NHS Digital in partnership with tech UK Friday

NHS Digital in partnership with tech. UK Friday 21 September 2018 10 am – 1 pm SNOMED Wi-Fi network: tech. UK Password: STB 9897321

Welcome Ben Moody Head of Health and Social Care tech. UK

Agenda Item Presenter Welcome and introduction Ben Moody, Head of Health and Social Care, tech. UK Purpose of the day Ian Binns, Head of Information Analysis Overview Denise Downs, Terminology SME Clare Perry, Mental Health Team, NHS Digital Questions and Answers Ben Moody, Head of Health and Social Care, tech. UK Workshop 1 Lessons Learnt Workshop 2 Questions and Answers Challenges? Denise Downs, SNOMED CT in General Practice Tricia Aveling, NELFT Support required? Ben Moody, Head of Health and Social Care, tech. UK

Purpose of the Day Ian Binns Head of Information Analysis (Community and Mental Health) NHS Digital

NHS Informatics Strategy • • SNOMED CT is a national standard under the Health and Social Care Act 2012 In 2014 National Information Board (NIB) published Personalised Health and Care 2020: – endorsed the retirement of Read/CTV 3 (completed April 2018) – required implementation of SNOMED across the NHS … • By April 2018: • By April 2020: • Social Care is in scope of the standard but there are currently no required implementation dates – systems used by GP service providers must adopt SNOMED CT – – – Secondary Care Acute Care Mental Health Community systems Dentistry And … other systems used in the direct management of care

Mental Health information • Mental Health is a key priority (as emphasised by numerous policy documents) • Information is required to: – – • We already collect lots of mental health data: – – – • via the Mental Health Dataset via UNIFY – some of which is also collected by the Mental Health Dataset no body wants providers to submit data twice! The world keeps changing … – – • understand the current situation monitor improvements the Mental Health Dataset is updated every year (which helps) SNOMED is updated every 6 months (which helps even more) Reducing the burden … – – improved SNOMED coverage will allow us to retire the duplicate collections reduce the chance of asking for additional ‘interim’ collections

Mental Health Outcomes and Improvements • The Improving Access to Psychological Therapies (IAPT) Data Set collects treatment and outcomes data. – This has been used very effectively to improve IAPT services. • SNOMED provides a more structured way of collecting outcomes and treatment data. – It could be used further to improve Mental Health services and outcomes. • Funding has been requested from DH to support a SNOMED Improvement Programme. – please tell us how we could help you to further improve SNOMED coverage.

Data Services Programme (DSP) • NHS Digital is implementing the Data Services Programme. • Hardware and Infrastructure used at NHS Digital to collect and analyse mental health data will change for MHSDS v 4. 0 (from April 2019). • This will support our move to FASTER DATA. • And will require all providers to update how they submit to MHSDS.

Aim of today: • Listen and understand: – Challenges to the adoption of SNOMED CT – What support do you think is required • NHS Digital and NHS England will take your comments on board for next steps

Overview Denise Downs Terminology SME, NHS Digital Matt Wickenden and Clare Perry Mental Health Team, NHS England

What is SNOMED CT? • A national common vocabulary of ‘Clinical phrases’ for electronic systems • Has content for all clinical professions and specialties to enable electronic exchange of data and decision support • For recording information in relation to the direct care of the patient • Is different to a classification (e. g. ICD-10) Examples: • Asthma • Headache • Open heart surgery • Referral to paediatrician • Ideal body weight • Serum glucose level • No family history of diabetes • No history of migraine

Why? Main reasons: • Reduce burden • Improve patient care Provides a more complete patient record.

Benefits

What does ‘do SNOMED’ mean? • Key data items can be sent/received/recorded using terms from SNOMED CT: – Diagnosis/symptoms – Procedures – Allergies – Medicines • Clinical data requested for datasets or in relation to national guidelines and processes in SNOMED CT e. g. – Assessment scales – Reason for referral – Family history – Observables/test results – Current problems

SNOMED CT Mental Health Matt Wickenden and Clare Perry england. mhinfrastructure@nhs. net 21 September 2018 www. england. nhs. uk

Supporting the FYFV commitments • NHS England has outlined a clear commitment to driving a more equal response across mental and physical health. A key element of this is ensuring that people have timely access to evidence-based and effective treatment • The intention of mental health access and waiting time standards is to provide timely access to evidence-based care for those in need • The Mental Health Services Data Set (MHSDS) captures intervention and questionnaires using SNOMED codes. FYFV commitments related to NICE recommended treatment are reliant on SNOMED codes. Not all local IT systems currently capture or map these codes • The expectation is that all areas will have implemented this methodology by 2020 www. england. nhs. uk 16

Reducing burden • Data quality (incl. coverage) issues undermine validity and utility of mental health data & delivery of FYFV • Until NICE concordance can be measured via recording interventions (using SNOMED codes) in the MHSDS, NHS England is required to commission bespoke data collections to measure quality of care • Bespoke collections put burden on the system and lead to duplication • National clinical audits starting to use existing data sets to assess team performance (via SNOMED codes) • ‘Moving towards a world without case notes’ www. england. nhs. uk 17

Outcomes Recording of outcomes is standard practice in physical health conditions and therefore, for parity of esteem, the same would be expected for mental health. Reporting of outcome measures through the MHSDS • Demonstrates the extent to which mental health services are helping people • National and international benchmarking of services • Drives service improvement The following are examples of policy specific requirements of SNOMED codes in relation to outcomes: • The Access and Waiting time standard for Early Intervention Psychosis services recommended the use of three outcome measures, Ho. NOS, DIALOG and QPR, and these should be collected at least twice in a referral in order for services to meet the standard. • A national outcome metric for children and young people’s mental health has been developed • ‘reliable improvement in symptoms and functioning’ • In 2018/19 data is being fed back to providers to drive improvement with support to understand differences between local and national reporting. www. england. nhs. uk 18

Closed referrals in 2017/18 www. england. nhs. uk 19

Current published guidance • Guidance for Reporting Against Access and Waiting Time Standards: CYP ED & EIP and FAQs document • Early Intervention in Psychosis – Recording and Reporting • Eating Disorder for CYP – Full Implementation Appendices • Dementia Care Pathway Appendices and Helpful Resources • Urgent and emergency mental health care pathways (Guidance for improving data quality in the MHSDS) • Perinatal MH Care Pathways Appendices and Helpful Resources www. england. nhs. uk 20

Contact details For general SNOMED and MHSDS enquiries please email england. mhinfrastructure@nhs. net For CYP providers looking to access their outcomes data please email sally. milne@nhs. net with the subject line ‘CYP MH Outcomes network’ www. england. nhs. uk 21

Questions and Answers Ben Moody Head of Health and Social Care tech. UK

Workshop 1 What are the challenges you face to enable you to comply in providing SNOMED CT?

Lessons Learnt: General Practice MHSDS A trust: NELFT

Ask for General Practice systems: • Users can record SNOMED CT terms e. g. to meet guidance • Send and receive SNOMED CT terms in messages e. g. an electronic Discharge • Process specifications in SNOMED CT e. g. for national commissioning Record Send / Receive Process • Systems have provided a browser to enable selection of terms for data entry, writing searches, templates, calculators etc.

Requiring the change • GPSo. C holds the contract with suppliers, required the change following the ISN • GPSo. C provided:

A transition

Maintain continuity Dual Coding Read Codes • Historical data mapped to SNOMED CT to enable searches and graphing over historical data Mapping SNOMED CT Codes • Time period when data ‘held’ in both old and new codes – either within the record or within a lookup table

User impact • End users: minimal impact • Users on pilots found SNOMED intuitive • Search/template developers: training via webex, users found SNOMED CT logical • Those webinars are recorded and available now (Web search: Delen primary)

Housekeeping • Thousands of existing reports and templates • BUT not been reviewed in years! • Data Quality Considerations

Lessons Learnt: MHSDS

Data received • Feels like allocating a classification rather than coding for patient care • Some codes are outside what would have been defined in data dictionary codes • Will allow to reflect current practice rather than lag change ECDS: £ 1 to a 1 p

SNOMED NELFT Approach Tricia Aveling Clinical Lead for Mental Health Outcomes

Use existing record keeping processes wherever possible § Use clinical language in the record, SNOMED in the background § Have a Trust agreed list of SNOMED codes assigned to picklist options, use mandated codes where available § Set key items as mandatory in the electronic patient record (EPR) where possible § Put SNOMED codes on the EPR set up where possible

Clinical View of Appointment Activities System View of Appointment Activities

Link forms to appointments for MHSDS

Summary § Make the process as meaningful and simple as possible for clinicians § Ensure close working between services, reporting teams and record system teams § Identify someone to take a lead on developing a draft mapping § Put procedure in place for new items to get initial coding and updating existing coding and mapping

Workshop 2 What support is required over the next 18 months? What messages would get buy in / get attention to instigate change?

Questions and Answers Ben Moody Head of Health and Social Care tech. UK

www. digital. nhs. uk @nhsdigital enquiries@nhsdigital. nhs. uk 0300 303 5678 www. techuk. org @tech. UK 0207 331 2000 Terminology helpdesk: Information. standards@nhs. net