Emergency Care Data Set (ECDS) General Show and Tell No.10, 30 August 2017 Peter Sherratt, ECDS implementation lead (NHS Digital) Dr Tom Hughes, ECDS lead clinician (Royal College of Emergency Medicine) Dr Dan Henning, ECDS clinical champion (Plymouth Hospitals) Dr Mark Ragoo, ECDS clinical champion (University Hospitals North Midlands) Steve Fenner and Iestyn Evans, SUS+ team (NHS Digital) James Humphries, Data Services for Commissioners (NHS Digital) Dr Phil Koczan, Emergency Care Discharge Summary 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 4th October @ 2pm Before we start 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 Peter Sherratt We’ll share the slides etc. following after the meeting Supporting documents are available on the ECDS web page (www.content.digital.nhs.uk/ECDS/ECDS-supporting-documentation) Next general show and tell is 4th October @ 2pm Send your comments to : ECDS@nhs.net

On this afternoon’s call: Brief review of Co-morbidities, Injury collection for acid attacks, Streaming Clinical champion and early adoption scheme update Focus on getting data out of SUS+ Technical aspects, extracts DSCRO / CCG update MESH refresher QA session – other submitted questions Emergency care discharge summary recap by the PRSB Quick progress update: SUS+ is ready, legal Directions are in place First early adopters expected to go live and submit soon Hampshire, Bucks, Chester, Central Manchester and others Crib sheets now available for download http://content.digital.nhs.uk/ECDS

ECDS Injury, co-morbidities, acid attacks Tom Hughes Peter Sherratt

Capturing Co-morbidities Official NHS List ‘Co-morbid conditions’ For auto-population from IT system e.g. Summary Care Record Electronic Patient Record Do not enter manually

Acid Attacks Intent = Apparent Assault [Activity status] [Activity] Mechanism = Burn, chemical [Drug / alcohol] + diagnosis = burn [body area affected] + refer + admit etc

Tom Hughes ECDS Clinical Lead ECDS : 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. Initial model = 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. Only CC and acuity need collecting at point of streaming The rest can be collected before or after depending on the model used. [should the first person that the patient meets be clinical?]

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 his 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

Questions? Full guidance is under production by NHS England and NHS Improvement This will cover 4-hour wait

ECDS Clinical Champions Update Presented by Dr Dan Henning and Dr Mark Ragoo

ECDS Clinical Champions have now been recruited and trained The ECDS Early Adopters scheme ECDS Go-live will be verified by a clinical champion on-site presence and SUS+ data submission: Data submission by midnight on 11th October demonstrating ECDS collection commenced before midnight on 30th September Compliance with the CQUIN data items – Chief Complaint and Diagnosis (95% data quality) Potential analysis of other key data items to verify a high quality implementation 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

SUS+ update including “getting the data out” Presented by Steve Fenner and Iestyn Evans

CDS010 (A&E) extract will remain unchanged Key points: CDS010 (A&E) extract will remain unchanged An additional extract will be available – ECDS (CDS011) mapped into CDS010 (A&E) to maintain continuity of format A new extract in a new format will be available QA: What validation checks would cause a file to be rejected? XML schema mandatory fields / field format / length etc. File size With bulk submissions can we resubmit the last 2 weeks’ worth of data on agreed day and the last 7 days’ worth of data on a daily basis? (as we may not be able to do net submission due to supplier issues)

DSCRO / CCG update Presented by James Humphries and Peter Sherratt

Update for DSCROs and CCGs   ECDS mapped to current A&E will be available from the outset to ensure continuity CCG Data Sharing Agreements (DSA) will require an update before commissioners can receive ECDS in the new format A briefing paper is being drafted to be presented at IGARD A Class Action application spanning all 207 CCGs to receive ECDS will be drafted Timescale is September / October subject to IGARD approval

Message Exchange for Social Care and Health (MESH) August 2017 Simon Richards – MESH Product Owner

New Client Release Key Background: ECDS will flow via MESH and not EDT Version 6.1.1 of the MESH client Support for large file transfers Software and Documentation available www.digital.nhs.uk/message-exchange-social-care-health MESH will re-use the DTS mailbox settings so DTS addressing will work. Requires a Java Virtual Machine to be installed. Supported on OSs that have a JVM of 1.7 or later (although does work with 1.6) . Linux now supported. Wizard-based installation that prompts user for the DTS installation location to re-use the folders. Supports auto-update mechanism that will update the MESH client if a new version is available MESH client launched from the command line in the same way as the DTS client and can therefore be run as a service under windows.

MESH – How it works N3 MESH Server Trust/ Supplier MESH Client/API SUS Animation of how MESH works. TLS TLS

How does MESH work? MESH Messages are a 2 file pair Control (.ctl) file – addressing information Attachment (.dat) file – renamed attachment Maximum file size up to 100MB standard Maximum 20GB with Chunking MESH client controls delivery Polls MESH mailbox Simple delivery mechanism Out folder for sending In folder for receiving Delivery/non-delivery reports generated Can be run as a Service Simple message format – comprises 2 files – Control and DAT files – Control defines the routing of the message, the DAT is the payload e.g. Word document renamed to .DAT Current maximum size limit is 100Mb for the DAT file, but developing MESH to handle larger files. Simple polling mechanism – polls every 10 minutes to check for files to download and send. Can handle multiple mailboxes in a single installation. MESH client – Files to send are placed into the OUT folder - <message>.ctl and <message>.dat Files downloaded are placed in the IN folder. Includes the ability to generate delivery and non-delivery reports Uncollected files are deleted after 5 days and a NDR sent to the originator

How Do I Name Files? MESH Messages are a 2 file pair Control file that contains addressing information Data file - payload Naming conventions Data file – <siteid><APP><sequence_id>.dat Control file -  <siteid><APP><sequence_id>.ctl Examples MESHTester-20170809132607-000012.ctl MESHTester-20170809132607-000012.dat Or ABCHC001-000000001.ctl  (where ABCHC001 is the Mailbox Name) ABCHC001-000000001.dat  Messaging Exchange for Social Care and Heath which is a replacement for the BT managed Data Transfer Service. This was the last part of the BT Spine Contract, which has now ended. MESH has been developed by the HSCIC Digital Delivery Centre – which oversees a number of key national applications and infrastructure for health and social care IT including SUS and Spine. Functionally equivalent to DTS, although has increase validation such as individual client certificates. Uses the Spine Core infrastructure which means active/passive resilience, transparent failover, auditing and Spine Core support

What Does the Control File Look Like? So for ECDS it might look like this; <DTSControl> <Version>1.0</Version> <AddressType>DTS</AddressType> <MessageType>Data</MessageType> <From_DTS>your MESH mailbox</From_DTS> <To_DTS>MESH Mailbox for SUS</To_DTS> <Subject>ECDS Submission </Subject> <LocalId>this should be auditable back to something local</LocalId> <WorkflowId>SUS_CDS</WorkflowId> <IsCompressed>N</IsCompressed> <Encrypted>N</Encrypted> <Compress>Y</Compress> <AllowChunking>Y</AllowChunking> </DTSControl> Detailed in MESH Client Interface Specification www.digital.nhs.uk/media/31989/MESH-Client-File-Interface-Specification-v-1-2/pdf/MESH_Client_File_Interface_Specification_v-1-2

What If I don’t set AllowChunking? If < 100MB (compressed) it will transfer If > 100MB (compressed) Transfer will fail The message will moved to the <Failed> folder Warning in the MESH.log

Summary Simple interface for sending/receive messages Live now – handles 15m+ message per month 24x7 support More info mesh@nhs.net www.digital.nhs.uk/message-exchange-social-care-health Webinar at: https://hscic.webex.com/hscic/ldr.php?RCID=36992b81bd2626b5f25edd8d3a5aea86

Questions

QA session – other questions you’ve submitted Presented by Peter Sherratt

Questions submitted before the webinar: Q: How will the HRG grouper process work, will we still be using the 17/18 local payment grouper? A: The local payment grouper is unchanged, so you’ll need to map in the same way as SUS+ will to ensure your local grouper and SUS+ output agree with each other. See Technical User Guidance at: http://content.digital.nhs.uk/ECDS/ECDS-supporting-documentation Q: Are there only weekly Monday to Sunday submissions? A: Not necessarily, you can make submissions for any time-frame you wish, but for CQUIN the data will be checked for quality once it’s a week old, i.e. we’ll check last Wednesday’s data as it is at midnight tonight. Q: Will there be a monthly refresh bulk submission as we currently do? A: You may do this, but if your data is kept up-to-date on a daily or weekly basis you may not need to do a monthly bulk update.

The Professional Record Standards Body Better records for better care

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

Next webinar is 4th October @ 2pm Future webinars…. They’re totally open – invite anyone Future topics will include: Data quality dashboards / validation 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 4th October @ 2pm Send your comments to : ECDS@nhs.net