The new contract: getting your data on computer
To get the best from the new contract you need to get the best from your computer, and this means good data input says Dr Paul Cundy
Practices should now be looking to 'data day' (January 1 2004) the date from which data will start counting towards your quality and outcomes Target Reports, which are due to be run in April 2005.
Data collected before then, except for some specifics like spirometry, will be valueless. Most data will only look back a maximum of 15 months, so entering anything before January 2004 is pointless.
What practices ought to be doing between now and then is thinking about the processes and ways of working that will enable them to collect the data from 'data day' onwards.
So what should you consider when you begin to look at data collection?
1Bear in mind that anyone can collect and input the data; you don't have to do it all yourself. So involve the whole team. This includes community staff, who in our patch have long wanted to get at our computers. Arrange meetings for the whole primary care team to explain the new contract to them and make a point of getting the message that data quality is going to be crucial in the future.
2Work through the new contract quality and outcomes framework document and establish which set of codes is relevant to your system, whether four byte or five byte. The latest set of codes are on www.bma.org.uk/ap.nsf/content/newreadcodes. Then make sure you set up agreed picking lists so you can find the codes quickly and easily. Different systems have different ways of doing this. In my practice we've set up code lists for CHD and diabetes and are working on the others. Your supplier's users group will be a good place to ask if the above sounds a bit daunting.
3Remember also that there are some data items that overlap several of the clinical quality markers; height, weight, smoking history, alcohol consumption, blood pressure and so on, so getting the data right for the one will do for the many.
4Make full use of your data sources. For example, newly registering patients are a rich source of new data because they are likely to consult soon after they register and can be encouraged to have a new patient health check.
We've just reviewed our patient registration process to ensure that we get as much background information as we can from new registrations.
When new patients' records arrive (yes we are working hard on getting electronic GP-to-GP transfer implemented but for the moment this will remain a paper transaction) these should be summarised, which is itself a separate new contract funded procedure.
Although these patients are initially exempted under the terms of the contract, most will stay on your list long enough to be counted.
5Opportunist screening is an excellent data source. You see 90 per cent of all your list every three years, and you only need to record a few coded items a day to meet the annual quality report. (Think about it. How many coded items for a diabetic? How many diabetics? How many codes per day?)
6Out patient letters, discharge summaries, out of hours and A&E unit reports can all hold data relevant to the quality and outcomes reports. Set up a process that captures the data. You may need to update or modify your scanning procedure to include coding.
7Electronic links can provide good data. Most practices should have pathology links and some will have others. You should certainly consider whether data delivered electronically could be useful.
8Capitalise on private and work-related health checks and medicals. After years of telling patients what a waste of time these are I now realise they line the coffers of our data repositories, so long may they continue. If only they came through electronically. They are a rich vein of measurements, tests and results. Make sure all the data gets carried across into your records.
9Take residential and nursing homes into account. I believe the residents of nursing homes or those in assisted accommodation should not be subject to new contract-driven activity but if the staff do a monthly, quarterly or annual blood pressure make sure you can get it back to the practice system.
10Finally of course all the above relate to getting positive data that will count towards your points but perhaps the most crucial group will be those subject to the exemptions. In effect, each exemption recorded adds to your points total. Making sure you have correctly identified and flagged all those legitimate exemptions is going to be a worthwhile activity. At the moment the codes for these aren't embedded in your systems but they should be with you soon so in the meantime concentrate on who the exemptions are and how to identify them.
Obviously this list could go on and on, but I think this is a fair start.