Receiving Data

When Clarity Informatics receive a SUS data upload (from Tusts or an agreed 3rd party provider) the data is subjected to a series of acceptance criteria to determine which patient records will form the population of a focus area.

As well as the diagnosis/coding criteria the data is also subjected to certain population criteria to ascertain whether the patient with a relevant diagnosis/coding could be excluded on the grounds of population exclusions.   These would include but not limited to  if a patient is under the age of 18 or if a patient died.

Uploading Data to Assure

Once a patient's dataset has been accepted as part of the population for a focus area the data will be uploaded and visible on Assure.  Users can then access the patient record and complete the measure questions. 

Completing Data on Assure

Measures Exclusions

During the design process of the quality measures certain measure exclusions will be included which, depending upon the answers given to specific measure questions, will excluded a patient record from a particular care measure but not from the focus area population overall.  Examples of such exclusions would be if a measure related to antibiotics but the patient did not require these as part of their treatment.  Therefore, if the measure questions were answered to reflect the fact the patient did not receive antibiotics then the patient would be excluded from that measure, but remain part of the overall focus area population.

Question 'Skipping'

During the quality measure design stage it will become evident that the answer to some questions will mean that other questions further down the 'flow' would become irrelevant.  In these instances 'skip logic' will be applied so that users are not completing questions unnecessarily.

PLEASE NOTE:  To enable the skip logic to work correctly and effectively the measure questions MUST be answered in numerical order, answering the questions out of order will affect the effectiveness of the skip logic and could result in users completing questions they may not have otherwise needed to.

Assessing the Outcome

Once all of the measure questions have been answered for a patient record, and the record has been saved the answers are assessedin line with the design specifications of each quality measure and determined whether each quality measure has been passed/failed or excluded.

This information is displayed in the Summary tab of each patient record with details of the reason a patient record has failed or excluded a measure. 

In addition, the Reports section of Assure enable various reports to be produced to show how overall patient care has been analysed at Hospital and Trust level.

Summary of Process

The term “Information Governance” covers a wide range of processes aimed at ensuring the effective, secure and legitimate management of data that is important to an organisation. The two major aspects of IG relating to participation in the Quality Improvement Service are compliance with:

• The Data Protection Act 1998; and
• The NHS Information Governance Toolkit.

The Data Protection Act deals with the rights and responsibilities of people and organisations concerning the use of personal identifiable data about other people (data subjects).  Clarity Informatics does not process any personal identifiable data and trusts (data controllers) are responsible under the Data Protection Act for ensuring that no personal identifiable data is sent to Clarity Informatics. Specific examples of data that Clarity should not receive (but sometimes does) include:

• Patient name;
• Patient NHS Number; and
• Other patient data such as date of birth, age, family details or gender.

Clarity does process pseudonymised personal data (*), such as the Local Patient Identifier, for people whose treatment is being monitored through the Quality Improvement Service. Clarity also processes data that could be considered as sensitive and / or confidential relating to the performance of individual NHS consultants, wards, hospitals, services, or trusts.

For these reasons, Clarity provides the following secure communication links:

• Pseudonymised* patient data is submitted from trusts to Clarity via an FTP (high security) connection with a unique IP address to each trust.
• Web reporting is via a higher security (https) internet connection.
• Sensitive and confidential communication, including anything containing pseudonymised patient identifiers is restricted to the Clarity Helpdesk system which is more secure than email systems (as well as having inbuilt message tracking).

These arrangements are part of Clarity’s Level 3 compliance with the NHS Information Governance Toolkit and its ISO 27001 Security Management System Certification.

* Pseudonymised data is different from personal identifiable data in that it cannot be used to identify an individual. However, even this precaution can be at risk if, for example, pseudonymised data becomes known to an unauthorised person who understands how the pseudonymisation method works and can reverse it.

The main toolbar is visible at the top of every page of the Assure system.

It contains links to various sections of the Assure system as well as links to the Clarity Assure Helpdesk and User Account settings.

This is divided into 3 parts

Notifications

Clarity may use this to bring particular issues to the attention of users.

Matching with SUS

This shows information relating to the current open discharge dataset as per the processing calendar. 

• Finished - records whereby the data has been entered and the 'Finished' tick box populated on the record
• Unfinished - records not marked as 'Finished'.
• SUS - patient records received via SUS data (or a created patient record has been matched to a SUS data record)
• Created - patient records created by the user and not matched to SUS data (may be waiting for SUS data upload)
• Incomplete - records that have not been started or have missing answers
• Complete - records that have all questions answered
• Total - total number of records for that focus area

Discharge Month

This gives a brief overview of the status of the records by focus area, it also shows when the close and open dates of discharge month datasets

This is where you can access all datasets within Assure, regardless of whether the dataset is open or closed.

When you first navigate to the Search page you will only see two fields, for more search options click on the 'More options' text.

Enter the relevant search criteria and click Search.

The results of your search will be shown with a summary view of each record.  More information can be seen by clicking the blue arrow next to each PatientID.

To access the measure questions click on the 'Measure' text.

If the patient has been created by a user and you wish to amend/view the patient information such as admission and discharge dates click on the 'Patient' text.  This will only be available for Created Patients.

Overview

This shows a summary of the patient information taken from the SUS data, such as

• length of stay
• Admission Date
• Discharge Date
• ICD10 Code

Patient Details

This contains information  such as

• Hospital Name
• Site Code
• Patient age
• Gender

Clinical Details

This contains information such as

• ICD10 Code
• Focus Area

Admission & Discharge

This contains information such as

• Source of Admission*
• Admission Date
• Discharge Date
• Discharge Destination*
• Discharge method*

*amendable fields

Questions

This is where you will complete the data from the patient record to enable the analysis of care provided to this patient.

More information on the questions specific to each focus area can be found within the regional sections of this wiki

North East - Focus Area Information

North West - Focus Area Information

Summary

The outcome of the analysis can be seen on the Summary tab, this details whether the patient record has passed, excluded or failed each quality measure and the reason for failing/exclusion.

This report shows the full details of each patient record including each measure question and answer.

IF YOU WISH TO EXPORT THIS REPORT PLEASE ENSURE THAT YOU USE THE PATIENT LEVEL (EXCEL EXPORT) REPORT

This report shows the overall performance of a Trust/Hospital by each measure.

Example report

This report is designed to show how a Trust's ACS and CPS scoring compares against the regional ACS and CPS.

PLEASE NOTE:  If all records are Not Set/Not Started nothing will be displayed on this report as it will not be able to calculate an ACS or CPS.

Shows the date and time of patient's sepsis diagnosis and when they received antibiotics.

This will only return results for case records that have data entered. If no patient records have been started for the criteria entered the report will only show the column headings.

If the patient record has been data entered but the date and time fields have no data or have 'unknown' selected these will be shown as blank fields in this report.

Example of report where no records have been started

Example of report with data started and some date and times not entered

The final column of the report shows the total hours between diagnosis and antibiotics, this reports full hours only therefore if antibiotics were given 1 hour 30 minutes after diagnosis this will show as 1.  

A minus figure in this report shows that the patient received antibiotics before their sepsis diagnosis.  Again, this is the full hour only.

Clarity have a dedicated Helpdesk system to manage user communications.

The Help section of Assure contains links to the Clarity Informatics Helpdesk where you can submit any queries you have about Assure.

Clarity Informatics use a helpdesk system to manage user enquiries throughout all of their products in a timely, efficient and professional manner.  There are 4 main areas of the Helpdesk which can be accessed from the help sections on each of the product websites.

• Home – main access page displaying the personal information of the user
• View Tickets – view all tickets (open and closed)
• Submit a Ticket – submit a new ticket to Clarity Informatics
• Knowledgebase – information on all relevant products for the user

It is important for all users to send their queries via the Helpdesk so that these can be accessed by all members of the team. This is to ensure that whether a particular team member is in or out of the office the query can always be passed to the appropriate person and be dealt with in a timely manner.

This is a secure method by which users can contact the Customer Service Team for Assure.  This is the only way contact with Assure should be made if you are included a Local Patient Identifier in your communication. 

Please note:  you should never send patient identifiable data such as patient names or NHS number to Clarity

When you raise a query with the helpdesk this starts a conversation between yourself and Clarity Informatics, known as a "ticket".

This menu options links to the dedicated Clarity Assure Help Wiki (where you are now) which contains various support documents relating to your regional quality improvement project, focus areas and measures. 

It contains such information as:-

• Guides for how to use the Assure system
• Processing Calendars - showing the deadline dates for data submission, data completion and report production
• eBulletins - the communications sent from Clarity to all users with an active Assure account advising of changes to the system, focus areas and/or support services

The Data Dictionary is the name given to the dedicated area of the Clarity Assure Help Wiki which contains the support documents for each focus area for each region.

It contains such information as

• Answer Guidance - guidance for users on where to find the information relevant to each measure question and how to identify the correct answer
• Measure Information - information on the areas of care being assessed as part of the quality improvement project
• Population - list of ICD10 codes (or similar) which have been agreed to identify those patient records who should form the population for a focus area
• Data collection form - this is a downloadable form which shows each question as well as the answer options so that users can use it as a summary sheet within the hard copy patient record.  This can help to speed up the data collation process and aide data input.

You can change your password to access to Assure system using this menu.

You can also assign a security question to your account, this question may then be used by the Assure Team of Clarity Informatics to confirm user information during discussions involving a user's account settings.

Users have the ability to create patient records on Assure to complete the measure questions before SUS data is loaded onto Assure.

PLEASE NOTE:  Once SUS data is loaded into Assure, a matching process takes place between created patients and SUS data.  If the information within the SUS data contradicts that within the created patient record, the SUS data will be dominant and, depending on the SUS data ICD10 coding, may result in the patient being removed from Assure altogether.  Similarly, if a patient record is created and is not able to be matched to SUS data, the created record will be removed from Assure.

 To be able to create a patient the user must enter the Local Patient ID and Admission Date.  Once this is entered the user can then enter a discharge date and specify the focus area to whose population the patient record will be included.

Using information within the SUS data a full list of Wards for a Trust/Site Code are shown within this section of Assure.  New Ward information can also be entered by users.

• Click on Ward option of main toolbar
• Search for relevant site code or name
• This will show all of the existing Wards assigned to that site
• To add a new Ward click on Add new record and complete form data.

Once a new Ward has been added it is available for selection within the measure questions form.