Cleaning Rules: Outpatients

Transcription

1 Document filename: HES OP Cleaning Rules Guide Directorate / Programme Information and Analytics Project Data Quality Document Reference HESDQ_In_004 Project Manager Julie Clough Status Final Owner HES Data Quality Team Version 3.0 Author HES Data Quality Team Version issue date 26/09/2016 Cleaning Rules: Outpatients Copyright 2015 Health and Social Care Information Centre

2 Document Management Revision History Version Date Summary of Changes /05/2015 Document Created /12/15 Removal section is added /09/2016 The corporate transformation from the Health and Social Care Information Centre to NHS Digital. Reviewers This document must be reviewed by the following people: Reviewer name Title / Responsibility Date Version HES Data Quality Team Secondary Care 08/04/ HES Data Quality Team Secondary Care 14/01/ HES Data Quality Team Secondary Care 26/09/ Approved by This document must be approved by the following people: Name Signature Title Date Version Madeleine Watson Programme Manager HES 15/04/ Julie Clough Julie Clough Principal Information Analyst Principal Information Analyst 14/01/ /09/ Page 2 of 36

3 Glossary of Terms Term / Abbreviation CCG CR HES HRG HSCIC NHS ODS OP PbR PCT RTT SUS What it stands for Clinical Commissioning Group Commissioning Region (of NHS England) Hospital Episode Statistics Healthcare Resource Group Health and Social Care Information Centre National Health Service Organisation Data Service Outpatients Payment by Results Primary Care Trust Referral to Treatment Secondary Uses Service Document Control: The controlled copy of this document is maintained in the NHS Digital corporate network. Any copies of this document held outside of that area, in whatever format (e.g. paper, attachment), are considered to have passed out of control and should be checked for currency and validity. Page 3 of 36

4 Contents 1 Introduction Purpose of Document Background 7 2 Data Removals 8 Removal 0001 Remove unmapped records 8 Removal 0010 Remove appdate before 8 Removal 0011 Remove apptdate after 8 Removal 0012 Remove firstatt = 5 8 Removal 0052 Remove duplicates in OP 9 3 Simple Validation 10 5 Removal of pipe characters Ethnos validation Date of Birth validation Appointment Date validation Referral Request Received Date validation Last DNA or Patient Cancelled Date validation Sex - M/F (retired) Sex validation Priority Type - R/U/T (retired) Priority Type validation (renumbered from 80) Main Speciality validation Treatment Speciality validation Medical Staff Type Seeing Patient format (retired) Medical Staff Type Seeing Patient validation (renumbered from 120) Attended or Did Not Attend validation (renumbered from 130) First Attendance validation (renumbered from 140) Service Type Requested validation (renumbered from 150) Source of Referral format (retired) Source of Referral validation (renumbered from 160) Outcome of Attendance validation (renumbered from 170) Attendance Type derivation (renumbered from 200) Days Waiting / Waiting Calculation Indicator derivation (renumbered from 270) Waitdays derivation Age on Day of Appointment derivation (renumbered from 280) 19 Page 4 of 36

5 301 Babyage derivation (renumbered from 300) Homeadd formatting Purcode special values Tretspef to mainspef (renumbered from 350) Carersi validation Referrer missing/invalid Consult missing/invalid Reggmp missing/invalid Gpprac missing Administrative Category validation (renumbered from 480) Location Class format (retired) Location Class validation (renumbered from 490) Opcs43 derivation (retired) Diagraw derivation Operraw derivation (renumbered from 610) Operative Procedure 4 th character (renumbered from 620) Diagnosis code format (renumbered from 630) Diagnosis code 4 th character (renumbered from 640) Diagnosis R69 X in 4 th character (renumbered from 650) Primary Diagnosis null Diagnosis code validation (renumbered from 670) Primary Operative Procedure validation Secondary Operative Procedures validation (renumbered from 690) Gppracha derivation Gppracro derivation Gpprpct/Gpprstha derivation CCG, AT and CR of GP Practice (from 2013/14) Treatment Area derivations CCG of Treatment (from 2013/14) Area Team and Commissioning Region of Treatment (from 2013/14) Purval derivation Purstha derivation (retired) Pctcode/Pctorig derivation Historic PCT of Responsibility derivation (retired) Postcode derived items Area Team and Commissioning Region of Residence (from 2013/14) CCG of Responsibility (from 2013/14) 35 Page 5 of 36

6 1210 IMD Derivation 35 4 HES Items Healthcare Resource Groups HES ID 36 Page 6 of 36

7 1 Introduction 1.1 Purpose of Document To inform users of Hospital Episode Statistics (HES) how we clean the data to improve the value and quality. This document and cleaning rule numbering should be used in conjunction with the HES User Data Dictionary. 1.2 Background Hospital Episode Statistics (HES) data for Outpatients (OP) comes from routine exchanges of information between healthcare providers (normally NHS trusts) and the commissioners for NHS patients in England. Healthcare providers collect administrative and clinical information locally to support the care of patients. The data is submitted to the Secondary Uses Service (SUS), which, as well as forwarding this data onto Commissioners, also copy the data into a SUS database. At prearranged times during the year, an extract from the SUS database is taken for HES. Data on SUS will continue to change but HES data is fixed as it was when the particular extract was taken. On taking a HES extract from SUS data, HES then validates and cleans the extract, before deriving new data items and making the information available in the data warehouse. This document contains a breakdown of rules used for cleaning the OP data and deriving new data items for HES. The HES cleaning rules that pertain to dates will check that the date is not before the start of the data year (year start) or after the end of the period being processed (period end). The data-year starts on 1 st April and ends on 31 st March. In most cases each rule cleans only one data-item. However, there are a few instances where a single rule cleans or derives a set of data-items, such as the postcode derived items. Field values are loaded and recorded without leading or trailing spaces. Therefore, codes originally supplied with superfluous leading or trailing spaces do not fail validation, and are not subject to cleaning because of them. Furthermore, a blank field is null not spaces. Retired A number of rules have been retired since the previous cleaning guide was published. Unless otherwise stated, this is due to changes to SUS meaning that a number of fields are now validated on submission, hence invalid values are no longer present within the HES data extracts. These rules were surplus to requirement and the published data has not been affected. Renumbered Rules For administrative reasons the numbering of some rules was changed in 2013/14. However, the code is not affected. Page 7 of 36

8 2 Data Removals As part of the process of improving the value and quality of the data, some records are removed during HES core processing. Records on any of these categories are removed: Records that cannot be attributed to a valid ODS provider Duplicate records Records that fall out of the reporting period Please note that the number of records deleted in months 3, 6, 9 and 12 are lower than other months as all records outside the reporting period are automatically removed prior to being processed in HES. Removal 0001 Remove unmapped records All records submitted under an invalid ODS provider code that cannot be attributed (mapped) to a valid one are deleted. For all records delete if: procode3 = 9X9 Removal 0010 Remove appdate before Deletes records where the date when an appointment was scheduled is before the submission year. apptdate < year start date Removal 0011 Remove apptdate after Deletes records where the date when an appointment was scheduled is after the submission year. apptdate > period end date Removal 0012 Remove firstatt = 5 Deletes records where the First Attendance is set to 5 (Referral to treatment clock stop administrative event) firstatt = 5 Page 8 of 36

9 Removal 0052 Remove duplicates in OP Records identified as being submitted multiple times are deleted from the monthly provisional data. See Methodology/pdf/HES_Duplicate_Identification_and_Removal_Methodology.pdf Page 9 of 36

10 3 Simple Validation 5 Removal of pipe characters The pipe character ( ) is used as a concatenation delimiter during processing and therefore the presence of this character in any fields can cause problems. This rule removes where present. 10 Ethnos validation Ethnic group, as supplied, is retained as ethraw/ethrawl. Ethnos is loaded from ethraw or, if that is null, from ethrawl. Ethnos is validated against the 2001 census values. For all records: Set ethnos = ethraw If ethraw is null set ethnos = ethrawl If ethnos is null or not in the range A, B, C, D, E, F, G, H, J, K, L, M, N, P, R, S, Z set ethnos to 99 (set to X prior to 2013/14) 20 Date of Birth validation The patient's date of birth (dob) must lie between 1/1/1802 and the last day of the period being processed. For all records: If dob is invalid set to the invalid date default 01/01/1801 If dob is null set to the missing date default 01/01/1800 Page 10 of 36

11 30 Appointment Date validation All Outpatient appointment dates (apptdate) must lie between the start of the current year and the last day of the period being processed. If apptdate is null set to missing date default 01/01/1800 If apptdate is < period start date OR apptdate > period end date OR invalid set to invalid date default 01/01/ Referral Request Received Date validation All Outpatient referral request received dates (reqdate) should fall between 1 st April 5 years previous to the current submission year and the last day of the current processing period. If reqdate is null set to missing date default 01/01/1800 If reqdate is < period start date 5 years previous OR reqdate > current period end date OR reqdate is invalid set to invalid date default 01/01/ Last DNA or Patient Cancelled Date validation All Outpatient last DNA or patient cancelled dates (dnadate) should fall between 1 st April 5 years previous to the current submission year and the last day of the current processing period. If dnadate is null set to missing date default 01/01/1800 If dnadate is < period start date 5 years previous OR dnadate > current period end date OR dnadate is invalid set to invalid date default 01/01/1801 Page 11 of 36

12 50 Sex - M/F (retired) The patient's sex (sex) is sometimes given, erroneously, as M/F or m/f rather than 1/2. For all attendances: If sex = M or m set sex = 1 If sex = F or f set sex = 2 60 Sex validation If sex is null, it is overwritten with the appropriate value for not known. For all records: If sex is null set sex = 0 70 Priority Type - R/U/T (retired) The priority type (priority) is sometimes given erroneously as R/U/T or r/u/t, not 1/2/3 If priority = R or r set priority = 1 If priority = U or u set priority = 2 If priority = T or t set priority = 3 Page 12 of 36

13 81 Priority Type validation (renumbered from 80) If priority is invalid, it is overwritten with the appropriate value for not known. If priority <> 1, 2, 3 or 9 set priority = 9 90 Main Speciality validation If the main specialty is null, it is overwritten with the appropriate value for not known. If mainspef is null Set mainspef = & 100 Treatment Speciality validation If the treatment specialty is null, it is overwritten with the appropriate value for not known. If tretspef is null set tretspef = & 110 Medical Staff Type Seeing Patient format (retired) If Medical staff type seeing patient (stafftyp) is not 2 characters in length then it is left padded with '0' or '00' as appropriate. 121 Medical Staff Type Seeing Patient validation (renumbered from 120) If medical staff type seeing patient (stafftyp) contains an invalid entry, it is overwritten with the appropriate value for not known. If stafftyp <> or 99 set stafftyp = 99 Page 13 of 36

14 131 Attended or Did Not Attend validation (renumbered from 130) If the Attended or Did Not Attend field (attended) contains an invalid entry, it is overwritten with the appropriate value for not known. If attended <> 2 7 or 9 set attended = First Attendance validation (renumbered from 140) If First Attendance (firstatt) is null, it is overwritten with the appropriate value for not known. If firstatt is null set firstatt = X 151 Service Type Requested validation (renumbered from 150) If Service Type Requested (servtype) is null, it is overwritten with the appropriate value for not known. If servtype is null set servtype = Source of Referral format (retired) If Source of referral (refsourc) is not 2 characters in length then it is left padded with '0' or '00' as appropriate. Page 14 of 36

15 161 Source of Referral validation (renumbered from 160) If Source of Referral (refsourc) is null, it is overwritten with the appropriate value for not known. If refsourc is null set refsourc = Outcome of Attendance validation (renumbered from 170) If Outcome of Attendance (outcome) is null, it is overwritten with the appropriate value for not known. If outcome is null set outcome = Attendance Type derivation (renumbered from 200) Attendance Type (atentype) is derived using the values of Attended or Did Not Attend (attended) and First Attendance (firstatt). If attended = 5 or 6 If firstatt = 1 set atentype = 1 Else if firstatt = 2 set atentype = 2 Else if firstatt = 3 set atentype = 21 Page 15 of 36

16 Else if firstatt = 4 set atentype = 22 Else set atentype = 3 Else if attended = 3 or 7 If firstatt = 1 set atentype = 4 Else if firstatt = 2 set atentype = 5 Else if firstatt = 3 set atentype = 24 Else if firstatt = 4 set atentype = 25 Else set atentype = 6 Else if attended = 2 If firstatt = 1 set atentype = 7 Else if firstatt = 2 set atentype = 8 Else if firstatt = 3 set atentype = 27 Else if firstatt = 4 set atentype = 28 Else set atentype = 9 Page 16 of 36

17 Else if attended = 4 If firstatt = 1 set atentype = 10 Else if firstatt = 2 set atentype = 11 Else if firstatt = 3 set atentype = 30 Else if firstatt = 4 set atentype = 31 Else set atentype = 12 Else if attended <> 2 7 set atentype = Days Waiting / Waiting Calculation Indicator derivation (renumbered from 270) Days waiting (waiting) is derived to give the days between the appointment date and either the Referral request received date or the Last DNA or patient cancelled date, if provided. If the calculation returns a negative then waiting is set to null. This field is not calculated if reqdate is missing or invalid. Waiting calculation indicator (wait_ind) indicates whether and how waiting has been calculated. If reqdate is null set waiting to null and set wait_ind = 1 Else if reqdate < 01/01/1970 set waiting to null and set wait_ind = 2 Else if reqdate > apptdate set waiting to null and set wait_ind = 3 Page 17 of 36

18 Else if reqdate is not a valid date set waiting to null and set wait_ind = 5 Else if dnadate is null and reqdate and apptdate are valid set waiting = apptdate reqdate and set wait_ind = 0 Else if dnadate is a valid date > 1/1/1970 and > reqdate and < apptdate set waiting = apptdate dnadate and set wait_ind = 0 Else set waiting to null and set wait_ind = Waitdays derivation Gives the period in days between the referral to treatment period start and end dates. waitdays = rttperend rttperstart If rttperstart is null/invalid OR rttperend is null/invalid OR if waitdays < 0 OR waitdays > 8887 set waitdays to null Page 18 of 36

19 281 Age on Day of Appointment derivation (renumbered from 280) The patient s age in years on the day of an appointment (apptage). It is recorded as a whole number of years (i.e. any days or months produced by the calculation are ignored, unless apptage is less than 1 year). apptage = apptdate dob (years) If dob and/or apptdate are null/invalid OR apptage < 0 set apptage to null If apptage > 120 set apptage = 120 For apptage < 1year If apptage (in days) = 0 set apptage = 7001 If apptage (in days) is between 1 and 6 set apptage = 7002 If apptage (in days) is between 7 and 28 set apptage = 7003 If apptage (in days) is between 29 and 90 set apptage = 7004 If apptage (in days) is between 91 and 181 set apptage = 7005 If apptage (in days) is between 182 and 272 set apptage = 7006 If apptage (in days) is between 273 and 365 set apptage = 7007 Page 19 of 36

20 301 Babyage derivation (renumbered from 300) The age of a baby, in days, on the day of the appointment is calculated by subtracting the baby s date of birth (dob) from the appointment date (apptdate). Babyage is not calculated if the patient is older than 28 days (i.e. apptage must be in the range 7001 to 7003). For apptage = : babyage = apptdate dob (days) If apptdate and/or dob are null or babyage < 0 set babyage to null 330 Homeadd formatting The postcode data item (homeadd) should contain a standard 8-character postcode. All postcodes have non-space characters in positions 6-8 and a space in position 5. Positions 1-4 contain left-justified characters and may contain trailing spaces, e.g. B1 3XT, B11 5TG, EC1N 3BN, GU26 8PQ. This rule corrects incorrectly formatted postcodes, as follows: 1. Convert lower case alpha characters to upper case 2. If string is less than 8 characters, remove spaces and, from resulting string, move right-most 3 characters to character positions 6-8, space-filling where necessary. For all records: If homeadd is incorrectly formatted, convert to correct 8-character format. 340 Purcode special values For all Outpatients, the purchaser/commissioner field (purcode) is cleaned, replacing the most common invalid values used for private patients and Supra Regional Services codes with valid codes. For all records: If purcode = TDHOO, TDH99, TDK00, THD00, THH00, DH000, DHOOO, DHL00, DHLOO, OOOOO or TDO00 OR the 1 st 3 characters = DOH set purcode = TDH00 Page 20 of 36

21 351 Tretspef to mainspef (renumbered from 350) If main specialty is missing or invalid, but treatment specialty is valid as a main specialty, transfer the treatment specialty to the main specialty. For all records: If mainspef = & and tretspef <> & set mainspef = tretspef 400 Carersi validation If the Carer Support Indicator field is null, it is overwritten with the code for not known. For all records: If carersi is null set carersi = Referrer missing/invalid If the referrer code field is empty, it is overwritten with the code for not known. If the referrer is not in a valid format, it is overwritten with the code for invalid. For all records: If referrer is null set referrer = & (below added from 2013/14) If referrer does not start with C, CD, D, G, S, ZE, ZN, ZS or ZW AND does not equal R , X , A , P or & set referrer = 99 Page 21 of 36

22 420 Consult missing/invalid If the consultant code field is empty, it is overwritten with the code for not known. If the consult is not in a valid format, it is overwritten with the code for invalid. For all records: If consult is null set consult = & (below added from 2013/14) If consult does not start with C, CD or D AND does not equal H , M , N or & set consult = Reggmp missing/invalid If the patient s registered GP code field is null, it is overwritten with the code for not known. If the reggmp is not in a valid format, it is overwritten with the code for invalid. For all records: If reggmp is null set reggmp = & (below added from 2013/14) If reggmp does not start with G, S, ZE, ZN, ZS or ZW AND does not equal A , P , R or & set reggmp = Gpprac missing If the GP practice code field is null, it is overwritten with the code for not known. For all records: If gpprac is null set gpprac = & Page 22 of 36

23 481 Administrative Category validation (renumbered from 480) Administrative category (admincat) is validated and re-derived where necessary. If admincat = 02, 2, 20, 21, 22 or 23 OR purcode = VPP00 set admincat = 02 If admincat = 01, 1, 10, 11, 12 or 1M set admincat = 01 If admincat = 03, 3 or 30 set admincat = 03 If admincat = 04, 4 or 40 set admincat = 04 Else set admincat = Location Class format (retired) If Location Class (locclass) is not 2 characters in length then it is left padded with '0' or '00' as appropriate. 491 Location Class validation (renumbered from 490) If Location Class (locclass) contains an invalid entry, it is overwritten with the appropriate value for not known. If locclass = 1 set locclass = 01 (included in this rule from 2013/14) If locclass <> 01, 02, 03, 04, 05 or 99 set locclass = 99 Page 23 of 36

24 565 Opcs43 derivation (retired) The OPCS43 flag indicates whether at least one operative procedure code is present in the OPCS4.3 set and not in the OPCS4.2 set. For epistat = 3 and epitype = 1, 2 or 3, for nn = 01 24: Set opcs43 = N If oper_nn is an OPCS4.3-only code set opcs43 = Y This rule was created temporarily to monitor uptake of OPCS4.3 and is now redundant. 600 Diagraw derivation The un-cleaned primary diagnosis (diag_01) is retained in diagraw. If diag_01 is not null set diagraw = diag_ Operraw derivation (renumbered from 610) The un-cleaned primary operative procedure code (opertn_01) is retained in operraw. If opertn_01 is not null set operraw = opertn_ Operative Procedure 4 th character (renumbered from 620) The operative procedure fields should comprise a letter followed by 3 digits. However, if the field consists of only three characters or the fourth character is a dash or period, the fourth character is set to a nine. For all appointments, for nn = 01-24: If opertn_nn = [A-Z] [0-9] [0-9] [< > or <.>] OR opertn_nn = [A-Z] [0-9] [0-9] set the 4 th character to 9 Page 24 of 36

25 631 Diagnosis code format (renumbered from 630) All ICD-10 codes start with a letter and are followed by two or three characters. The third digit is preceded by a full stop in ICD-10, but this is not stored in the HES diagnosis fields. Therefore, all diagnoses are updated to reflect this. For all appointments, for nn = 01 12: If 1 st 5 characters of diag_nn = ann.z set 1 st 5 characters of diag_nn to annz<space> append the 6 th character where present NB. a = alpha (i.e. a letter), n = numeric and z = numeric or x 641 Diagnosis code 4 th character (renumbered from 640) All ICD-10 diagnosis codes start with a letter and are followed by two or three digits. If the code consists of only 3 characters or the fourth character is a space, and the first three characters are valid, then if the first three characters form a valid three character ICD-10 code, an X is appended. If not, a 9 is appended. For all records, for nn = 01 12: If the 4 th character of diag_nn is a space OR diag_nn is three characters long If the 1 st 3 characters of diag_nn plus X form a valid code set the 4 th character of diag_nn to X Else set the 4 th character of diag_nn to 9 append the 5 th and 6 th characters where present Page 25 of 36

26 651 Diagnosis R69 X in 4 th character (renumbered from 650) For all diagnoses (diag_01 to diag_12) coded as not known/invalid (R69), the fourth character should be X. Therefore, it is corrected if necessary. For all records, for nn = 01 12: If the 1 st three characters of diag_nn = R69 and the 4 th character <> X set the 4 th character to X append the 5 th and 6 th characters where present 660 Primary Diagnosis null If the primary diagnosis field is null the diagnosis is overwritten with the value for missing. For all records: If diag_01 is null set diag_01 = R69X6 671 Diagnosis code validation (renumbered from 670) All diagnoses containing data are checked against the ICD-10 codes having four characters. Where it is not possible to match all four characters with an ICD-10 code, the diagnosis is overwritten with the value for not valid. For all records, for nn = 01 12: If the 1 st 3 characters of diag_nn = R69 no need to look up on the table Else validate the 1 st 4 characters of the diagnosis codes against the ICD-10 code reference table If diag_nn is invalid set diag_nn = R69X8 Page 26 of 36

27 680 Primary Operative Procedure validation Where there is an entry in the primary operative procedure field, this is checked against a library of valid OPCS-4 codes, excluding codes commencing with Z. If a match cannot be found, the contents are overwritten with the code for invalid operative procedure. If the field is null, it is set to hyphen indicating no operation. If opertn_01 is null set opertn_01 = - (prior to 2013/14 opertn_01 was set to X997 if null) If opertn_01 starts with Z, O11, O13 or O14 OR opertn_01 <> - or & OR opertn_01 is not a valid OPCS code set opertn_01 = & (prior to 2013/14 X997, X998 and X999 were all deemed valid in opertn_01; from 2013/14 they are set to &) 691 Secondary Operative Procedures validation (renumbered from 690) The secondary operative procedure fields are checked against a library of valid OPCS-4 codes. If a match cannot be found, the contents are overwritten with the code for invalid operative procedure. For all records, for nn = 02 24: If opertn_nn <> X998 or X999 and is not null and is not a valid OPCS code set opertn_nn = & 1110 Gppracha derivation The Health Authority of the GP practice that recommended treatment. Look up gpprac on the Organisation Units table If gpprac is found and orgtype = PRACTICE set gppracha = Health Authority of the identified organisation unit Else gppracha = Y Page 27 of 36

28 1120 Gppracro derivation The Regional Office of the GP practice that recommended treatment. Look up gpprac on the Organisation Units table If gpprac is found and orgtype = PRACTICE set gppracro = RO of the identified organisation unit Else gppracro = Y Gpprpct/Gpprstha derivation The PCT and Strategic Health Authority of the GP practice that recommended treatment. Look up gpprac on the Organisation Units table If gpprac is found and orgtype = PRACTICE then gpprstha = Health Authority of the identified organisation unit gpprpct = PCT of the identified organisation unit Else gpprstha = Y and gpprpct = CCG, AT and CR of GP Practice (from 2013/14) The CCG, Area Team and Commissioning Region where the patient's GP Practice is registered. Look up gpprac on the Organisation Units table. If found: set ccg_gp_practice = CCG of the identified organisation unit set at_gp_practice = Area Team of the identified organisation unit set cr_gp_practice = Commissioning Region of the identified organisation unit If cr_gp_practice is null set cr_gp_practice = at_gp_practice Else set ccg_gp_practice = 59999, at_gp_practice = Y and cr_gp_practice = Y Page 28 of 36

29 1145 Treatment Area derivations Derives administrative areas where the treatment took place. The provider code (procode) on the incoming data may be: A 3-character code representing an NHS trust or independent provider A 3-character NHS trust or independent provider code followed by pseudo site code such as '00' A valid 5-character code of the main site of the provider A 5-character code representing a treatment centre at an NHS trust or an independent provider A 5-character code of another provider such as a hospice. Entries appear on the Organisation Units table for providers and some provider sites. Each entry contains a data item procodet (provider code for tabulation) which contains a 3- character or a 5-character code indicating whether the data should be aggregated at the 3- character level or whether it should be presented at the 5-character level. Look up 1 st 5 characters of procode on Organisation Units table. If 5-character procode <> procodet of Organisation Units table entry then should be aggregated at 3-charcter level: Look up 1 st 3 characters of procode on Organisation Units table. When organisation is found at 5 or 3 character level: procodet = tabulation provider code of the organisation protype = provider type of the organisation pcttreat = PCT of the organisation sthatret = StHA of the organisation gortreat = GOR of the organisation hatreat = HA of the organisation rotreat = RO of the organisation If any of the above are null, use default values below: procodet = 1 st 5 characters of procode protype = null pcttreat = sthatret = Y gortreat = Y hatreat = Y rotreat = Y00 Page 29 of 36

30 1146 CCG of Treatment (from 2013/14) Assigns the CCG where the patient was treated and sets the origin field to show how this has been derived. Firstly derives CCG from the postcode of Site of Treatment. If not available, the Provider postcode is used. First pass looks up sitetret in Organisation Units table to obtain the Site of Treatment postcode. If found: look up postcode in the NHS Postcode Directory ccg_treatment = CCG related to identified postcode ccg_treatment_origin = 1 Second pass looks up procodet in Organisation Units table (if procodet ends in -X, looks up 1 st 3 characters) to obtain the Provider postcode. If found: look up postcode in the NHS Postcode Directory ccg_treatment = CCG related to identified postcode ccg_treatment_origin = 2 Else ccg_treatment = and ccg_treatment_origin = Area Team and Commissioning Region of Treatment (from 2013/14) The Area Team and Commissioning Region where the patient received treatment are derived using the CCG of treatment. Look up ccg_treatment on the Organisation Units table. If found: set at_treatment = Area Team of the identified organisation unit set cr_treatment = Commissioning Region of the identified organisation unit If cr_treatment is null set cr_treatment = at_treatment If ccg_treatment = set at_treatment = Y and cr_treatment = Y (Unknown) Page 30 of 36

31 1150 Purval derivation Purval indicates whether the commissioner (purcode) is one that is recognised throughout the NHS (purval = 1). If the commissioner code is not recognised (purval = 0) it may be that the code is one that has been agreed locally between the hospital provider and the health care commissioner concerned. Look up 5-character purcode and then 1 st 3 characters of purcode in Organisation Units table. If either found: set purval = 1 Else set purval = Purstha derivation (retired) Look up purcode in organisation Unit table. If not found: look up purcode [1, 3] in the Organisation Unit table. If found: set purstha = Strategic Health Authority of organisation found else set purstha = Y This rule was retired from 2013/14, however Strategic Health Authority is still derived from GP Practice, treatment site and home postcode in rules 1125, 1145 and 1200 respectively Pctcode/Pctorig derivation Pctcode is the 'PCT of responsibility'. Ideally, it is identified by establishing the PCT of the patient's GP practice. However, if that information is not available, the algorithm defaults to the PCT of the GP practice of the patient's GP, and then to the patient's PCT of residence. First try GP practice Look up gpprac in the Organisation Units table. If found: pctcode = PCT of gpprac pctorig = 1 (derived from GP practice code) If GP practice not found, then try GP Look up reggmp in Healthcare Practitioner table. If found: Pick up GP's practice code Look up GP's practice code in Organisation Units table. If found: pctcode = PCT of GP's practice pctorig = 2 (derived via GP code) Page 31 of 36

32 If GP not found, then try postcode Look up homeadd in the Postcode table. If found: Check PCT of residence on Postcode table is a PCT or Care Trust, not a Health Board If orgtype is PCT or CARETRUST pctcode = PCT of postcode (respct) pctorig = 4 (derived via patient's postcode) Else pctcode = and pctorig = 6 If postcode not found If pctcode is null pctcode = pctorig = Historic PCT of Responsibility derivation (retired) The Historic PCT of responsibility (pctcode02) is ideally identified by establishing the historic PCT of the patient's GP practice. However, if that information is not available, the algorithm defaults to the PCT of the GP practice of the patient's GP, then to the purchaser code if that is a PCT and, failing that, to the patient's PCT of residence. First try GP practice Look up gpprac in the Organisation Units table. If found: pctcode02 = PCT of gpprac pctorig02 = 1 (derived from GP practice code) If GP practice not found, then try GP Look up reggmp in Healthcare Practitioner table. If found: Pick up GP's practice code Look up GP's practice code in Organisation Units table. If found: pctcode02 = PCT of GP's practice pctorig02 = 2 (derived via GP code) If GP not found, then try Commissioner Code Look up purcode [1, 5] in the Historical Organisation Units table. If not found: Look up purcode[1, 3]<space><space> in the Organisation Unit table. If found: Page 32 of 36

33 pctcode02 = PCT of organisation found pctorig02 = 3 If Commissioner Code not found, then try Postcode Look up homeadd in the Postcode table. If found: Check PCT of residence on Postcode table is a PCT or Care Trust, not a Health Board If orgtype is PCT or CARETRUST pctcode02 = PCT of postcode (respct02) pctorig02 = 4 (derived via patient's postcode) Else pctcode02 = and pctorig02 = 6 If postcode not found If pctcode02 is null pctcode02 = pctorig02 = Postcode derived items The full postcode of the patient s home address (homeadd) is used to populate the derived fields giving other area classifications for the patient s place of residence. Look homeadd up in the Postcodes table. If the postcode is found: Else gridlink = Y Set the following items from the Postcode entry: gridlink, currward, currward_ons, rescty, rescty_ons, resha, resstha06, respct06, ccg_residence, resladst, resladst_ons, resro, resgor, resgor_ons, ward91, oacode01, oacode6, pcon, pcon_ons, cannet, canreg, lsoa01, msoa01, rururb_ind, oacode11, lsoa11, msoa11, resstha02*, respct02* Set the pcfound flag to Y currward = Y currward_ons = Y rescty = Y rescty_ons = Y Page 33 of 36

34 resha = Y resstha06 = Y respct06 = ccg_residence = resladst = Y resladst_ons = Y resro = Y00 resgor = Y resgor_ons = Y ward91 = Y oacode01 = Y oacode6 = Y pcon = Y pcon_ons = Y resstha02 = Y* respct02 = 59999* Set the pcfound flag to N Note oacode01, lsoa01 and msoa01 were named oacode, soal and soam respectively prior to 2013/14; fields oacode11, lsoa11 and msoa11 were added to rule from 2013/14 * resstha02 and respct02 were only populated prior to 2013/ Area Team and Commissioning Region of Residence (from 2013/14) Sets the Area Team and Commissioning Region where the patient lived immediately before admission, appointment, or attendance. Look up ccg_residence in Organisation Units table. If found: at_residence = Area Team of the identified organisation unit If at_residence is null set at_residence = Y cr_residence = Commissioning Region of the identified organisation unit If cr_residence is null set cr_residence = at_residence Page 34 of 36

35 1205 CCG of Responsibility (from 2013/14) Assigns the most suitable CCG of responsibility and sets origin field to show how this is derived. Uses the CCG of GP practice where available. If not, uses CCG of residence then CCG of treatment. First try CCG of GP practice If ccg_gp_practice is in the form [0-9][0-9][A-Z] set ccg_responsibility = ccg_gp_practice set ccg_responsibility_origin = 1 If no valid CCG of practice, try CCG of residence If ccg_residence is in the form [0-9][0-9][A-Z] set ccg_responsibility = ccg_residence set ccg_responsibility_origin = 2 If no valid CCG of residence, try CCG of treatment If ccg_treatment is in the form [0-9][0-9][A-Z] and ccg_treatment_origin = 1 or 2 if ccg_treatment_origin is 1 set ccg_responsibility_origin = 3 if ccg_treatment_origin is 2 set ccg_responsibility_origin = 4 set ccg_responsibility = ccg_treatment If no valid CCG of treatment If ccg_responsibility is null set ccg_responsibility = set ccg_responsibility_origin = IMD Derivation If the first character of the soal is E and IMD data exists for this soal, then the Indices of Mass Deprivation fields are populated. Page 35 of 36

36 4 HES Items At a later stage in the processing the following data items are added to the APC records: 4.1 Healthcare Resource Groups Healthcare Resource Group (HRG) Codes are generated using approved NHS grouper software. This process will normally produce the same codes as generated by NHS providers, but the effects of data cleaning and possible differences in the implementation of the grouper may lead to differences. Note that HES generates HRGs on an episode basis, whereas the Connecting for Health SUS PbR service provides spell based HRG analysis (i.e. in the case of multiple episode spells, one of the HRGs is selected to represent the whole spell). 4.2 HES ID The HES Identifier is a code intended to uniquely identify an individual patient across all data years from onwards. It is generated by a complex algorithm that compares a number of person-related items collected by HES (currently NHS number, home address postcode, provider code + local patient identifier, gender and date of birth). Users of the HES ID should be aware that the integrity of this data item cannot be guaranteed in all cases. There is always a slight possibility that records for different people may inadvertently be assigned the same identifier because of similarities in the person items. Page 36 of 36