In 2017/18 the NJR undertook a review of the data that it collects about joint replacement procedures: the Minimum Data Set (MDS). The review was completed in the middle of the year, and development started in October 2017. The planned go-live for MDS Version 7 (MDSv7) is early June 2018. In addition to making changes to the data being collected, the project will also refresh the user interface on the data entry application which has remained largely unchanged since 2003. The changes will not entail the re-training of staff, however. The updated data entry system will also support more Internet browsers.
The reasons for the changes are due to changes in clinical practice and advances in the variety and design of implant technology: the two factors are often inter-related.
The NJR established an MDS Review Group with Mr Matthew Porteous as the Chair. The reason for the formation of the group was to ensure that proposed changes were appropriate to the aims of the NJR, necessary, and did not impose an additional data entry burden on the staff collecting and entering the data. All proposed changes were reviewed by, and agreed with, the relevant professional societies, along with the NJR’s Regional Clinical Coordinators. Some proposals sought to collect too much data, most of which was more relevant to the needs of research than to the aims of a registry. With MDSv2, the NJR learned that asking for too much data to be collected results in poor compliance and poor data quality. The Review Group had the final say on the changes and these were communicated to the professional societies.
There were many changes but most included the addition of new options under existing headings. Some data fields, including free text fields, were also removed. The major changes were to Shoulder primary and revision procedures which are significantly different to MDSv6. Another major change is the addition of ‘Debridement and Implant Retention (DAIR)’, both with and without modular exchange, to all revision procedures. Although the NJR has always viewed these procedures as a revision, there has been some doubt amongst surgeons as to whether or not DAIR procedures should be submitted. It is hoped that the inclusion of DAIR will reduce the number of un-reported revision procedures.
All hospitals have been informed of the move to MDSv7 and a communications plan was been prepared to ensure that all hospitals are ready for the go-live date. The new MDSv7 collection forms were made available in March 2018.
For NHS England, the NJR is an NHS Information Standard, DCB1567 ‘National Joint Registry Data Set’. As such, any changes have to go through a formal approvals process. The process usually takes up to five months complete and includes peer review, a consultation period, an assessment of the burden, and ensuring the changes are agreed with the NHS Data Dictionary. The outcome of the process is four documents:
• A Change Specification
• The Specification
• An Implementation Guide
• An Information Standards Notice.
More information and these documents, including the NHS Data Dictionary entry, are available from the ‘Standards and collections section’ of the NHS Digital website.