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NHS Care Records Service Slide 1 An Overview of SUS Release 11 - Use Web Training Presentation 1.

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Presentation on theme: "NHS Care Records Service Slide 1 An Overview of SUS Release 11 - Use Web Training Presentation 1."— Presentation transcript:

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2 NHS Care Records Service Slide 1 An Overview of SUS Release 11 - Use Web Training Presentation 1

3 NHS Care Records Service Slide 2 Agenda SUS PbR Processing Extracts

4 NHS Care Records Service Slide 3 In this part of the session we will look at : Annual Update Best Practice Readmissions Age Derivations Spell Construction Exclusions ICD-10 A+E Codes SUS PbR Processing For 2012/13

5 NHS Care Records Service Slide 4 Annual Update Introduction SUS PbR is updated each year to align its processing methods with the annual PbR Policy guidance published by the Department of Health to support each financial year. The primary focus of SUS PbR Release 11 is to implement the DH PbR policy for 2012/13 across SUS PbR’s processing methods, extracts and user interface. In addition to policy updates, further changes have been made to improve the usability aspects of the online system and extracts. These changes have been implemented as a direct response to feedback received from users following previous releases.

6 NHS Care Records Service Slide 5 Annual Update Facts and Figures In 2012/ HRGs are now included in the National Tariff against 1168 in 2011/12 In 2012/13 there are 1215 Daycase Tariffs against 1168 in 2011/12 In 2012/13 there 296 HRG available for Short Stay Emergency Tariff against 356 in 2011/12 In 2012/13 there are 83 Procedural HRG carrying an OP tariff against 60 in 2011/12 Specialised Services for Children in 2012/13 at 50% against 60% in 2011/12

7 NHS Care Records Service Slide 6 Annual Update SUS Processing SUS processing logic has been changed to accommodate the relevant business rules and tariff changes outlined in Department of Health PbR Guidance 2012/13 with SUS PbR processing submitted data for the years 2010/11, 2011/12 and 2012/13 HRG4 grouping logic has been applied to Admitted Patient Care (APC), Outpatients (OP) and Accident and Emergency (EM) 2011/12 and 2012/13 Exception: Accident & Emergency (EM) Spells processed for 2010/11 processed using HRG3.2 grouping logic

8 NHS Care Records Service Slide 7 Best Practice Best Practice Session 1 Background Best Practice Tariff Indicators Specialised Service Codes & Best Practice Flags formats Counts Best Practice Session 2 Invalid Combinations Short Stay Emergency Spells with BPT flags National Tariff Adjustment Applying BPT Action Flags BPT Action Flag definitions

9 NHS Care Records Service Slide 8 Best Practice Background The Department of Health introduced Best Practice Tariff adjustments in 2010/11 with the aim of reimbursing providers for improving the quality of care. Best Practice initially addressed four high volume areas; cataracts, fragility hip fracture, gall bladder and acute stroke. These were chosen due to the significant and unexplained variation in practice and to give a clear consensus of what clinical best practice constituted. Best Practice was further extended in 2011/12 to cover additional procedures across breast surgery, gynaecology, orthopaedics, urology, hernia repair, interventional radiology, total primary hip and knee replacements and transient ischaemic attack.

10 NHS Care Records Service Slide 9 Best Practice Best Practice Indicators Best Practice has been extended again in 2012/13 with the following effects: There are now approximately 40 BPT Indicators (flags) for procedures eligible for Best Practice Tariff adjustment Best Practice flags/adjustments applied to APC Spells only

11 NHS Care Records Service Slide 10 Best Practice Specialised Service Codes and Best Practice Flags This year the Grouping process will output separate Specialised Service Codes (SSC) and Best Practice flags with the format of these flags being the same for the Local Payment grouper and the SUS Grouper. The Grouper formats are: Specialised Service Code (SSC) = SSnn e.g. SS08 Best Practice = BPnn e.g. BP36 Note: Making this change ensures that the difference between BPT and SSC flags is much clearer for users from a processing and output perspective.

12 NHS Care Records Service Slide 11 Best Practice Flags from the Grouper for Best Practice are produced at Spell level Flags from the Grouper for Best Practice are DISTINCT i.e. only one distinct value per Spell. However you can have multiple flags per Spell (but not the same flag multiple times) RowNoProvSpNoIterationSpellFlag SS BP BP BP BP SS SS23 Example output from Local/SUS Grouper

13 NHS Care Records Service Slide 12 Best Practice Counts SUS will provide an SSC “count” and a BPT “count” in APC Spells showing the number of flags output by the Grouper. The individual BPT and SSC flags (maximum of 5) are shown in the APC Spell extracts in the following attributes called: SSC Specialised Service Code 1 Specialised Service Code 2 Specialised Service Code 3 Specialised Service Code 4 Specialised Service Code 5 BPT BPT Indicator 1 BPT Indicator 2 BPT Indicator 3 BPT Indicator 4 BPT Indicator 5

14 NHS Care Records Service Slide 13 Readmissions Session 1 Recap of Readmissions in 2011/12 Pairs of Readmissions Events Readmissions Flags Multiple Years Transfers Readmissions Extracts Session 2 Pathway Linkage ‘Child’ Spell eligibility ‘Parent’ Spell eligibility DH Tariff Adjustment (Parent) DH Tariff Adjustment (Child) How to interpret the extract Examples of Pathways

15 NHS Care Records Service Slide 14 Readmissions Readmissions in 2011/12 Readmissions policy was introduced in April 2011 Commissioners can decide to retain funds for Spells that are deemed a readmission within 30 days to make investments in other areas to reduce the number of readmissions Readmission activity in SUS for 2011/12 output to a Managed Service “Readmissions” extract available to Commissioners only.

16 NHS Care Records Service Slide 15 Readmissions Readmissions in 2012/13 – Pairs of Readmissions Events Readmissions in 2012/13 are processed in the same way as last year using a readmissions pathway with the following changes: A pathway may contain more than one ‘Pair’ of readmission events A Pair being the original admission (Parent) with a readmission (Child) within 30 days This means that each individual ‘Pair’ needs to be evaluated for eligibility rather than the whole pathway

17 NHS Care Records Service Slide 16 Readmissions Readmissions Flags A series of flags have been introduced to show eligibility as a ‘Readmission’ and which Financial year the events belong to: RAP ELIGIBLE PARENT RAP ELIGIBLE CHILD RAP DH Tariff ADJUSTMENT PARENT RAP DH Tariff ADJUSTMENT CHILD RAP Validation Parent Indicator RAP Validation Child Indicator Financial Year These flags will appear on the Readmissions extract (which is a YEARS to DATE extract, which starts from the 1st April 2011).

18 NHS Care Records Service Slide 17 Readmissions Multiple Years SUS will reprocess the 2011/12 readmission data using the Release 11 logic to ensure that the data is consistent across both years of the readmission. New pathway identities will not be assigned. If the readmission Spell (Child) has a previous discharge Spell (Parent) in an earlier financial year. To process this type of cross financial year ‘Pair’ the reference used will be that associated with the financial year of the Child.

19 NHS Care Records Service Slide 18 Readmissions Transfers Two new attributes have been added to the Readmissions extract which help users identify where a transfer between providers forms part of a readmission pathway. The new attributes identify the originating and destination spell/provider. Transfers between providers are ‘flagged’ where the transfer is after 1st April 2012 and referred to by the following terms: Transfer Out - The Spell that transfers the patient will be flagged as ‘TP1’. Transfer In - The Spell that receives the patient will be flagged as ‘TC1’.

20 NHS Care Records Service Slide 19 Readmissions Readmission Extracts Extracts to both Commissioners and Providers are provided in Release 11 Pathways may contain events that cross multiple Commissioners and multiple Providers If a Commissioner has one event in a pathway then all events of that pathway will be included in their extract for Release 11 If a Provider has one event in a pathway then all events of that pathway will be included in their extract for Release 11

21 NHS Care Records Service Slide 20 Age Derivations Release 11 will apply derivations to calculate AGE as follows: A+E = Arrival Date minus Date of Birth in complete YEARS (no Rounding) OP = Appointment Date minus Date of Birth in complete YEARS (no Rounding) APC Episodes = Episode Start Date minus Date of Birth in complete YEARS (no Rounding) or based on Age at CDS Activity Date where Date of Birth has not been submitted These derivations will populate a NEW attribute EPISODE AGE.

22 NHS Care Records Service Slide 21 Age Derivations Prior to Release 11, on an APC Episode, AGE was derived as AGE AT START OF Spell (Admission date minus DOB) and then used in PbR processing In Release 11, the AGE at episode start will be used to input to the Grouper using the new attribute EPISODE AGE For an APC Spell the age will be taken from the episode that is classed by the Grouper as the pseudo dominant episode (Spell Report Flag =’1’) This will populate a NEW attribute Spell AGE

23 NHS Care Records Service Slide 22 Spell Construction Spell Construction – Same Day Admissions In previous years, the rule for same day admissions was complex. An episode would be joined to a Spell if the same patient on the same day was admitted to the same provider and the Length of stay was zero and episode flags had been set.

24 NHS Care Records Service Slide 23 Spell Construction Spell Construction – Same Day Admissions To cater for same day admissions in Release 11, if an episode has the following conditions then it will create a new Spell without further consideration: EPISODE NUMBER is equal to ‘1’ LAST EPISODE IN Spell is equal to ‘1’ Length Of Stay is ‘0’ This logic will be applied for all years being processed in SUS PbR once Release 11 has been transitioned. The order that Spell logic is applied is as follows: DAYCASE CONFIDENTIAL Spells SAME DAY ADMISSIONS NHS NUMBER HPS + DOB + SEX

25 NHS Care Records Service Slide 24 Exclusions Exclusions occur at 3 different stages of the PbR process to ensure that only appropriate data records are processed in line with current DH PbR business rules. The stages are: 1.Pre-processing excludes records with insufficient data to process within PbR Example - an APC Episode with no Admission Date would not be capable of creating or linking to an existing Spell. 2.Pre-grouping excludes elements which DH define as not contributing to the Spell HRG 3.Post –Grouping exclude APC Spells, OP or A+E Episodes from having the tariff applied Note: In previous releases events excluded in point (1) have not been made available via extracts.

26 NHS Care Records Service Slide 25 Exclusions PbR UnSpellable Activity Release 11 introduces a new single (APC, OP and A+E) Managed Service extract “PbR UnSpellable Activity”. This will contain events excluded in pre-processing that have not been made available via extracts in previous releases. A full extract will be available to NHS CFH and HSCIC to all providers and commissioners. Note: Data that cannot be attributed to a particular provider/commissioner will be available to HSCIC.

27 NHS Care Records Service Slide 26 Exclusions Outpatients Procedural HRG processing Prior to Release 11 Where an OP Attendance has been assigned a procedural HRG (does not begin with WF) and no tariff is assigned to the HRG in OP Mandatory tariff, SUS PbR will derive an ‘Attendance HRG’ (does begin with WF) In previous years the tariff has then been applied using the SUS Attendance HRG In Release 11 an additional step is performed to apply MSC and TFC OP Exclusions using the SUS Attendance HRG and then apply tariff if the episode is not excluded

28 NHS Care Records Service Slide 27 Exclusions OP Attendance TFC 102 and HRGAA20Z Outpatient Exclusions Example 1 OP Attendance has a TFC of 102 and the OP Attendance has a grouper assigned HRG for AA20Z. OP Mandatory tariff has no entry for AA20Z SUS PbR derives an Attendance HRG of WF01A. SUS PbR applies OP TFC Exclusions. WF01A + TFC of 102 is excluded, so no tariff applied. Apply Tariff No Tariff Available Derive Attendance SUS HRG OPC TFC Exclusions Applied If Excluded - NO Tariff

29 NHS Care Records Service Slide 28 Exclusions OP Attendance TFC 101 and HRG0AA20Z Outpatient Exclusions Example 2 OP Attendance has a TFC of 101 and the OP Attendance has a grouper assigned HRG for AA20Z. OP Mandatory tariff has no entry for AA20Z SUS PbR derives an Attendance HRG of WF01A. SUS PbR applies OP TFC Exclusions. WF01A + TFC of 101 is NOT excluded. OP Mandatory Tariff for WF01A + TFC 101 results in a tariff of £96. Apply Tariff No Tariff Available Derive Attendance SUS HRG OPC TFC Exclusions Applied If NOT Excluded apply tariff - £96

30 NHS Care Records Service Slide 29 Exclusions Exclusions - Global Validations A global validation will be introduced following spell creation in Release 11 where if the Spell does not have all days between the Admission Date and Discharge Date (inclusive) accounted for by episode start and end days (inclusive), the Spell will be deemed to have a data quality issue. The Spell will be classed as not PbR Qualified (excluded from tariff) and have the Spell Core HRG set to NA. The following attributes will be set: a)‘Spell EXCLUSION REASON’ will be set to ‘MISSING_EPISODES(S)’ in APC Spells extract. b)‘PbR EXCLUDED IND’ will be set to ‘2’ in APC Episode Extract. c)‘Spell in PbR/Not in PbR’ will be set to ‘9’.

31 NHS Care Records Service Slide 30 Exclusions Excluded Episodes transformed to Single Episode Spells Excluded Episodes are considered as Single Episode Spells which will be displayed in the APC Spells, A+E and OP extracts, each with its own unique ID and with its original Spell ID also present in the extract to allow traceability back to the Spell the episode was excluded from. The Spell in PbR/Not in PbR will be set with ‘7’ to mark the Spell as ‘A singleton episode Spell created by an excluded episode’

32 NHS Care Records Service Slide 31 ICD-10 ICD-10 Codes International Classification of Diseases (10th Revision) and OPCS codes (Office of Population Censuses and Surveys) are grouped together in SUS to form HRGs which are used in tariffing Spells. The fourth edition of the ICD-10 diagnosis classification will be implemented from April SUS Auto Grouper and appropriate reference data tables will be updated accordingly. For activity relating to previous financial years for example a discharge date before 31/3/12, grouping will use the valid ICD-10 code set and processing rules for that year and will not UZ01Z when the “deleted” codes are submitted against activity for 2010/11 and 2012/12. Note: SUS will not group until a Spell is complete.

33 NHS Care Records Service Slide 32 A+E Codes SUS PbR will apply the following processing rules to A+E Treatment Codes 1. No spaces will be removed from the Original Input Data 2. Truncate to three characters (including any spaces) 3. Pass the three character code to the SUS Auto-Grouper 4. The original Treatment Code will be used to populate the extracts These will only be applied to EM episodes that have an AE ARRIVAL DATE equal to or greater than 1st April 2012.

34 NHS Care Records Service Slide 33 A+E Codes SUS PbR will apply the following processing rules to A+E Investigation Codes 1.No spaces will be removed from the Original Input Data 2.Truncate to TWO characters (including any spaces) 3.Pass the two character code to the SUS Auto-Grouper 4.The original Investigation Code will be used to populate the extracts

35 NHS Care Records Service Slide 34 A+E Codes SUS PbR will apply the following processing rules to A+E Diagnosis Codes 1. No spaces will be removed from the Original Input Data The original Diagnosis Code will be used to populate the extracts.

36 NHS Care Records Service Slide 35 Derivation of PCT from GP Practice Prior to Release 11 the PCT was derived for APC using the CDS ACTIVITY DATE From Release 11, for APC episodes SUS will derive the PCT from date at the episode start date The APC Spell PCT will be the PCT derived on the pseudo dominant episode (Spell Report Flag =’1’) Derivation of PCT

37 NHS Care Records Service Slide 36 Extracts In this part of the session we will look at: Online Extracts Managed Service Extracts Changes to Existing Extracts

38 NHS Care Records Service Slide 37 Extracts Online Extracts There are 3 new Online Extracts for 2012/13: Critical Care (CC) Multi-Birth (MB) Ward Stay (WS)

39 NHS Care Records Service Slide 38 Extracts Managed Service Extracts for 2012/13 PbR UnSpellable Activity This new extract will allow the user to see all records submitted to PbR and details all episodes that have not been eligible for PbR processing (and as a consequence have no PbR derived attributes). This new extract will allow the user to see all records submitted to PbR. Provider Readmissions To support Providers, the Readmission extract that was previously only available to Commissioners is now available to Providers.

40 NHS Care Records Service Slide 39 Changes to Existing Extracts To support users and the new functionality the following extracts have been amended. The embedded workbook below contains the new attributes that have been added to extracts in Release 11 Release 11. They are as follows; APC Spells APC Episodes Outpatient Episodes A&E(EM) Episodes UnSpellable (New) Readmissions Critical Care Ward Stay Multi Births Note: FULL online extracts reflect the changes mentioned in these standard extracts. Extracts

41 NHS Care Records Service Slide 40 Extracts Changes to Existing Extracts The following extracts do not have new attributes in Release 11: BP - Cataracts Supplementary APC Spells Supplementary APC Episodes Supplementary Outpatients Supplementary Emergency Medicine (EM) APC Error Extract OP Error Extract EM Error Extract

42 NHS Care Records Service Slide 41 Extracts APC Spells Extract Attributes Removed in R11 Best Practice SSC Best Practice SSC Applicable BPT Combination Indicator PbR Readmission Indicator Number of Spells Prior to Readmission Number of Spells Following Readmission First Spell Identifier (Readmission) Organisation Code (Code of Provider of Original Parent Admission)

43 NHS Care Records Service Slide 42 Extracts Outpatient Extract Attributes Removed in R11 BPT Combination Indicator EM Extract Attributes Removed in R11 Core HRG For Information HRG Code Version - For Information EM Extract Attributes Removed in R11 The Readmissions extract has had 105 attributes removed to reduce the IG issues with sharing data between Providers where pathways have more than Provider involved.

44 NHS Care Records Service Slide 43 Extracts Ward Stay Extract Attributes Removed in R11 Episode Number Multi Birth Extract Attributes Removed in R11 Episode Number

45 NHS Care Records Service Slide 44 In this part of the session we will look at: De-duplicating Records due to Reasons for Access Extracts

46 NHS Care Records Service Slide 45 Extracts De-Duplicating Records To prevent the duplication of extracts where multiple reasons for access exist and to reduce the need for local users to locally de-duplicate the 2012/13 PbR extracts the “Include Copy Recipient” has been removed as a separate selection option. Consequently SUS PbR will read the organisation code against every reason for access and output only one instance of the record regardless of the number of reasons for access. This “Single Record” approach applies to all extracts with the exception of supplementary extracts where multiple rows may be displayed.

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