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Making data fit for the future

Neil Kelly

The NHS is embarking on its biggest data migration exercise ever, moving data from systems that have been in use for decades, owned by organisations who have never been involved in anything like this before. How are trusts likely to cope with this challenge and what issues are they likely to face?

For data to be migrated from localised information silos to national systems, steps must first be taken to ensure the quality of that data. According to Steve Tuck, chief strategy officer at Datanomic, all trusts are facing up to much the same problem; they need to ensure that their data conforms to standards and they need to move it.

The first step is to understand what information is there, where it came from and how it is used. Once profiled and enhanced, validity rules can be built in maintain quality. NHS organisations may have data quality issues beyond the immediate requirements of CRS migration. Problems might be common across the NHS, but there are no channels for sharing the knowledge when they are resolved.

Duplicate records

John Wiltshire, sales and marketing director at Stalis, believes that trusts have developed a false sense of security over the quality of their data and serious issues are not being addressed. They may have a high percentage of patient records populated with NHS numbers, for instance, but the information is often wrong.

He worries that some of the new CRS systems will simply accept poor quality data because the NHS number is not a key field and not validated. If a patient has been to two hospitals, separate valid records will have been created in each hospital's PAS system. When the data is merged, "valid duplicates" are created.

Of all the data quality issues, duplicate records are regarded as one of the most serious, as they can result in commissioning bodies paying many times over for a single treatment.

One of the big questions concerns how much data should trusts migrate to these new systems, and what should they do with the rest of it. The system the data came from will be shut down, as the cost savings in no longer having to run it may have been central to trusts' business plans.

Wiltshire maintains that data migration is not particularly expensive, but it can be complex and it needs to be done properly. Additionally, says Tuck, data which is not migrated still needs to be maintained, in a searchable archive. That archive needs to be integrated so that it can be queried in conjunction with LSP data.

Accessibility

Richard Zeronian, district sales manager at Emc's UK Healthcare division believes that storage technology is not changing, but it is no longer adequate to simply archive data on tape. It can now be held in a more accessible format, at low cost. According to Zeronian, the NHS has become the largest UK market for Content Addressable Storage (CAS) technology.

John Wiltshire considers that archiving is best done as part of the migration process. It means the data gets cleaned and provides a view of what, and what was not, uploaded. An existing system may have integrated maternity and A&E modules, but only one module might be migrated during a particular project phase. The trust may need an interim solution so that the information can be seen in its totality and properly maintained.

According to Zeronian, best practice for interrogating current data is to run queries against replicated data held in a data warehouse. This prevents live systems crashing under the strain of trying to run a complex query. Trusts will always need access to local data for ad hoc reporting, but Wiltshire warns that some LSP solutions are not offering it. They should be able to provide HL7 compliant data, which trusts can then interrogate using standard ODBC tools.

Trusts will need to think carefully about how they will manage Payment By Results (PBR), where they will need to run reports combining clinical activity data with financial data. In order for PBR to work, says Tuck, accurate forecasts of requirements and spending must be available.

Commissioners must be able to ensure that the right treatments are validated against the right tariffs, coded with valid ranges, so that they cannot, for example, be charged for a hysterectomy performed on a man. Currently, Wiltshire warns, trusts do not even have the necessary information systems to even tell them which clinical procedures they are good at or how to cost them.