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IQAP Standard for Migration ofPatient Administration System DataProgramme NPFIT DOCUMENT RECORD ID KEY

Sub-Prog /Project

IQAP

Prog. Director M.Cooke

NPFIT-FNT-TO-DQM-0041.08

Owner N. Wilson

Author N Wilson

Version 3.0

Version Date 12/07/06 Status Approved

IQAP Standard for Migration ofPatient Administration System Data

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IQAP Standard for Migration of Patient Administration Data NPFIT-FNT-TO-DQM-0041.08 v3.0

Approved

Amendment History:

Version Date Amendment History0.1 18/03/05 First draft for comment

0.2 11/04/05 Updated with review comments




1.0 05/09/05 Approved version for issue.

2.0 13/04/06 Gateway approval statement added3.0 12/07/06 Migration Analysis Cleansing Services details added

Forecast Changes:

Anticipated Change When

Updates to incorporate IPU requirements May 2005

Reviewers:

This document must be reviewed by the following. Indicate any delegation for sign off.

Name Signature Title / Responsib ili ty Date Version

Andy Truscott Information Governance 0.2

JamesHawkins

Technical IntegrationManager

0.2

Jeremy Thorp IQAP Programme Board 0.2Phil Walker IQAP Programme Board 0.1

Iain Marsland SHA Rep IQAPProgramme Board

0.2

Sue Millard Demographics Lead,IQAP

0.2

John Gresty Data Migration

Consultant IQAP

0.2

Davie Hay Cluster Lead IQAP 0.2, 2.1

Nicci Wilson IQAP Senior ProjectManager

2.1

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Contents1 Introduction ...............................................................................................52

Purpose ....................................................................................................6

3 Background...............................................................................................6 4 Migration Standards Checklist ..................................................................7Appendix A Checking Archive Records Business Process ......................... 13

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1 Introduction

1.1 NHS Connecting for Health is a programme specifically aimed atdelivering the long term government-led vision of a unified NHS thiswill be made possible by provision of an information and communicationinfrastructure that will support integration and interoperability of keybusiness systems. A key component of this implementation is the NHSCare Records Service (NCRS). The NHS Care Record Service willenable patient record details to be accessed, at the appropriate level,anywhere in England, via use of a unique ID. The unique ID to beemployed throughout the NHS and it associated systems is the NHSnumber.

1.2 Ensuring a high level of data quality throughout NHS systems is crucialfor the success of NHS Connecting for Health. One of the functions of

the Information Quality Assurance Programme (IQAP) is to ensure thatguidance documents are set in place to advise stakeholders of thestandards necessary to ensure safe clinical and administrativemanagement of patient information. It is envisaged that theimplementation of IQAP standards will support recognition of many dataquality issues prior to migration so that they can be addressed andmitigated for before deployment of systems that directly support the NHSCare Record.

1.3 In December 2001, the Department of Health introduced the ExternalGateway system to help control the amount of guidance, targets andplanning requirements issued to the NHS from the Department.

The Demographics and Data Quality team from NHS Connecting forHealth approached the Departments Gateway Team with examples ofwas appropriate to issue via Gateway.

The Departments Gateway team have confirmed that the guidance &best practice documents do not need to go through Gateway as theywould class them as routine, technical/specialised work and projectorientated.

As such the guidance & best practice documents will be issued via the

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2 Purpose

2.1 This document will detail standards that should be followed by migratingNHS organisations, in collaboration with Local Service Providers (LSPs),while migrating Patient Adminstration Systems (PAS) to ensure that anyPatient Administration System data to be migrated into a NHS CareRecord Service (NCRS) is compatible with, and safeguards, operationaluse of the Spine.

2.2 This document only considers specification of standards and businessrules for transfer of person demographic data and associatedadministrative episodic data.

2.3 The document refers to management of migration of patient recordsfrom patient administration systems in P1R1 and P1R2. Futurereleases of functionality will require additional rules to be developed fortransfer of clinical data. Additional guidance will be made available to

support clinical data migration.

3 Background

3.1 NHS organisations have an accumulation of current and historic data

held within their patient indices on their PAS patient master index (PMI)and other electronic systems, or on paper records. That data isfundamental to the business of a health care provider, and forms thebasis for clinical, corporate and operational activity.

3.2 The NHS patient records are public records under the terms of thePublic Records Act 1958 S. 3 (1) (2), and subject to legalconsiderations and clinical governance provisions. NHS trust officers

have defined responsibilities associated with the management andstorage of records within their organisation1.

3.3 The NHS Care Records Service will be populated with records using theNHS number as the unique identifier2.

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At least 95% of records of Active patients must have an NHS numbertraced and verified in the six months prior to migration.

A recently traced and verified NHS number will be required to migratethe records for all other patients (historic/inactive).

3.5 The new Care Records systems within NPfIT will have the functionalityto access the Spine the national mechanism for linking all patient

records on the new Care Records Service via the NHS number toidentify whether or not the patient has a previous history of treatmentwithin the NHS. In order to preserve the integrity of national patientrecords, and in particular, avoid individuals records being fragmentedacross different patient numbers, IQAP has ruled that only a maximumof 5% of patient records defined as active3 may be migrated to the newsystem without an NHS number. Trusts will have the option of migratingnon-active patient records with NHS numbers to the new system. It is

expected that any non-active record migrated will have verified NHSnumber attributed to record at point of transfer.

3.6 The consequence of this is that each trust will have a population ofhistoric patients for whom it has not been possible to trace an NHSnumber and who should not therefore have the record migrated to thenew system. Trusts are concerned that entries will still be required toaccess case note references. There is concern if these patients present

for treatment at the trust in future, staff may not be aware that the patienthas a history at the hospital and has case notes. This concern must beaddressed but balanced against the risk to the spine of importing dirtydata. This situation introduces a fundamental requirement for trusts toconduct data cleansing activities prior to any migration to supportretrieval of NHS numbers for all patient records.

3.7 If data cleansing is not conducted within local units, prior to migration tothe P1R2 environment, there is a risk that, within the 5% of unnumberedactive patients, additional duplicate records will be created on the Spine,during and post migration. This inflation of the Spine and thefragmentation of clinical records is an inevitable consequence of thepresence of duplicates.

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Detail for each of the activities and the benefits realised is outlined in each ofthe relevant subsections.

Activity Timescale ResponsibleBody

4.1 Migrating organisation use NSTS batchtracing for tracing for NHS numberretrieval.

Immediateand ongoing

NHS trust

4.2 Migrating organisations use NSTS on linefor tracing of non matches (preferably at

point of contact with patient)


NHS Trust

4.3 Trust extracts NSTS batch for all un-numbered records and forward datasecurely to NHS Central Register forMACS


NHS Trust

4.4 NHS Central Register perform listcleaning against file supplied by trust

Immediatelyon receipt ofNSTS file

NHSCENTRALREGISTER

4.5 Analysis on data quality issues performedagainst any residual unmatched records

Immediatelyafter fileprocessed.

IQAP/NHSCentralRegister

4.6 Post analysis rationalisation of data byapplication of IQAP business rules

Prior tomigration

NHS Trust

4.7 Rationalised data that is not to bemigrated stored for retention purposes.(Trust decision as to method of storage

should be determined at point of projectinitiation.)

4 weeksprior tomigration

NHS Trust

4.8 Organisational data quality plandeveloped for resolution of remainingdata quality issues

4 weeksprior tomigration

SHA/IQAPClusterLead/NHSTrust

4.9 SHA performance monitor trust progressagainst data quality plan

Ongoing SHA

4.1 NSTS Batch Tracing

NHS organisation should employ the NHS Strategic Tracing Service (NSTS)on a regular basis to retrieve NHS numbers for all new registrations.

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4.2 NSTS On-Line Tracing

NHS organisations should develop processes and facilities to allow front linestaff to access NSTS on-line tracing. Records that have failed to find a NHSnumber through batch tracing should be flagged for further investigation.When a patient with a flagged record presents at unit i.e. outpatient clinic etcclarification of patients details should be sought. IQAP PDS TracingGuidance for front line NHS staff has detailed set of questions for provision ofperson demographic details. On-line tracing should be used at point of patientcontact to retrieve NHS number for patient. Additional guidance is also

available from NSTS Service User Manual.

IQAP Cluster Leads will monitor on-line usage against batch tracing outcomesto determine whether units are working on clearing unmatched records by useof processes above. IQAP Cluster Leads will liase with SHA data qualityleads to provide regular reports on on-line usage. SHAs should promoteusage of NSTS on-line for verification of patient details and retrieval of NHSnumbers.

4.3 Migration Analysis Cleansing Services (MACS) Submission

As part of existing data quality schedules, NHS organisations will be given theopportunity to submit all un-numbered records in the same format as NSTSbatch files to the Migration Analysis Cleansing Services (MACS). It should benoted that the Migration Analysis Cleansing Services will only be madeavailable to units that have previously employed NSTS Batch tracing. Thisservice will be made freely available to the NHS via the IQAP Cluster Leads.Upon submission the NHS Central Register will process the files ofunnumbered records which will then be returned to the relevant NHSorganisations for reload into their legacy PAS systems.

Regular use of both NHS Strategic Tracing Service and Migration AnalysisCleansing Service in the migration preparation will ensure an organisation isbest placed to achieve the standards laid out in the IQAP guidance on Active

Patients.

For further information reference IQAP Procedures for utilising the NHSNumber Tracing Service NPFIT-FNT-TO-DQM-0107 and contact your IQAPCluster Lead to discuss when your organisation can make use of theMigration Analysis Cleansing Service.

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4.5 Migration Analysis Cleansing Services (MACS) Data Analysis ofUnmatched Residual

Together IQAP and the NHS Central Register have developed a suite ofanalysis routines that will be run against the residual unmatched records onthe output file to determine underlying data quality issues that are impactingon NHS number matching. This analysis will identify records that may bepotential duplicates, data anomalies and thus should be rationalised orexcluded from transfer.

The results of the analysis of unmatched records will be fed back to NHSorganisations to support the development of an organisation specific dataquality plan. It is anticipated that the analysis will identify areas where basicregistration processes could be improved. i.e. surname/forenamemanagement, default date of birth management and management of deathnotifications. The analysis reports will enable IQAP to work closely withmigrating organisations, Clusters and LSPs to assess data quality and

readiness.

4.6 IQAP Data Rationalisation Business Rules

Records that fall within the criteria to follow will be unlikely to have NHSnumber that can be attributed them as a result of the quality of the data. Thequality of the data will also impact on ability to safely allocate identification of

previous registrations and case note references to any individual.

These records should not be migrated and trusts should consider whether therecords need to be perpetuated in any form given that it will be difficult todetermine the validity of the record and any associated case note referencesfor any patient presenting at unit.

Business Rules for Data Rationalisation

Records with missing date of birth

Records of patients with an age over 120 (where no record of death)

Records with a forename of foetus

Records with baby forename and date of birth greater than five years before point of migration

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4.7 Storage of Data not migrated

The recommendation for rationalisation does not presuppose deletion of anypatient record. It will be necessary for each trust to determine the actions thatneed to be undertaken in order that the trust meets its medico/legalrequirements, in relation to the retention of patient data. IQAP has producedan archive requirements documents that outlines considerations fordevelopment of any technical archive facility for management of patientrecords from PAS systems.

The mechanism that any trust employs for storage and access of case notereferences should reflect the volume of data to be stored without NHSnumber. I.e. it may be feasible to retain small volumes of person and casenote references in hard copy. Whatever mechanism is employed for storagetrusts should ensure that any new registration or referral enacted on theNCRS system includes a search of storage or archive facility to determinewhether case note references exist for patient. A suggested process for thisoperation is outlined below as Appendix A

Where NHS organisations have selected an electronic archive facility, LSPsshould support NHS organisations by supply with a single search processthat can be invoked for all new registrations and referrals.

When a referral is being entered onto NCRS complaint system and no matchfound on local PMI then archive or other repository should be searched andif match found ( as per process outlined below) users offered opportunity totransfer case note reference numbers in other identifier field on NCRS

system.

Functionality is also required to flag record that has had case note referencetransferred to be excluded from any further search. This will ensure that casenote reference only linked to single record on NCRS system.

4.8 Data Quality Improvement Plans

Strategic Health Authority Data Quality Leads, IQAP Cluster Leads and NHSTrusts should work co-operatively to develop a trust specific data qualityplans, using outputs from analysis of residual unmatched records analysis.These plans should support the resolution of the pre-existing unmatchedrecords, but also, more importantly, put in place data quality improvementplans that will mitigate the risk of future data anomalies. i.e. revised processesf fi ti f d hi d t il t f t f t t ith ti t

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4.9 SHA Performance Monitoring

SHAs should adopt a proactive role in the performance management of basicdemographic and administrative data. This data has always had an impact onstar ratings, albeit in a limited form; however with the introduction of multipleorganisationss data being held in a single instance of an NCRS applicationthe impact of one trusts performance on another trusts business is greatlyincreased. IQAP Cluster Leads will work co-operatively with SHA data qualityleads to ensure that a comprehensive performance framework is developed.

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IQAP Standard for Migration ofPatient Administration System DataProgramme NPFIT DOCUMENT RECORD ID KEY

Sub-Prog /Project

IQAP

Prog. Director M.Cooke

NPFIT-FNT-TO-DQM-0041.08

Owner N. Wilson

Author N Wilson

Version 3.0

Version Date 12/07/06 Status Approved

Appendix A Checking Archive Records Business Process

Is patient on livedatabase?

Is patientpresent?

Has archive checkedflag been set?

Check details with PDS Create new record

Y

N

Commence procedure formerging case notes.

Set matched flag againstthis archive record.Any more matching

archive records?More than one set of

case notes?

Set archive checked flag onthe live patient record.

DRAFT for discussion purposes only

Start

N

YError in search GOTOStart

Y

N

Is Patient on Archive

Confirm Details orUpdate Live record

Locate paper records fromArchive references

End

N

N

Y

N

Y

Y

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