Emergency Care Data Set (ECDS) Commissioner Show and Tell No.1, 28 April 2017 Dr Tom Hughes, ECDS lead clinician (Royal College of Emergency Medicine) Peter Sherratt, ECDS implementation lead (NHS Digital) Aaron Haile, ECDS project manager (Royal College of Emergency Medicine) Martin Campbell, Head of Pricing (NHS England) Alastair Hill, NHS Contract Lead (NHS England) 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.

Before we start Next webinar focused on Commissioners is 26th May 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 Aaron Haile 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 Next webinar focused on Commissioners is 26th May Send your comments to : ECDS@nhs.net

On this afternoon’s call we will be covering: An introduction to the ECDS and its benefits The inclusion of the ECDS in the CQUIN scheme Considerations to do with Tariff and contracts Quick progress update: The ECDS Information Standard has now been published here

Why do we need ECDS? An introduction Presented by Dr Tom Hughes and Peter Sherratt

‘Flying Blind’ – Health Select Committee, 2013 Reason for attending Other patient group includes: Assault – 0.65% Deliberate self-harm – 0.56% Firework injury - 0.03% Brought in dead – 0.01% NHS Digital. 2017. Hospital Accident and Emergency Activity, 2015-16. Accessed 01/02/2017. Available at http://www.content.digital.nhs.uk/catalogue/PUB23070

Diagnosis NHS Digital. 2017. Hospital Accident and Emergency Activity, 2015-16. Accessed 01/02/2017. Available at http://www.content.digital.nhs.uk/catalogue/PUB23070

Key data set changes Changes to existing CDS Type 010 data items Attendance Category Source of Referral Diagnosis (& diagnosis qualifier) Investigations & Treatments Attendance Disposal code – Discharge status/Discharge Destination/Discharge Follow up Clinician details Initial Assessment Time – Decision to Admit New data items Chief Complaint Diagnosis Qualifier Acuity Injury Introduction of new concepts ECDS will introduce a new CDS Type – CDS Type 011 ECDS. SNOMED CT for some subsets Weekly >> Daily data feed

Implementation and scope of deployment In scope Timescale Type 1 & Type 2 Emergency Departments (approx. 190 sites) From October 2017 (early adopters sooner) Type 3 & 4 Emergency Departments & UCC’s (approx. 240 sites) Any time from October 2017, must complete by Oct 2018 Out of scope currently: Ambulatory Emergency Care (AEC) Data should flow at least weekly>>daily from April 2018 or sooner. Daily means recent data covering at least the previous 24 hours. Data should improve as time passes – doesn’t have to be perfect for yesterday, but should be good after a week. Very recent data won’t be used for Tariff – there will be at least a month to get data right. Incentivisation is provided by the 2017/2019 CQUIN scheme (see target 8a). CDS Type 010 A&E will remain active until at least 2019 to allow for cut-over of all ED’s. but no expectation that there will be dual running

Key Milestones - Recap For Type 1 & 2’s transition roughly between Sep – Nov Start collecting ECDS by 1st Oct to get 100% CQUIN (50% from 1st Dec) Sites will probably want to avoid going live on 30th September because it’s a Saturday. Assuming maximisation of CQUIN sites will want to go live during w/c 25th Sept at the latest (meaning that for Sept or Oct there may be mixed data for the month)

Trusts with multiple EDs Different ED sites can transition at different times Trusts may stagger ‘go live’ for different ED sites e.g. Type 1 and 2’s flow ECDS and concurrently Type 3’s flow CDS 010 (old A&E data set)

Example Implementation Timeline (Sep-Dec) ECDS timeline The top row is the activities for ECDS The bottom row is the CDS 010 activities Colours denote data by month The blue box is the latest date to make a CDS 010 submission assuming that a site goes live with ECDS on or before 1 October 2017 (except the HES end of year submission)

Other Useful Information User Guidance will be available to help ED staff / Informatics staff / data coders to capture and submit better quality data Technical Guidance will be available to assist IT / Informatics teams e.g. MESH / XML deployment guidance Posters / Crib sheets will be available to help ED staff enter new data items

ECDS and the CQUIN Presented by Peter Sherratt

The ECDS part of the 2017-19 CQUIN Intro Incentivisation for the ECDS is provided by the 2017/2019 CQUIN scheme (see target 8a). High level overview The CQUIN calculator Principles and Things to note CQUIN Part 1 (Q1 17/18) (demonstrable & credible plans) CQUIN Part 2 (Q3 17/18) Worked example for CQUIN Part 2 (Q3 17/18) CQUIN Parts 3 – 6 (Q1 18/19 to Q4 18/19) Achieving high quality data

The ECDS part of the 2017-19 CQUIN High level overview Part 1: Q1 17/18 – Providers submit demonstrable and credible planning for a 1 October 2017 Go-live. Parts 2-6: Q3 17/18 to Q4 18/19 – Providers are assessed on data quality and submission frequency in incrementally more challenging ways. Reports will be generated from the SUS+ system which will provide reliable metrics to both providers and commissioners. We can only issue guidance and advice to commissioners on how to administer the scheme.

The ECDS part of the 2017-19 CQUIN Principles and things to note No “cliff edge” Data quality is more important than submission frequency – weightings reflect this The CQUIN is based on sites being live on 1 October 2017 However, the main focus of reward is for December 2017 (start of winter pressures) A report(s) will be made available in SUS+ to enable monitoring against this recommended approach General data quality – all items are important Specific item data quality – later SUS downtime etc. Arbitration / dispute resolution Reports should be run about a week after the end of the quarter

The ECDS part of the 2017-19 CQUIN CQUIN Part 1 (Q1 17/18) (demonstrable & credible plans) Plans to be submitted to commissioners by 30th June 2017 We recommend you share your plans with ECDS@nhs.net Plans should be sufficiently detailed to give credibility – we have produced a template “model plan” (see CQUIN guidance document appendices) Evidence of support and engagement should be sought from: Senior management inc. Directors of finance, IT EDIS supplier, XML broker etc. ED staff (management, clinical, nursing, clerical) Informatics staff

The ECDS part of the 2017-19 CQUIN CQUIN Part 2 (Q3 17/18) If there’s £50,000 available for this part of the CQUIN… Priority 1: Going live with ECDS from 1 December 2017 (50%) (£25000 – data for the whole of Dec) Priority 2: Data Quality (40%) (£20,000 available – Chief complaint and Diagnosis) • Greater than 95% (Good) attracts 40% £20,000 of payment • 90-95% (Medium) attracts 20% £10,000 of payment • <90% (Poor) 0% No payment Priority 3: Frequency and timeliness (10%) (£5000 available) There are 13 weeks in this quarter – so you get 1/13th of £5000 (£385) for each weekly submission More worked examples coming up….

The ECDS part of the 2017-19 CQUIN Worked examples for CQUIN Part 2 (Q3 17/18) Scenario Go Live Date Data Quality (Diagnosis & Chief Complaint) No. of weekly submissions (out of 13) A 1 October 2017 96% (Good) 13 B 20 November 2017 94% (Medium) 6 C 1 December 2017 95% (Good) 1 D 2 December 2017 90% (Medium) 4 If there’s £50,000 available for this part of the CQUIN… Scenario Go Live Date Data Quality Weekly submissions Total A £25,000 £20,000 £5000 £50,000 B £10,000 £2308 £37,308 C £385 £45,385 D £0 £1538 £11,538

The ECDS part of the 2017-19 CQUIN CQUIN Parts 3 – 6 (Q1 18/19 to Q4 18/19) Split data quality and daily submissions 60/40 Chief complaint, Diagnosis, Acuity, Discharging Clinician, Referral Source and Discharge Status Finally, achieving high quality data – please view the CQUIN guidance document appendices.

The ECDS part of the 2017-19 CQUIN The CQUIN Calculator This is provided without warranty, feel free to get your CQUIN team to check it. The CQUIN Guidance Document This is not compulsory but does contain helpful guidance

ECDS National Tariff Considerations Presented by Martin Campbell, Alastair Hill and Peter Sherratt

ECDS: National Tariff considerations What we plan to cover Reasons for the changes Technical solution How will ECDS impact on payment? (tariff / HRGs) Mitigations How the NHS Standard Contract can help Pete

Objectives – record activity accurately Correctly capture the activity carried out in Emergency Departments by: Introducing new investigations and treatments to the list of possibilities – e.g. mental health, dementia, sepsis treatment protocols. Not encouraging the capture of inappropriate, incorrect or useless data – e.g. genitourinary contrast exam, fracture review, “other”. Enable future HRG / Tariff development. Decision: Modify the list of investigation and treatment codes and manage any risk to the payment system. Pete

How will ECDS impact payment? We are not planning to make any changes to the HRGs or associated prices as part of the introduction of ECDS. For the vast majority of Providers there will be minimal impact. Mitigations are straightforward. If required, the NHS Standard Contract sets out arrangements for the financial impact of agreed changes to be made neutral for a time-limited period. Paul

How will ECDS impact payment? The mapping has been developed with the Casemix National Expert Working Group and Royal College of Emergency Medicine with the view to limit or mitigate any impact (so far as is possible). However, the update to the underlying code set may have an impact on casemix / payment due to: Introduction of new codes Retirement of existing codes (e.g. the “other” code as SNOMED does not allow for the capture of “other”) Update in coding to reflect more accurately clinical practice Paul

A&E records based on SNOMED codes Technical solution Current process: A&E records based on existing investigation and treatment codes (Data Dictionary) Future process: A&E records based on SNOMED codes Background mapping to Data Dictionary investigation and treatment codes Paul

Mitigations If coding is good already, there’s little to do. “Other” will only exist in the background – review use of “other”. Familiarise staff with the new code sets as part of ECDS training – they should be much better than the current sets. Obsolete and confusing codes are being removed – important to know which ones are being retired so you can train staff. Pete / Paul

Contract mitigations The NHS Standard Contract already contains arrangements to mitigate the short-term financial impact of changes in the way patient activity is counted and coded (Service Condition 28 of the Contract). Our intention is to make clear, in guidance, that implementation of ECDS is a counting and coding change under SC28 and that – unless an alternative approach is agreed locally – the financial impact will have to be ‘neutralised’ in the short term. If you implement ECDS on 1 October 2017, the period of neutralisation will run until 31 March 2019. Our guidance will propose a simple methodology for this. Set a historic baseline for average A&E attendance price based on 17/18 prices. Work on the basis that any variance from this average relates to ECDS and must therefore be neutralised. But allow local flexibility so that, by agreement, the impact of any genuine casemix change can still be identified and take financial effect (where specific care pathway changes can be shown to have affected patient flows and mix, say). Alastair

Do you have any questions? Any further questions can be sent to: NHS Standard Contract team at: nhscb.contractshelp@nhs.net Pricing team at: pricing@improvement.nhs.uk ECDS@nhs.net

Future webinars…. Next webinar focused on Commissioners is 26th May We plan to hold a webinar roughly every 3 weeks They’re totally open – invite anyone Future topics will include: HES transition EDSSS update by PHE (ED Syndromic Surveillance) Detail on the user guidance / technical guidance A focus on the early adopters scheme Implementation support – materials Performance management / SitRep / 4 hour Benefits case studies A focus for ED staff / managers [10th May 2017 at 2pm] – Registration Link. Let us know anything particular you’d like us to cover again or in more detail Next webinar focused on Commissioners is 26th May Send your comments to : ECDS@nhs.net