WSIC Dashboards: Care Professionals Dashboard User Guide V4 Non-Costed and Costed Versions If you are having problems logging in, please contact the NWL Service Desk via email Service.Desk@nw.london.nhs.uk, or call 020 3350 4050. Please contact the Service Desk if your account has been disabled for any of the following reasons: - You have attempted to log in 3 or more times; - You have not accessed the WSIC Dashboards within the last 60 days; - You are employed on a contract basis and an expiry date has been given on the user access form returned to the WSIC Dashboards Programme Team. In this case we will need the approver for your practice to confirm that your account can be re-enabled. Website: http://integration.healthiernorthwestlondon.nhs.uk/informatics WSIC.dashboards@nw.london.nhs.uk For feedback on the WSIC Dashboards please email WSIC.Dashboards@nw.london.nhs.uk
Date Version Author Notes 18/05/2016 1.1 Tiffany Grant Draft 31/05/2016 2.0 Alice Green Editing and formatting 15/06/2016 2.0 Tiffany Grant Published on http://integration.healthiernorthwestlondon.nhs.uk/in formatics/dashboard 17/10/2016 2.1 Olivia Walicki Spend sections added and updates made 26/10/2016 2.2 Amanda Lucas / Tiffany Grant Review and final edits 24/01/2017 3.0 Olivia Walicki / Tiffany Grant General updates. Data provenance and social care sections added 15/05/2017 3.1 Rachel Meadows / Olivia EFI section added. General updates. Walicki 22/05/17 4.0 Rachel Meadows Formatting and published Page 2
Table of Contents Section 1: Overview of the WSIC Data Warehouse... 6 The WSIC Data Warehouse... 7 Who is developing the WSIC Dashboards?... 8 Key Benefits of the WSIC Care Professional Dashboard... 9 Section 2: Key uses of the dashboard... 10 There are 3 main uses of the Care Professionals View... 11 1. Provide summary information on an individual patient s care history in preparation for MDT meetings... 12 2. Case management and tracking of patients... 13 3. Case finding patients who may require or benefit from proactive intervention... 134 Section 3: Good to know... 15 User access to patient data... 16 Data timelines... 18 Sensitive data... 20 Long-term conditions and QOF... 20 Spend... 21 Page 3
Calculating Patient Level Costs... 22 Care Plan... 24 Data Provenance... 25 Section 4: Setup and login... 26 Browsers and platforms... 27 How to log into the dashboards via TPP SystmOne... 28 How to log into the dashboards via EMIS Web... 29 How to log into the dashboards via the website... 30 Section 5: Page by Page Guide... 31 The Care Professionals Home Page... 32 The Care Professionals Watch Lists... 36 The Patient Radar... 38 The List Maker... 40 The Activity View... 41 Electronic Frailty Index (EFI)... 43 The Patient Spend View... 45 Page 4
The Prescriptions View... 47 The GP Activity View... 49 The Social Care View... 51 The Acute Diagnoses View... 53 The Acute Diagnoses View... 54 The Procedures View... 56 The Care Professionals View Patient Profile... 58 How to get help or feedback... 59 Page 5
Section 1: Overview of the WSIC Data Warehouse Page 6
The WSIC Data Warehouse WSIC secure data warehouse, integrated care per patient records Via Apollo Medical This guide focuses on the Care Professional Dashboard Page 7
Who is developing the WSIC Dashboards? Key enabler to North West London s Sustainability and Transformation Plans (STPs) Page 8
Key Benefits of the WSIC Care Professional Dashboard The WSIC Care Professional Dashboard will help to deliver the direct care in the following ways: Helps to identify and support patients for targeted care with watch lists which update automatically in response to new information from multiple care settings. Facilitates discussion and coordination between care professionals from different settings by providing a shared patient narrative accessible from any location with N3 access. Provides visibility and access to patient activity across all care settings, regardless of source clinical system, without requiring manual data collection. Reduces reliance on hard-copies of notes, manual data access and tracking, aiding continuity of information between MDT members. Aids the monitoring of patient outcomes for both individuals & groups in practice populations. Provides a summary snap shot view to gain an overview of a patient s care. Ability to drill down to individual patient level using hover overs and tool tips for easy use. Page 9
Section 2: Key uses of the dashboard Page 10
There are 3 main uses of the Care Professionals View 1. Provide summary information on an individual patient s care history in preparation for MDT meetings. 2. Case management and tracking of patients using the individual patient information, including GP activity, acute diagnoses and procedures, and medications. Use of tool tips and hover overs. 3. Case finding patients who may require or benefit from proactive intervention. Each of the main uses of the WSIC dashboard are shown on the following pages Please note: this is a working programme. Further developments will be added to enhance the use of the dashboard, such as other Long Term Condition radars. Page 11
1. Provide summary information on an individual patient s care history in preparation for MDT meetings View a summary of an individual patient s activity, including a list of LTCs, health and social care service usage, key outcomes and current medications. Understand which services the patient is using and whether or not they have a care plan. See on a map where the patient s activity has taken place. Page 12
2. Case management and tracking of patients View detailed information on a patient, such as the history of acute diagnoses made. Using the green icons a user can see more information on patients, such as history of prescriptions, GP activity, or acute procedures. Page 13
3. Case finding patients who may require or benefit from proactive intervention Use the watch lists for different perspectives, or prioritising patients for proactive care. The colour used to highlight a patient name will change with the number of watch lists that the patient appears in. Click through to see the care history of the chosen patient by clicking on their name. Page 14
Section 3: Good to know Page 15
User access to patient data It is important to understand the following regarding the data available in the WSIC data warehouse and this particular dashboard. Only users with a legitimate direct care relationship with a patient will be able to see that patient s information. Those who do not wish to have their data shared are filtered out at source; therefore, their data is not pulled through. This means that a user from a non GP care setting may not see all of the patient s data for whom they are caring but rather, only data concerning those who have not opted out. A patient may opt out or dissent from sharing data across any care setting, meaning that no data will appear for those patients in any of the pages or calculations in the dashboards. Page 16
Population data segments Each CCG is moving towards all patient data. This is expected to be completed by summer 2017. CCG Brent Harrow Hillingdon Central London Hounslow Hammersmith & Fulham West London Ealing Population Data Segment All Adults All Adults All Adults All Adults All Patients All Patients All Adults All Patients Page 17
Social Care Mental Health Community Out of Area Acute Acute Data timelines The data available in the system is based on feeds that are updated at varying rates: Care Setting Provider Data Set & Frequency Chelsea and Westminster Hospital NHS Trust London North West Healthcare NHS Trust Hillingdon Hospitals NHS Foundation Trust Imperial College Healthcare NHS Trust West Middlesex University Hospital Trust Royal Brompton & Harefield SLAM - Monthly SUS Monthly 18 Out-Of-Area Acute Providers SLAM - Monthly SUS Monthly Central London Community Health (includes Community Independence Service) Hounslow and Richmond Community Health London North West Healthcare NHS Trust Central & North West London NHS Foundation Trust Central and North West London NHS Foundation Trust West London Mental Health Trust Community -Monthly Mental Health - Monthly Have established social care data feeds for: West London, Central London, Hammersmith & Fulham, Brent and Hounslow Monthly Page 18
The system is, therefore, intended as an enabler in understanding the long-term needs and history of patients and the patient group, not for urgent response planning. Each page of the dashboard includes a time stamp in the top right corner explaining when the most recent data is available to/from, and an information i button in the bottom right corner where there is information on data timelines. Page 19
Sensitive data Sensitive data, such as sexual health and HIV codes, abuse codes, etc., are not included in the system and are, in fact, never shared with the WSIC data warehouse. For a full list of the read codes and sensitive codes not included, please visit the website: http://integration.healthiernorthwestlondon.nhs.uk/informatics/information_sharing Long-term conditions and QOF The grouping of patients into long-term condition (LTC) groupings is based on the Quality and Outcomes Framework (QOF) flags, rather than just the diagnosis. For example, a patient will be marked in the dashboard as having the LTC of asthma if that patient has both been diagnosed with asthma and has recently been receiving medication for that condition. The diagnosis itself is not sufficient. This is relevant for the LTCs of asthma, epilepsy and mental health. Page 20
Spend There are two versions of the Care Professional Dashboard, the costed and uncosted versions. The default version is the uncosted version of the Dashboard, and you can switch to the costed version from the home page of the Care Professional Dashboard as shown below. The costed version of the Care Professionals Dashboard provides additional information about patient spend by using sector costs. You will be able to see overall sector costs as well as drill down to see the spend on individual patient activity on the Patient Activity and Patient Summary screens, and will have access to an additional Patient Spend page. To access the costed version of the dashboard you will have to switch views by selecting the Switch Views icon on the dashboard homepage (see below), which will take you to the Costed View Homepage (see pages 32 and 33). Page 21
Calculating Patient Level Costs Patient level costs refer to the indicative spend calculated separately for each patient for each healthcare sector, as explained below. Validation work is still underway on the social care patient level costs and these costs are preliminary. GP Costs: These are a combination of GMS/PMS/APMS contracts commissioned by NHS England and locally commissioned (CCG) schemes such as LIS/LES/OOHS. Prescribing costs are not currently shown as they cannot be matched to individual patients. These costs reflect the actual Outturn costs for historic years and YTD budgets for the current year. Practice level costs are apportioned across age groups based on historic analysis of appointment utilisation and then to patients, based on the number of recorded daily contacts that patient has had with the practice. The age group split is required as practices do not currently supply data for all registered patients e.g. children. The cost allocation assumes that all patient contacts for the specified age group consumes the same resource so all contacts will have the same unit price. Acute Costs (SLAM): These are based on actual activity and costs (i.e. primarily cost per case) as reported by Trust issued patient level SLAM reports. Some contractual adjustments e.g. Emergency Threshold adjustments, Re-admission and other contractual penalties are applied retrospectively at the patient level. Page 22
Costs do not reflect the sometimes significant values that are not reported at patient level e.g. Direct Access or Contractual caps. Community Costs: These are based primarily on block contract values split across service lines or other groupings of activity. Indicative activity plans are generally used to determine unit costs and values are assigned to the patient based on their share of the service line activity and include only those costs that can be traced back to a specific patient. Mental Health Costs: These are based primarily on block contracts, and therefore fixed in cost terms regardless of activity levels. The values are assigned to patients based on the overall share of activity defined under In Scope services and Out of Scope services. In Scope services cover cluster bed days as defined under the national framework for mental health activity classification, whilst Out of Scope services cover locally defined services. Social Care Costs: These are based on the total cost of the various care packages received by the client. Clients can be receiving more than one care package at any one time and the costs only include those that have been specifically identified to the client less any contribution by the client. Page 23
The receipt of social care data is still in its early stages, with Local Authorities gradually coming on stream and starting to send data through. The costs of Social Care still need to be reviewed and validated centrally. Care Plan A patient is shown as having a care plan if they have a read code beginning 8CM* on their record. A patient will appear in the care plan out of date watch list if the newest 8CM* read code on the patients history is older than 12 months, or it is prior to the latest A&E attendance or non-elective admission, otherwise it is up to date. So if a patient has never had an 8CM* read code on their record they will not be on any of the following lists: Has a care plan (radar) Care plan out of date (watch list) Care plan up to date (watch list) Page 24
Data Provenance Dates for most recent GP data update will now be specific to the practices to which you have access. You will be able to view this when you hover over the i information button on the right hand side of the screen. Hover over to see data provenance information This means that you will be able to check when data for your practice was last uploaded into the dashboards and will be aware when it is not up to date. Page 25
Section 4: Setup and login Page 26
Browsers and platforms The WSIC Dashboards are supported by the following browsers and platforms: Web browsers supported Chrome Web browsers supported Windows XP or above Firefox (3.x or later) OS X or ios 5.x or later Internet Explorer (IE 11) Safari (3.x or later) Android 3.2 or later Page 27
How to log into the dashboards via TPP SystmOne Quick link to the Dashboard will be found here. For TPP SystmOne: There is a now a direct link to the WSIC Dashboards log in page in TPP SystmOne. The log in link can be found with the left hand side home screen icons Page 28
How to log into the dashboards via EMIS Web For EMIS Web: To establish a direct link to the WSIC Dashboards in EMIS Web you will have to manually add the URL. Go to the Organisation Notepad section, and click on the Add Note button which is the green plus sign in the top right hand corner. Copy and paste the Dashboard log in link (https://nww.analytics.southl ondoncsu.nhs.uk/#/signin) into the dialogue box and click ok. This will save the dashboard link in the Organisation Notepad section Page 29
How to log into the dashboards via the website 1. Open one of the following web browsers from a computer or tablet (e.g. ipad) within N3 network: - Chrome, Firefox (3.x or later), Internet Explorer (IE 11 or later), Safari (3.x or later) 2. Navigate to the URL http://integration.healthiernorthwestlondon.nhs.uk/informatics/dashboard 3. Click on the icon for DASHBOARD login. 4. Enter your username and password when prompted. Note: you will need to enter NWLondon\ before your username. Tip: The first time you log in your browser will ask you if you would like your log in details saved, if you would like your credentials to be saved please, click yes. Alternatively, you can save the following link as a bookmark on your browser: https://nww.analytics.southlondoncsu.nhs.uk/ Page 30
Section 5: Page by Page Guide The following section includes information on each page in the dashboard, including: 1. An overview of the page and summary of how to use it 2. Explanation of the functions available on the page (if applicable) 3. Details on the calculations included on the page Page 31
The Care Professionals Home Page To enter the costed version of the dashboard which contains patient spend information, click on the Switch Views icon. Notes on usage Use this page to enter the Care Professionals dashboard. Click on the Patient Search icon to navigate to a screen where it is possible to search for a patient by NHS number. Click on the Watch Lists icon to navigate to a screen displaying five watch lists to help prioritise patients. Click on the Patient Radar icon to navigate to a screen providing a list of patients against key pieces of information, including use of services across care settings, and watch list appearances. Page 32
Click on an icon to either enter Patient Search, Watch Lists or the Patient Radar Click this icon to access the GP Data Quality Dashboard and the List Maker screen Navigate to the home page Hover over to see information about the dashboard Page 33
The Patient Search Notes on usage Use this dashboard to search for patients explicitly by NHS number. Use the boxes above to search by name, NHS number, CCG, GP practice network, GP practice and patient segment. Click on the orange arrow of your chosen patient to be given a list of options to access patient summary When search fields are cleared, no patients will be displayed. Page 34
Select CCG, GP network, GP practice and patient segment Search by NHS number Click to view a more detailed patient summary Navigate to the other pages within the workbook Hover over to see information about the page and data coverage Page 35
The Care Professionals Watch Lists Notes on usage Review the watch lists to help prioritise patients who may require intervention. These watch lists are subject to change as new data feeds become available. Use the filters to restrict the watch list only to the patients meeting the chosen criteria. Click on a patient to see which other watch lists they are highlighted in. The colour of the background for a patient corresponds to the number of watch lists they currently appear in. Clicking on a patient will also display a list of further analysis options. Page 36
Calculation Definitions Recent diagnosis: this watch list contains patients who have been diagnosed with an LTC in the past two months, in either primary or acute care settings. SLAM and primary care data (SystmOne or EMIS) are used. Care plan out of date: this watch list contains patients who have not had a care plan review either since their last A&E attendance or NEL admission, or in the past 12 months. SLAM and primary care data (SystmOne or EMIS) are used. Recent DNA: this watch list contains patients who have not attended an outpatient or community appointment in the past two months. SUS and community care data are used. Regular A&E users: this watch list contains patients who use A&E services the most. It is ordered by the number of times a patient has attended A&E over the past six months. SLAM data is used. Regular inpatient users: this watch list contain patients who use acute inpatient services the most. It is ordered by the number of elective (including day case) or non-elective inpatient admissions over the past six months. SLAM data is used. Page 37
The Patient Radar This column will only appear in the costed view Notes on usage Filter and sort your patients into a priority list for proactive patient management. Use the filters above to restrict the list of patients based on your chosen criteria. It is possible to restrict the list based on the services used and care plan status by using the Filter Category 1 and Filter Category 2 options. Sort this list by using the Sort By... option, allowing the list to be sorted by the number of watch lists they appear in. Page 38
Calculation Definitions Number of watch lists: this counts the number of times a patient appears in the current set of watch lists. Has care plan: shows a tick if the patient currently has a care plan registered in the GP system. Care plan up to date: shows a tick if a patient with a care plan has had a review in the past year and not had any A&E or acute NEL activity since this review. Community care user: shows a tick if the patient has used community services in the selected time period. Mental health user: shows a tick if the patient has used mental health services in the selected time period. Social care user: Shows a tick if the patient has used social care services in the selected time period. Summary YTD: Shows the spend for each patient across all care categories selected from the dropdown menus. Costs are for the current year only. Please refer to the section on sector costs for an understanding of how these costs are calculated and the caveats that apply. Page 39
The List Maker Filter to, and make a list of patients with specific LTCs Notes on usage This tool can be used to filter to specific LTCs and create lists of patients in your GP practice. There are currently 41 LTCs available. The list can be downloaded as a CSV file and printed. Ticks show where a patient is a user of a particular service. Page 40
The Activity View Care home flag will appear for patients in in care homes For patients where a PAM score and level is recorded, it will be displayed at the top of the activity screen This section will only appear in the costed view Notes on usage Track this patient's activity across all care settings for the chosen time period. Filter the date range shown by using the filter in the top left hand corner of the screen. Hover over a bar to display more information, including the date of the activity, the provider, reason, outcome, or relevant diagnoses and procedures. Page 41
Calculation Definitions The indicators in the top right hand corner of the screen are the same as in the Patient Radar screen. The LTC list is produced by running the QOF 2014-15 algorithm on the primary care data for this patient. Days not in hospital: defined as the number of days in the time period minus the number of days as an EL/NEL inpatient and number of days as a mental health inpatient. The time period is chosen based on the choice in the top right hand corner of the page and the last day that data is available. The activity counts on the right are generated by counting rows of data or summing the relevant length of stay field in each data set. Care planning activity: defined as any GP event recorded with a V2 READ code (or equivalent) in the 8CM hierarchy. This dashboard enables a specific patient s costs to be analysed by sectors and types of activity This dashboard allows the patient s costs to be viewed over a selected time period (e.g. last two years) Please refer to the section on sector costs for an understanding of how these costs are calculated and the caveats that apply. Page 42
Electronic Frailty Index (EFI) A drill down of the EFI tool is available when clicking on the EFI score EFI is displayed here. Notes on usage A national tool for assessing frailty of each person in the population EFI will appear on the Patient Summary screen Will be categorised into four categories Fit, Mild, Moderate & Severe EFI will appear on the Patient Summary screen Page 43
Calculation Definitions Based on a set of 36 indicators (deficits), clustered into 7 groups The algorithm calculates 35 out of the 36 EFI indicators this excludes Polypharmacy as there is no national algorithm available to calculate this. A patient s EFI score is based on their total number of indicators/deficits Frailty is classed as one of the following: FIT / MILD / MODERATE / SEVERE 36 indicators grouped - Page 44
The Patient Spend View Notes on usage Sector costs displayed in swimlanes Overall sector costs Patient Spend icon This screen is only available in the Costed version of the dashboard See an individual patients spend across all care settings for the chosen time period. Filter the date range shown by using the filter in the top left hand corner of the screen. Hover over a section of the graph to display more information about the total cost of patient activity for different care settings over time. Hover over a bar to display more information about the cost of a specific activity. Page 45
Calculation Definitions This dashboard provides a graphical presentation of a patients costs over the selected time period. The costs for each category of care are shown against the bars in the lower section of the dashboard. Whilst the total of all these costs are shown in the graph in the middle section of the dashboard. Please refer to the section on sector costs for an understanding of how these costs are calculated and the caveats that apply. Page 46
The Prescriptions View Notes on usage See this patient's prescribed medications in primary care settings. Filter the medications that were issued only in the past three months, or all prescriptions made in primary care. Use the issue type to view the type of prescription. - Acute - a one-off prescription - Repeat - intended to be given again. Prescriptions can be sorted in chronological order or by drug name. Page 47
Calculation Definitions The LTC list is produced by running the QOF 2014-15 algorithm on the primary care data for this patient. The number of drugs currently prescribed: defined as the number of distinct drugs with last issue date within three months of the most recent data point in the data set. Page 48
The GP Activity View Notes on usage Track this patient's read coded primary care activity over the chosen time period. Use the drop down menus in the top left hand corner of the screen to filter on GP events occurring within your chosen time period, or within a particular group of READ codes by hierarchy group. Use the event dates located at the bottom of the screen to easily view a patient s primary care history. Page 49
Calculation Definitions The LTC list is produced by running the QOF 2014-15 algorithm on the primary care data for this patient. Page 50
The Social Care View 10 categories of social care Primary Special User Groups (SUGs) Notes on usage View a patient's social care services over your chosen time period You will be able to view social care data under 10 categories of care and 2 others, Uncategorised and Other Activity is shown in swim lanes so that you can view services against a timeline Hover over the service to see the provider, start date and service type Primary special user group gives an indication of the reason for the patient s social care support Page 51
Calculation Definitions Primary special user group(s) give an indication of the reason for the patient s social care support Open activity is activity that has not been marked with an end date, or has an end date in the future. The main Primary Special User Groups (SUGs) in use are: o Absent parenting o Abuse or neglect o Disability o Family dysfunction o Learning disability support o Foster Carer (Children's Finance only) o Mental health support o Parental illness or disability o Physical support o Sensory support o Social support o Support with memory and cognition Additional SUGs may be in use by particular Local Authorities. Page 52
The Acute Diagnoses View Click on a row or event for more detail Drill down for more detail on read codes by hovering over the column heading and clicking the '+' as above Notes on usage Track this patient's acute diagnoses recorded over the chosen time period (displayed in ICD-10 groupings). Use the drop down menus in the top left hand corner of the screen to filter on acute diagnoses having been made within your chosen time period, or within a particular group of ICD-10 codes by hierarchy group. Page 53
The Acute Diagnoses View Notes on usage Columns with more detail will appear. Click on a row or event for more information. Use minuses to backtrack through columns. Page 54
Calculation Definitions The LTC list is produced by running the QOF 2014-15 algorithm on the primary care data for this patient The number of diagnoses: defined as the number of distinct diagnoses found across all acute points of delivery. Please note this will not double count diagnoses made in different PODs (i.e. A&E, IP, OP). Page 55
The Procedures View Notes on usage Track this patient's acute procedures performed over the chosen time period (displayed in OPCS 4 groupings). Use the drop down menus in the top left hand corner of the screen to filter on acute diagnoses having been made within your chosen time period, or within a particular group of OPCS 4 procedure codes by hierarchy group. Page 56
Calculation Definitions The LTC list is produced by running the QOF 2014-15 algorithm on the primary care data for this patient. The number of procedures: defined as the number of all procedures found across each acute point of delivery. Please note this will count all occurrences of all diagnoses made in acute settings, e.g. 5 MRI scans will be counted as 5 procedures. Page 57
The Care Professionals View Patient Profile Total patient spend will only appear in the costed view Total spend of patients activity across all care settings for the chosen time period Notes on usage See a summary of this patient's activity, current medications and other key information. Use the drop down menus in the top left hand corner of the screen to filter on acute diagnoses having been made within your chosen time period. Click on a care setting on the left hand side of the page to highlight and show provider information on the map, and vice versa. Patient activity spend will only be displayed in the Costed View Page 58
Calculation Definitions The indicators in the top right hand corner of the screen are the same as in the Patient Radar screen. The LTC list is produced by running the QOF 2014-15 algorithm on the primary care data for this patient. Days not in hospital: defined as the number of days in the time period minus the number of days as an EL/NEL inpatient. The time period is chosen based on the choice in the top right hand corner of the page and the last day that data is available. The activity counts on the right are generated by counting rows of data or summing the relevant length of stay field in each data set. Care planning activity: defined as any GP event recorded with a V2 READ code (or equivalent) in the 8CM hierarchy. This dashboard complements the patient activity dashboard and shows, for a specific patient, the costs across the different care settings. Please refer to the section on sector costs for an understanding of how these costs are calculated and the caveats that apply. Page 59
How to get help or feedback If you are having problems logging on, please email the NWL Service Desk via email Service.Desk@nw.london.nhs.uk, or call 020 3350 4050. For feedback on the dashboards please email WSIC.Dashboards@nw.london.nhs.uk. Website http://integration.healthiernorthwestlondon.nhs.uk/informatics WSIC.dashboards@nw.london.nhs.uk P