance trust. 4) Providing benchmarking data to AACE has allowed the member ambulance trusts to explore the variation in outcomes for patients transported to hospital by ambulance. The ongoing benefit is that the trusts will be able to highlighted opportunities for knowledge share and the transfer of best practice to improve patient outcomes in regions that had the greatest variation. Signals from Noise (sfn) is used to identify areas where performance can be improved. The sfn tools and associated methodologies are then used to support and measure transformation programmes. The sfn tools are specifically designed to engage wider clinical and management teams in the understanding of HES data by presenting it in a unique and highly visual manner. sfn is used to support service transformation in such as the redesign of stroke care, urgent care and integration between ambulance and A&E departments. In England there are a number of engagements which are providing tangible results - Imperial College Health Partners - engagement which required Lightfoot to review the efficacy of the discharge COPD ‘care bundle’ rolled out across North West London. Baseline assessment of current impact and development of on-going KPIs and monitoring solution. Analysis of Emergency Readmissions: Multiple engagements including; Doncaster & Bassetlaw, Stockport Acute, University College Hospital; Brighton & Sussex; Leeds University Teaching and Papworth Hospital. Urgent Care Reviews: Nottingham University Hospitals; Royal Devon & Exeter; Shrewsbury & Telford Strategic Performance Reviews: South East Coast Ambulance, South West Ambulance; London Ambulance, North East Coast Ambulance for major service wide performance reviews including commissioning support focus utilising urgent care data from HES. Association of Ambulance Chief Executives (AACE): provision of nationwide benchmarking solution to ACCE and ten national ambulance trusts utilising HES data. Supporting strategic objectives in their National Programme. Completing evidence based research to support national commissioning discussions. One such client, PenCHORD are currently working with the South West Cardiovascular Strategic Clinical Network and NHS England using HES data to respond constructively to Sir Bruce Keogh’s Urgent and Emergency Care Review. This analysis models patient location along with their primary diagnosis and treatment received and allows the Strategic Clinical Network to forecast onset-to-treatment times for stroke and acute myocardial infarction with different service configurations. Sfn has also enabled analysis of demand in individual hospitals, informing local service evaluation of, for example, non-emergency surgery (enabling hospitals to better meet referral to treatment target times).
Lightfoot’s offering is designed to support and enable continuous performance improvement projects in the NHS and allied health care organisations. Specific outputs include • Charts and graphical representations of data • Tabulations and summarised data • Statistical analysis • Written reports and recommendations for stakeholders based on findings from analysis and supported by Statistical Process Control (SPC) charts from the sfn tool • SPC signals and alerts indicating processes where behaviour has recently changed In all cases these are for Lightfoot’s clients for use with operational staff and clinicians to support performance improvement work by presenting HES data in a unique and highly visual manner through the sfn tool. The data is presented in dashboards, charts and in written reports as required by clients. In addition a client may require to use sfn SPC charts to demonstrate to commissioners and other NHS organisations or members of the public where improvements to service levels or patient experience have resulted in their initiatives. In these cases the results analysed through sfn are used in reports and client case studies. All charts and reports included in the outputs use aggregate data (small numbers suppressed) in line with the HES Analysis Guide, derived from the HES data and presented via the sfn tool.
All processing of record level data will take place on hardware and software wholly owned and controlled by Lightfoot. Processing of record level data takes place within the datacentre without data being transferred to or processed using laptops, desktops or networks outside of the datacentre. C4L provide Lightfoot with a secure rack, power and internet connection within their facility within which Lightfoot host their servers, network switches and firewalls. All access by third parties is through the Signals from Noise (sfn) tool. The connection to this tool are encrypted over SSL and requires the end user to authenticate. The sfn tool has a specific processing layer responsible for applying small numbers rules to all charts and tabulations prior to returning the results to the user/third party. To summarise the process - HES Data will be downloaded via SEFT to Lightfoot’s secure data centre facility. This data will then be processed on a server with controls specifically designed for processing of sensitive data. These controls include restricted access and physical security managed under ISO27001. The HES files will be processed and loaded into a SQL server database in a format suitable for Lightfoot’s OLAP tool – signals from noise (sfn). Once text based data has been loaded into the SQL database it will be stored on the secure area of the server encrypted using AES 256 bit encryption. Once the loaded database has been reconciled with trusted national reference sources it is promoted to the production server. Once promoted to production only third parties as specified above in Section 5 Objective for processing will be given access to the signalsfrom noise (sfn) tool. Lightfoot’s clients require data to be viewed through the sfn tool because this allows users to run immediate real time queries across several years of HES data. The sfn tool provides unique views of the data with functionality (not available in traditional reporting tools) that support the use of statistical process control techniques which is needed by our clients for the measurement of process performance and provide greater understanding of patient flow and pathways. The sfn tool provides unique views of the data with functionality (not available in traditional reporting tools) that support the use of statistical process control techniques which is needed by Lightfoot for the measurement of process performance and provide greater understanding of patient flow and pathways. For some customers within the customer groups stated above, Lightfoot will provide secure access for analysts to complete their own analysis and prepare reports and summary dashboard using the sfn tool. Patient level data does not leave the Lightfoot secure hosting facility, and the analysts do not have access to record level data. Lightfoot will maintain a user log and provide full training for all such users. All such users will be made aware of compliance to the HSCIC Hospital Episode Statistics (HES) Analysis Guide. In all cases summary and statistical analysis will be automatically processed to suppress small numbers before being presented. Lightfoot confirm that no record level data will be provided to any third party.