This report, produced in September 2006, details findings and recommendations from research exploring the potential use of Hospital Episode Statistics (HES) and the Patient Episode Database Wales (PEDW) to support the appraisal and revalidation of consultant physicians. In doing so, the quality of consultant-level data was investigated through a clinical coding project, along with how it might be improved.
For the Royal College of Physicians’ Information Laboratory (iLab)
- Continue to encourage clinicians to engage with trust information/coding departments, and to use and validate consultant-level data, by:
- demonstrating the benefits to the individual in using/improving the data by highlighting its usefulness for appraisal, service development, research and audit
- highlighting the importance of an understanding of APC-related dataset issues as a precursor to informed contribution to the development of electronic records
- managing expectations through education regarding the utility and limitations of locally - and nationally - held data.
- Assess the current practices of local trust information/coding departments with regard to the provision of activity data to individual clinicians,
- highlighting areas of good practice
- exploring what support they require in order to engage clinicians with data.
- Explore how higher-level analyses (ie hospital/departmental-level) of diagnoses and/or procedures might be used to engage individual clinicians in the use of data.
- Publish the results of further work to the wider community.
For NHS trust information and coding departments
- Provide individual consultants with activity data concerning their practice on a regular basis (e.g. in preparation for annual appraisal).
- Support clinicians in the explanation of activity data provided and work with them to address data quality issues arising from such discussions.
- Formalise channels of communication between clinicians and administrative/clinical coding staff.
- Work in partnership with the RCP iLab and other trusts in sharing experiences and examples of providing activity data to individual consultants.
For consultant clinicians
- Assist all staff involved in data collection and processing in formalising channels of communication.
- Request the local provision of activity data in support of consultant appraisal.
- Understand the limitations of local and national data as outlined in this report, and work constructively with trust information/coding staff to address data quality issues.
- Clearly document details of diagnoses and procedures in the clinical record and discharge documentation, and highlight the importance of doing so to junior staff.
- Consider using structured proformas for the capture of clinical information.
- Communicate all transfers of care to those responsible for daily ward returns.
For the General Medical Council
- Formally recommend that while HES/PEDW may be useful for some consultants in supporting local appraisal, national comparisons of these data should not be used to support the revalidation of an individual’s fitness to practise.
- Obtain and publish an accurate and contemporaneous record of the specialty practice of UK doctors.
For the Department of Health, the Welsh Assembly Government and national organisations such as Connecting for Health, Informing Healthcare and The Information Centre
Actions for the centre require both attention to current datasets and the development of new clinical information systems to provide more clinically meaningful measures of activity. Achieving positive outcomes through the latter is naturally a longer term process than the former (reflected in the sequence of actions suggested below). However, there is a need for both to run concurrently. We are aware that some of this work is already underway.
- Formally recommend to the NHS that in its current form the data submitted by trusts to HES/PEDW should not be used to monitor the performance of individual consultant physicians on the basis of national comparisons.
- Invest in a programme of work to identify the support necessary for trust information/coding departments to undertake comprehensive clinical engagement, using existing sources of data. A national review of the responsibilities, pay, status, training and supply of clinical coding staff is strongly recommended.
- Review the current admitted patient care (APC) dataset regarding:
- the appropriateness of assigning activity to individual consultants in light of current working practices
- the current use of, and necessity for ‘main specialty’ and ‘treatment function’ codes.
- Expand national hospital episode databases to include administrative, demographic and clinical outpatient data as soon as possible.
- Consider carefully the justification for better reflecting clinical practice by the subsequent continued establishment of new datasets and processes which will increase the burden of data collection.
- Work together to establish how individual clinicians’ activity might best be captured with new clinical information systems and used for secondary purposes.
- Work with clinicians to identify standards for the structure and content of records when captured in defined patient-professional contacts, in order to:
- capture all aspects of clinical activity, including those outside traditional organisational boundaries
- identify in the records all individuals with responsibility for patient care, including non-consultant clinicians
- reflect team working and shared care
- identify their information needs for both primary and secondary uses