HES consultation attracts 164 responses

A consultation on plans to greatly expand the Hospital Episode Statistics dataset and make it available for electronic extraction attracted 164 responses.

A series of technical and strategic workings are being held through to February and a roadmap for roll-out across the country, including a number of pilot sites, will follow.

In July, NHS England launched a consultation on its proposal to require an extended HES dataset to be provided electronically from the beginning of the next financial year.

The HES expansion includes the regular extraction of tests and results, investigations performed and medications prescribed, as well as nursing observations.

The plan is for this new dataset to be able to be collected by the Health and Social Care Information Centre by April 2014, however NHS England admits that most acute trusts will not have the IT systems necessary to achieve this by that date.

The expanded HES dataset will ultimately be linked with a large primary care dataset due to start being extracted from GP systems next spring, to create new Care Episode Statistics.

The consultation period ended in mid-September and attracted 164 responses.

An NHS England spokesperson said the organisation is going through the replies.

“A series of stakeholder workshops are planned later this year to review the findings and to begin developing recommendations that reflect the consultation, whilst ensuring we meet the needs of NHS patients, providers, commissioners and researchers,” the spokesperson said.

One of the groups that responded was the Royal College of Physicians. It argues that the priority for NHS England and the HSCIC should be the implementation of patient-focused electronic health records, based on national standards for the record structure and content.

The RCP recently published national standards for patient records as part of work commissioned by the HSCIC and it recommends these should be adopted as a “first step”.

The response says that despite the government’s vision to digitise the NHS, the implementation of electronic health records has been “variable”.

“Most hospitals do not operate an integrated information system based on the patient record and often information systems for different clinical areas run in parallel to each other, with limited operability with systems beyond the hospital,” it says.

The college argues that a single, patient-focused EHR should be the basis for all data collections and would reduce the bureaucratic burden on providers.

It also believes that enabling patients to access their own records should be a priority.

The Royal College of Nurses response to the consultation recommends that the national strategy, “drives fit for purpose clinical systems and clinical recording standards as it is these that will ensure delivery of NHS England’s data strategy rather than the repeated redefinition of national data sets”.

It supports extraction of data items from EPRs where there is a clear legal and sensible purpose for the extraction and it is practical. Also, as long as the extraction requirements are “unlikely to have an adverse impact on clinical practice”.

However, it believes that the current recommended extraction of nursing observations does not have a clear purpose, is not practical for most organisations and is not clinically sensible as collection would have an adverse impact on practice.

It says extracting all ‘temperature’ readings without a stated purpose and context will result in hundreds of observations for a short stay in intensive care and tens for an acute illness. “Who will use these data for what?” the response asks.

The RCN also says that specifications for extraction should align with the national record standards published by the RCP and HSCIC.

Cerner vice president and managing director Emil Peters summarised the company’s submission, arguing that addressing the gap in EPR capability across NHS hospitals is essential to ensure that hospitals collect and submit accurate clinical data.

“This requires significant investment, not just financially, but through clinical input to ensure the systems are designed and deployed to support local needs and workflows. Staff training is also required to make sure systems are used widely and effectively.

“Given the resource required to introduce EPRs that can meet the requirements of care.data extract, we strongly believe that priority should be given to electronic information that satisfies both a primary and secondary use, such as: nursing observations; medications; and results, incorporating order communications including tests and investigations," Peters said.

“In order for health data to be captured, shared and reported electronically across different wards, departments and providers, all elements of its definition, context and structure will need to be defined and promoted by NHS England in partnership with the professions and industry.”