 Hi, thank you very much for having me today. So I'll be talking from the Queensland perspective and trying to fill in a little bit from the national perspective where I can. So apologies to people in other jurisdictions. This is mainly about Queensland. So my topic today is accessing and using linked health data. So I'm from the Statistical Services Branch within the Queensland Department of Health. So just a little bit first about that branch. So we have a broad sort of role in data collection and analysis and processing within the Queensland Health Department. So we collect, process, analyse and disseminate statistics about health of Queenslanders and use of health services. We also have a role in developing statistical standards and maintaining a data dictionary about a lot of the data items that are collected in Queensland data collection. We also play a central role in data linkage. So the data linkage unit is located within the statistical services branch and also a provision of data for health services, policy planning, management monitoring and evaluation and of course research. So there is a data custodian role within the statistical services branch relating to some of the data collections within Queensland Health. So those relating to hospitalisation, perinatal and also by proxy for death registration information as well. So today I'll just be talking about what data linkage is, how linked data are used and how to apply for access to linked data. So I guess the thing that a lot of people talk about when they talk about linked data is that data are collected and they sit in silos. So for example within any given hospitalisation or hospital event we might have ambulance data, emergency department, admitted patient data and it's for some people death registration data. So currently particularly where you're looking at a cross hospital there's no unique identifier to join that information together. And then within any given hospitalisation you'll have some more data collections that sit in isolated silos. So you might have pathology, pharmaceuticals, intensive care unit, operating room, mental health, perinatal data to name a few. Outside of that hospital event there are other data collections that are isolated as well. So things relating to notifiable conditions, vaccinations, outpatient services, registry information. So there are sort of things like cancer registries, stroke registries and a number of others, trauma. And then there's primary care information. So that sits outside of the state jurisdiction so relating to DP visits, MBS and PBS. And then there are other things like aged care data. Then you can take it further and we can look at things like education, police and justice, child protection, surveys about issues that relate to health, census data, et cetera, et cetera. So there's a lot of information out there. Each joint together could be quite useful but it's just sitting in a lot of silos. So the reason that we do linkage is that across all of these data collections or most of the data collections there's not a unique identifier that can say that that information relates to a single person across collections. So we use data linkage. It's a process that uses person level identifying information, things like name, date of person, address to determine which records within a data source or between data sources relate to a particular individual. Okay, when we talk about linkage we're usually referring to probabilistic matching. So we're using probability to work out which records within different data collections relate to an individual. So the strength of that is that not all of the information needs to be available and the quality of all of those identifiers of it needs to be perfect to allow us to make a match between the data collection. So why do we link? Basically because if we combine all of this information it provides much richer information than the individual collection by themselves. So within health we can use that information to look at patients across facilities. We can look at following up cohorts. We can look to ensure that people haven't died when particular organisations like Health or researchers are wanting to make contact with an individual so that they're not contacting an individual's family and causing more pain. We can also link data to reduce the need to collect additional data which can be quite expensive. So within Australia in the health context data linkage was identified as an important research tool by the National Collaborative Research Infrastructure Strategy back in 2005 and they allocated funds to progress the development of linkage infrastructure within Australia. So the Population Health Research Network or PHRN was formed and nodes were created representing each jurisdiction in Australia to set up linkage infrastructure. So within Queensland in the Queensland Department of Health we have data linkage Queensland. There's Cheryl within New South Wales and they also link ACT data. They were set up before the funding for PHRN was in place but they're also part of that network. Again, Western Australia has been operating a linkage unit for a long time prior to that but they're also part of that PHRN network. There is SA&T data linkage to conduct linkage for South Australian Northern Territory. In Victoria there's the Centre for Victorian Data Linkages and Tasmania have the Tasmanian Data Linkage Unit. Nationally the Australian Institute of Health and Welfare have a linkage unit that links health related data. The ABS also do some linkage for non-health related data collections and they also do some linkage to health. And within Queensland the Queensland Government statistician's office also does some linkage of non-health related data collection. So as I said, AHW does some linkage of health related data collection so the reason to go to the AHW rather than to a state based linkage unit is for linkage of those national data collections so MBS, PBS and residential aged care or if you need to know information about people within a jurisdiction who might have a service event or who might have died and been registered in a different jurisdiction so they can link to, for example, the National Death Index whereas within a jurisdiction we would link to the death registration data within that jurisdiction for people who are registered there. Okay, within Queensland Health we have two main forms of data linkage so we have production linkage. So we're creating a master linkage file that has enduring linkage between core health data collections and I'll tell you what collections we're linking in a minute. Our linkage production linkage is done in near real time so we're doing linkage every two weeks to try to be as up to date as we can for the collection where possible and our master linkage file contains about 45 million records at this stage. The other part of linkage within Queensland is request linkage so we are able to either provide data from our master linkage file or we do a customized linkage where that data collection isn't within our master linkage file and that's for both research and government requests. Within our master linkage file the data collection that we have included and the time periods are off on the screen here so the big one that we get most requests for is the Queensland hospital admitted patient data. We have both public and private records hospitals included there. The time periods that we have names and addresses on our data for the two different types of hospitals is different so we can link a lot further back with our public hospitals than we can with our private. We have names and addresses on our public system going back to 1995 so we'll be linking back to that period. Currently we're linked back to 2001. In private hospitals we only have names and addresses from July 2007. We also have emergency department data our perinatal data relating to all births that occur in Queensland. We have death registration data. We're linking that back to 1995 as well and currently it's back to 2001. We have birth registration, elective surgery and outpatient waiting list that relates to public hospitals. We also have some internal programs so surgery connect program which is about contracted care in private hospitals that's contracted by public hospitals. We have Queensland ambulance service data that's just recently been joined through our master linkage file and we'll be going back to 2008 with that but we're just at this stage linked to two months. In progress we have notifiable conditions in vaccination, non-admitted patients, data for public hospitals, sort of outpatient clinics. We're going to be linking air retrieving so that includes flying doctors and care flights information and we are in negotiation with the education department to link some of their collections so that people can look at things like NAP plan results and AEDC. We also can have conducted in the past a linkage to other ad hoc data collections so some of those I've listed on this slide so registries, camps for pap smear trauma, strokes, suicides. Other government agencies, corrections, transport and main roads, mines and natural resources linked to other Queensland health data collections for community mental health is a common request we receive. Pathology, pharmacy, operating room and ICU and then other cohorts that have been provided by clients. So how linked data are used? So within Queensland health we get a lot of requests, probably about 60% of our requests come from within the department and they're around things like trying to understand prevalence of diagnoses and diseases and comorbidities. Planning, so looking at the number of people who are using services, the number of episodes per person, looking at readmission rates, patient transfers and patterns of where patients are going between hospitals. We also have requests for monitoring and evaluation purposes so looking at service use and patient outcomes and trying to just improve allocation and recruitment of funds across different services. Clinically there's a lot of use of linked data at the point of patient care comes from a different system that's just linking within hospitals. So that's looking at things like previous services used by a patient when they actually arrive at a hospital and looking at things like allergies and drug information that's already been recorded in the system and that's part of the electronic medical record and also we have a system within Queensland called the viewer that is sort of the interface where clinicians are able to view that information. For research I've just included a few examples. I mean we have sort of over a hundred requests per year that we receive for projects. We hold a data linkage symposium every year and it is possible to video conference into that if people are interested in other jurisdictions or to come along. It's actually being held next Wednesday so if you just look on our website there are details of that. But these presentations are all available on our website and they have...so there's more information about them. So there's things like looking at the relationship between mental illness and offending cardiovascular health in people who are hospitalized for burns. Looking at Indigenous status on data collections where there's not good coverage of that particular data item. So the example here is cervical screening data. Looking at vaccination programs and looking at outcomes for patients who have been vaccinated and then one very interesting presentation from Alfonpo's in last year that looked at cost effectiveness of homelessness intervention so that links a lot of different data collections from across all different sectors including health. So how to access link data in Queensland. So access to confidential data in Queensland we have legislation called the Public Health Act and you also need to fill in a form that relates to that. We also need ethics approvals. So I'll give you a link in a minute to our website and that has linked then to the different areas and departments that contain more information about that process. So it's important to note, I guess, that Queensland Health remains the data custodian of all Queensland Health data and that data can't be shared or published except in an aggregate form. Data can only be used for the purposes outlined in an approved request. So all of that information goes into a Public Health Application also on the ethics protocol. The information about what you're able to do with data that you obtained from Queensland Health is all detailed on the Public Health Act application and if you need to access the same data set or a different researcher would like to access the same data set for another project what you'd need to do is just an amendment to that Public Health Act application and ethics or if it's very, very different than a new application might be required. So this is the Queensland Health website relating to data linkage and we've got lots of resources there for people to understand how they apply for linked data or linkage services within Queensland. We've also got some resources that people find quite useful so we've got a nice table there that lists all of the commonly requested data collections that people are accessing from us. It's got a column with contacts to sort of apply for that linked data and then some resources as well some manuals and forms that relates that data collection to help you understand scope and coverage in that data collection. So for example one of the forms for our Admitted Patient Data Collection we've done these up for several of our data collections relates to the commonly requested data items from those collections and what they look like, a bit of information about them so those forms are all available on our website. And that's all from me, thank you very much.