Safety recommendation
It is recommended that NHS Digital include provision for identifying, prioritising and monitoring patients at risk of developing sight loss within the next version of the national Commissioning Data Set. Provision should include the ability to record a risk rating and the recommended follow-up date for each patient, meaning these are mandated data items for collection by hospital eye services. This should be carried out in consultation with key stakeholders such as the Royal College of Ophthalmologists and patient administration system suppliers.
Response:
As well as including the ability to flow this information in CDS, it is important that measures are taken to ensure that the relevant tests are being carried out clinically and that the associated information is being recorded locally. Enabling the flow of the data is the last step in the process and will not in itself ensure that relevant information is capture for clinical purposes.
We therefore also suggest that consideration should be given for other bodies to introduce alternative methods of incentivising the completion of these fields, in order to highlight the importance of this information – for example, a financial incentive scheme. However, we would recommend that any such plans are not taken forward during the current COVID-19 outbreak to ensure that undue burden is not imposed on hospital services. We are happy to discuss this further.
Once CDS v6.3 is released, we will continue to assess and publicise the data quality of the ECAD field and work with the Royal College of Ophthalmologists to improve data completeness where required. We will also engage with the Professional Records Standards Body (PRSB) to further promote the completion of this important information. ACTIONS: An update to the Commissioning Data Sets (CDS) to create a new version, v6.3, is planned for development during this financial year (2020-21).
The recommendations made by the HSIB report on ‘Lack of timely monitoring of patients with glaucoma’ have been included as requirements for CDS v6.3 and investigated for possible inclusion by the NHS Digital Data Set Development Service. Work has already taken place to investigate the possibility of using SNOMED CT to capture the risk rating for patients. CDS v6.3 will include the ability to capture SNOMED CT codes, due to a number of potential benefits.
In particular, the inclusion of SNOMED CT allows quicker reaction to changes in national reporting requirements, as SNOMED CT is routinely updated every 6 months and more frequently if the change is required to meet a national priority. This is particularly relevant in the context of the current COVID-19 outbreak – if a SNOMED CT structure existed within CDS, the new code for COVID-19 could flow within this structure without the need for structural changes to the data set or separate data collections/linkage being established.
As well as any new diagnoses, SNOMED CT could also be used to capture the risk rating for patients, and we have already discussed this with the Royal College of Ophthalmologists (Melanie Hingorani) and NHS England and NHS Improvement (James Young). We note that there is already a set of nationally defined risk stratifications agreed by the Royal College of Ophthalmologists, so it should be possible for equivalent SNOMED CT codes to be authored representing each of the risk categories (high/medium/low).
Our clinical terminologists are currently looking into this. Regarding the Earliest Clinically Appropriate Date (ECAD), this is already captured within CDS but unfortunately our analysis shows that this field is completed for very few (around 1% of) outpatient appointments.
Mandating this field is not necessarily possible within CDS because the data set covers many areas of acute care, some of which may not record the ECAD for valid reasons. The development of a new data item specifically for this purpose has been considered, but this would amount to duplication of the ECAD item and would not be appropriate to add to CDS because the data set is used to record activity across many other hospital services. We will nevertheless investigate whether any changes to CDS v6.3 could assist with the completion of this field, or whether any additional analysis could be carried out to inform further measures.
As well as including the ability to flow this information in CDS, it is important that measures are taken to ensure that the relevant tests are being carried out clinically and that the associated information is being recorded locally. Enabling the flow of the data is the last step in the process and will not in itself ensure that relevant information is captured for clinical purposes.
We therefore also suggest that consideration should be given for other bodies to introduce alternative methods of incentivising the completion of these fields, in order to highlight the importance of this information – for example, a financial incentive scheme. However, we would recommend that any such plans are not taken forward during the current COVID-19 outbreak to ensure that undue burden is not imposed on hospital services. We are happy to discuss this further.
Once CDS v6.3 is released, we will continue to assess and publicise the data quality of the ECAD field and work with the Royal College of Ophthalmologists to improve data completeness where required. We will also engage with the Professional Records Standards Body (PRSB) to further promote the completion of this important information.
TIMELINES: Subject to funding being received (see below), the following timescales for CDS v6.3 are planned: April – October 2020: Data Coordination Board (DCB) approvals process completed, including public consultation. October/November 2020: updated CDS Information Standards Notice (ISN) published. November 2020 – April 2022: CDS v6.3 implementation period Ongoing: data quality assessment and reporting.
The funding to progress CDS v6.3 through the relevant approvals process (DCB process) is currently being sought. Due to the rapidly developing picture around COVID-19, it may be that the development of CDS v6.3 is prioritised and accelerated to enable the flow of SNOMED CT and the resultant benefits. There is a risk that the Data Co-ordination Board considers that other projects should take priority, potentially delaying the development of CDS v6.3
Response received on 30 April 2020.