NHS Digital Data Release Register - reformatted

Harvey Walsh Ltd projects

Harvey Walsh Ltd - data dissemination

554 data files in total were disseminated unsafely (information about files used safely is missing for TRE/"system access" projects).

Harvey Walsh Ltd - data dissemination — DARS-NIC-05934-M7V9K

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 - 'Other dissemination of information', Health and Social Care Act 2012 s261(1) and s261(2)(b)(ii), , Health and Social Care Act 2012 s261(2)(b)(ii), Health and Social Care Act 2012 s261(2)(a)

Purposes: Yes (Supplier)

Sensitive: Non Sensitive, and Sensitive, and Non-Sensitive

When:DSA runs 2020-03-17 — 2020-11-30 2017.06 — 2024.09. unreported DPA breaches; breached contract — audit report.

Access method: Ongoing, One-Off

Data-controller type: HARVEY WALSH LTD

Sublicensing allowed: No

Datasets:

Hospital Episode Statistics Admitted Patient Care
Hospital Episode Statistics Accident and Emergency
Hospital Episode Statistics Critical Care
Hospital Episode Statistics Outpatients
Summary Hospital-level Mortality Indicator
Civil Registration (Deaths) - Secondary Care Cut
Mental Health Services Data Set
HES:Civil Registration (Deaths) bridge
Civil Registration - Deaths
Emergency Care Data Set (ECDS)
HES-ID to MPS-ID HES Accident and Emergency
HES-ID to MPS-ID HES Admitted Patient Care
HES-ID to MPS-ID HES Outpatients
COVID-19 Second Generation Surveillance System
Diagnostic Imaging Dataset
Electronic Prescribing and Medicines Administration (EPMA) data in Secondary Care for COVID-19
Medicines dispensed in Primary Care (NHSBSA data)
Bridge file: Hospital Episode Statistics to Diagnostic Imaging Dataset
Covid-19 UK Non-hospital Antigen Testing Results (pillar 2)
COVID-19 Vaccination Status
Civil Registrations of Death - Secondary Care Cut
Hospital Episode Statistics Accident and Emergency (HES A and E)
Hospital Episode Statistics Admitted Patient Care (HES APC)
Hospital Episode Statistics Critical Care (HES Critical Care)
Hospital Episode Statistics Outpatients (HES OP)
Mental Health Services Data Set (MHSDS)
Summary Hospital-level Mortality Indicator (SHMI)
COVID-19 Electronic Prescribing and Medicines Administration (ePMA) in Secondary Care
COVID-19 Second Generation Surveillance System (SGSS)
Diagnostic Imaging Data Set (DID)
COVID-19 UK Non-hospital Antigen Testing Results (Pillar 2)
COVID-19 SGSS First Positives (Second Generation Surveillance System)

Objectives:

Harvey Walsh is an IT solutions, NHS Informatics and Healthcare Consultancy which provides services to the NHS, Pharmaceutical and Device Industry, Patient Groups and Healthcare Charities.

Harvey Walsh uses pseudonymised, monthly refreshed HES data to undertake analysis, develop services and provide solutions to support commissioning for NHS organisations, which includes GP Practices, CCGs, Regional Teams AHSNs, Health and Well-Being Boards, Provider Trusts, Ambulance Trusts and CSUs. The services and solutions provided include analysis and outputs for the purposes of informing commissioners, clinicians and clinical networks on uptake on innovation national policy guidelines, including NICE, patient pathways, benchmarking and disease burden analytics. The insights and analysis may be on a national level or down to individual practice level.

Harvey Walsh also utilise these HES data to provide services to commercial organisations within the pharmaceutical, medical device industry, patient organisations and healthcare charities. These organisations use the outputs and insights to work collaboratively with NHS organisations to promote health and improve the well-being of patients. The use of the data supports the development of innovative solutions and service improvement, to track outcomes and provide the real world evidence as required by the NHS, NICE, Monitor and NHS England. The aim of which is to improve patient care and support enhanced access to improved services and innovative solutions. In addition these clients use this data for the purposes of providing supporting information required by the NHS for business cases, epidemiological research, pathway analysis, burden of disease analysis, health economic research, predictive analytical modelling, NICE submissions and quality and outcome analysis. The outputs of which are shared directly or indirectly with the NHS to support improvements in patient care.

In addition to this analytical work, Harvey Walsh also provide a tool called AXON 360. AXON 360 is an online tool that is hosted within the Harvey Walsh offices in a secure server room from a dedicated network. AXON 360 incorporates aggregated HES, QOF and primary care prescribing data, this tool allows users to analyse healthcare data, derive a range of insights and produce reports to support improvements in patient care and provide insights and evidence for commissioners and healthcare professionals. Data is also analysed for the purposes of informing commissioners, clinicians and clinical networks on uptake on innovation, national policy guidelines, including NICE, patient pathways, benchmarking and disease burden analytics. The insights and analysis may be on a national level or down to individual practice level. All data is aggregated and small numbers are suppressed, including secondary suppression as per the HES analysis guide.

The outputs that utilize the HES data are provided directly to the NHS or indirectly to the NHS via pharmaceutical and device companies using bespoke outputs, reports, dashboards, research papers and via a tool called AXON 360 produced by Harvey Walsh. ALL of the outputs from the analysis of HES are used directly or indirectly for the provision or promotion of health and improved patient care and are not wholly commercial.

Yielded Benefits:

Harvey Walsh has delivered numerous projects in 2017/18, below are 5 examples showing how HES data has been used with both the NHS and commercial clients to benefit patients and Health and Social Care: NHS England & Imperial College Health Partners Suspicion of Sepsis Interactive data dashboard to support clinicians in recognising the suspected symptoms of Sepsis and the risk rate per hospital/provider/CCG Improved awareness resulting in faster diagnosis and treatment. BBraun Orthopaedic Pathways Analysis Capacity and outcomes model for use with Healthcare Professionals to benchmark and highlight variation in care, time to treatment and outcomes in hip, knee and spine surgery. Reduction in variation of outcomes and financial savings to the NHS. LivaNova Healthcare Utilisation pre and post treatment with innovative device for Epilepsy Management Numerous outputs, including publication, model and interactive dashboard. The dashboard was developed in 2018 and shows the variation in referral for specialist Epilepsy Management in England Improved referral for patients with Epilepsy and outcome evaluation to demonstrate savings for both patients and the NHS. RNIB 5 Year Review of Ophthalmology Services in England A review of services in Ophthalmology across disease type in England, comparing outcomes between CCGs and Providers published as a report. Driving service equity to improve access to treatment and speed of referral for patients. Pfizer Pathway analysis on Renal Cancer across England An interactive narrative dashboard for use with NHS Commissioners and Healthcare Professionals. The objective of which is to provide insights for local services and to provide support for service evaluation and improvement Improved referral to specialist centres and increased time to treatment.

Expected Benefits:

Harvey Walsh has held a data sharing agreement for over 8 years and has provided services to the NHS (trusts, CCGs, GP practices) and other healthcare related companies (Pharmaceutical and Device Companies, Patient Groups and Charities) during this time. Harvey Walsh have contracts which run through to 2018 and beyond and would expect to provide HES outputs through to this time.

The solutions and projects that Harvey Walsh undertake have utilized cohort data from 2006 to date, and have been used for numerous different projects.

The benefits that are provided from the analysis and insights of the HES data are direct and indirect to the patient and health and social care environment.
Below are examples of direct benefits to patients and the NHS:

1: NHS England issued Clinical Commissioning Policy:

Vagal Nerve Stimulation for Epilepsy April 2013 Reference: NHSCB/D04/P/d.
Vagal Nerve Stimulation is used in refractory and drug resistant Epilepsy. Working with a device company and in collaboration with a Neurology Clinical Guidelines group analysis using HES has been undertaken to determine the:
• Burden of Epilepsy and Variance across England demonstrating the patient pathways into specialist care
• Modelled the capacity and potential requirements of surgical units so that patients who are suitable for treatment gain earlier access to treatment
A health economic evaluation was undertaken on the healthcare utilisation pre and post implant to provide evidence to commissioners and NHS England on the benefits for patients as unplanned activity reduces as does cost to the NHS.
This evaluation has been published Burke T, Hughes D, Forsey J, Bunker M, Bhattacharya D, Smithson WH, A Study of the Impact of VNS on Health Care Utilisation in England, SEIZURE: European Journal of Epilepsy (2015), http://dx.doi.org/10.1016/j.seizure.2015.11.002

2: Idiopathic Pulmonary Fibrosis Pathway Analysis:

This project was undertaken with a commercial client for use in collaborative working with the NHS. Idiopathic pulmonary fibrosis (IPF) is a chronic and ultimately fatal disease characterized by a progressive decline in lung function. The term pulmonary fibrosis means scarring of lung tissue and is the cause of worsening dyspnoea (shortness of breath). Fibrosis is usually associated with a poor prognosis.

In its earlier stages IPF mimics many routine chest conditions and requires specialist diagnostics to make a definitive diagnosis. Once diagnosed it is managed under specialist commissioning arrangements at key specialist centres such as the Royal Brompton.

It’s quite possible for a patient to have many hospital admissions to local Hospital Trusts then specialist Chest Units before receiving a final diagnosis and referral to the appropriate Tertiary Specialist Centres.

This makes determining a patient pathway difficult and the planning and commissioning of IPF services complicated. Tertiary referral trusts and their clinicians face challenges in planning and optimising capacity of IPF services due to the paucity of service data for this rare condition and the wide geographical distribution of patients.

The IPF Pathway Analysis and Dashboard output supports the NHS to identify the current resource management of patients who may be identified as Idiopathic Pulmonary Fibrosis (IPF) patients in England. The dashboard provides a comprehensive Health Episode Statistic (HES) patient pathway and outcomes analysis from 2009 – 2014 across different co-morbidities and organisations. The data is displayed as reports and bespoke dashboards in order to support the NHS to plan for future patient and resource management requirements, for patients who may have IPF.

In addition, by determining IPF records in 2014 to go back through the HES record for those patients to the first admission for a chest related condition and calculate two factors:
• The Time from first Chest Condition Admission to diagnosis of IPF
• To determine any patterns of Chest Conditions admissions that could be used as a marker for patients at risk of developing IPF to speed referral to the appropriate Tertiary Referral Specialist Trust for definitive diagnostics with aim of diagnosing and treating IPF earlier.

The numbers of patients in England has been static around 5250 for the last 5 years accounting for approximately 7000 spells per year and costing on average £15m per year.

For the first time it has been possible to say that the average time from first presentation with a chest condition to diagnosis with IPF is between 400 and 600 days.

The top 5 chest conditions that account for the majority of hospital admissions prior to a diagnosis with IPF are:
1. Lobar Pneumonia Unspecified
2. Chronic Obstructive pulmonary disease with acute lower respiratory infection
3. Abnormal findings on diagnostic imaging of lung
4. Pneumonia unspecified
5. Interstitial Pulmonary disease unspecified

Which presents an opportunity for the NHS to work to identify the types of patients with this pattern of admissions for definitive IPF diagnostics so reducing the time from presentation to diagnosis and treatment. Therefore directly improving outcomes for patients and reducing costs for the NHS.

3: Analysis of TURPS Patient Pathways for England:

This work was undertaken with a commercial client to support NICE submission and to provide data to NHS England on innovative surgical techniques. Transurethral resection of the prostate (TURP) is a type of prostate surgery done to relieve moderate to severe urinary symptoms caused by an enlarged prostate, a condition known as benign prostatic hyperplasia (BPH).

During TURP, a combined visual and surgical instrument (resectoscope) is inserted through the tip of the penis and into the (urethra). The urethra is surrounded by the prostate. Using the resectoscope, excess prostate tissue is removed that's blocking urine flow and increases the size urethra that allows the patient to empty their bladder.

Current surgical approaches like TURP can leave permanent side effects such as urinary incontinence and erectile dysfunction. The aim of this project was to understand how many Patients had BPH, the number of TURPs undertaken for BPH and the complications associated with those TURPs and the long term impact of those complications on patient hospital admissions. This would indicate the real costs and patient impact of TURP as a baseline against which alternative less invasive procedures might be evaluated.

A longitudinal analysis was performed on the HES Data Set for England and all records with a recorded diagnosis of BPH in 2013 who had within the same year undergone TURP.

Harvey Walsh then identified subsequent admissions over the following year for the complications associated with TURP for those patients with a diagnosis of BPH also having a TURP in 2013.

This data was presented nationally, and by CCG and hospital trust.

Summary

Post-operative complications add approximately 23% to the actual costs of performing TURP procedures and have a significant impact on patients’ lives. It is clear that clinically patients who undergo TURP and subsequently are admitted for a TURP complication will have that recorded in their notes.

However, as the admissions for complication do not generally coincide with the spell during which the procedure is performed it may be very difficult for commissioners to see the impact in terms on subsequent hospitals admissions LOS and costs for patient undergoing TURP without investing scarce time and resource for data analysis for a procedure that is routine for this condition.

Further as you would expect the peak in complication numbers & costs occurs in the year following procedure. However, in the 5 years following surgery many of the complications persist in reoccurring spells.

TURP remains the standard procedure to relieve moderate to severe urinary symptoms caused by an enlarged prostate. In reviewing alternative procedures to TURP those that are less invasive but preclude the complications from TURP could have an impact on service cost and efficiency but potentially patient outcome not just in year but in the longer term.

It was on the basis of this data analysis that the client was able to secure a meeting with the Office of Life Sciences to discuss complications of TURP as part of their remit to look for opportunities for innovation in patient care. This has now spread to NICE and there are on-going meetings to discuss the management pathways for these patients providing a direct benefit to patients by offering innovative procedures with less chance of complications whilst saving money for the NHS.

4. Renal Cancer Commissioning Insights Dashboard. (Commissioned by Pfizer)
A quarterly refreshed insights tool that provides aggregated metrics to Providers and CCGs on:
• Numbers of patients/growth/decline
• Time to referral
• Pathway of treatment
• Healthcare utilisation
• Variation and comparison

The Pathways for Renal Cancer vary across the country. The objective of this project was to provide information and insights on current referral and management pathways for Renal Cancer to Commissioners and Clinicians. So that gaps in service provision and variation in care can be addressed by the development of local education and pathway support.

This programme brings benefits to patients as it address service variation and supports improvement in quicker referral times to specialist centres for treatment and interventions

5. IBS Insights Tool (Commissioned by Allergan)
A monthly refreshed dashboard that provides aggregated metrics to CCGs and Clinicians on the IBS Pathways showing:
• Rates of scopes
• Variation
• Burden of IBS
• Capacity mapping

Irritable Bowel Syndrome (IBS) is often misdiagnosed and patients have unnecessary scopes which result in high costs for CCGs and capacity issues for Providers. The objective of this project was to show the current referral and management pathways for IBS to CCGs and provide the data and insights for service reviews and the development of local protocols to support appropriate referrals and reduce the numbers of referrals and thus reduce costs.

This programme provides benefits to patients by reducing physical diagnostic scopes which are often not required and benefits to providers as capacity can be reduced and CCGs save money on scopes.

6. Atrial Fibrillation Insights Tool (Joint working Greater Manchester AHSN and Diatchi Sankyo)

A monthly refreshed model with aggregated data (HES, QOF, Prescribing and GRASP) which maps the local impact and variation of AF across Greater Manchester Atrial Fibrillation is a ACS and QOF condition which is actively managed by GPs and CCGs. However significant numbers of patients still enter hospital as unplanned emergency admissions each month. The aim of this programme was to provide an in-depth analysis of AF across Greater Manchester, highlighting variance in care, uptake of NICE Guidance. Areas where performance and outcomes where not as good as expected were supported by educational and transformational programmes via the AHSN.

This programme provides benefits to patients by improving how they are treated and aims to reduce admissions to hospital. This in turn benefits CCGs and Providers by reducing costs and unplanned admissions.

7. Saving Sight Campaign (commissioned by RNIB)

Analysis of variation of Cataract Procedures across England by CCG to determine time to treatment.

Originally commissioned in 2013, Harvey Walsh undertook a deep dive analysis on Cataract services in England to develop a publication Surgery Deferred Sight Denied Report 2013. This report showed significant variation in access to first and second eye surgery. This resulted in a number of interventions and educational support by the RNIB. In 2016 Harvey Walsh were asked by the RNIB to undertake a refreshed analysis based on the 2013 study. This analysis shows increases in treatment and a decrease in the variation of care with over 100,000 additional procedures taking place since the initial study.

This programme has produced improvements in time to treatment and the treatment of second eye blindness resulting in benefits for patients and the wider healthcare arena.

8. Impact of Vaccination on the rates of Pneumococcal Disease in England since 2006 (Commissioned by Pfizer)

Analysis of HES data to produce aggregated national analysis on the rates of Pneumococcal Disease over 10 years The complications of Pneumonia can lead to devastating outcomes such as death, meningitis and sepsis. The objective of this analysis was to determine whether vaccines have had an impact on these complications and the outputs will be used to provide evidence to NICE and other NHS bodies to support their decisions on future vaccine programmes.

This work has provided benefits to patients by providing outputs to support further vaccine programmes which will result in less people developing the consequence of Pneumonia Infections.

Outputs:

Harvey Walsh undertake numerous projects utilizing HES on a yearly basis, approximately 82 distinct projects were completed in 2015/16. The outputs are varied and in different formats ranging from reports, charts, dashboards, budget impact models, health economic models, system dynamic models, health economic analysis, risk stratification, research papers and publications and AXON 360, see example at end of document.

These outputs have achieved many useful things including changes in patient care, reduction in costs, uptake and monitoring of NHS policy. Harvey Walsh have a number of rolling contracts and Harvey Walsh expect to produce outputs on these up until at least 2018.

Any output or analysis is ultimately delivered to improve patient care, pathways or healthcare services.

Further details of outputs follow in the Benefits Section of this application.

Processing:

Harvey Walsh have received data on a monthly basis for the past 6 years. Harvey Walsh processes this data in the following ways;

The raw flat HES files are downloaded from the SEFT server onto a drive on a secure dedicated in house server within Harvey Walsh offices in Runcorn. The data are then processed with costing algorithms applying tariffs to HRGs and all records are imported into two different databases within SQL Server - an archive database that has every requested column from the data files included, and a summary database that has a subset of columns for speed of processing. (please see Appendix 1 for flow of download and processing)

A verification process takes place on row count and then additional processing is undertaken applying the NHS cost algorithms and readmission calculations, the data is then ready to be made available for further use.
The data are then split in two ways, for bespoke analysis by the SQL Analyst team and for the AXON 360 system. For bespoke analysis the refreshed data from the summary database is transferred via an internal secure network to 4 named analysts desktop SSD drives within SQL server.
Only certain employees have access to the record level data in SQL and each of their machines is physically secure within a locked office and has 256 bit encryption and password protection. The employees who access record level HES data are logged on an access control register and are under contractual obligations with regards the safe and secure processing of sensitive data. Harvey Walsh is ISO27001/2013 compliant and all staff are fully trained on HES and undergo regular data security training.

Prior to presentation to customers all outputs produced are checked by a Manager to ensure compliance to the HES Analysis user guide and all outputs have the stated purposes included and since 2015 have been recorded on a data output register. In addition a Privacy Impact Assessment (PIA) is now done on all HES analysis prior to commencement of a project.
The AXON 360 system is processed as follows, the data are aggregated to a spell level (all related episodes made into a single spell row), and then this is further aggregated to an organisation and code level (ICD10, OPCS, HRG) when being rolled up into an OLAP cube. AXON 360 does not display individual episode or spell level data, the data are aggregated to an organisation or code level. The cube aggressions of data at a diagnosis or organisation level will be accessed via the AXON application’s server code via a stored procedure on SQL Server. This allows another layer of security between the data and the AXON application layer.

The data viewable in an AXON 360 report is pre-processed, aggregated and suppressed. AXON 360 is on a separate dedicated server on its own segregated network. This means that there is no access to the raw underlying HES data that is stored on a separate dedicated server within the Harvey Walsh facility.
Harvey Walsh have also provided documented methodology to illustrate that the small number suppression they employ actually goes beyond the HES Analysis Guide providing further assurances.

No record level data is provided to any third party organisation in any format. The only output will be aggregated data with small numbers supressed as described and in line with the HES Analysis Guide.

The data are not used to target sales individuals towards specific healthcare professionals and the data are not used within sales collateral used by sales/marketing teams this includes sales brochures, emails, direct mailing or advertising of pharmaceutical products.

No record level data are transferred, stored or processed outside of the Harvey Walsh facility in Cheshire.