Routinely collected sexual health data
NaSH (National Sexual Health System) is a clinical management IT system being rolled out across all sexual health settings in Scotland. The system is designed to be a full electronic patient record, and includes information on sexual risk factors such as recent and lifetime sexual history, clinical conditions, test results, prescribing, and demographics (e.g. ethnicity, postcode/area).
NaSH has a sophisticated reporting database, for which an anonymised data view has been created, similar to that in use for research in primary care systems. This could be a useful resource for future sexual health research, subject to appropriate ethical review, and would enable research to make better use of existing data, be cheaper than initiating large-scale surveys, give access to high-risk populations, and provide the means to respond to immediate research questions.
We conducted a scoping review to assess the issues involved in accessing and using NaSH for sexual health research. Our next step is to explore local, West of Scotland data for proof of concept studies to demonstrate the potential of the NaSH data.
In our review we highlight that although anonymised data views have been set up, not all NHS boards complete all data fields and use of NaSH in real time has been problematic and variable. Most social and lifestyle risk factors (except for sex, age, postcode and ethnicity), likely to be of interest in social research, are not currently included in the national dataset. Inconsistencies in the data collected can also occur across repeat visits. For example, recent sexual contact could be recorded with a partner of the same sex, at the same time as the lifetime sexual history indicates contact only with an opposite sex partner. There is no check back to highlight inconsistent data in real time to the user. We identified a critical issue of data over-writing, in that the data views only reflect current, visible data. Whilst episode-based data remain true, lifetime sexuality and smoking status, for example, can change over time, and the ‘original’ or preceding data are written over. This limits use to cross-sectional analysis and precludes any longitudinal research. Furthermore, longer term retention of NaSH data and availability to researchers out with the NHS are issues that have yet to be addressed.
NaSH data could benefit sexual health research, but the quality of base data is fundamental and we need to identify the key information that should be on the system. There is a potential conflict between the need for comprehensive and complete data for research purposes and the need for a routine clinical system to function in a routine way. However, concerns over data collection, storage and retention should be considered within the context of the wider public health benefit. Greater use of NaSH data could aide in the assessment of the indicators set out in the Scottish Government’s Sexual Health and Blood Borne Virus Framework and have a key role in the future sexual health research agenda in Scotland.
McDaid L, Docherty S, Winter A. Review of the National Sexual Health IT System (NaSH) in Scotland: the potential for sexual health research. MRC/CSO Social and Public Health Sciences Unit Occasional paper no. 24, Glasgow, 2013open access
- Andy Winter