Mental Health NHS Providers Event forNew SubmittersFriday 23rd October 2015 Leeds

Community and Mental Health Team,

Health and Social Care Information Centre

Welcome and Introductions

Nicholas Richman

Service Development Manager (Community & Mental Health)

Welcome and introductions

• Welcome• Introductions• Fire exits• Toilets• Agenda for the day• Political context

Introduction to the Dataset

Nicholas Richman

Service Development Manager (Community & Mental Health)

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Once upon a time…

• MHMDS introduced in 1999 in the Mental Health National Service Framework

• First clinical data set• Mandated from April 2003• CAMHS data set was mentioned in the

Children’s National Service Framework in 2004

• Changes of government, shifting priorities and economic downturn all caused delay!

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ISN Publication and Mandation Dates

• ISN published on 16th July 2015, available here:

www.hscic.gov.uk/isce/publication/SCCI0011• Supplier compliance by 1st January 2016• Providers start collection on 1st January 2016• Providers start submitting from 1st February 2016• Submission in IDB format not XML yet!• Will carry out Operational Assurance Testing with providers• January MHSDS submission 1st – 22nd Feb (tbc)• Publication of EIP waiting times by the end of March – with

DQ information per provider where data not available

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Useful Documentation

• SCCI website www.hscic.gov.uk/isce/publication/SCCI0011

– Requirements Specification– Change Specification– Implementation Guidance– Information Standards Notice

• HSCIC website www.hscic.gov.uk/mhsds

– Data Model– Enhanced Technical Output Specification– User Guidance– Technical Guidance (Baseline and Planned Future)– BSP Baseline Functionality

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Starting to submit data

• Start small and build up• MS Access Intermediate Data Base (IDB)• Bureau Service Portal (BSP)• Submission windows (Primary and Refresh)• Validation on submission• Pre and post deadline• Provider, commissioner and national extracts• Data quality feedback

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Data Model – What does it all mean?

• The administrative ‘backbone’• Outpatient vs. inpatient activity• Clinical data• Mental Health Act• Clinical terminology• Scored assessments (inc. CYP IAPT)• Care clusters• Identifying the commissioner• Waiting Time Measurement (16 Care Pathways)

Clinical Terminology Diagnosis

MHS001 Master Patient Index

PK Local Patient Identifier (Extended)

Organisation Code (Local Patient Identifier) Organisation Code (Residence Responsibility) Organisation Code (Educational Establishment) NHS Number NHS Number Status Indicator Code Person Birth Date Postcode of Usual Address Postcode of Main Visitor Person Stated Gender Code Ethnic Category Religious or Other Belief System Affiliation Group Code Language Code (Preferred) Person Death Date

MHS101 Service or Team Referral

PK Service Request Identifier

FK1 Local Patient Identifier (Extended) Organisation Code (Code of Commissioner) Referral Request Received Date Referral Request Received Time NHS Service Agreement Line Number Source of Referral for Mental Health Referring Organisation Code Referring Care Professional Staff Group (Mental Health and Community Care) Clinical Response Priority Type Primary Reason for Referral (Mental Health) Service Discharge Date Discharge Letter Issued Date (Mental Health and Community Care)

MHS601 Medical History (Previous Diagnosis)

FK1 Local Patient Identifier (Extended) Diagnosis Scheme in Use Previous Diagnosis (Coded Clinical Entry) Diagnosis Date

MHS603 Provisional Diagnosis

FK1 Service Request Identifier Diagnosis Scheme in Use Provisional Diagnosis (Coded Clinical Entry) Provisional Diagnosis Date

MHS604 Primary Diagnosis

FK1 Service Request Identifier Diagnosis Scheme in Use Primary Diagnosis (Coded Clinical Entry) Diagnosis Date

MHS605 Secondary Diagnosis

FK1 Service Request Identifier Diagnosis Scheme in Use Secondary Diagnosis (Coded Clinical Entry) Diagnosis Date

MHS606 Coded Scored Assessment (Referral)

FK1 Service Request Identifier Coded Assessment Tool Type (SNOMED CT) Person Score Assessment Tool Completion Date

Clinical Terminology Relational Structure

Clinical Terminology Data Structure

Care Activity Identifier Coded Assessment (SNOMED CT)

Assessment Score

12345 895191000000100 1

12345 895211000000101 3

12345 895231000000109 2

12345 895251000000102 4

12350 895191000000100 2

12350 895211000000101 2

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SNOMED CT Description SNOMED CT Code

Health of the Nation Outcome Scale for Children and Adolescents item 1 - disruptive, antisocial or aggressive behaviour (observable entity)

895191000000100

Health of the Nation Outcome Scale for Children and Adolescents item 2 - overactivity, attention and concentration (observable entity)

895211000000101

Health of the Nation Outcome Scale for Children and Adolescents item 3 - non-accidental self injury (observable entity)

895231000000109

Health of the Nation Outcome Scale for Children and Adolescents item 4 - alcohol, substance/solvent misuse (observable entity)

895251000000102

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Data Model – What does it all mean?

• The administrative ‘backbone’• Outpatient vs. inpatient activity• Clinical data• Mental Health Act• Clinical terminology• Scored assessments (inc. CYP IAPT)• Care clusters• Identifying the commissioner• Waiting Time Measurement (16 Care Pathways)

Care Clusters

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Data Model – What does it all mean?

• The administrative ‘backbone’• Outpatient vs. inpatient activity• Clinical data• Mental Health Act• Clinical terminology• Scored assessments (inc. CYP IAPT)• Care clusters• Identifying the commissioner• Waiting Time Measurement (16 Care Pathways)

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Data Model – What does it all mean?

• The administrative ‘backbone’• Outpatient vs. inpatient activity• Clinical data• Mental Health Act• Clinical terminology• Scored assessments (inc. CYP IAPT)• Care clusters• Identifying the commissioner• Waiting Time Measurement (16 Care Pathways)

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16 Care Pathways

1. Psychoses incl.Schizophrenia

2. Bi polar disorder

3. Depression

4. Anxiety disorders

5. Obsessive compulsive disorder

6. Phobias

7. Organic brain disorders including Dementia

8. Alcohol and drug misuse

9. Somatoform disorders

10. PTSD

11. Eating disorders

12. Perinatal disorders

13. Personality disorders ( 10)

14. Self harm behaviours

15. Conduct disorders in children

16. Neurodevelopmental conditions

– ADHD

– Autistic spectrum disorders

Experience of a Care Provider

presented by Sarah Peevers, Clinical Business Analyst, Huntercoombe

MHLDDS – Experience of a Provider

Sarah PeeversClinical Business Analyst

MHLDDS – Experience of a Provider

• The Carenotes EPR System was introduced to The Huntercombe Group in October 2014

• My first involvement was during the initial intro to MHLDDS with Advance Systems in January 2015

• Extensive work was needed to map all external codes to each selection / field in Carenotes during February 2015

• Another Carenotes system upgrade was required to ensure it is compatible with MHLDDS ahead of the first submission

• Several test reports organised to ensure data needed was in Carenotes – new system meant many gaps!

• Supporting sites to understand MHLDDS requirements• Issue with lack of info for patients who have been with us for

several years

MHLDDS – Experience of a Provider

• First submission was scheduled for April 2015 – however delayed due to issues with the access to the Portal

• Submissions have slowly gotten more complete and each month a new section of data is added

• HSCIC have been extremely helpful in supporting with the process, responses to queries are very timely

• Analysis of data post submission can be a little misleading• Hurdles have been with the supplier / THG data collection –

not HSCIC• Now looking to see what MHSDS brings – awaiting new

codes and extract so that testing can start. Timelines are a little tight..

Questions and Answers

Lunch12.30 – 13.15

Experience of a System Supplier

presented by Richard Langedijk, Solstice

“Simple Solutions for Complex Problems”

©Solstice – suppliers of

MHSDS - Experience of a Supplier

Simon HurleyRichard Langedijk

HSCIC Mental Health Provider Event for New MHSDS Submitters

23rd October 2015

“Simple Solutions for Complex Problems”

©Solstice – suppliers of

Agenda

• Introduction

• Setting the scene

• Our Experience• Our Approach• Structure • Format• Other things to consider

“Simple Solutions for Complex Problems”

©Solstice – suppliers of

Introduction Solstice

• Providers of a service user record system (e-MDS) to MH & LD service providers• Specifically designed to ensure reporting compliance (incl. MHSDS)

• Consultancy Services• Data Flow Analysis and process optimisation• System Review & Analysis• System Integration & Implementation• Information Governance Compliance / IG Toolkit• N3 Process

“Simple Solutions for Complex Problems”

©Solstice – suppliers of

Setting the scene – Provider Group 1

Those with a service user record system, which provides the option to automatically generate the MHSDS on the push-of-a-button

“Simple Solutions for Complex Problems”

©Solstice – suppliers of

Those with no Service User Record system

Setting the scene – Provider Group 2

Good luck !

“Simple Solutions for Complex Problems”

©Solstice – suppliers of

Providers with a system(s), but with the in-house obligation to produce datasets

Setting the scene – Provider Group 3

Data Mart SQL queries

MHSDS

?

Option 2

?

Option 1

“Simple Solutions for Complex Problems”

©Solstice – suppliers of

Our experience

“Simple Solutions for Complex Problems”

©Solstice – suppliers of

Our Approach

• Our system will generate the MHSDS (end November 2015)

• Get an indication of the scope of the changes as soon as possible• TUG Meetings, Supplier Meetings

• Two main documents – study them in detail• Technical Output Specification, User Guidance

• If you have any questions, don’t be afraid to ask the CMH Team

“Simple Solutions for Complex Problems”

©Solstice – suppliers of

Structure

“Simple Solutions for Complex Problems”

©Solstice – suppliers of

Structure – Service Request ID

• Ward Stays are linked to • Hospital Spells are linked to • Service Requests (referrals) are

linked to • Patient Record

• You may need to consider what constitutes a new referral request

“Simple Solutions for Complex Problems”

©Solstice – suppliers of

Structure – Assessment Data

• Each outcome assessment (e.g. HoNOS, CGAS) must now be linked to a care activity and a care contact

• ‘Dummy’ records may be required if your assessments aren’t linked to care contacts

“Simple Solutions for Complex Problems”

©Solstice – suppliers of

Structure – RC Assignments

• A change in MHA section now requires a new RC assignment record

“Simple Solutions for Complex Problems”

©Solstice – suppliers of

Format - SNOMED

• List of outcome assessment SNOMED codes have now been included within the Technical Output Specification

• If your system uses SNOMED codes, check that the codes used match those in the Specification

• If your system doesn’t use SNOMED codes, then use the HSCIC list in a mapping table

• SNOMED codes have not been issued for interventions or observations (other than ECT and Smoking Status)

“Simple Solutions for Complex Problems”

©Solstice – suppliers of

Other Things to Consider

• GP Assignment Table is now mandatory – use code V81999 where the GP data isn’t available or none of the data will flow

• Data Scope• Different types of restraint (Chemical, Mechanical,

Physical)• Segregation• Disability Types• How is this data collected (if at all)?

• Data Validation• Check the Technical Output Specification to see what

validation will take place on submission to build data quality checks into your system

“Simple Solutions for Complex Problems”

©Solstice – suppliers of

Other Things to Consider

• Check what outcome assessments are being used in your organisation against the list in the technical output specification (increase from 7 to c. 40)

Brief Parental Self-Effi cacy Scale scoreChild Group Session Rating Scale scoreChild Outcome Rating Scale total scoreChildren's global assessment scale scoreClinical Outcomes in Routine Evaluation - 10 clinical scoreCommission for Health Improvement Experience of Service QuestionnaireCurrent View Eating disorder examination questionnaireGeneralized anxiety disorder 7 item scoreGoal Progress Chart - Child/Young Person - goal scoreGroup Session Rating Scale scoreHoNOS (Working Age Adult) HoNOS 65+HoNOSCA - Parent, Clinician or Self RatedHoNOS-LD HoNOS SecureHow Are Things? Behavioural Diffi culties (Oppositional Defiant Disorder)

Index of Family Function and Change - 15Kessler Psychological Distress Scale 10 scoreMAMS (Me and My School) QuestionnaireMHCT AssessmentsOutcome Rating Scale total scorePatient health questionnaire 9 (PHQ-9) total score RCADS (Revised Children's Anxiety and Depression Scale)Revised Child Impact of Events Scale scoreStrengths and Diffi culties Questionnaire (2-4, 4-17 or 11-17 self rated)Session Feedback Questionnaire scoreSession Rating Scale scoreSheffi eld learning disabilities outcome measure scoreShort Warwick-Edinburgh Mental Well-being Scale scoreWarwick-Edinburgh Mental Well-being Scale scoreYoung Child Outcome Rating Scale scoreYoung Person's Clinical Outcomes in Routine Evaluation clinical score

“Simple Solutions for Complex Problems”

©Solstice – suppliers of

• Organisational structure• Clear roles and responsibilities• Single point of accountability• Visibility across the entire data flow

• Data Quality• Correct, complete and timely• Real time validation (“rubbish in, ……”)• Data Quality reports – pre-submission checks• Is all data even captured? Available?• Multiple data entry points and same data recorded

twice in different systems?• Staff training

Not just about ‘systems and codes’

Bureau Service Portal, DUC and XML

presented by Navin Bose – Higher Datasets Maintenance Analyst

Steps for New MHSDS Providers• Visit the HSCIC Webpage for MHSDS v1.0 http://www.hscic.gov.uk/mhsds

• Check to see if your service will fall within the scope of the mandated MHSDS v1.0 Data Set requirements: http://www.hscic.gov.uk/isce/publication/SCCI0011

• Gain NHS Secure N3 Connection: http://n3.nhs.uk/customerinformation/howdoi/

• Register your service with ODS : http://systems.hscic.gov.uk/data/ods • Email: Exeter.helpdesk@hscic.gov.uk requesting that you would like to register for an ODS

code for your organisation.

• Complete IG toolkit: https://www.igt.hscic.gov.uk/

• Register a Caldicott Guardian (CG) for your organisation (requires ODS code): http://systems.hscic.gov.uk/data/ods/searchtools/caldicott/cg_standard.doc

• Request BSP access using OpenExeter DUC forms (requires CG and ODS code and N3 connection):  http://systems.hscic.gov.uk/ssd/prodserv/mhsds.pdf (will be available soon)

• OpenExeter portal login (N3 connection only): https://nww.openexeter.nhs.uk/nhsia/index.jsp

HSCIC Webpage for MHSDS v1.0Make it a habit to visit the HSCIC Webpage for MHSDS v1.0 http://www.hscic.gov.uk/mhsds regularly!

Wide range of guidance and supporting documents available for MHSDS providers and System Suppliers.Submission Guidance Documents:• MHSDS Data Model• MHSDS v1.0 User Guidance• MHSDS v1.0 Technical Guidance • Baseline Technical Output Specification• MHSDS v1.0 Technical Output Specification

Planned Future Technical Output Specification(s)• MHSDS v1.0 Technical Output Specification

Organisational assessment and planning tools• MHSDS v1.0 Implementation Planning Template • MHSDS v1.0 Readiness Assessment Tool • MHSDS v1.0 System Conformance Checklist

Organisation Data Service

http://systems.hscic.gov.uk/data/ods ODS is provided by the Health and Social Care Information Centre (HSCIC) and is responsible for the publication of all organisation and practitioner codes and national policy and standards with regard to the majority of organisation codes.

Registration Process:

ODS Primary Contact Form (OC1) and Site Request SheetOrganisation site code request sheet (XLS, 25.5kB) - Apply for NHS Trust, Care Trust, CCG site codes etc.

Form OC1 (DOC, 133.5kB) - Register a new primary contact for an NHS organisation, or amend details of an existing contact.

Non-NHS Organisation code request form (DOC, 157.0kB) - Apply for Non-NHS organisation code.

Caldicott Guardian FormThe Caldicott Guardian form which all sites will need to have in place before we can allocate users to the systemhttp://systems.hscic.gov.uk/infogov/caldicott

MUST HAVE “WET”

SIGNATURE OF CALDICOTT GUARDIAN

FORMS MUST BE SENT BY POST

Caldicott Guardian FormRemember:

Open Exeter web pageThe Open Exeter page where all the documents livehttp://systems.hscic.gov.uk/ssd/prodserv/vaprodopenexe/

MHSDS

Data User CertificateThe DUC form (Data User Certificate) which the Caldicott Guardian signs to allow accessMental Health and Learning Disabilities Data Set (MHMDS/MHLDDS) Data User Certificate (PDF, 57.7kB)

Data User Certificate

MUST HAVE “WET” SIGNATURE OF CALDICOTT

GUARDIAN MATCHING SIGNATURE ON HSCIC’s CALDICOTT REGISTER

FORMS MUST BE SENT BY POST

Bureau Service Portal (BSP) Login

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BSP – MHSDS Home Page

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BSP – MHSDS – File Upload

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BSP – MHSDS Home Page

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BSP – Download Validation Summary Report

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BSP – Download Pre-Deadline Extract

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MHSDS Extracts in XML Format

MHSDS Extracts in XML Format

• After processing these tables are transformed into an xml file

• Can be opened using any Internet Browser, NotePad++ or any XML tool

• Can be easily imported into Access or SQL• Retains table structure when imported into

Access

Support for new MHSDS Providers

• The Community & Mental Health Team is available to support all providers with MHSDS Submissions

• Queries can be sent via: Enquiries Teamo Email: Enquiries@hscic.gov.uko Tel.:0845 300 6016

• For BSP Login/Access issues and portal performance, please contact:o exeter.helpdesk@hscic.gov.uko Tel.: 0845 371 3671

Feedback You Will Receive

presented by Amina Butt, Senior Information Analyst

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Where do I get feedback reports?

• Bureau Service Portal• Data Quality Notices• Data Quality Publication

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BSP – Summary Report

• Every submission attempt• In submission window – Perfect time to

correct!• Descriptions on portal and in TOS

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BSP – Warnings and Diagnostics

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BSP – Aggregate Counts

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Data Quality Notices

• Every successful submission• 2 weeks after window closes• Distributed through Data Depot• Pre-publication• Example records provided• Use along with post processing extracts from

BSP• Description/Constructions

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Data Quality Notices

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Data Quality Notices - Example records

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A real example

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How could this have been avoided?

• BSP - Warnings

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Also….

• BSP – Diagnostics

• BSP – Aggregate Counts

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Data Quality Measures Publication

• Monthly on both Primary and Refresh• National view and by provider• VODIM• Consistency• Care Spell Volume Time Series• Unclosed Spells• Data Integrity• Rules

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VODIM

• 27 data items

• Our example: Ward Security and Site Code of Treatment can’t be assessed

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Data Consistency

• Mental Health Act Episodes• Care Programme Approach Episodes• Payment By Results Care Cluster Episodes• Community Treatment Order Episodes• Hospital Provider Spell Episodes• Ward Stay (WRDST) Episodes

• Our example – Ward Stay Episodes is zero

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Data Integrity

• Gatekept admissions• PCT codes• Restraints• Seclusion• Self Harm• Assault• Intervention

• Comparison against known activities and other collections e.g. KP90, Unify

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Useful Resources

• http://www.hscic.gov.uk/mhldds• http://www.hscic.gov.uk/mhsds

– Technical Output Specification– Validation Rules– Metadata

• Email: mhmds@hscic.gov.uk

Feedback you will receive

presented by Amina Butt – Senior Information Analyst

Questions and Answers