New GMS Contract QOF Implementation. Dataset and Business Rules - Coronary Heart Disease Indicator Set

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1 Data and Business s Coronary Heart Disease Specification Author Phil Brown Version No 7.0 Version Date 18-Jan-2005 New GMS Contract QOF Implementation Dataset and Business s - Coronary Heart Disease Indicator Set

2 Amendment History: Version Date Amendment History Draft Jun-2003 From Peter Horsfield Sep-2003 Standard Headers and footers Applied and set to approved Nov-2003 Added headers and footers to Version 0.4 received from Pete Horsfield on 03/11/ Nov-2003 Amended following 4 Country review Jan-2004 Amended following January READ Code Release Feb-2004 Amended following 4 Country, GPSS and internal review Apr-2004 SNOMED-CT codes added, 4-byte Read codes removed Jul-2004 Amended following July READ code release Sep-2004 Amended following 4 Country Review Jan-2005 Amended following January READ Code Release Jun-2005 Amended following 4 Country Review July-2005 Signed off following 4 Country review July-2005 Amended following July 2005 Read Code release and January 2005 SNOMED CT release Aug-2005 Amended following 4 Country review Sep-2005 Signed off following 4 Country review

3 New GMS contract Q&O framework implementation Dataset and business rules Coronary heart disease indicator set Notes 1) The specified dataset and rulesets are to support analysis of extracted data to reflect the status at a specified point in time of patient records held by the practice. In the context of this document that specified time point is designated the Reference date and identified by the abbreviation REF_DAT. In interpreting the specification REF_DAT should be taken to mean midnight of the preceding day (i.e. a REF_DAT of equates to midnight on ). 2) To support accurate determination of the population of patients to which the indicators should relate (the denominator population) these rulesets have been compiled with a prior assumption that the reference date is specified prior to extraction of data and is available for computation in the data extraction routine. The reference date will also be required to be included in the data extraction to support processing of rules that are dependent upon it. It is possible that an alternative approach could be adopted in which rules to determine the denominator population by registration status would be applied as a component of rule processing. If this second approach were to be adopted it would be essential to specify default time criteria for determining the registration characteristics of the denominator population during the data extraction process. Additionally there would be a requirement to supplement the dataset and rulesets to support identification of the appropriate denominator population. 3) Clinical codes quoted are from the July 2005 releases of Read codes version 2, clinical terms version 3 (CTV3) and the January 2005 version of SNOMED-CT. The % wild card and code ranges (e.g. G342 - G3z) are to be interpreted as standard MIQUEST expressions. 4) Datasets comprise a specification of two elements: a) ion criteria. These are the criteria used to determine the denominator population against whom the indicators are to be applied. b) Clinical data extraction criteria. These are the data items to be exported from the clinical system for subsequent processing to calculate points allocations. They are expressed in the form of a MIQUEST Report-style extract of data. The record of each patient that satisfies the selection criteria will be interrogated against the clinical data criteria. A report of the data contained in the selected records will be exported in the form of a fixed-format tabular report. Each selected patient will be represented by a single row in the report. Rows will contain a fixed of fields each containing a single data item. The of fields in each row and their data content will be determined by the clinical data criteria. Data items that match the clinical data criteria will be exported in the relevant field of the report. Where there is no data to match a specific clinical criterion a null field will be exported. 5) sets are specified as multiple rules to be processed sequentially. Processing of rules should terminate as soon as a Reject or condition is encountered

4 6) s are expressed as logical statements that evaluate as either true or false. The following operators are required to be supported: a) > (greater than) b) < (less than) c) = (equal to) d) (not equal to) e) AND f) OR g) NOT 7) Where date criteria are specified with intervals of multiples of months or years these should be interpreted as calendar months or calendar years. 8) The new GMS contract requires that influenza vaccinations should be given between 1 St September and 31 st March of any given contract year in order to qualify for the relevant indicators. Hence in the contract year the relevant dates will be 1 St September 2004 and 31 st March 2005 inclusive. In this document these dates are expressed as variable parameters FLU_COM and FLU_END respectively. For the purposes of data extraction these variables will be required to be specified prior to processing the relevant rules.

5 Dataset Specification 1) Patient selection criteria: a) Registration status Current registration status Currently registered for GMS Qualifying criteria Most recent registration date < (REF_DAT) Previously registered for GMS Any sequential pairing of registration date and deregistration date where both of the following conditions are met: registration date < (REF_DAT); AND deregistration date >= (REF_DAT) b) Diagnostic code status Code criteria Qualifying diagnostic codes Time criteria Included G3-G3401 G342-G366 G38 G3z Gyu3% % % % % % XE2uV% (excluding Xa07j%, G341.%) Earliest < (REF_DAT)

6 2) Clinical data extraction criteria Field Number Field name Data item Qualifying criteria 1 PAT_ID Patient ID Unconditional 2 REG_DAT Date of patient registration 3 EXC_COD 9h0% % XaJ4J% (Exception reporting codes) 4 EXC_DAT Date of EXC_COD Chosen record 5 IHD_COD G3-G3401 G342-G366 G38 G3z Gyu3% % % % % % (Ischaemic heart disease codes) XE2uV% (excluding Xa07j%, G341.%) Earliest < REF_DAT 6 IHD_DAT Date of IHD_COD Chosen record 7 ANG_COD G311% G33-G330z G33z-G33zz Gyu % (excluding ) G33..% (Angina codes) Earliest episode < REF_DAT 8 ANG_DAT Date of ANG_COD Chosen record 9 MI_COD Latest first or new episode <

7 G30% G35% G38% Gyu % (excluding %) (Myocardial infarction codes) X200E% (excluding XE2aA%) REF_DAT 10 MI_DAT Date of MI_COD Chosen record 11 EXR_COD 3213% 33B9% (excluding 33B92) 8H44, 8HRA, 8HVJ, 8HTJ 9N0f 573D, % , % , , % , %, (Exercise test codes) 33B9.% 8H44. XaCFM XaBTR% XaFs5, XaFs4 XE2rf, Earliest < REF_DAT AND >= (ANG_DAT 3 months) 12 EXR_DAT Date of EXR_COD Chosen record 13 EXREXC_COD 8I3S 33BE (Exception codes for exercise test) XaJIB XaK6V Earliest < REF_DAT AND >= ANG_DAT 14 EXREXC_DAT Date of EXREXC_COD Chosen record 15 SMOK_COD D 137F-137H 137J-137V 137X-137h % (excluding ) % (excluding ) (Smoking habit codes) Ub0oo% (excluding XE0oo, XaIQi% ) 16 SMOK_DAT Date of SMOK_COD Chosen record

8 17 NSMOK_COD XE0oh (Code for never smoked) Most recent of SMOK_COD < REF_DAT 18 NSMOK_DAT Date of NSMOK_COD Chosen record 19 CSMOK_COD C-137D 137G-137H 137J 137M 137P-137R 137V 137X-137f 137h % (excluding %, ) % (excluding ) (Current smoker codes) 137R.% XE0og% (excluding XaIuQ) 137C. 137G. 137M. XaIIu XaItg XaJX2 Most recent of SMOK_COD < REF_DAT 20 CSMOK_DAT Date of CSMOK_COD Chosen record 21 CESS_COD 6791, 67A3 8B2B, 8CAL, 8HTK 13p% 9OO% 9N4M, 9N2k, 8H7i 67H1, 8B3Y, 8B3f , % , , % % , , , % (Smoking cessation codes) XaFw9 Xa1dC% XaIQn, XaFst XaEKU, XaIQi% XaBUG% XaIye XaJIs XaItC XaIpo XaCGl% 22 CESS_DAT Date of CESS_COD Chosen record 23 BP_COD

9 246% (excluding 2460, 246H, 246I, 246K, 246L, 246M) % (excluding , , ) % (excluding , , , %, %, , %) (BP recording codes) X773t% (excluding XaI9f, XaI9g) 246..% (excluding 2460., XaCFN, XaCFO) 24 BP_DAT Date of BP_COD Chosen record 25 BP_SYS 26 BP_DIA Value 1 of BP_COD (Systolic BP value) Value 2 of BP_COD (Diastolic BP value) Chosen record Chosen record 27 BPEX_COD 8I3Y XaJkR (BP recording exception codes) 28 BPEX_DAT Date of BPEX_COD Chosen record 29 HTMAX_COD 8BL XaJ5h (Code for maximal BP therapy) 30 HTMAX_DAT Date of HTMAX_COD Chosen record 31 CHOL_COD 44OE 44P-44P4 44PH 44PJ % , , , (Total cholesterol codes) XaIRd XE2eD% XaFs9 XaJe9 44P1., 44P2., 44P3., 44P4. 32 CHOL_DAT Date of CHOL_COD Chosen record 33 CHOL_VAL Value 1 of CHOL_COD (Total cholesterol value) Chosen record

10 34 CHEXC_COD U60CA TJC24 TJC % % (Codes for exception from serum cholesterol target; persisting) XaIsC, XaIro XaJYw Xa5bP% 35 CHEXC_DAT Date of CHEXC_COD Chosen record 36 TCHEXC_COD 8BL1 8I3C 8I27 8I63 8I (Codes for exception from serum cholesterol target; expiring) XaJ5i XaIIl XaIIg XaG2V XaJYw 37 TCHEXC_DAT Date of TCHEXC_COD Chosen record 38 XSAL_COD 14LK ZV148 U6051 TJ % % (Salicylate contra-indications: persistent) XaIpk Xa5FM% XE22E% Xa5dp% U XSAL_DAT Date of XSAL_COD Chosen record 40 TXSAL_COD 8I24 8I38 8I66 8I (Salicylate contra-indications: expiring) XaDvH XaFsE XaIIi XaJ5a 41 TXSAL_DAT Date of TXSAL_COD Chosen record 42 XWAR_COD

11 14LP TJ42% (excluding TJ420) U6042 ZV14A % % (Warfarin contraindications: persistent) XaJ60 TJ42.% (excluding TJ420) U6042 XaJ8B Xa5yP% 43 XWAR_DAT Date of XWAR_COD Chosen record 44 TXWAR_COD 8I25 8I3E 8I65 8I71 8I2R 8I3d 8I6N 8I7A (Warfarin contraindications: expiring) XaFsz XaIIn XaIIh XaJ5b XaKAB XaKAD XaKA7 XaKA0 45 TXWAR_DAT Date of TXWAR_COD Chosen record 46 XCLO_COD 14LQ U6048 ZV14B (Clopidogrel contraindications: persistent) XaJ8V XaJ3e XaJ5v 47 XCLO_DAT Date of XCLO_COD Chosen record 48 TXCLO_COD 8I2K 8I3R 8I6B 8I (Clopidogrel contraindications: expiring) XaJ6Y XaJ6Z XaJ5l XaJ5c 49 TXCLO_DAT Date of TXCLO_COD Chosen record

12 50 OSAL_COD 67I8 8B63 8B3T 8B6P % (OTC salicylate codes) XaFsi XaF7N XE0hr% XaJd8 51 OSAL_DAT Date of OSAL_COD Chosen record 52 SAL_COD bu2% di1% j11% blm% bu4% % % (Salicylate prescription codes) bu2..% x04tl% blm..% bu4..% 53 SAL_DAT Date of SAL_COD Chosen record 54 CLO_COD bu5% % bu5..% (Clopidogrel prescription codes) 55 CLO_DAT Date of CLO_COD Chosen record 56 WAR_COD bs% 8B2K % % (Warfarin prescription codes) x01o3% x01o5% XaKAk 57 WAR_DAT Date of WAR_COD Chosen record

13 58 XBB_COD 14LL TJC6% U60B7 ZV14C % % (Beta-blocker contraindications: persistent) XaJ5x Xa5jo% Xa5LL% TJC6.% U60B7, XaJ8U 59 XBB_DAT Date of XBB_COD Chosen record 60 TXBB_COD 8I26 8I36 8I62 8I (Beta-blocker contraindications: expiring) XaFt0 XaFsB XaFvr XaJ5d 61 TXBB_DAT Date of TXBB_COD Chosen record 62 BB_COD bd% % (excluding %) (Beta-blocker prescription codes) bd % 63 BB_DAT Date of BB_COD Chosen record 64 XACE_COD 14LM U60C4 ZV14D % % (Ace inhibitor contraindications; persistent) XaJ5y XaJ8Y Xa60w% Xa5cT% XaIrq, U60C4 65 XACE_DAT Date of XACE_COD Chosen record

14 66 TXACE_COD 8I28 8I3D 8I64 8I (Ace inhibitor contraindications; expiring) XaG2W XaIIm XaIIf XaJ5e 67 TXACE_DAT Date of TXACE_COD Chosen record 68 XAII_COD 14LN U60CB ZV14E (AII antagonist contraindications: persisting) XaJ5z XaJ8o XaIzK XaJ8W 69 XAII_DAT Date of XACE_COD Chosen record 70 TXAII_COD 8I2H 8I3P 8I6C 8I (AII antagonist contraindications: expiring) XaInW XaIyw XaJ5m XaJ5f 71 TXAII_DAT Date of TXAII_COD Chosen record 72 ACE_COD bi% ba% bk6% % % (Ace inhibitor prescription codes) bi % ba % 73 ACE_DAT Date of ACE_COD Chosen record

15 74 AII_COD bk3-bk5 bk7-bk9 bkb% % % (AII antagonist prescription codes) x03j2% x03ls% 75 AII_DAT Date of AII_COD Chosen record 76 XFLU_COD 14LJ U60K4 ZV14F % % (Flu vaccine contraindications: persisting) XaIAA XaJ7u XaJ8X Xa5um% Xa5WJ% 77 XFLU_DAT Date of XFLU_COD Chosen record 78 TXFLU_COD 8I2F 8I6D 68NE 9OX (Flu vaccine contraindications: expiring) XaIBI XaIOT 68NE. XaJ5n 79 TXFLU_DAT Date of TXFLU_COD Chosen record 80 FLU_COD n47% 65E ZV % (excluding %) (Flu vaccination codes) n47..% 65E.. ZV FLU_DAT Date of FLU_COD Chosen record

16 Indicator rulesets Version Date: 218-Jan Indicator CHD 1: The practice can produce a register of patients with coronary heart disease The terms of this indicator will be satisfied if the practice is able to produce a data extraction according to the above criteria. No numerator or denominator determination is required. NEW GMS CONTRACT QOF IMPLEMENTATION Page 16 of 27

17 Version Date: 218-Jan Indicator CHD 2: The percentage of patients with newly diagnosed angina (diagnosed after 01/04/03) who are referred for exercise testing and/or specialist assessment. a) Denominator ruleset 1 If ANG_COD = Null Reject Next rule 2 If ANG_DAT >= Next rule Reject 3 If EXR_DAT <= (ANG_DAT + 12 months) AND If EXR_DAT >= (ANG_DAT - 3 months) Next rule 4 If REG_DAT >= (REF_DAT 3 months) Reject Next rule 5 If EXC_DAT >= (REF_DAT 15 months) Reject Next rule 6 If EXREXC_DAT <= (ANG_DAT + 12 months) Reject Next rule 7 If ANG_DAT >= (REF_DAT 3 months) Reject b) Numerator ruleset: To be applied to the above denominator population 1 If EXR_DAT <= (ANG_DAT + 12 months) AND If EXR_DAT >= (ANG_DAT - 3 months) Reject NEW GMS CONTRACT QOF IMPLEMENTATION Page 17 of 27

18 Version Date: 218-Jan Indicator CHD 3: The percentage of patients with coronary heart disease, whose notes record smoking status in the past 15 months except those who have never smoked where smoking status should be recorded at least once since diagnosis. a) Denominator ruleset 1 If SMOK_DAT >= (REF_DAT 15 months) Next rule 2 If NSMOK_DAT >= IHD_DAT Next rule 3 If REG_DAT >= (REF_DAT 3 months) Reject Next rule 4 If EXC_DAT >= (REF_DAT 15 months) Reject Next rule 5 If IHD_DAT >= (REF_DAT 3 months) Reject b) Numerator ruleset: To be applied to the above denominator population 1 If SMOK_DAT >= (REF_DAT 15 months) Next rule 2 If NSMOK_DAT >= IHD_DAT Reject NEW GMS CONTRACT QOF IMPLEMENTATION Page 18 of 27

19 Version Date: 218-Jan Indicator CHD 4: The percentage of patients with coronary heart disease who smoke, whose notes contain a record that smoking cessation advice has been offered within the last 15 months. a) Denominator ruleset 1 If CSMOK_COD = Null Reject Next rule 2 If CESS_DAT >= (REF_DAT 15 months) Next rule 3 If REG_DAT >= (REF_DAT 3 months) Reject Next rule 4 If EXC_DAT >= (REF_DAT 15 months) Reject Next rule 5 If IHD_DAT >= (REF_DAT 3 months) Reject b) Numerator ruleset: To be applied to the above denominator population 1 If CESS_DAT >= (REF_DAT 15 months) Reject NEW GMS CONTRACT QOF IMPLEMENTATION Page 19 of 27

20 Version Date: 218-Jan Indicator CHD 5: The percentage of patients with coronary heart disease, whose notes have a record of blood pressure in the previous 15 months. a) Denominator ruleset 1 If BP_DAT >= (REF_DAT 15 months) Next rule 2 If BPEX_DAT>= (REF_DAT 15 months) Reject Next rule 3 If REG_DAT >= (REF_DAT 3 months) Reject Next rule 4 If EXC_DAT >= (REF_DAT 15 months) Reject Next rule 5 If IHD_DAT >= (REF_DAT 3 months) Reject b) Numerator ruleset: To be applied to the above denominator population 1 If BP_DAT >= (REF_DAT 15 months) Reject NEW GMS CONTRACT QOF IMPLEMENTATION Page 20 of 27

21 Version Date: 218-Jan Indicator CHD 6: The percentage of patients with coronary heart disease, in whom the last blood pressure reading (measured in the last 15 months) is 150/90 or less. a) Denominator ruleset 1 If BP_SYS <= 150 AND If BP_DIA <= 90 AND If BP_DAT >= (REF_DAT 15 months) Next rule 2 If BPEX_DAT>= (REF_DAT 15 months) Reject Next rule 3 If REG_DAT >= (REF_DAT 9 months) Reject Next rule 4 If EXC_DAT >= (REF_DAT 15 months) Reject Next rule 5 If IHD_DAT >= (REF_DAT 9 months) Reject Next rule 6 If HTMAX_DAT >= (REF_DAT 15 months) Reject b) Numerator ruleset: To be applied to the above denominator population 1 If BP_SYS <= 150 AND If BP_DIA <= 90 AND If BP_DAT >= (REF_DAT 15 months) Reject NEW GMS CONTRACT QOF IMPLEMENTATION Page 21 of 27

22 Version Date: 218-Jan Indicator CHD 7: The percentage of patients with coronary heart disease, whose notes have a record of total cholesterol in the previous 15 months a) Denominator ruleset 1 If CHOL_DAT >= (REF_DAT 15 months) Next rule 2 If REG_DAT >= (REF_DAT 3 months) Reject Next rule 3 If EXC_DAT >= (REF_DAT 15 months) Reject Next rule 4 If IHD_DAT >= (REF_DAT 3 months) Reject b) Numerator ruleset: To be applied to the above denominator population 1 If CHOL_DAT >= (REF_DAT 15 months) Reject NEW GMS CONTRACT QOF IMPLEMENTATION Page 22 of 27

23 Version Date: 218-Jan Indicator CHD 8: The percentage of patients with coronary heart disease, whose last measured total cholesterol (measured in last 15 months) is 5 mmol/l or less. a) Denominator ruleset 1 If CHOL_VAL <= 5 AND If CHOL_DAT >= (REF_DAT 15 months) Next rule 2 If REG_DAT >= (REF_DAT 9 months) Reject Next rule 3 If EXC_DAT >= (REF_DAT 15 months) Reject Next rule 4 If IHD_DAT >= (REF_DAT 9 months) Reject Next rule 5 If CHEXC_COD Null OR If TCHEXC_DAT >= (REF_DAT 15 months) Reject b) Numerator ruleset: To be applied to the above denominator population 1 If CHOL_VAL <= 5 AND If CHOL_DAT >= (REF_DAT 15 months) Reject NEW GMS CONTRACT QOF IMPLEMENTATION Page 23 of 27

24 Version Date: 218-Jan Indicator CHD 9: The percentage of patients with coronary heart disease with a record in the last 15 months that aspirin, an alternative anti-platelet therapy, or an anti-coagulant is being taken (unless a contraindication or side effects are recorded). a) Denominator ruleset 1 If SAL_DAT >= (REF_DAT 15 months) OR If WAR_DAT >= (REF_DAT 15 months) OR If CLO_DAT >= (REF_DAT 15 months) OR If OSAL_DAT >= (REF_DAT 15 months) Next rule 2 If REG_DAT >= (REF_DAT 3 months) Reject Next rule 3 If EXC_DAT >= (REF_DAT 15 months) Reject Next rule 4 If IHD_DAT >= (REF_DAT 3 months) Reject Next rule 5 If XSAL_COD = Null If TXSAL_DAT = Null AND Next rule 6 If XSAL_COD = Null AND If TXSAL_DAT < (REF_DAT 15 months) Next rule 7 If XWAR_COD = Null If TXWAR_DAT = Null AND Next rule 8 If XWAR_COD = Null AND If TXWAR_DAT< (REF_DAT 15 months) Next rule 9 If XCLO_COD = Null If TXCLO_DAT = Null AND Next rule 10 If XCLO_COD = Null AND If TXCLO_DAT< (REF_DAT 15 months) Reject b) Numerator ruleset: To be applied to the above denominator population 1 If SAL_DAT >= (REF_DAT 15 months) OR If WAR_DAT >= (REF_DAT 15 months) OR If CLO_DAT >= (REF_DAT 15 months) OR If OSAL_DAT >= (REF_DAT 15 months) Reject NEW GMS CONTRACT QOF IMPLEMENTATION Page 24 of 27

25 Version Date: 218-Jan Indicator CHD 10: The percentage of patients with coronary heart disease who are currently treated with a beta blocker (unless a contraindication or side effects are recorded ) a) Denominator ruleset 1 If BB_DAT >= (REF_DAT 6 months) Next rule 2 If REG_DAT >= (REF_DAT 3 months) Reject Next rule 3 If EXC_DAT >= (REF_DAT 15 months) Reject Next rule 4 If IHD_DAT >= (REF_DAT 3 months) Reject Next rule 5 If XBB_COD Null Reject Next rule 6 If TXBB_DAT >= (REF_DAT 15 months) Reject b) Numerator ruleset: To be applied to the above denominator population 1 If BB_DAT >= (REF_DAT 6 months) Reject NEW GMS CONTRACT QOF IMPLEMENTATION Page 25 of 27

26 Version Date: 218-Jan Indicator CHD 11: The percentage of patients with a history of myocardial infarction (diagnosed after 1st April 2003) who are currently treated with an ACE inhibitor. a) Denominator ruleset 1 If MI_DAT >= Next rule Reject 2 If ACE_DAT >= (REF_DAT 6 months) OR If AII_DAT >= (REF_DAT 6 months) Next rule 3 If REG_DAT >= (REF_DAT 3 months) Reject Next rule 4 If EXC_DAT >= (REF_DAT 15 months) Reject Next rule 5 If MI_DAT >= (REF_DAT 3 months) Reject Next rule 6 If XACE_COD = Null If TXACE_DAT = Null AND Next rule 7 If XACE_COD = Null AND If TXACE_DAT < (REF_DAT 15 months) Next rule 8 If XAII_COD = Null If TXAII_DAT = Null AND Next rule 9 If XAII_COD = Null AND If TXAII_DAT < (REF_DAT 15 months) Reject b) Numerator ruleset: To be applied to the above denominator population 1 If ACE_DAT >= (REF_DAT 6 months) OR If AII_DAT >= (REF_DAT 6 months) Reject NEW GMS CONTRACT QOF IMPLEMENTATION Page 26 of 27

27 Version Date: 218-Jan Indicator CHD 12: The percentage of patients with coronary heart disease who have a record of influenza vaccination in the preceding 1st September to 31st March. 1 a) Denominator ruleset If FLU_DAT >= FLU_COM If FLU_DAT <= FLU_END AND Next rule 2 If REG_DAT >= (REF_DAT 3 months) Reject Next rule 3 If EXC_DAT >= (REF_DAT 15 months) Reject Next rule 4 If IHD_DAT >= (REF_DAT 3 months) Reject Next rule 5 If XFLU_COD Null Reject Next rule 6 If TXFLU_DAT >= (REF_DAT 15 months) Reject b) Numerator ruleset: To be applied to the above denominator population 1 If FLU_DAT >= FLU_COM AND If FLU_DAT <= FLU_END Reject NEW GMS CONTRACT QOF IMPLEMENTATION Page 27 of 27

New GMS Contract QOF Implementation Dataset and Business Rules - Coronary Heart Disease Indicator Set

Data and Business s Coronary Heart Disease Specification Author Paul Amos Version No 13.0 Version Date 06-Oct-2008 New GMS Contract QOF Implementation Dataset and Business s - Coronary Heart Disease Indicator