NHS Digital Data Release Register - reformatted
CSL-UK (CompuFile System Limited) projects
12 data files in total were disseminated unsafely (information about files used safely is missing for TRE/"system access" projects).
ESPRIT tool — DARS-NIC-01207-V9G9P
Type of data: information not disclosed for TRE projects
Opt outs honoured: No - data flow is not identifiable, Anonymised - ICO Code Compliant, No (Does not include the flow of confidential data)
Legal basis: Health and Social Care Act 2012, Health and Social Care Act 2012 – s261(1) and s261(2)(b)(ii), Health and Social Care Act 2012 s261(1) and s261(2)(b)(ii), Health and Social Care Act 2012 - s261 - 'Other dissemination of information', Health and Social Care Act 2012 s261(2)(b)(ii), Health and Social Care Act 2012 s261(2)(a)
Purposes: Yes (Consultancy)
Sensitive: Non Sensitive, and Non-Sensitive
When:DSA runs 2019-09-02 — 2020-09-01 2017.06 — 2024.11.
Access method: Ongoing, One-Off
Data-controller type: COMPUFILE SYSTEMS LIMITED
Sublicensing allowed: No
Datasets:
- Hospital Episode Statistics Outpatients
- Hospital Episode Statistics Critical Care
- Hospital Episode Statistics Admitted Patient Care
- HES-ID to MPS-ID HES Admitted Patient Care
- HES-ID to MPS-ID HES Outpatients
- Hospital Episode Statistics Admitted Patient Care (HES APC)
- Hospital Episode Statistics Critical Care (HES Critical Care)
- Hospital Episode Statistics Outpatients (HES OP)
Objectives:
Compufile Systems Ltd (CSL) is a data intermediary, and has been helping healthcare organisations understand and process data for over 25 years.
CSL process non-sensitive, pseudonymised HES data to provide third parties involved in the delivery of healthcare with aggregated, masked data (small numbers not shown), and provide expertise and advice to help them interpret these numbers.
DATA MINIMISATION
CSL have reduced the amount of data requested in this refresh, filtering out main specialties that are not required for CSL's customers. The full breadth of geographical data within HES is still required in order to provide analysis to a number of different organisations with different areas of interest.
CSL have minimised the fields received for each data set to ensure only data relevant to CSL's usage is received. The data provided to NHS Suppliers is further limited to the specialty areas relevant to the use specified in their contracts with us. Access for NHS Customers is limited to the data for the Trusts & CCGs relevant to their needs (typically data for their Trust or CCG unless doing bench-marking exercises).
CSL will retain a maximum of 5 years of HES data. This will be on a rolling basis, whereby old data are destroyed as new data are received.
CUSTOMERS
CSL’s services are offered to a variety of organisation types involved in the provision of healthcare to patients:
• NHS organisations (Type 1), made up of Clinical Commissioning Groups, Clinical support units and Hospital trusts only. A basic service is now provided free of charge to NHS organisations, though subject to the same purpose limitations set out below. This service has been piloted from Spring 2016, and will be rolled out more widely through the remainder of 2016.
• NHS suppliers (Type 2), including medical device companies and life science companies to carry out the functions included in any contracts/commissioning from NHS organisations, or to support initiatives to deliver cost savings or quality of care improvements to their NHS customers (usage is not permitted for solely commercial purposes)
Further detailed explanations of the purposes for which the two types of organisation use the data is provided below, with examples given.
PURPOSES
Purpose 1 (patient pathways and variations by organisational / patient factors)
To show aggregated patient pathways through the hospital system and provide an understanding of how patients are treated, and how treatment differs by key factors such as Trust, CCG or patient demographic (customer types 1 and 2)
This is the most common type of analysis requested by CSL customers, allowing them to compare and quantify diagnosis and treatment patterns. This information is used by NHS organisations to identify where costs are being incurred and could be avoided, or where resources could be better focused to improve patient care or make scarce resources go further. It is also used to understand treatment pathways within hospitals, referral patterns and to help in system redesign. NHS organisations also use this data to review key data that they are obliged to monitor by the government. For instance, the level of surgical site infections, which CSL intends to provide free of charge to the NHS organisations in 2017.
As an example of data use for this purpose, CSL were asked by a CCG to investigate their non-elective respiratory admissions, identify if they had increased and whether a more robust community service would have kept them out of hospital.
NHS suppliers share this information with their NHS customers to help them identify potential opportunities for improving the effectiveness of treatment, or delivering cost reductions. These analyses also enable them to put together the cost-benefit analyses that are required as part of the process of gaining NICE approval or getting on formularies.
For example, a Type 2 organisation shares analyses of the data with NHS organisation and relevant key healthcare professionals within the NHS to provide understanding of patient group profiles in their disease areas of expertise (age/gender/co morbidities/past events) over time. This is used in the Identification of specific high risk patient groups and development of improved services and patient treatments.
For analysis in this area to be effective, CSL requests permission to hold a rolling 5 year period of data. This enables CSL to:
• Define with some confidence (depending on the disease area) cohorts of patients with newly diagnosed conditions i.e. those that have not been admitted for the condition for a number of years
• Analyse aggregated patient journeys over extended periods, to provide proxy’s for patient outcomes and identify relapses that may occur years after treatment
Provide more substantial aggregated information on rare diseases, where numbers in any one year are too small to enable robust analysis
Purpose 2 (Benchmarking – other organisations and good practice)
To compare actual treatments with best practice and NICE guidelines and to contrast Trusts and CCGs with each other. Both NHS and supplier organisations use this type of analysis to identify how trusts and CCGs are performing when benchmarked.
This enables Type 1 organisations to compare how they are performing with other similar organisations, and to identify areas where they are significantly different to their peers, or are divergent from NICE guidelines. This assists them to spot anomalies and recognise areas where procedures need to be reviewed.
As an example of data use for this purpose, CSL have recently worked with a CCG to compare the frequency with which a particular procedure is undertaken in similar patient cohorts at the different Trusts they commission services from. A wider comparison was also conducted nationally to add context to the analysis. This has enabled the CCG to identify areas where pathway redesign is necessary, and to open a dialogue with their trusts regarding the appropriateness of the level of procedures being carried out.
CSL is currently in the process of finalising a service free to NHS trusts and CCGs to enable them to benchmark their performance in some key areas such as surgical site infection. This will enable NHS organisations to identify top performers from whom they can learn and improve their own services, and will be in place in 2017.
NHS supplier organisations also use this information to plan initiatives or services to support the NHS or help them meet NICE guidance and reduce inequalities.
For example, a supplier of specialist post-operative care equipment share analysis, including HES data, with their hospital customers. This helps these trusts monitor their adherence to NICE guidelines in this area of shared clinical expertise.
Purpose 3 - (Identification, implementation, and monitoring of improvement plans)
To quantify patient subsets to identify opportunities for cost savings or joint working initiatives and to monitor these initiatives once in place. This is often related to Purpose 2; having identified areas of development within a Trust or CCG, NHS and supplier organisations work together to improve a particular area of delivery within the NHS.
The data CSL provide their customers is used as a trusted common source to identify and quantify the needs and opportunities for improvement for a given initiative and then to monitor progress over time.
In respect of Type 1 organisations for example, CSL recently worked with a CCG to provide data and insights to aid its program of redesigning its COPD services, having previously identified this as an area of critical importance.
As a further example, one of the Type 2 organisations CSL work with incorporate the data into budget impact models to share the financial burden of a disease and its related co morbidities with the local health economy and facilitate pathway redesign for the improvement of patient care.
Yielded Benefits:
Some examples of benefits delivered within the past year: 1) Nice Quality standard [QS68] targets the healthcare system to deliver “Coronary angiography and PCI within 72 hours for NSTEMI or unstable angina”. This target is in place to reduce the risk or a further cardiovascular event, and ultimately to improve life expectancy. CSL has provided some extensive analysis to a cardiologist working for a local trust to help measure the effect of a pathway redesign they have implemented recently on the number of patients meeting this target. Using these data, they have repeated the analysis for three other NHS Trusts, enabling the cardiologist to work with these trusts to identify areas of performance that can be improved following the experience of the initial Trust. Approximately 1/3 of the 70,000 or more patients received an angiography or PCI outside of the recommended time last year, so improvements in this area can have a large impact on patient survival and quality of life. 2) CSL has worked with a CCG over a number of years to provide data and insights to aid its program of redesigning its COPD services. This was initiated following the CCG’s identification of this area as a high priority for improvement of patient care. Subsequently the CCG has achieved a reduction in emergency admissions for COPD of over 2%. This came at a time when the national level of admissions were rising at 1%. This means potentially 100 emergency admissions being avoided by the CCG per annum, saving in the region of £200,000 pa. In the latest data they have the proportion of COPD admissions that are an emergency in this CCG are approximately 10% lower than the national average.
Expected Benefits:
In the next twelve months CSL will continue to provide data to support longer term initiatives already started earlier this year, and to provide additional support for new initiatives which will lead to further benefits.
• CSL will provide authorised NHS subscribers with free access to benchmarking data to enable them to quickly and effectively compare key patient care metrics with those of similar organisations.
This will enable subscribers to identify areas of good and poor practice, and to identify colleague organisations within the NHS that are applying best practice and learn from them.
Target Date: Q1 2017
• CSL will provide authorised NHS subscribers with analysis and insight to support their initiatives to improve patient care in their areas of focus.
For example, working with a CCG in London CSL will quantify the burden on the local health economy for Diabetes-Related foot amputation, Diabetes-Related hospital stay, Incidences of Diabetes-Related Diabetes Keto-Acidosis & Incidences of Diabetes-Related hospital re-admission. These data will be used to identify and drive any local service and commissioning redesigns required. Diabetes and diabetes related complications are a massive drain on NHS resources so even small benefits realised will have a significant impact on the CCG as well as benefiting the relevant patients.
Target date: Q1 2017
• CSL will continue to support NHS suppliers to identify joint working opportunities with the NHS, to work with the NHS to deliver cost savings, support patient care services, and improve performance against NICE guidelines.
For example, CSL is supporting NHS suppliers in initiatives to reduce readmissions for heart attack patients, reduce surgical site infections, and redesign treatment pathways for patients with type 2 diabetes.
Target date: Ongoing
Update: -
(1) Project Title - Non-elective respiratory admissions
Delivered and expected benefits
CSL were able to quantify the level of admissions, the rate at which they are increasing (6.2% vs a national increase of 4.3%) and specify which specific respiratory diagnoses were driving this growth (J09-J18 - Influenza and pneumonia).
CSL also discovered that the level of GP requested admissions was substantially higher than other CCG’s (35% vs a national average of less than 15%), and were able to identify which GP practices had admissions increasing above the CCG average (Some were increasing at over 100% year on year).
The CCG is now able to use this information to identify where community services are required. The data have enabled them to ensure scare resources can be spent most effectively to reduce these admissions and work with their GP’s to put these services in place.
Timelines:
This is an ongoing initiative at the CCG so admissions will be monitored over the coming months & years to measure progress.
(2) Project Title - Reducing COPD admissions
Delivered and expected benefits
Subsequently the CCG has achieved a reduction in emergency admissions for COPD of over 2%. This comes at a time when the national level of admissions is rising at 1%. This means potentially 100 emergency admissions are being avoided by the CCG per annum, saving in the region of £200,000 pa.
Timelines:
CSL will continue to monitor the progress in this CCG over the coming years.
(3) Project Title - Revision of orthopaedic procedures
Delivered and expected benefits
Focused by this information, the medical supplier is now investigating ways to help their NHS customers put in place the necessary measures to reverse this increase in revisions following key Orthopaedic procedures. These include the provision of training, help with service redesign and non-promotional support.
Timelines:
CSL expect to see more tangible benefits from this analysis in 2017.
Outputs:
All outputs are shown as aggregated data (with small numbers supressed in line with the HES Analysis guide). It is not possible to see record level results. The results are provided to users as cross-tabulations, charts, flow diagrams or reports within the Esprit tool or in documents.
Each output is filtered to include the data relevant to the question being asked, and is then cross-tabulated by the variables important to the analysis, such as hospital trust or diagnosis,
CSL does not provide healthcare professional level data to clients to ensure that it cannot be used for targeting or direct marketing.
Analyses are provided as one-off reports or updated on a regular basis to monitor changes within care provision.
CSL will be providing a standard set of benchmarking reports to NHS organisations (in line with CSL’s permitted purposes), with subscribers from the NHS able to view these reports within CSL’s secure Esprit environment. The technological requirements to fulfil this aspect of CSL’s output are being completed this summer, and CSL expect to launch this service in Q1 2017.
Update: -
(1) Project Title - Non-elective respiratory admissions
Description
CSL were asked by a CCG to investigate their non-elective respiratory admissions, identify if it had increased and whether a more robust community service would have kept them out of hospital.
To do this CSL queried the HES data and compared all CCG’s in England. For the specific CCG, CSL also compared their GP practices.
(2) Project Title - Reducing COPD admissions
Description
CSL has worked with a CCG over a number of years to provide data and insights to aid its program of redesigning its COPD services. This was initiated in 2014 and refreshed in 2015, following the CCG’s identification of this area as a high priority for improvement of patient care.
(3) Project Title - Revision of orthopaedic procedures
Description
An eminent professor's review of Orthopaedic care resulted in the “Getting it right first time” paper (http://www.gettingitrightfirsttime.com/downloads/briggsreporta4_fin.pdf) to set out a vision of how musculoskeletal disease can be funded within a difficult budgetary environment.
The report finds that “Complications following orthopaedic surgery are costly to the patient and the NHS. Infection alone in THR and TKR can cost £70,000 per patient to treat, yet varies in incidence between NHS providers. If the lowest infection rates could be achieved throughout the NHS, current annual savings would be £200 – £300 million. This would allow an extra 40,000 – 60,000 joint replacements to be undertaken annually at no extra cost and no requirement for potential rationing by commissioners.”
A provider of medical equipment to the NHS has worked with CSL systems to help their NHS customers identify savings opportunities in line with this initiative.
They have identified an increase in revision of orthopaedic procedures, a trend which has continued over consecutive years. This information has highlighted an opportunity to save significant cost to the NHS as well as inconvenience to patients.
Processing:
Use of HES data to populate CSL's analysis and Esprit tool
The pseudonymised patient records are only held by CSL and never shared with any other organisation at record level. These data are imported into a secure database where they are organised for analysis within CSL’s own software (ESPRIT).
No patient data are linked to other data sources at a patient level. Aggregated patient data are provided in ESPRIT alongside other practice level open data, including QoF and Deprivation statistics. ESPRIT allows the data to be queried without the need to provide the user with access to the raw data, and only provides aggregated, masked results in line with the HES Analysis Guide.
Use of Esprit tool by CSL
CSL often conducts analyses for clients, using the data organised within the Esprit system. These analyses delivered to third parties in the Esprit tool’s secure front end or as PDF / Excel reports.
Use of Esprit tool by third parties
CSL permit selected third parties to access the Esprit tool to conduct their own analysis only under a controlled process.
Before providing data to any organisation, CSL go through a multi-layered procedure to ensure the organisation and each user who will access the data is aware of the limited way the data may be used and the consequences of its misuse:
• Organisations are provided with an overview presentation stating the limitations and regulations applying to the data’s use during the early stages of the engagement process, and prior to any commitments being made by CSL
• Type 2 organisations sign a contract which passes on the pertinent terms and conditions from CSL’s framework agreement with the HSCIC. Type 1 organisations agree to similar terms and conditions upon access of the data.
• Organisations complete a purpose document, which requires them to state (with reference to CSL’s permitted purposes) how they will use the data, and the benefits they expect to deliver to the Health and Social Care System by doing so
• This is reviewed by the Board at CSL, who ensure that the prospective customer’s stated purposes are subsets of CSL permitted purposes (both in word and spirit). Where they are not, the customer is informed and given the option to drop this purpose or walk away.
• A further document is then completed by the prospect to state the subset of the data they require, the named users who will access it, and some relevant security details including the IP addresses from which the data access will be permitted
• Once this is in place, access is only granted following the completion of mandatory compliance training covering once more how the data must be used.
Clients are reminded of the objectives for which the data may be used, and that data must be used to improve patient care and/or to support cost benefit analyses to assist commissioning and/or reduce treatment costs. This is conveyed via a message in ESPRIT each time it opens or footer on reports containing HES data.
Each time a user opens CSL’s portal (ESPRIT) to view data, the login screen reminds them of the purposes of use permitted under this data sharing agreement, and that by logging into the system they agree to this restriction. Contracts with clients enable CSL to enforce these terms and terminate the contract with immediate effect if they are not adhered to.
Aggregation and Masking of data
CSL provides aggregated, masked data (compliant with the stipulations set out in the HES Analysis Guide) in the form of Excel/PDF reports or via their Esprit analysis tool.
Only substantive employees of CSL will access the data. On no occasion is record-level data provided to 3rd parties. On no occasion are small numbers provided to 3rd parties.
Customers agree to make no attempt to reverse engineer or calculate the values of small numbers, and CSL’s masking routines remove a higher number of sibling values than required by the HES analysis guide in order to further protect small numbers from reverse calculation.
Small numbers are removed at the calculation stage within the Esprit tool, well before the stages at which the data leaves the secure servers for display.
Territory of use
CSL only provides data to customers within the UK, and all data processing takes place in England.