Limited public access to cardiac surgery data agreed

The Central Cardiac Audit Database is to have a public portal allowing access to selected cardiac surgery mortality data.

The Healthcare Commission, Department of Health and Society of Cardiothoracic Surgeons have reached an ‘agreement in principle’ to allow the public limited access to what has up to now been a closed system.  The move comes as cardiothoracic surgeons come under intense pressure to make their mortality data public.

A number of national newspapers have used the Freedom of Information Act to request crude mortality data from cardiac units with a view to publishing it.

In February the Daily Telegraph published data obtained from the Royal Brompton and Harefield Trust. The Guardian has requested unit- and surgeon-specific data from all 37 cardiac units in England. The Independent has also made some FOI requests.

Meanwhile, trusts providing the data have published it on their websites, in line with the Department of Health’s good practice guidance on handling FOI requests.

The Society of Cardiothoracic Surgeons – which in 2002 committed itself to publishing risk adjusted data for individual surgeons – has condemned these moves to publish piecemeal data that takes no account of risk.

James Roxburgh, honorary secretary of SCTS, which represents 220 cardiothoracic surgeons, said: "We have very severe reservations. We do not believe it is in the best interests of patients because it does not provide proper information for choice. It may lead to risk averse behaviour by surgeons as they refuse to take on high risk patients in future."

The STCS has been hampered in its attempts to deliver the data it promised first by a lack of IT infrastructure and second by difficulties in developing rigorous risk adjustment.

In 2004 the Department of Health and Healthcare Commission agreed to add the SCTS’s audit to the CCAD, which was already collecting data on acute myocardial infarction, angioplasty and paediatric cardiac surgery.

Professor Sir Bruce Keogh, president elect of the SCTS and a Healthcare Commissioner, said: "The technology is now up and running in almost all trusts and they have started to submit their data. We are not in a position yet to say what the quality of that data is."

The agreement to set up a public portal pre-dated the current controversy and ideas were at an early stage, he added. "We need to start working on how best to start presenting data."

It would be unlikely to allow real time access, said Sir Bruce. "One of the problems with real time data is that people tend to clean it up and resubmit. We have to work out at what point we say that the data is now locked. We would want to present locked data that we know is good."

He added: "We do need a mechanism which ensures that data is not so far out of date as to be meaningless."  He was anxious not to follow the example in New York where public surgeon specific data is three years old.

Despite the reservations about the impact of publishing crude mortality data, Sir Bruce said he welcomed the impact of FOI on levering information from clinicians.

He said: ‘The concept that information on publicly funded activities should be available to the people who fund them through taxation is a very good one. But of course it makes clinicians nervous.’

Instead of fighting FOI clinicians should be "turning their intellectual activities towards how best to present information." They needed to accept that all specialties had measurable outcomes and that the public was intelligent enough to interpret results.

He said: "We have to open up the whole broad debate. The question is how do you stop clinicians being frightened?"