White paper proposals to use Quality and Outcomes Framework data to make commissioning decisions should only be followed with extreme caution, the Primary Health Care Specialist Group (PHCSG) of the British Computer Society has warned.
The PHCSG says the QoF database held on the Quality Management and Analysis System (QMAS) has been collected purely for payment purposes and cannot simply then be used for commissioning care or public health work despite proposals that it should be used for these new purposes, contained in the government’s white paper on care outside hospitals.
Ewan Davis, chairman of the PHCSG, told the Healthcare Computing conference in Harrogate last week that a meeting of the PHCSG to discuss the impact of the white paper on primary care informatics had revealed "much concern" among members about use of QoF data.
The white paper, Our Health, Our Care, Our Say, includes several references to QoF data which it describes as "a clinical database that is unparalleled anywhere else in the world."
The white paper adds: "It is essential that such a unique database is used to improve local decisions on meeting needs. We will ensure that commissioning decisions use QOF data about the local population."
However Cheryl Cowley, a PHCSG committee member who works on the QMAS team at Connecting for Health, told the session that the sole aim of the QoF was to improve quality.
She said: "QMAS is designed only to pay people but the data is already being used for other purposes."
Cowley gave the example of the mental health indicators of the QoF which she said showed that data could be correct for QoF but not an accurate picture of mental health needs across an area.
She added: "It depends who put the data in and what that means. Exceptions can be appropriate for payment systems and not appropriate for other purposes."
Later Davis told EHI Primary Care that the PHCSG was not saying the QoF data could not be used for other purposes but that the limitations of the data and the way it which it had been generated had to be taken into account by those planning to do so.
He added: "There are a number of significant distortions in the data most of which are legitimate for the purposes for which they were collected although there may also be incidences of ‘diagnostic drift’ but we don’t know the extent of that. What we are saying is that if you don’t understand the way the QoF data was assembled you are more likely to misuse it."
At the session Davis presented the results of the PHCSG’s deliberations on the white paper and the challenges it presents for primary care informatics.
He said the white paper would mean the need to develop finer-grained IT systems and services that could be rapidly reassembled to meet changing policy and organisational requirements.
He added: "We need an architectural framework that starts with allowing sharing of knowledge, information and workflows between heterogeneous systems."
Informatics would need to deliver sharing of data and workflows across increasingly fragmented care pathways, to interwork with local government and independent sector systems, to support new approaches of delivering care, to make knowledge and information available to patients and to reach into community facilities and patients’ homes, Davis added.
He told the session: "The policy can’t be delivered without radically different IT and yet the policy makers seem blind to the complexities of the changes required in healthcare business processes and IT."
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