RNOH Clinical Outcomes Strategy February 2012

Transcription

1 RNOH Clinical Outcomes Strategy February 2012

2 Document Control Title RNOH Clinical Outcomes Strategy Version 3.0 Status For Approval by the Trust Board Publication Date February 2012 Author Clinical Outcomes Group Stanmore Stuart Coalwood Asst. Director of External Compliance and Quality Assurance Adrienne Flanagan Histopathology consultant Andrew Goldberg Foot and Ankle Surgery consultant Chris Gooding Consultant Orthopaedic Surgeon Iva Hauptmannova Research and Development Manager Simon Lambert Upper Limb Surgery consultant Saroj Patel Director of IM&T and Human Resources Matt Shaw Spinal Surgery consultant Andrew Wheeler Head of Clinical Coding Owner Description Dr Saroj Patel, Director of Workforce, IM&T and Corporate Affairs First draft of the RNOH Clinical Outcomes Strategy for Consultation with the Executive Team and the Clinical Outcomes Group Stanmore (COGS) Contact Details Dr Saroj Patel Director of Workforce, IM&T and Corporate Affairs Royal National Orthopaedic Hospital Brockley Hill Stanmore Middlesex HA7 4LP Phone: RNOH Clinical Outcomes Strategy, V3.0, February 2012 Page 2 of 21

3 CHANGE CONTROL DETAILS Date Version Summary of changes January 2012 V 1.0 Document created January 2012 V 2.0 Updated following consultation February V 3.0 Further update following COGS review meeting - Final version for approval Glossary of Terms Used Term PROMs COGS VTE PAS C-Store SPRINT NICE SSISS NJR SUI HES OPCS Definition Patient Reported Outcome Measures Clinical Outcomes Group - Stanmore Venous Thromboembolism Patient Administration System Clinical Documentation Library used by RNOH Spinal Patient Research Internet Tool National Institute for Health and Clinical Excellence Surgical Site Infection Surveillance Service National Joint Registry Serious Untoward Incident Hospital Episode Statistics Operating Procedure Codes ICD10 International Classification of Diseases Version 10 Snomed-CT AHP CQUIN EQ5D SF36 COF Systematized Nomenclature of Medicine -- Clinical Terms Allied Healthcare Professionals Commissioning for Quality and Innovation A standardised measure of health outcome developed by the EuroQol Group A multipurpose short form health survey with 36 questions Clinical Outcome Form RNOH Clinical Outcomes Strategy, V3.0, February 2012 Page 3 of 21

4 Table of Contents 1. Introduction The Process to Develop the Strategy The National Context - the NHS Outcomes Framework The Key RNOH Drivers PROMs Data Demonstrate Complexity of RNOH Casemix Problems with current data collection Doctors Revalidation Requirements Leading the way Thought Leadership Provide Data for the Whole Patient Pathway Provide a Comprehensive System to Identify Clinical Variance The RNOH Clinical Outcomes Measurement Strategy Identifying the Data to be Collected Defining the Data Standards Data Collection Processes and Systems Recommended Implementation Approach The Specific Deliverables for Phase Resources Required for the Enabling Technology Resources Required for Data Collection Recommendations for the Board...17 Appendix A The NHS Outcomes Framework 2012/13 at a Glance 18 Appendix B Clinical Outcomes Data Requirements 19 RNOH Clinical Outcomes Strategy, V3.0, February 2012 Page 4 of 21

5 Executive Summary It is vital that the RNOH demonstrates the health benefits of the care provided, if it is to realise its vision and have a sustainable future. As mandated by the Board, the Clinical Outcomes Group Stanmore (COGS) was convened. The group determined that the RNOH devotes significant resource to collecting hundreds of data items throughout the patient journey. There is a lot of repetition and inefficiency in the wide variety of processes in place, many data items are not available for wider use and some data are lost all together. The RNOH Outcome strategy developed by COGS recommends a comprehensive approach to collecting outcomes data to: 1. Demonstrate health benefits for our patients 2. Capture the complexity of patients and casemix 3. Facilitate the appraisal and revalidation of consultants 4. Allow strategic decision making based on evidence 5. Inform the commissioning process for specialised Orthopaedics care 6. Provide clinical and management information across the entire patient journey 7. Support Clinical Units to define and collect their own data This will enable the RNOH to lead in the measurement of clinical quality, benchmarking with other providers and will inform the commissioning process for specialised orthopaedic care. Given the complexity of the requirements a 2 phase approach I recommended. Phase 1 will deliver the processes, procedures and technical solution suitable for the whole Trust, implemented and embedded in two or three clinical units. The technical solution will connect existing systems where relevant and allow customisation rather than a centralised one size fits all approach. The upfront investment will be 334k but the incremental cost of making the system available to the rest of the Trust (Phase 2) will be significantly less, as very little further technology investment will be required. The above does not include any additional resources required to collect the data. This is likely to be 27k to 40K for Phase 1. The on-going data collection costs for the whole Trust could be 324K to 648K per annum. However, it is envisaged that some of these costs will be offset by improved efficiencies in the existing data collections processes and utilisation of existing resources as much of this data is already collected in the Trust. RNOH Clinical Outcomes Strategy, V3.0, February 2012 Page 5 of 21

6 1. Introduction At the Trust Board Meeting on 28 th September 2011, it was agreed that collection of comprehensive clinical outcomes data are key to informing the RNOH s strategic direction. Evidence based clinical practice and best practice patient pathways align with our vision to be a world class centre of excellence. In addition, as stated in the NHS Outcomes Framework 2012/13, submission of outcomes evidence will be a mandatory requirement and will form an integral part of future payment mechanisms and commissioning decisions. It is therefore fundamental to our future financial viability. If RNOH is to realise its vision and have a sustainable future, it is vital that it can demonstrate the health benefits of the care it provides. RNOH must lead in the use of clinical measures and in the development of clinical classifications, best practice systems and lean processes to collect and analyse this data. This will enable the RNOH to measure clinical quality, benchmark with other providers and inform the commissioning process for both general and specialised orthopaedic care. Commissioned by the Trust Board, the Clinical Outcomes Group - Stanmore (COGS) was established to develop a single coherent strategy for outcomes data definition and collection across the Trust. The membership of the group ensured that the strategy was clinically led and also informed by other key departments including Research and Development, Informatics, Clinical Coding and Information Technology. This paper is the product of the work of the Clinical Outcomes Group - Stanmore and is being submitted to the Board to seek approval of both the strategic direction and the investment required to enable implementation. 2. The Process to Develop the Strategy As mandated by the Board, the Clinical Outcomes Group Stanmore (COGS) was convened with the following membership: Stuart Coalwood Asst. Director of External Compliance and Quality Assurance Adrienne Flanagan Histopathology consultant Andrew Goldberg Foot and Ankle Surgery consultant Chris Gooding Consultant Orthopaedic Surgeon RNOH Clinical Outcomes Strategy, V3.0, February 2012 Page 6 of 21

7 Iva Hauptmannova Research and Development Manager Simon Lambert Upper Limb Surgery consultant Saroj Patel Director of IM&T and Human Resources Matt Shaw Spinal Surgery consultant Andrew Wheeler Head of Clinical Coding The objectives for the group were to: 1. Establish what clinical outcome data are required 2. Identify what data are already collected 3. Propose a strategy to meet the Trust s needs 4. Develop an implementation plan The outcome of the work undertaken to achieve objectives 1 and 2 above is summarised in Appendix B. A detailed list of patient and clinical questionnaires already used within the Trust was also compiled, demonstrating the significant resource already utilised in collecting large quantities of data. Two things were apparent, the data collected does not meet the current and future needs of the Trust and current processes and data management was inefficient and ineffective. It was agreed the strategy should meet the following key requirements: 1. Ensure that core data are collected across the Trust adopting a Collect Once Only principal 2. Deliver technology to enable the flexible and efficient collection of Outcomes data 3. Ensure that existing systems can be incorporated, and preferably are improved by the recommended approach 4. Design the solution so that additional data can be collected to meet the variety of needs of clinical units 3. The National Context - the NHS Outcomes Framework The White Paper, Equity and Excellence: Liberating the NHS sets out how the improvement of healthcare outcomes for all will be the primary purpose of the NHS. This means ensuring that the accountabilities running throughout the system are focussed on the outcomes achieved for patients, not the processes by which they are achieved. The RNOH Clinical Outcomes Strategy, V3.0, February 2012 Page 7 of 21

8 purpose of the NHS Outcomes Framework 2012/13 is to reflect the vision set out in the White Paper. The key drivers for the Outcomes Framework are: Aligning NHS, public health and adult social care outcomes to support integration. This is at the heart of the Government s modernisation programme and delivering value for money agenda. The NHS Outcomes Framework will be closely aligned to the Public Health Outcomes Framework and the Adult Social Care Outcomes Framework. Holding the new Commissioning Board (or an equivalent body within Department of Health), accountable for securing improved outcomes for patients through the commissioning process. Promoting equality and reducing health inequalities, in line with the Equality Act 2010 and, subject to parliamentary approval, in fulfilling the health inequalities duties proposed in the Health and Social Care Bill. International comparison. This is particularly relevant because Department of Health research indicates that the NHS currently achieves relatively poor healthcare outcomes in certain major healthcare areas when compared to our peer countries. To act as a catalyst for driving quality improvement and outcomes measurement throughout the NHS by encouraging a change in culture and behaviour, including a stronger focus on tackling health inequalities The NHS Outcomes Framework is structured around five domains shown in Figure 1 below. These set out the high-level national outcomes that the NHS should be aiming to improve. Domains one to three include outcomes that will measure the effectiveness of care provided; domain four will measure what the patient experience was like and domain five includes outcomes on the safety of the care provided. An At a Glance summary of the NHS Outcomes Framework for 2012/13 is included in Appendix A. RNOH Clinical Outcomes Strategy, V3.0, February 2012 Page 8 of 21

9 The NHS Information Centre, NICE and associated bodies are working to develop the detailed indicators to measure the outcomes in the Framework. The first iteration of these will be published with the NHS Information Strategy to be published later this year. Figure 1 The Domains of NHS Outcomes Framework, 2012/13 4. The Key RNOH Drivers This Section provides the RNOH strategic context and key internal drivers for collection of comprehensive clinical outcomes data. 4.1 PROMs Data The annual PROMs results, last published in August 2011 for the year ending in March 2011, appear to show that outcomes at RNOH for Total Hip Replacement and Total Knee Replacements are poor compared with the average across the whole of England and also compared with other specialised Orthopaedic Trusts. The lack of comprehensive clinical RNOH Clinical Outcomes Strategy, V3.0, February 2012 Page 9 of 21

10 outcomes data makes it is impossible to ascertain what factors are affecting the RNOH outcomes data. It is vital that the RNOH is able to measure and demonstrate the quality of its care in terms of outcomes. This will enable us to improve care delivery, improve the understanding of what affects patient reported outcomes and improve the external understanding of the true value and quality of RNOH care. 4.2 Demonstrate Complexity of RNOH Casemix It has been amply demonstrated over the last few years via both internal and external reviews that existing data sets do not adequately capture the full complexity of the casemix at RNOH. Furthermore, the complexity that can be captured using existing classifications is very difficult to use for commissioning, for isolating specialised activity and for comparison with other providers. An important part of collecting meaningful Outcomes data will be to reliably identify and describe specialised and complex care. The RNOH needs to collect data that is designed specifically to capture differences in complexity. 4.3 Problems with current data collection The Clinical Outcomes Group Stanmore investigated the current data collection processes at RNOH. There are a large number of isolated processes in place for collecting data for both internal and external purposes. Following the gap analysis carried out between the data which is required and the data that is already collected, it is clear that a large proportion of the data are already held somewhere in the Trust. The problem is that at present the approach to this is disparate, with a lack of clear and integrated technical solution, lack of data standardisation and weak overall governance. This results in a lack of coherence with each department doing their own thing using stand-alone systems. This creates information silos or, worse still, valuable data are lost on paper as analysis or integration is difficult and expensive. Data stored on systems may not be available outside the relevant department. This also results in inefficient utilisation of the resources used to collect the data. Some data are captured and then manually re-entered to meet external reporting requirements. In some cases, such as National Joint Registry forms, the data are recorded manually and sent externally so the Trust has no record of the collected data. At a corporate level this leaves the Trust with RNOH Clinical Outcomes Strategy, V3.0, February 2012 Page 10 of 21

11 weak evidence with which to defend the complexity of the work undertaken, the outcomes delivered and increasingly exposed in a very rapidly changing NHS. A vivid example is the number of separate questionnaires and forms currently completed by and for our patients. Table 1 shows some of the key questionnaires currently used within the Trust. The number of data items concerning a patient during their care ranges between 661 and 900. Of this, approximately 300 questions are duplicated at various stages of the patient pathway. Patients are being asked the same questions several times when there is no need. Data that already exists on one system is re-entered manually into other systems. A large proportion of the questionnaires are paper forms making it difficult to access the data. Even where the data are captured electronically it is held in standalone systems and therefore the data are not available for wider use. Questionnaires Anaesthetic Nutritional Assessment Cancer Pain Clinical Outcome Form Pre-Admission Enhanced Recovery Project PROMS Post Op Front Sheet (Notes) PROMS Pre Op Hip/Knee Score Real time Inpatients National Inpatient Survey Real time Outpatients National Outpatient Survey Research Consent National Joint Registry Hip/Knee Primary VTE Assessment National Joint Registry Hip/Knee Revision Table 1 -Patient Questionnaires 4.4 Doctors Revalidation Requirements The General Medical Council s guidance on Supporting information for appraisal and revalidation and the Academy of Medical Royal Colleges Guidance on Supporting Information for Revalidation for Surgery clearly states that together with other information, doctors will be required to provide and discuss the following outcomes data on their clinical work, at least once every five years, during their appraisal: Quality improvement activities including review of clinical outcomes data that are robust, attributable and well-validated. Significant events -includes details of direct involvement in any clinical incidents or serious untoward incidents (SUIs) since the last appraisal. Feedback from patients and, if appropriate, carers, using a validated tool. RNOH Clinical Outcomes Strategy, V3.0, February 2012 Page 11 of 21

12 The Trust should provide the clinicians with systems and processes to collect and collate this information easily, accurately and comprehensively. 4.5 Leading the way Thought Leadership The RNOH has a reputation for high quality care and innovative surgery. The significant reputation and historical standing of the Trust cannot currently be backed up with sufficient evidence as to its quality. As a leader in its field the Trust should be seen to provide not only care with the best possible outcomes and with continuous quality improvement based on the effective and efficient use of clinical data, but to inform and guide best practice clinical pathways for all orthopaedic activity based on evidence rather than reputation. Leadership in Orthopaedics should extend to using the most effective and efficient means of data capture and specifying what data should be captured to support clinical pathways. 4.6 Provide Data for the Whole Patient Pathway Clinical data for RNOH patients is captured routinely for inpatient and daycase care. There is little provision to capture clinical data for most non-inpatient activity. It is therefore very difficult to provide information on the entire patient pathway, especially if the pathway does not involve an inpatient stay. The RNOH should capture data throughout the patient journey so that it is possible to address questions such as: How many new patients were seen in Outpatients with diagnosis A? How many patients who were referred with diagnosis B went on to have procedures? How many patients with presenting complaint C went on to be admitted? 4.7 Provide a Comprehensive System to Identify Clinical Variance At present there is a system for incident reporting at the Trust. The reporting mechanism can be time consuming and probably risks minor incidents and deviations from ideal care not being reported. If there was more complete and meaningful clinical data captured throughout the patient journey it would be possible to easily identify more minor care variance with the aim of improving care quality. There are many possible indicators of care quality that could be used if the data was available to isolate specific care pathways. RNOH Clinical Outcomes Strategy, V3.0, February 2012 Page 12 of 21

13 5. The RNOH Clinical Outcomes Measurement Strategy Given the national and local drivers set out above, it is clear that development of a comprehensive clinical outcomes measurement framework and associated systems and processes is critical for the future of RNOH. If RNOH is to fulfil its vision it must provide the thought leadership in this area and lead the way, not just for specialist orthopaedic care but all orthopaedic care in the NHS. This can only be achieved if we can provide evidence based on appropriate and rigorous data standards, processes and approach. The strategy for measurement of outcomes therefore states the underpinning principles and interventions. 5.1 Identifying the Data to be Collected To enable the measurement of outcomes and therefore health gain it is vital to accurately and consistently collect comprehensive data related to both the inputs and the outputs e.g. interventions carried out, co-morbidities, and severity of the condition the patient presented with, any adverse incidents as a result of the intervention and outcomes. With respect to outcome data, in many cases it is important to collect outcome data from two sources the clinical point of view and the patient point of view. Due to differences in patient pathway, the interventions required and varying clinical practices in the units, it is clear that it not possible to define a single data set that must be collected by all units. The data to be collected will therefore be in two categories: 1. Trust Wide Core data - to be collected for all patients by all clinical units to be defined as part of this strategy for the Trust as a whole. 2. Clinical Unit Specific data - specified by individual units and collected for all patients seen by the respective unit. The Stanmore Clinical Outcomes Group has begun the definition and categorisation of the generic data set that will be required for all patients. This is shown at Appendix B. The analysis also identifies the gap in data collection and where data are already collected, how it is collected and where it is stored. It is recognised that this is very much an initial definition set which will be refined once phase one is completed and as the system is rolled RNOH Clinical Outcomes Strategy, V3.0, February 2012 Page 13 of 21

14 out to other units. In addition, the data set may not include all the indicators specified in the NHS Outcomes Framework as this tool is being further refined. 5.2 Defining the Data Standards There are numerous data standards and definitions that are already in use within the NHS and within the Trust. Some of these are based on national and international standards and some locally defined within the Trust. There are also well tested instruments to measure outcomes. The issue facing the Trust is that these standards do not always provide the level of granularity required to define the complexity of the work carried out at the RNOH; nor are they able to accommodate the definition of innovative or new procedures. This makes it difficult to accurately measure health gain. The strategy for the RNOH will therefore be to use standards where they work but also to create more granular and clinically useful data standards for measuring inputs and outputs called Stanmore Procedure Codes (SPCs) and Stanmore Diagnostic Codes (SDCs). These will be mapped to the NHS standards such as OPCS, ICD10 and Snomed-CT, providing accurate, high quality and comparable health gain measures. 5.3 Data Collection Processes and Systems To address the issues described in Section 3 and to improve data quality, the strategy is to adopt a Collect Once Only data collection philosophy data will be captured once at the point of creation, facilitated by integrated technology solutions. The key requirements of the informatics solution will be: 1. Easy to use and available where required. 2. Provides a consolidated view of the data held within the current Trust-wide systems. 3. Provides user friendly data collection functionality to collect the missing data. 4. Sophisticated reporting and analytical tools. 5. Can facilitate automatic submission of high quality national data returns such as the National Joint Registry, PROMS etc. 6. Is flexible to accommodate the needs of individual Clinical Units. Given the volume of data that needs to be collected and to facilitate consistent and RNOH Clinical Outcomes Strategy, V3.0, February 2012 Page 14 of 21

15 comprehensive data collection it is envisaged that additional resources will be required. There are opportunities to utilise existing resources that already collect this data. 6. Recommended Implementation Approach A critical success factor for the implementation of the strategy is appropriate engagement at all levels of the Trust. The definition of the data to be collected must be clinically led, the processes and procedures for the collection must be led by the operational teams and informatics and technology by the IM&T Directorate. Given the scale of the change required the recommendation is to implement the strategy in two phases. Phase 1 will deliver the processes, procedures and technical solution suitable for the whole Trust. This will be tested by two or three clinical units providing a robust basis for expansion of the approach to other units. Therefore the upfront investment will be substantial but the incremental cost of making the system available to the rest of the Trust will be significantly less as no further technology investment will required. 6.1 The Specific Deliverables for Phase 1 Detailed specification of the Outcomes data for the phase 1 units Understand the gaps in terms of existing collection and systems capabilities Specify and develop applications that can address these gaps Review the current process of collection, document and agree necessary changes and identify level of additional (administrative) resource needed to capture the data within the revised process Identify and procure any necessary middleware or integration engine software needed to ensure there is no duplicate data entry required. Use this to integrate current and new applications developed with the main hospital systems Test all components and agree deployment plans including training Implement and assess learning for deployment into other units RNOH Clinical Outcomes Strategy, V3.0, February 2012 Page 15 of 21

16 Develop reporting outputs for various stakeholders to ensure meaningful use of the information collected It is estimated that the delivery of phase one will take between 12 to 18 months but that remains to be confirmed as detailed specifications are produced, market soundings are completed to assess the technical solutions available and project plans are developed. Once phase one is completed, rolling out the system and processes to the rest of the Trust should be relatively quick, as long as engagement is forthcoming from the units both clinically and operationally. The technical infrastructure will be selected and implemented to ensure scalability for Trust wide roll out. 6.2 Resources Required for the Enabling Technology Table 2 summarises the anticipated funding requested at this time to support the development work. Area Details/why needed Funding required Project manager, Project support officer, procurement/ specification support and technical assistance Although the trust has some of the resources necessary this additional support will ensure that the project is coordinated and driven and all 114K (1 band 8b 65K, one band 5 29K and ad hoc technical support 20K) necessary specifications and software procurements are delivered. Software development Development of application to plug 100K (applications) gaps in outcomes data collection. Integration engine To ensure that no duplication of data 120K entry is required and that the applications developed are integrated with trust systems. Total 334K Table 2 Resource Requirements for the Pilot RNOH Clinical Outcomes Strategy, V3.0, February 2012 Page 16 of 21

17 6.3 Resources Required for Data Collection The above costs do not include any additional resources required to collect the data. For Phase 1 this is likely to be 2 or 3 WTE at the cost of 27k to 40K for 6 months as these will only be required after the technology infrastructure implementation has been completed. Completion of Phase 1 will provide more accurate information on the resources required. Based on an estimate of 1 or 2 administration posts per unit, the on-going cost of data collection for the whole Trust could therefore be 324K to 648K per annum. However, it is envisaged that some of these costs will be offset by improved efficiencies in the existing data collections processes and utilisation of existing resources as much of this data is already collected in the Trust. 7. Recommendations for the Board It is recognised that the lack of co-ordination and clear outcomes data is exposing the Trust to risk in the short term as the Outcomes Strategy is being implemented. It is therefore suggested that in order to mitigate this risk the Trust supports the work of the Specialist Orthopaedic Alliance in co-ordinating existing national data sets and publishes benchmarking and interpretation of this outcome data. This is being considered for data related to surgical site infections, MRSA, C-Diff, revisions due to infection and readmissions due to infections. The Board are asked to: 1. Approve the Clinical Outcomes Strategy. 2. Commit 334K of funding in the financial year 2012/13 for Phase 1 3. Authorise the Clinical Outcomes Group - Stanmore (and any delegated groups) with the task of implementing Phase 1 of this strategy. 4. Support the work of the Specialist Orthopaedic Alliance to mitigate the short term risk. RNOH Clinical Outcomes Strategy, V3.0, February 2012 Page 17 of 21

18 Appendix A The NHS Outcomes Framework 2012/13 at a Glance RNOH Clinical Outcomes Strategy, V3.0, February 2012 Page 18 of 21

19 Appendix B Clinical Outcomes Data Requirements Dataset Current Situation Currently captured electronically Core - must be delivered Trust wide Plan Patient Demographics Demographics captured on the PAS. address and mobile number not always captured Core Done Out-patient diagnostic codes Not captured Core Phase 1 Inpatient diagnostic codes Inpatient procedure Codes Captured by coders based on casenotes, within a week of discharge. No clinician validation of local codes Captured by coders based on casenotes, within a week of discharge. No clinician validation of local codes Core Done Core Current Surgical Information Consent Paper based operation notes for majority. Some use of C-Store. SPRINT (spinal) allows surgeon and patient to complete form online No comprehensive consent for use of imaging, notes or photos is currently captured Future Core Phase 1 An electronic system has been developed for Stanmore Biobank which could be used by all units Consent for theatre and for specific research trials would remain separate and be captured at the requisite time RNOH Clinical Outcomes Strategy, V3.0, February 2012 Page 19 of 21

20 Dataset Current Situation Currently captured electronically Core - must be delivered Trust wide Plan Photos/Videos Bar Codes of Implants/ Prosthesis Doctors might take photos on their own handheld devices and store in the K-Drive. No tagging to patient record possible. Data protection issues A stock control system is being developed as a piece of bespoke software, connected to PAS for patient details. Bar codes of all products that are implanted into patients must be identifiable Future Core Phase 1 Adverse events (complications/ incidents). Examples include: Surgical site infections MRSA C-Diff Revision due to infection Readmissions due to infection Service targets These are incompletely captured using a variety of mechanisms: Core Phase 1 Incident reporting system Patient reported Doctor/AHP captured (e.g. complications, wound infection noted in the clinic or Untoward operative event) Pathology results (e.g. abnormal results) HES (e.g. readmissions) Other national databases (e.g. NJR, SSISS etc.) Examples include CQUIN targets, VTE assessment, COF etc. Information not collected in a central repository. Core Phase 1 Financial data Service Line Reporting is available via Insight but accuracy of data needs to be improved. Service line and patient level costing to be able to calculate new metrics such as cost per health gain Core Phase 1 RNOH Clinical Outcomes Strategy, V3.0, February 2012 Page 20 of 21

21 Dataset Current Situation Currently captured electronically Core - must be delivered Trust wide Plan Imaging data Tags to images that enable images relating to particular conditions (i.e. diagnostic codes) to be recalled. Some functionality on RIS but only to radiologists and not available on PACS Future PROMS - Patient Reported Outcomes Measures Pilots exist (e.g. SPRINT) to collect quality of life scores (e.g. EQ5D or SF36) Core Phase 1 Region specific (e.g. Oxford Hip & Knee Scores etc.) Future Condition specific (e.g. The Western Ontario Shoulder Instability Index (WOSI)) Future National forms captured independent of RNOH e.g. NJR Core Phase 1 Paper based forms captured by teams and filed in notes, ad hoc. Future Other Questionnaires A comprehensive list of questionnaires currently administered has been collated. Only some are electronic. There is a requirement for an electronic mechanism for clinical units/teams to easily capture information completed by either healthcare professionals or patients Core Phase 1 Patient Experience Data Bespoke RNOH system using tablets to collect data from Inpatients and Outpatients, plus paper based Department of Health national Inpatient and Outpatient surveys Core Phase 1 RNOH Clinical Outcomes Strategy, V3.0, February 2012 Page 21 of 21