Myocardial Ischaemia National Audit Project - University College ...

egarding previous medical history. The dataset is revised everytwo years to meet the requirements of users and to respond todevelopments in the management of ACS and is due for revisionin late 2012. The dataset is available on the MINAP web pages:http://www.ucl.ac.uk/nicor/audits/minap/dataset.Data are collected by nurses and clinical audit staff andentered in a dedicated data application (either on-line or webbased). Alternatively hospital personnel may collect datausing commercial software. The project uses a highly secureelectronic system of data entry, transmission and analysisdeveloped by the NICOR Technical Team. The audit has beenrunning continuously since 2000 and all hospitals in Englandand Wales that admit patients with ACS contribute data (exceptScarborough General Hospital and Kingston Hospital).Participating hospitals are requested to enter all patients withsuspected myocardial infarction. Approximately 91,000 recordsare uploaded annually and by August 2012 the databasecontained over 1 million records, making it the largestdatabase of its kind in the world.2.4 Security and patient confidentialityAll data uploaded by hospitals are encrypted on transmissionand stored encrypted on the NICOR servers. NICOR managesaccess control to the servers via user IDs and passwords. Allpatient identifiable data are pseudonymised by the NICORtechnical team before release to the project management teamvia a secure drop box on the NICOR server. Patient identifiabledata are only available for the purpose of record linkage. Dataheld within NICOR are managed within a secure environmentfor storage and processing provided by the UCL network andwithin the UCL information governance and security policy.NICOR is registered under the Data Protection Act. Additionally,NICOR - of which MINAP is part - has support under section251 of the National Health Service (NHS) Act 2006 (Ref: NIGB:ECC 1-06 (d)/2011).NICOR staff recognise that confidentiality is an obligation andregularly undergo information governance training to ensureunderstanding of the duty of confidentiality and how it relatesto patient data.2.5 Case ascertainmentIn practice MINAP records the great majority of patientshaving STEMI in England and Wales. However it is recognisedthat a small minority of hospitals do not enter all their nSTEMIpatients, mainly due to lack of resources, although in therecent year there has been an improvement in this area. Thetrue number of heart attacks is difficult to establish, as it isnot possible to compare MINAP data with Hospital EpisodeStatistics (HES), the only possible comparator, except inaggregate. Although HES reports approximately 105,000hospital admissions per year with myocardial infarction,it is not possible to separate this number into the clinicalcategories used within MINAP. MINAP records about 30,000STEMIs, but only about 50,000 nSTEMIs annually. Frominternal data we consider that approximately 80,000 nSTEMIsper year would be an appropriate number. However, withthe expanding analytical capacity within NICOR, there arenow plans to explore other ways of establishing the caseascertainment rate in MINAP and to provide a clearer pictureon the incidence of heart attacks in England and Wales.MINAP Eleventh Public Report 201211