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November 24, 2014

Towards a digital future

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Gary Culliton reports on HIQA’s efforts to drag the delivery of healthcare and its information into the digital age.

New HIQA reports on information governance (IG) — which cover information sharing, quality assurance, confidentiality, privacy and records management — and on data quality are initial milestones aimed at bringing health information here into the digital age.

Only one of four countries reviewed by the Authority, in a new survey, displayed significant interaction between organisations responsible for national data collection and data providers. In England, this interaction was primarily through the provision of education, guidance and feedback on the results of data quality assessment, a HIQA review showed. The review did not find a similar level of interaction in New Zealand.

HIQA has published an international review of data quality, which refers to data that is accurate, valid, reliable, relevant, legible, complete and available in a timely manner to decision-makers for healthcare delivery and planning purposes.

National standards for data quality identify what structures and processes organisations should have in place to create a supportive environment for data quality, and outline a framework to enable the collection, analysis, sharing and use of good quality data to support the delivery of health and social care and to report on performance.

This review found that service providers were usually supported through the provision of education, primarily by organisations responsible for national data collection holdings and predominantly on the topic of coding. Examples of support and education for data quality in England include the NHS Classification Service, which has developed a training and accreditation strategy to ensure that clinical coders receive core training and to support continuing professional development of NHS clinical coders.

NHS Information Centre helps organisations improve data quality by hosting the Data Quality Guild, a network of data quality champions and practitioners. Members can become members of an online community called ‘Guildspace’ that provides access to various data quality tools and expertise.

In Canada, for example, the Canadian Institute for Health Information publishes reports annually on the quality of data submitted by each of the regions to its national collections. Also in Canada, the Newfoundland and Labrador Centre for Health Information provides guidance through the provision of feedback to organisations within its region.

All healthcare organisations produce a large volume of data, ranging from administrative data used to manage organisations, to laboratory results and subjective descriptions of a patient’s state of health.

National standards
The development of national standards and guidance for health information governance in Ireland will contribute to delivering better, safer care, HIQA believes.

As a first step, HIQA conducted this review of international practice, which examined data quality initiatives in England, Wales, Canada and New Zealand. HIQA will consider the relevant information from this review to identify the best practice options that may be tailored for Ireland to inform the development of national standards and associated guidance.

Examples of support and education for data quality in New Zealand include regional education programmes provided by the clinical coding section of the Ministry, the provision of a coding query service and maintenance of an online historical database of queries.

In addition to coding manuals and a data dictionary, guidance is also available in England electronically via websites, such as NHS Connecting for Health, that can provide guidance on information governance. The NHS Information Centre also hosts a searchable web library called the Data Quality Lexicon containing a number of data quality resources.

The HIQA review found that the assessment of data quality was commonly carried out by organisations responsible for regional or national collections. Healthcare provider organisations submit data to regional or national organisations that are mandated to collect the data. They then apply quality checks and provide feedback to the data providers on the quality of the data submitted. Feedback can be in the format of data quality annual reports, data quality key performance indicators (KPI) reports or data quality dashboards. Healthcare providers are then expected to institute data quality improvements based on these reports and in some cases can be penalised financially for poor-quality data.

Examples of data quality assessment in England include NHS organisations self-assessing data quality through the Information Governance (IG) toolkit. While organisations may be audited against the self-assessment there is no evidence that this happens in practice. The Secondary Uses Service (SUS) assesses the quality of data submitted by NHS-funded organisations and provides feedback through data quality KPI reports and data quality dashboards. The next step will be to develop the standards and guidance for data quality in Ireland to support the delivery of better, safer care using the international review as a resource.

Meanwhile, the anticipated Health Information Bill will likely include legislative provision for the development of IG standards. HIQA will also be responsible for setting these standards, developing supporting guidance documents and monitoring compliance. As part of the IG suite of standards, HIQA will develop national standards for IG management.

Safe care
Good IG is essential to ensuring an appropriate balance using personal health information as required to provide appropriate and safe care and protect the rights and interests of service users, HIQA said. The Authority believes the rights to privacy, confidentiality and security of their personal health information would be protected.

The purpose of HIQA’s recent international review of governance management is to explore the experience internationally of IG management and its associated principles and practices. This review is the first step in the process of developing national standards for IG management for the health and social care sector in Ireland.

The next step is for the Authority to commence drafting the standards and supporting guidance, based on the themes that have been identified. This work will be completed in consultation with stakeholders, it has stressed.