National Clinical Analysis and Specialised Applications Team
National Radiotherapy Dataset - RTDS
Radiotherapy is a major modality in the treatment of cancer and also represents a significant sector
within the NHS, in terms of both workforce and capital investment. From 1st April 2009, all facilities
providing radiotherapy services are required to return the RTDS, the current version of which can be
Radiotherapy Attendance Record and Dataset v4.doc.
When the radiotherapy Körner return was disbanded in 1995, there was no longer a central collection of data for radiotherapy activity. Dr Brian Cottier recognised the gap in information and looked towards the Verify and Record, a software system loaded on microcomputers linked to an accelerator, to supply the missing data. The V & R quickly evolved to a more complex networked client-server environment, Oncology Management System (OMS).
NATCANSAT piloted a project of Radiotherapy Episode Statistics (RES) which ran from 2003 to 2008. The objective was to investigate the feasibility of extracting data from the OMS and linking it with patient demographic data found only on the hospital administration systems. It soon became apparent the processes of data entry and coding with the OMS were inconsistent between radiotherapy trusts and for a central reporting to become feasible a common set of currencies, formatting and coding needed to be adopted. Work on this standardisation of the data continues particularly around the coding of the new technologies such IMRT and SABR. Nevertheless the Information Standards Board mandated the Radiotherapy Dataset RTDS and since April 2009, NATCANSAT accepts records on every patient treated with radiotherapy in the UK.
Mandation of Data Set
The Information Standards Board mandation has been in 3 stages:
RTDS with 92 data fields of both business and clinical information sits in a state-of-the-art SQL server. We report on real time data, by multiple parameters, (radiotherapy provider, by treatment machine, geographical area, primary diagnosis and tumour site). Aggregated data is used to analyse trends over time.
Version 4 of the dataset mandates the submission of:
From the onset, it was envisaged that electronic data would be taken from the radiotherapy treatment machines, (Linear Accelerators). Linear Accelerator manufacturers, Varian, Siemens, and Philips now known as Elekta had begun integrating software into the machine which could record the patient treatment plan and verify the plan against the actual treatment parameters, the Verify and Record system. The software rapidly evolved to interface with other software systems and applications, initially the radiotherapy planning and patient scheduling system then patient information. Over the past 10 years the manufacturers have advanced the Verify and Record system and the other software modules into what we know today as the Oncology Management System. The RTDS toolkits are software programs that transform data extracted from the various Oncology Management Systems in use into the data format required for RTDS. Five different toolkits with many upgrades and versions have been developed during the past 3 years; although one of those is no longer in use.
Our rationale is unique to NHS information collection in that we focussed on the data processing and quality assurance being performed at the point of extraction which allows data inconsistencies and anomalies to be identified and corrected at the source. Additionally it creates a copy of the processed data and summary reports for local use and validation.
An example of data reformat available within the toolkit is primary diagnosis coding. At the onset of RTDS, ICD9, ICD0-3 and ICD10 4 digit coding were in use. The toolkit extract the diagnosis and converts it to the required ICD10 3 digit format without the user needing to modify their system. However with time providers have begun to migrate to the RTDS coding structures, and common currencies.
The data processing for RTDS is complex as data is collected at various levels, at exposure record, plan or prescription, episode and patient demographics which are required to link together forming a relational MS Access database.
Extracting dataset from a source other than the hospital administration system was a novel concept. There were four significant reasons for this decision.
The early pilot study had highlighted three major issues; firstly the majority of trusts had never extracted data from their system and many did not have the expertise to do so, secondly the individual manufacturer systems differed completely in structure and the data entered onto those systems varied between Providers and lastly some of the commissioning information required for the OPCDS part of the dataset was not stored in the system and would need to be taken from the hospital administration system.
In order for RTDS to be collected in a timely and consistent manner and to avoid onerous burden of work on the Trusts, it was concluded that there needed to be a dedicated team who would acquire and progress specialist knowledge necessary for extracting data from each of the manufacturer's systems, to develop software applications to simplify the process of data extraction and to act as a resource of information for Providers and others, in all aspects of radiotherapy.
OMS continue to evolve at a vast rate with one or two upgrades occurring within a year, and major version changes every other year. Commercial sensitivities surround the changes and it is often easy for manufacturers to work with a third non interested party, the RTDS team, in the first instance than their customers. Likewise if an improvement to enhance RTDS within OMS is suggested by us or by a trust, to declare it as the UK group carries much more influence.
Additionally trusts switch to different systems when a great deal of support and training is required during the changeover period, especially for RTDS returns to continue to flow. There have been 7 system changeovers with 12 upgrades in 2011.
The current and an archive of the manufacturer specific toolkits can be downloaded for the RTDS website.
Technical support and virtual visits can be arranged through the RTDS helpdesk.
Unlike many NHS data collections, the RTDS dataset consists of highly specialised clinical information with different degrees of granularity which needs to collected and stored at 5 different levels or tables in a relational SQL database which requires adequate and appropriate identifiers for data linkage. This is in order to accommodate the requirements of the Information Standards Board and facilitate interoperability with other data standards. This results in a highly complex database structure, which requires an in depth knowledge of SQL programming, and of the data itself, to extract meaningful intelligence.
At present monthly summary extracts are processed and sent to the Cancer Registries and on a quarterly basis to Concentra for inclusion in the RPORT radiotherapy modelling tool, and to the Cancer Commissioning toolkit. However, the main bulk of the reporting is done through the RTDS Microsite
Returning data and analysis and reporting back to the providers and then on to the wider NHS is seen as the key component to the success of the dataset. It is done at 3 stages.
QA Reports The QA progress aims to report back to providers with 48 hours of receipt of the submission. The response consists of an email message signifying pass or fail with details of any data problems with suggestions for fixing it. In addition attachment to the email contains QA reports with details of all the data fields and QA criteria and a summary of the activity by number of episodes, attendances and machines. With feedback from providers we have modified the reports and additional summary reports are planned for the coming year, although there is a limitation to the reporting as the data is not merged at this point i.e. only the data month reporting.
Submission logs traffic light system to show trusts when the RTDS was received and if it has subsequently passed QA. http://nww.natcansat.nhs.uk/rtds/ (N3 connection required)
Validation Reports Once the submission has been uploaded into SQL merged database, the reports are generated from cubes allowing real-time reporting through the RTDS website (microsite). For one week the provider only can view and validate their data.
Spins-offs of participating in RTDS are:
Radiotherapy data submission for England needs to be sent to PHE through their data portal.
There is a dedicated RTDS UK microsite to view aggregated and benchmarked radiotherapy reports. To access this site please register at www.rtds.nhs.uk. Please note that the principles of data protection are upheld with strict information governance policies in place and you may be asked to sign a non disclosure agreement.
There is a dedicated RTDS helpdesk available weekdays from 9am to 5pm:
Tel: 0870 840 8033
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