A feasibility study was started in 2018 to consider the development of a platform to host NJR services. The purpose of the platform is to deliver a set of services used by all NJR applications and reporting services. The Platform will act as a single point of access to all services for users so that, for example, only one user name and password will be required to access all NJR services that a user is permitted to use. The Platform will enable new applications and services to be delivered more quickly and easily than is possible now, make reporting and the use of data more flexible, and will ensure that the NJR services are not vendor-dependent.
The feasibility report, ‘Alpha Phase’ will be complete in the summer of 2019 and will be considered by the Steering Committee before the next stage, ‘Beta Phase’, is started. Beta Phase will include the implementation of the Platform’s shared services and the migration of at least one service from its current platform. The first service to move across is likely to be NJR Clinician Feedback. The Alpha Phase report will recommend the order in which reporting services will be implemented, with the final priority order being agreed by the Steering Committee.
The NJR delivers three key systems as part of its ‘Feedback’ reporting services to clinicians, trust and hospital management, and to suppliers.
NJR Clinician Feedback
NJR Clinician Feedback is a secure, surgeon-only website that enables surgeons to compare their clinical practice with that of their colleagues at a local, regional and national level. In 2018/19 a number of changes were made to the service and these included:
• A new Standard Mortality Ratio (SMR) funnel plot based on the most recent five years of data.
• Changes to the Primary Procedure Report and the Revision Procedure Report (for hips and knees only) to account for the changes introduced as part of the MDSv7 implementation. These reports were also made available to surgeons other than consultant surgeons, i.e. any surgeon grade where the surgeon is listed as ‘Lead Surgeon’.
• Changes to the Revision Rate Report for hips and knees to account for the new primary and revision procedure types included in MDSv7.
It was agreed that, as NJR Clinician Feedback was likely to be the first service implemented on the new Platform, any further changes would be limited to outcomes reports for hip and knee joint replacements only. The remaining planned changes for 2019/20 include:
• Changing revision funnel plots based on all NJR data (‘Life of Registry’ data) to those based on the last ten years of data (hips and knees only).
• The inclusion of a new report, similar to the Consultant Level Report, for Associate Grade Surgeons (the ‘Surgeon Level Report’).
• Notifications to surgeons for whom there is either a Consultant Level Report (CLR) or a Surgeon Level Report (SLR) that the reports are available.
• Reminders to Consultants that their appraisal is due and that their CLR is available for download and should be used as part of the appraisal.
Consultant Level Report
The Consultant Level Report contains information about a Consultant’s practice, including the outcomes of surgery, where available. The British Orthopaedic Association (BOA) encourages surgeons to use the report as part of the appraisal and revalidation process and surgeons are required, via NJR Clinician Feedback, to declare that they have read the report, validated the data contained in it, and that they intend to use it as supporting information for their next annual appraisal. Changes to the report for the report produced in 2018 included:
• Adding funnel plots as ‘Lead Surgeon’ so that the consultant can determine the outcomes of those procedures where they were the operating surgeon.
• The addition of a funnel plot showing a 90-Day Standardised Mortality Ratio.
• A new table showing ‘Revision of revisions’.
NJR Management Feedback
NJR Management Feedback is aimed primarily at senior management, including Chief Executives, Medical Directors, hospital managers, and Clinical Directors. The reports contained within NJR Management Feedback are also made available to Consultants, via NJR Clinician Feedback, but only for those trusts or hospitals with which they are associated.
The service currently includes an Annual Clinical Report and Price Benchmarking reports.
NJR Supplier Feedback
NJR Supplier Feedback is a secure online subscription service for manufacturers and suppliers of orthopaedic implants, designed to help suppliers with post-market surveillance.
In addition to providing data about the use of implants in primary procedures, NJR Supplier Feedback enables suppliers to access data about the use of their own implants in revision and revision of revision procedures. Data is available for all joint types.
A number of different services are available dependent upon the subscription level signed up to by a supplier, including an Implant Quality Monitoring (IQM) service which provides pre-formatted reports on individual implants and patient reported outcomes. From 2018/19 these included implant level PROMs scores.
Any device supplier wishing to register for a subscription service or to find out more about what the service provides should contact the NJR Service Desk.
Annual Clinical Report
The Annual Clinical Report (ACR) provides senior management with information about the joint replacement activity in their organisation, including outcomes. For the 2017/18 report published in 2018, the following enhancements were included:
• The use of data from Patient Episode Database Wales (PEDW) to determine the compliance rates for ankle, elbow, and shoulder joint replacement procedures in NHS Wales.
• The report detailing those surgeons who had, or had not, downloaded their Consultant Level Report was expanded to include information about whether or those surgeons had declared that they had read their report and planned to use it as part of their next appraisal.
• Two new Standardised Revision Rate (SRR) funnel plots for knee replacements.