Emergency Care Data Set (ECDS) Systems Supplier Show and Tell March 2017 Aaron Haile, ECDS engagement lead (Royal College of Emergency Medicine) Peter Sherratt, ECDS implementation lead (NHS Digital) Tom Hughes, ECDS Lead Clinician (Royal College of Emergency Medicine) Stuart Baskerville, Simon Richards, Sarga Moore – MESH Team (NHS Digital) Version: v0.1.1 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.

Before we start Next webinar focused on Suppliers is 29th March @ 2pm. 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 Previous (provider) webinars have been recorded and links are available We’ll be going through some things in more detail on this call General update MESH National Tariff considerations (high level) QA Most people will be muted – please send your comments and questions via the WebEx chat function, or raise your hand 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 Next webinar focused on Suppliers is 29th March @ 2pm. Send your comments to : ECDS@nhs.net

Quick progress update The SCCI process is on track for ISN publication – mid-April 2017 The XSD file has now been assured and will be published in the next couple of weeks Any feedback – let us know now We’ll re-issue the draft XSD files as some people had problems with the original .RAR file Results of the Provider webinar The poll gave us 89.6 “confidence weighted” departments and an average confidence of 58.38% (up nearly 3%) which would translate to about 140 EDs if consistent throughout England.   That’s based on a much bigger sample size of 75 Trusts covering 160 EDs, meaning over 40% of all Trusts gave us an answer.

What is MESH? MESH is a secure application-to-application messaging service Message Exchange for Social Care and Health NHS Digital developed and managed service Functional replacement for DTS Use of robust, secure and modern Spine Core infrastructure 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

Key facts about MESH 13+ million messages exchanged every month 7500 active accounts 9000+ organisations NHS Digital Service Use of robust, secure and modern Spine infrastructure Expanded uses Usage stats increasing every month

Who uses MESH? The main users of MESH are general practices and pathology departments Other users include: Exeter systems National screening services National services e.g. CQRS and GPES 111 services Ministry of Defence sites Transfer of Care (discharges) GPs and pathology departments account for 60 per cent of all DTS traffic Most service users have their DTS arrangements managed by their system supplier, a small minority don’t, and we are engaging directly with these organisations and providing support

DTS/MESH user types We can categorise service users into three main types. System suppliers Service users (who have their DTS/MESH arrangements managed by their supplier) Service users who manage their own DTS/MESH arrangements

How does MESH work? Messages comprises Maximum file size up to 100Mb Control (.ctl) file – addressing information Attachment (.dat) file – renamed attachment Maximum file size up to 100Mb MESH client controls delivery Polls MESH mailbox Simple delivery mechanism Out folder for sending In folder for receiving Delivery/non-delivery reports generated 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

MESH – Future State N3 Internet Facing MESH Server Direct API Lab MESH Client MESH Client GP Practice TLS TLS Animation of how MESH works.

Introducing the MESH client Java based client (JVM 1.7) SSL mutual authentication using Java Keystore Supported on Windows server and client, Linux, Solaris, SCO, AIX, HP-UX Wizard-based installation Automatic Updates Command-line support Can be run as a Windows service 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.

Installation pack Available @ http://systems.digital.nhs.uk/ddc/mesh/guidance Pack Contents Wizard install tool Installation guide Certificate management Running as a service Interface Spec WorkflowID guidance Example config file

MESH Server API New feature with MESH HTTP based API Enables suppliers to integrate directly with MESH Replaces MESH/DTS client EMIS first live deployment Specification available Exposing the API used by the MESH client to send/receive Enables Systems to talk directly to MESH without the need for a client

MOLES MESH OnLine Enquiry Service (MOLES) Functional replacement for DTS Registration and Tracking Service (RATS) Smartcards required to access the service User/organisation administration Message Tracking, Trading Partner Report, Mailbox Lookup API Usernames and Passwords will be transferred to MOLES as will the organisational information. Current RATS functionality will be transferred to MOLES and will allow user/mailbox administration and message tracking. Message tracking API will also be supported for querying message statuses.

Testing Environment Available for Testing Testing of: MESH client DTS client with the adapter ( to be withdrawn) MOLES Message Tracking API MESH Server API Further details at http://systems.digital.nhs.uk/ddc/mesh/test-client Issues raised via the SA Service Desk – sa.servicedesk@hscic.gov.uk Testing is key: MESH client testing – ensuring the client systems work the same way as DTS DTS client – ensure the DTS Adapter works in the same way as DTS Moles – Familiarise yourself with the new interface Message Tracking API – integration with existing systems MESH Server API – suppliers wanting to test the new API to send/receive messages without the need for the client

Migration Progress DTS to MESH Central Service migrated from BT in January 2016 Initial deadline for transfer 30 June Decommissioning period July to 30 September DTS Adapter closed 1 October IP Whitelist process instigated to limit and control access Extended use requires specific individual approval All new installations via MESH Client or API @ 3rd October 95% complete Testing is key: MESH client testing – ensuring the client systems work the same way as DTS DTS client – ensure the DTS Adapter works in the same way as DTS Moles – Familiarise yourself with the new interface Message Tracking API – integration with existing systems MESH Server API – suppliers wanting to test the new API to send/receive messages without the need for the client

MESH Roadmap MESH client support for larger files using file chunking (20Gb) MESH Endpoint Lookup Web interface to find MESH mailbox RESTful API interface available Initially ODS Code and WorkflowId (message type) Expanding to NHS Number and D.O.B MESH Internet Gateway Extends use to Internet access MESH User Interface Webmail style interface to MESH N3 access via smartcard Internet access via one time passcode Looking at new developments for MESH: Looking at supporting file chunking to support larger files – would need to know volumetrics on this before suppliers start using this – available in August with a new MESH client EndPoint Lookup – available within MOLES and as an API for suppliers to integrate too – allows MESH mailboxes to be searched via ODS (Org code) and WorflowID MESH Internet Gateway – extends the accese to MESH/MESH API on the Internet – available in the next couple of months MESH UI – provide a webmail style interface for non-technical users to send/receive messages via MESH – generates the control and DAT file in the background, provides MOLES message tracking in the same UI Available on both N3 and Internet – available end of 2016

MESH User Interface Looking at new developments for MESH: Looking at supporting file chunking to support larger files – would need to know volumetrics on this before suppliers start using this – available in August with a new MESH client EndPoint Lookup – available within MOLES and as an API for suppliers to integrate too – allows MESH mailboxes to be searched via ODS (Org code) and WorflowID MESH Internet Gateway – extends the accese to MESH/MESH API on the Internet – available in the next couple of months MESH UI – provide a webmail style interface for non-technical users to send/receive messages via MESH – generates the control and DAT file in the background, provides MOLES message tracking in the same UI Available on both N3 and Internet – available end of 2016

Summary Simple interface for sending/receiving messages Live now – handles 13m+ message per month Different client solutions available 24x7 support Planned roadmap of product development mesh@nhs.net https://www.digital.nhs.uk/messaging-exchange-social-care-health As discussed.

ECDS Q&A Feedback Technical Output Spec changes January addendum updates have now been made and covered the following: Updated definitions Some formats have had ‘min’ and/or ‘max’ added e.g. all SNOMED codes are now ‘min n6 max n18’ Format change to some ODS codes, from ‘min an5 max an9’ to ‘min an3 max an5’ Data item specific changes are outlined in the Jan – March 2017 Addendum which we will circulate EMERGENCY CARE PLACE OF INJURY (LATTITUDE AND LONGITUDE) has been split into two data items CLINICAL TRIAL IDENTIFIER & DISEASE OUTBREAK NOTIFICATION are now grouped under there own group ‘ Research and Outbreak Notification’ Question – Now that changes have been made following schema testing is it useful to share v6.2 of the ECDS or should we wait until we publish the ISN in April? 2. Mandated & Required data items All mandated items in the schema will need to flow as part of CDS Type 011 else the submission will fail validation Some ‘Required’ fields must also be submitted from October 2017 to satisfy the CQUIN. These fields are: EMERGENCY CARE ACUITY (SNOMED CT) / EMERGENCY CARE CHIEF COMPLAINT (SNOMED CT) EMERGENCY CARE DIAGNOSIS (SNOMED CT) (including CODED CLINICAL ENTRY SEQUENCE NUMBER and DIAGNOSIS QUALIFIER) PROFESSIONAL REGISTRATION ENTRY IDENTIFIER/ PROFESSIONAL TIER (EMERGENCY CARE) & CARE PROFESSIONAL DISCHARGE RESPONSIBILITY INDICATOR (EMERGENCY CARE) to identify the Discharging clinician EMERGENCY CARE ATTENDANCE SOURCE (SNOMED CT) EMERGENCY CARE DISCHARGE STATUS (SNOMED CT)

ECDS Q&A continued… 3. Use of flags 4. Discharge fields Chief Complaint and Diagnosis code sets also include flags for certain information. These flags are designed to support implementation and use of the data set by ‘flagging’ certain information to note, please see below: Injury – Whether the chief complaint or diagnosis is likely to be the result of an injury, indicates that the injury data items should be collected. Male/Female – Whether specific conditions are specifically male or female to avoid data quality issues e.g. pregnant males Ambulatory Emergency Care (AEC) – these are conditions that map to the current list of diagnoses that are suitable for ambulatory care. Notifiable Disease – Indicates that this is a Notifiable disease and should be restrained Allergy – these conditions are associated with allergic reactions and would help trigger the ED IT system to collect and send information about possible allergy cause as part of the discharge summary / electronic message. 4. Discharge fields The previous CDS field ‘A&E Disposal code’ conflated discharge information and this has now been broken down into three individual items to provide more accurate information relating to outcomes and where patients go after the ED: Emergency Care Discharge status – Captures whether treatment took place within the ED, if the patient was streamed to another service (NHSE update from last week regarding GP streaming) or if the patient left before treatment was complete. Emergency Care Discharge Destination – Identifies the intended destination of the patient following discharge from the Emergency Care Department such as ‘Home’, ‘Ward’ or ‘AEC’. Emergency Care Discharge Follow up – Identifies the specific service to which a patient was referred for continuing care following an Emergency Care Attendance such as ‘GP’, ‘Community Psych Services’ or No referral’.

Send your comments to : ECDS@nhs.net Before we finish What timescales are XML brokers working to for going through the assurance process? Tell us what’s driving your timescales and what could potentially be done to help if necessary Release of ECDS spec 6.3 Final XML file set 3. We are looking to identify early adopter sites which would go live during September and potentially even as early as August 2017 Come back to us if you have any sites that are interested 4. Are there any particularly difficult parts of the spec you’re struggling with? Send your comments to : ECDS@nhs.net

Future webinars…. Future topics will include: The transition period Guidance materials that will be available The early adopters scheme Let us know anything particular you’d like us to cover again or in more detail Next webinar focused on Suppliers is 29th March @ 2pm Send your comments to : ECDS@nhs.net