Why is CAN02 changing to CAN04?

NHS England announced a change in July 2024 for PCN DES IIF indicator CAN02 to become CAN04. This follows months of a known data quality issue for EMIS where Practices "... may not have accurate indicator values".

CAN02 is also known as NCD123.

Problem

EMIS had been reporting a single number for each of the denominator and numerator - see below where the table counts clinical codes. The same behaviour had been happening in CAN01 (NCD112) in previous contract years.

     

The problem with this is that it counts every instance of a code, so a double coded referral would increase the denominator while a double coded fit test might increase the numerator. This led (usually) to some very low achievement scores due to the sheer number of referral codes for the same episode (eg: the doctor codes it, then the secretary codes it on the eRS referral, and the code is attached to the proforma).

PCIT had always got around this problem using the following numerator report which counted one episode per patient per month. The reality of cancer referrals is that most patients would only have 1 during the year, or potentially a separate second referral months later. This approach proved to be more accurate, with the caveat that a QFIT and referral coded at the end of one month and another referral code for the same episode was coded early in the next month would count twice (eg: referral coded by doctor on afternoon of Friday 30th, and secretary completes the referral with another code on Monday 2nd).

Investigation

The problem hasn't stopped there, although this next element was only reported to NHS England in late July 2024.

The effective parent search in Enquiry Manager for the above CAN02 numerator report is called FAECIMM_COD (2).

The rule here is written very similarly to how PCIT produced the rule and it works. This counts all of the patients who had a referral and a QFIT in the correct timeframe.

The problem is that the report uses a criteria of NCD123 GICANREF DATE . This exposed a problem where not all of the patients in the FAECIMM_COD (2) search were being listed in the report.
We found where a referral and QFIT are exclusively coded on the same date (that is, there is no QFIT code between 21 and 1 day before the referral), GICANREF ignores them, reducing the numerator.

Solution

NHS England's solution has been to introduce CAN04 to replace CAN02. The description for this is:

The proportion of patients who have had a lower gastrointestinal urgent suspected cancer referral in the reporting year where at least one urgent suspected cancer referral was accompanied by a faecal immunochemical test result, with the result recorded in the 21 days leading up to the referral.

This basically means a patient is counted in the numerator if there is a single counting episode, much like QOF indicators. In practical terms, this is likely to mean that EMIS will use the search FAECIMM_COD (2) as the numerator underneath a parent of patients aged greater than equal to 65 years. The denominator will be the search Percentage of lower gastrointestinal two week wait (fast track) cancer referrals. Reports used up until now will be redundant.

      

In addition to CAN04, CAN03 replaces CAN01 which has been a Management Indicator since April 2023 - this tracks where the FIT could be coded between 21 days before and 14 days after the referral. Again, the indicator will count patients rather than the number of codes.

• Related Articles

• Why is a code available for picking for some users but not others

  Some users find they are unable to select codes that others use, or that are in Local Enhanced Service specifications. The usual reason for some codes not being seen is because they are "EMIS codes". These are legacy codes that were usually created ...

• Action chaser Salbutamol adding to register in last 3m of year (HP182)

  Purpose: This protocol will: Make sure performance against "AST007 - asthma with a review in the last 12 months" is optimised What does it actually do? The protocol performs the following functions: When issuing an inhaler the patient details are ...

• Eligible for Diabetes Prevention Programme (HP267)

  Purpose: This protocol will: Increase the proportion of patients newly diagnosed with NDH that are referred to the Diabetes Prevention Programme What does it actually do? The protocol performs the following functions: Checks when loading the record ...

• Target for SMR (HP231)

  Purpose: This protocol will: highlight patients who should be targeted for an SMR under the PCN DES for 2023/24 What does it actually do? The protocol identifies the following patients: Those on high risk medications (NSAIDs), antiplatelet & ...

• Problems with loading templates

  A number of practices have highlighted to us that they are having issues with loading templates within EMIS.  As with most complex problems, there is a swiss cheese cause to many of the issues that occur.  In this article we're going to highlight the ...