With patient data being migrated from myriad local systems to the National Care Records System (NCRS), data cleanliness is fast becoming a serious, pressing issue for NHS trusts in England.
Similar NHS IT modernisation plans around the whole of the UK mean that all NHS organisations need to address the issue of data cleanliness and readiness for migration to new systems.
Data has been collected and stored sometimes for decades in these local systems and an Audit Commission report in April 2004 found the quality much wanting. The limited functionality of some of these systems and consequent lack of utility to clinicians often resulted in a haphazard collection process; staff simply did not see the point.
Collecting accurate patient data can be difficult enough before one even considers the additional complexities of mental health patients changing aliases, new-born babies being known by several names before parents agree on the final one, or members of ethnic groups whose conventions on use of names do not fit easily into the rigid fields of some of the more elderly systems.
Over the years there has not been a uniform approach to clinical coding; some trusts have been using ICD-10, but many have relied on local codes.
NHS organisations have data quality issues beyond the specific requirements of CRS migration. Many problems are common across the NHS, but when they are resolved in one area the knowledge often is not shared with others who might still be struggling with the same issues.
"I can’t emphasise too strongly that there is no need for trusts to wait until they absolutely have to clean their data."
-- John Wiltshire, Sales and Marketing Director, Stalis Ltd
It is hard to understate the urgency of such problems and the need for trusts to make progress with them. Industry experts report that some trusts take over two years to tackle their data issues. In addition there are benefits to be reaped from starting the data cleansing process before the impending delivery of new national systems actually forces the issue.
John Wiltshire, Sales and Marketing Director of Stalis Ltd, says: “I can’t emphasise too strongly that there is no need for trusts to wait until they absolutely have to clean their data. They can derive benefits, such as improved business processes and help with Payment by Results, from cleaned data in their current systems.
“Even organisations experiencing delays in the delivery new systems, can make progress and deliver local improvement. Plus, starting data cleansing will give them a better understanding of the issues to look out for and address in the new systems.”
Some NHS information managers take the view that data migration was not properly planned within the National Programme for IT in England, despite the fact that it is one of the most important issues. Many feel they were left on their own to decide what to migrate, what they were going to do with the remainder and where they were going to find the money to pay for it.
Guidance on what the national programme says about data migration is available on the Connecting for Health (CfH) website, along with a specification for archiving.
The Information Quality Assurance Programme (IQAP) was set up within CfH to provide guidance on improving and standardising data. The agency has developed a set of tools, in the first instance mainly applicable to hospital PAS systems, and a back office project is addressing the specific problem of duplicate records. If their data was of sufficient quality, trusts could in theory migrate all their data. The minimum requirement is for all active records with at least 95% of NHS numbers populated and closed records going back three years.
Generally, NHS trusts do not have the necessary data migration skills in house and some SHAs do not even have a data quality lead. However, CfH has said that it is making central funding available and will support arrangements made with third party suppliers through formal change control procedures.
Good practice in preparing for data migration is critical. According to Wiltshire, data migration is not as expensive as some might think, but it can be complex and it needs to be planned and executed properly. The necessary tools can be rented, rather than bought, and there are suppliers, Stalis included, who will offer fixed costs. Wiltshire believes that trusts should go with a supplier who offers a complete end-to-end service, as the migration is likely to go wrong if not done by someone who really understands the data and knows what to look for.
The possible consequences of not preparing well can be considerable, he says. The risk of attaching the wrong record to the wrong patient is significant when integrating records from disparate systems. Trusts need to understand the impact of integrated records and plan to test for every eventuality.
A worst-case scenario might include a complete disruption of business continuity, with systems unavailable. As clinicians come to rely more on electronic records, duplicates - which will usually be incomplete - may present a real danger to the patient. Trusts may also suffer from loss of financial control and end up paying several times over for the same treatment.
There are a number of sources to which trusts can turn for help; third-party suppliers with long experience in addressing exactly these business issues. Stalis’ CareXML suite of applications, methodologies and services has been developed to help healthcare providers extract, manage and benefit from the information they collect as a by-product of their clinical and administrative systems.