Emergency Care Data Set (ECDS) General Show and Tell No.9, 25 July 2017 Peter Sherratt, ECDS implementation lead (NHS Digital) Tom Hughes, ECDS lead clinician (Royal College of Emergency Medicine) Iain Wallen, Director of Information and Analytics (NHS Improvement) Martin Orton, Director of Delivery & Development (PRSB) Darren Wooldridge, Project Manager, Emergency Care Discharge Summary Standard Project (PRSB) Version: v1.0 The ECDS project is a collaborative project between the Department of Health, the Royal College of Emergency Medicine, NHS England, NHS Digital, NHS Improvement, NHS Providers and Public Health England. This document has been produced on behalf of the ECDS Project Board in collaboration with the organisations listed above.

Next general show and tell is 30th August @ 2pm Before we start We’ve enabled “PC audio” so you can listen on your PC speakers as well as phone We are recording the webinar for the benefit of others The previous webinar links are available through the QA document Most people will be muted – please send your comments and questions via the WebEx chat function to Rozanne Addams We’ll be running a quick poll towards the end We’ll share the following after the meeting: The slides The links to the recordings The transcript of the QA session along with written answers Supporting documents are available on the ECDS web page (www.content.digital.nhs.uk/ECDS/ECDS-supporting-documentation) Next general show and tell is 30th August @ 2pm Send your comments to : ECDS@nhs.net

On this afternoon’s call: Emergency care discharge summary presentation by the PRSB More on streaming and how to implement it with ECDS ECDS clinical champions and the Early Adoption scheme Crib sheets and other ECDS support materials Quick progress update: SUS+ progress is good First early adopters expected to submit during August The ECDS web page has been updated: Technical user guidance to v1.4

Vision and mission OUR VISION OUR MISSION To optimise the health and wellbeing of UK citizens through the wide spread adoption of high quality, standardised records. OUR MISSION To become the authoritative voice for the development and widespread use of standards that ensure all digital health and social care records are of the highest quality. A record is the information that health and care professionals, and increasingly patients themselves, capture for their ongoing care. Standardising the information will make sure the records are of a consistently high quality and the same information is captured every time. What is a standardised record? High quality records are about good patient care – we all need to be interested in that.

About us We are unique PRSB Member organisations We work with member organisations who represent more than 750,000 frontline clinicians and care professionals as well as patients and the public. PRSB Member organisations Academy of Medical Royal Colleges Royal College of Nursing Royal College of General Practitioners  Royal College of Paediatrics and Child Health  Royal College of Pathologists  Royal College of Physicians  Royal College of Psychiatrists  Royal College of Surgeons of England  Royal College of Obstetricians & Gynaecologists Royal College of Emergency Medicine Royal College of Anaesthetists Royal College of Midwives Royal College of Radiologists Royal College of Occupational Therapists National Voices British Computer Society  British Psychological Society Royal Pharmaceutical Society Association of Directors of Adult Social Services Association of Directors of Children’s Services Care Provider Alliance Allied Health Professions Federation Public Health England Resuscitation Council (UK) Institute of Health Records and Information Management INTEROPen HL7 Tech UK

About us We build national consensus We work across all of the professions, patient groups and the public to build support for standards. Our job is to bring all the right people together from across the UK - clinicians, social care workers, patients and the public. We are a ‘not for profit’ community interest company We are an independent voice owned by our members. Our members are the professional bodies who represent the health and care professions and patient/carer representative groups

What is a care record standard? Each care record has a list of headings. The record standard headings define what you see when you are recording or reading information in a care record, particularly making sure that information is recorded in the right place. They are developed with extensive research so that they are easily understood and reflect what works best for patients and care professionals. Example of a record standard heading

Developing a standard ✔ 1 2 8 7 3 6 ✔ ✔ 5 ✔ 4 ✔ In consultation the PRSB identify a priority area 1 PRSB puts together an expert group 2 8 Keeping standards up to date – maintenance and support 7 Pilot and implementation 3 Work collaboratively to develop a standard 6 Member organisations sign off and endorsement ✔ Literature review ✔ ✔ Workshops 5 ✔ Online surveys (UK wide) PRSB independent assurance committee 4 NHS Digital creates technical messaging Professional standards authoring ✔

Current record standards Published record standards Standards for the clinical structure and content of patient records Revised e-discharge summary Emergency care discharge summary Ambulance handover process Mental health discharge summary Crisis care (Healthy London) In development Care home information sharing Child health events Outpatient letters Digital care and support plans

E-discharge summary standard The revised e-discharge standard is designed to facilitate better care for patients after hospital discharge to GP. The standard, which was published in May, has developed information models for 11 key headings in discharge summaries. It also includes information on medicines and revised information models for diagnoses, procedures, allergies and reactions.

What will it mean for patients and professionals? The model and implementation guidance will help professionals safely transfer patient information. NHS Digital has developed technical standards so that the e-discharge summary can be implemented across the UK. It means GP systems can pull the information straight through from hospitals. The standard NHS contract mandates providers to use PRSB headings to structure the discharge summary - from October 2018 they will be need to send structured and coded discharge summaries to GPs. You can find out more on our website www.theprsb.org

Emergency care discharge summary standard The standard, published in June, is practical and easy to implement as it was led and designed by the professionals who will be using it. The project was commissioned by NHS Digital and managed by the PRSB, supported by the Royal College of Physicians Health Informatics Unit. Clinical leads included the Royal College of Emergency Medicine and the Royal College of General Practitioners. The standard builds on the emergency care data set (ECDS) project, which has created a new data set for urgent and emergency care services.

What will it mean for patients and professionals? Details on emergency visits will be available more quickly to GPs to improve on-going patient care. Key information will directly enter the GP record, reducing the risk of transcription errors and improving the safety of care.   The EC discharge summary project supports The Keogh Urgent and Emergency Care review, by helping to enable improved discharge from hospital EC departments. The PRSB is able to offer support and guidance on how to implement the standard. You can find out more on our website www.theprsb.org

Standards into practice Standards are not useful unless they are put into practice. We need to raise awareness and drive culture change to adopt use of standards as the norm Standards are a key enabler that supports the system’s vision for a high quality, safe and efficient health and care system making best use of digital technology to improve services Buy-in from front line staff is critical for success – technology is the means not the end Shifting the culture of health and care will take time, persistence and consistent messages and actions We need to recognise there is wide variation in maturity and technical sophistication in local care systems We will work closely with the most advanced to prove what is possible whilst providing practical help and direction to those further back in their plans Our offer includes tested tools, training and support to put standards into practice

www.theprsb.org info@theprsb.org @ProfRecordsSB

Tom Hughes ECDS Clinical Lead ECDS and Streaming Tom Hughes ECDS Clinical Lead

Streaming: initial announcement £100m capital fund in 2017 budget (Luton) model specifications: Band 7 nurse performs streaming 0800-2300 x 365 2xGP, 1x (Band 5) nurse, 1x (Band 2) HCN No diagnostics This was the model announced at the time of the budget. Now no longer rigid application of Luton model

Subsequent Clarification Flexible about model ‘Urgent Treatment Centre’ Streaming must be measured Need to understand patient flow (CCG) Clinical Governance (clinicians) UTC activity = type 3 ED [ECDS not compulsory in type 3 until 2018] Row back on ‘single model’ Terminology of UTC replacing Urgent Care Centre Consensus about need to record streaming Directive from NHSE/ NHSI that UTC activity must be recorded as type 3

Minimum ECDS Streamed data set Patient Name Patient Identification - NHS number / demographics Arrival Date / Time (automatically entered) Chief Complaint Acuity Discharge Status – service to which streamed Departure Date / Time (automatically entered) ECDS does not define streaming process ECDS just defines the data collected, not how streaming occurs.

Streaming options Streamed to primary care service / GP Streamed to Urgent Care Centre Streamed to Emergency Department Streamed to Ambulatory Emergency Care service Streamed to falls service Streamed to frailty service Streamed to mental health service Streamed to pharmacy service Streamed to dental service Streamed to ophthalmology service Streamed to Emergency Department only used when patient is streamed from UTC / type 2 (Specialist ED) / type 3 (MIU) / type 4 (Walk in Centre)

Capturing streaming in ECDS Key points Streaming = 1x complete ECDS episode Streaming does not attract tariff 4 Hr standard start from first streaming Reported through standard ECDS structure

Scenario A Alice falls breaking her femur and is taken to the ED. Straightforward type 1 ED attendance attracts tariff four-hour standard applies. Type 1 ED

Scenario B Bob sustains a 5 cm laceration to his arm. Attends ED, streamed to co-located GP. Two ECDS patient episodes one streaming, attracts no tariff one type 3, which attracts tariff. Four-hour standard applies from the time of streaming Stream to GP Type 3 ED

Scenario C Carol sustains a 5 cm laceration to her arm. Attends ED, streamed to adjacent MIU/ UCC. Two ECDS patient episodes one streaming, attracts no tariff one type 3, which attracts tariff. Four-hour standard applies from the time of streaming Stream to UCC Type 3 ED

Scenario D Dan - 62-year-old man, presents to ED with a toenail infection, streamed to co-located UTC. On arrival at the UTC it turns out he has a fever and diabetes and is streamed back to the ED. Three ECDS episodes Two streaming – attract no tariff One treatment – attracts tariff four-hour standard applies from first streaming Stream to UTC Stream to ED Type 1 ED

Tiers

Tiers – default = 1

Questions?

ECDS Champions and Early Adopters scheme Presented by Peter Sherratt on behalf of NHS England

ECDS Clinical Champions have now been recruited and trained The ECDS Early Adopters scheme Over £¾million has been identified by NHS England CCIO Keith McNeil and CIO Will Smart to support early adoption Funds will be allocated to the first ~40 Trusts to go live before 1 October Primarily aimed at Type 1 ED’s First of each Eye and Paediatric Type 2 to go live Additional funds will be available to support early adopter case study sites – maximum of 6 ECDS Go-live will be verified by a clinical champion on-site presence and SUS+ data submission Full details will be given during August If you think you may be going live before 1 October and have not been in touch, please let us know via ECDS@nhs.net

ECDS Crib Sheets and Supporting Materials Presented by Peter Sherratt and Tom Hughes

Reception Chief Complaint Acuity Diagnosis ECDS flyer

Next webinar is 30th August @ 2pm Future webinars…. They’re totally open – invite anyone Future topics will include: Data quality dashboards / validation More detail on the early adopters scheme Benefits case studies and lessons learned from our early adopters Let us know anything particular you’d like us to cover again or in more detail Next webinar is 30th August @ 2pm Send your comments to : ECDS@nhs.net