Clinical governance and accountability

Clinical Governance and Accountability in Cancer Networks - Data Logging and Data Attribution - - Roger Cooley#, Roger James* #Lecturer, Computing Laboratory, University of Kent at Canterbury *Clinical Director, Kent Cancer Network Summary Managed care networks require a novel approach to data collection and clinical governance. Prospective data collection requires accountability to be linked to attributability for data logging. Networks are more likely to involve transfer of patients between health sectors and systemic (multi-disciplinary) rather than individual accountability. In NHS cancer networks there is an urgent need to co-ordinate prospective data collection and clarify its relationship with clinical governance. At present a series of datasets cover structural, process and outcome standards for cancer patients. Multiple Datasets · The Manual of Cancer Service Standards [1] governs the collection of data regarding structures (staffing and policies). A planned bi-annual review of performance using the Manual is likely to include measures of implementation of policies. · The Gillis Report [2] recommends the transfer of accountability for collecting the cancer registry core dataset to NHS Trusts from 2001. This dataset currently includes processes such as pathological and radiological staging and treatment. Ultimately cancer registries link these data to epidemiological outcome measures like mortality. · Other processes covering performance such as waiting times to treatment are collected through Trust and Health Authority management systems. · The Cancer Minimum Dataset [3] is designed to collect a series of processes for all patients with cancer. · From time to time, clinicians collect retrospective audit or prospective randomised clinical trial outcome data. These link individual patient survival times, response, recurrence and adverse events to individual treatment. Recommendations · The collection of most process-orientated data for the three commonest cancers should be be via the Multi-Disciplinary Team Meeting (MDTM) held in most cancer units (Hospitals) on a weekly basis.. · Many data relevant to cancer are recorded on electronic systems in trust management, pathology or radiology departments. Research is needed to propose specification techniques for ICT systems to support MDTM's or components of other relevant systems, and hence contribute to the incremental implementation of the ''Information for Health'' agenda. There is also a need to show how data logging and attribution problems can be ameliorated through ICT supported systems. · A coherent approach to clinical governance based on prospective data collection involves alignments with Knowledge Management, Information Systems Specification and Health Informatics. It also implies the development of systems that will enable each health professional to cooperate in decision making in such a way that decisions and commitments are attributable, that quality assurance is facilitated to ensure that data collection is both accurate and timely.