Emergency Care Data Set (ECDS) General Show and Tell No.6, 16 May 2017 Peter Sherratt, ECDS implementation lead (NHS Digital) Aaron Haile, ECDS project manager (Royal College of Emergency Medicine) Nick Hunt, Solutions Assurance (NHS Digital) Alex Elliot and Helen Hughes, Real-time Syndromic Surveillance Team (Public Health England) James Salt and Steve Fenner, SUS Team (NHS Digital) Pat Carter, ECDS business analyst (NHS Digital) Julie Clough, HES team (NHS Digital) Zac Whitewood-Moores, UK Terminology Centre (NHS Digital) Tim Ireland, Technical and Professional Services (NHS Digital) 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 is 6th June @ 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 The previous webinar links are available through the transcript document Please stay 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 is 6th June @ 2pm Send your comments to : ECDS@nhs.net

We’ll be going through some things in more detail on this call The assurance / compliance process EDSSS presented by PHE ECDS User Guidance Data deletion / sandpit / testing More info on the HES mappings SNOMED FAQ SQL Scripting Previous webinars have covered General introduction Tariff and payment CQUIN Transition process Mappings Quick progress update: CCG and ED webinars went well ECDS Directions are on track to be approved and SUS+ development is on track

Compliance / Assurance process Presented by Nick Hunt

Process for XML assurance / compliance SA (NHS Digital Solutions Assurance) provide suppliers with ECDS test data in the form of Wessex flat files (one set per supplier) that cover a set of scenarios and a file specification along with some “rules” on processing the files (such as ordering of records on upload) suppliers convert the flat files into CDS XML interchanges and submit these to a “test” environment SA compare the submitted CDS XML interchanges with a set of expected results any discrepancies from this comparison are analysed / discussed to determine whether the supplier is compliant and therefore allowed to proceed or whether they have to fix their system and re-submit

Emergency department syndromic surveillance Alex Elliot & Helen Hughes Real-time Syndromic Surveillance Team Public Health England ECDS Webinar No. 6 16 May 2017

What is ED syndromic surveillance? Why do we do it? What do we do now? Outline What is ED syndromic surveillance? Why do we do it? What do we do now? How ECDS will improve it Outline of slides ECDS Webinar No. 6 16 May 2017

8 One of PHEs remits it to protect the health of the public. Surveillance of impact on health Real-time Syndromic Surveillance – CIDSC from science to practice and policy Real-time Syndromic Surveillance – CIDSC from science to practice and policy ECDS Webinar No. 6 16 May 2017 Mini Flu Conference – 1 Feb 2017 Mini Flu Conference – 1 Feb 2017

What is syndromic surveillance? 1-2 weeks 9 More traditional surveillance methods are not quick! Mainly focussed on infectious diseases and what if there’s no standard lab testing carried out? Other sources of ED data in particular have a longer time until data is available (eg HES) Real-time Syndromic Surveillance – UoW Big Data and Google Flu ECDS Webinar No. 6 16 May 2017 Real-time Syndromic Surveillance – CIDSC from science to practice and policy

What is syndromic surveillance? 10 Syndromic surveillance does not wait for the final confirmation: use the initial diagnoses/ signs/ symptoms as recorded on first contact with health care provider Real-time Syndromic Surveillance – CIDSC from science to practice and policy ECDS Webinar No. 6 16 May 2017 Real-time Syndromic Surveillance – UoW Big Data and Google Flu

Why syndromic surveillance? Early warning Situational awareness Reassurance “Provide support to other public health surveillance programmes within Public Health England” 11 We are not working alone within the public health system. This is not a standalone system, we work closely with and provide support to other surveillance programmes Real-time Syndromic Surveillance – CIDSC from science to practice and policy ECDS Webinar No. 6 16 May 2017 Mini Flu Conference – 1 Feb 2017 Mini Flu Conference – 1 Feb 2017 Real-time Syndromic Surveillance – CIDSC from science to practice and policy

Why syndromic surveillance? “A national public health insurance policy” 12 We are considered a national public health insurance policy – there if needed. Real-time Syndromic Surveillance – CIDSC from science to practice and policy ECDS Webinar No. 6 16 May 2017 Mini Flu Conference – 1 Feb 2017 Mini Flu Conference – 1 Feb 2017 Real-time Syndromic Surveillance – CIDSC from science to practice and policy

Current PHE syndromic system data sources OTC sales Sentinel GP (RCGP) Tele-health (NHS 111) Social media (Twitter) Emergency department GP in hours Ambulance HCW absenteeism Web activity GP out of hours 13 Within PHE we coordinate a number of syndromic surveillance systems, including the Real-time Syndromic Surveillance – CIDSC from science to practice and policy Real-time Syndromic Surveillance – CIDSC from science to practice and policy ECDS Webinar No. 6 16 May 2017 Mini Flu Conference – 1 Feb 2017 Mini Flu Conference – 1 Feb 2017

“Emergency Department Syndromic Surveillance System” What is EDSSS? “Emergency Department Syndromic Surveillance System” 7 EDSSS is the emergency department syndromic surveillance system Run by PHE, built with and supported by the College Created largely in preparation for the Olympic Games Remains as a Legacy of London 2012 Real-time Syndromic Surveillance – UoW Big Data and Google Flu ECDS Webinar No. 6 16 May 2017

What is EDSSS? Sentinel network of EDs across England and Northern Ireland Collecting & analysing an anonymised subset of the ECDS on a daily basis Initially recruited EDs using Symphony (EMIS) EDs currently reporting from 3 different software systems: Symphony, Millennium (Cerner) & Oceano (CSE) 8 Currently have 35 EDs reporting daily The data collected from each ED is a line for every attendance, taking a small subset of the fields from the ECDS: Basic patient demographics, arrival info, info on the clinical presentation and diagnoses, investigations and treatments and discharge details Patient identifiable information is not included (no DOB/ NHS number/ address/ full postcode) We only take the information the department collect, if there’s a field we would like, but they don’t use it, we accept that it will always be blank (often the case for triage info) The records are not validated or checked before transmission, so some fields may be filled in or updated later, but this will not be reflected in the syndromic surveillance data: used as a snapshot of what happened yesterday to compare each day with what is ‘normal’ in that ED/ across the country as a whole (it is not used for analysis of wait times or comparisons between EDs) Real-time Syndromic Surveillance – UoW Big Data and Google Flu ECDS Webinar No. 6 16 May 2017

The secret to success EDSSS (current): No additional requirements for clinicians Minimal setup for Trusts Automated data capture/transfer Clinical agreement with Trust IT agreement with Trust Governance agreement with Trust BUT ED recruitment resource intensive for PHE ECDS Webinar No. 6 16 May 2017

How EDSSS collects data (current) N3 connection: Data pulled by PHE Automated: daily at 8:30am Manual*: as required ED 3rd party IT ED database Data from all EDs made available as a single source EDSSS dataset EDSSS dataset Server Data validation: Dates & ages Virtual server (capacity up to 5 days) EDSSS dataset EDSSS database Data validation (format) anonymisation (postcodes) N3 connection: Data sent on request Automated: daily by 7:45am Manual*: as required PHE 17 2 main parts to the EDSSS data extraction, how it is prepared and then how it is transferred to us: Data from existing database is translated into a format similar to the new ECDS, with entries all coded and anonymised before being ‘packaged’ into a daily extract within the ED/ Trust server 3rd party IT supplier used to extract the daily extract and transfer across N3 network to PHE ECDS Webinar No. 6 16 May 2017

EDSSS outputs Acute respiratory infection Asthma www.gov.uk/government/collections/syndromic-surveillance-systems-and-analyses Daily analysis and interpretation of data Weekly reports Ad hoc responses to local national public health emergencies. ECDS Webinar No. 6 16 May 2017

ECDS for EDSSS Benefits: Standardised coding/better quality data National rollout Single collection point (NHS Digital) Challenges: Frequency (daily) Governance (central) ECDS and CDS v10 will standardise use and reporting of clinical coding across English EDs (currently CDS, ICD10, SnoMed, bespoke etc) National rollout provides the potential to move from a sentinel system to full coverage of the country which strengthens surveillance Ability to collect data through a single point ie NHSD makes it easier Biggest challenge is replacing existing EDSSS DAILY data with a daily feed from ECDS system. Early unvalidated data essential for sitrep and early performance data and also allows syndromic surveillance. Later cleaned data suitable for commissioning/payments ECDS Webinar No. 6 16 May 2017

Thank you Questions? ECDS Webinar No. 6 16 May 2017

ECDS User Guidance Presented by Aaron Haile

ECDS – User Guidance All those involved in the collection and submission of ECDS ED staff (clerical, clinical and management) Information management departments IT system suppliers Does cover Overlapping standards/data collections ECDS & SNOMED CT Usability Each data group & data item Does not cover Justification for the Information Standard Technical guidance – SUS/HES/MESH/Validation

ECDS – User Guidance Data group:

ECDS – User Guidance Data item:

Other Useful Information 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

Data deletion / testing / sandpit Presented by James Salt and Steve Fenner

HES Mapping update for Transition Period Presented by Pat Carter / Julie Clough

HES Mapping Interim period for HES – August 2017 to April 2018 ECDS mapped back to CDS 010 for specific data items used for HES (for 2017 – 2018 annual statistics / Reports) Mapping documentation will be available to providers Not part of formal ECDS documentation (no warranty) Changes / Updates will be communicated via webpage Mappings will not be used for SEM Extract – two separate extracts from SUS+: SEM (CDS 010 submitters) ECDS data mart

CDS 010 data mapped from ECDS data CDS 010 Data Item for HES ECDS Data Item(s) used to map PERSON GENDER CURRENT PERSON STATED GENDER CODE A&E ARRIVAL MODE CODE EMERGENCY CARE ARRIVAL MODE (SNOMED CT) A&E ATTENDANCE CATEGORY CODE EMERGENCY CARE ATTENDANCE CATEGORY A&E ATTENDANCE DISPOSAL CODE Multiple ECDS data items including: - EMERGENCY CARE DISCHARGE STATUS (SNOMED CT) - EMERGENCY CARE DISCHARGE DESTINATION (SNOMED CT) - EMERGENCY CARE DISCHARGE FOLLOW UP (SNOMED CT) A&E INCIDENT LOCATION TYPE - EMERGENCY CARE PLACE OF INJURY (SNOMED CT) - EMERGENCY CARE INJURY ACTIVITY STATUS (SNOMED CT) A&E PATIENT GROUP - EMERGENCY CARE INJURY INTENT (SNOMED CT) - EMERGENCY CARE INJURY MECHANISM (SNOMED CT) - EMERGENCY CARE INJURY ACTIVITY TYPE (SNOMED CT) - EMERGENCY CARE ATTENDANCE CATEGORY SOURCE OF REFERRAL FOR A&E EMERGENCY CARE ATTENDANCE SOURCE (SNOMED CT) A&E DIAGNOSIS EMERGENCY CARE DIAGNOSIS (SNOMED CT) A&E INVESTIGATION EMERGENCY CARE CLINICAL INVESTIGATION (SNOMED CT) A&E TREATMENT EMERGENCY CARE PROCEDURE (SNOMED CT)

HES Mapping We are NOT mapping: Carer Support Indicator this data item has been removed in ECDS and there is no other data item which can be used for mapping) A&E Staff Member Code the DQ of this is low and the field format has changed – we haven’t worked out a way to map this and due to the low DQ we decided we didn’t need to worry about it

SNOMED CT in the Emergency Care Data Set Frequently asked questions (and some answers) presented by Zac Whitewood-Moores, Clinical Data Standards Specialist

Information Standards Notices SNOMED CT® http://content.digital.nhs.uk/isce/publication/scci0034 Commissioning Data Sets: Emergency Care Data Set http://content.digital.nhs.uk/isce/publication/SCCI0092-2062 Information Sharing to Tackle Violence Minimum Dataset http://content.digital.nhs.uk/isce/publication/isb1594 Accessible Information http://content.digital.nhs.uk/isce/publication/SCCI1605

Which bits of SNOMED CT do I need? SNOMED CT is a wide ranging terminology for use across health and social care Subsets identify content for a specific purpose In Release Format 2 you may see these referred to as reference sets abbreviated to refsets The Data Dictionary for Care (dd4c) identifies the subsets required for the Emergency Care Data Set (and others of course) with links to relevant resources https://dd4c.digital.nhs.uk/dd4c/publisheddatasets/1

SNOMED CT downloads from “TRUD” UK Edition of SNOMED CT https://isd.digital.nhs.uk/trud3/user/authenticated/group/0/pack/26 International UK Clinical UK Drugs SNOMED CT subset pack (including descriptions) – Emergency Care https://isd.digital.nhs.uk/trud3/user/authenticated/group/0/pack/40/subpack/296/releases

Changes to subsets Subsets are currently updated every 6 months to reflect changes in requirements, clinical practice and SNOMED CT (nationally and internationally) We have become aware that a name change resulted in a new subset creation, rather than an update to the name, the Emergency care attendance source simple reference set (RF1 Original ID  75011000000136, RF2 ID 999002991000000109) will persist, this matches the name in the ECDS standard and given the mixed content. Emergency care source of attendance findings simple reference set will be inactivated (RF1 Original ID75061000000139, RF2 ID 999003041000000106) The metadata in dd4c already reflects these changes but the duplicate subset in the release files will persist till the next release of SNOMED CT.

Supporting use in Emergency Care Specialist resources to inform design choices

SNOMED CT specialist resources SNOMED International Technical Implementation Guide https://confluence.ihtsdotools.org/display/DOCTIG SNOMED International has links to SNOMED CT browsers https://confluence.ihtsdotools.org/display/DOC/SNOMED+CT+Browsers+-+Online Practical Guide to Reference Sets https://confluence.ihtsdotools.org/display/DOCRFSPG/Practical+Guide+to+Reference+Sets

SNOMED CT Education and Training resources NHS Digital https://hscic.kahootz.com/connect.ti/t_c_home/view?objectId=301107 SNOMED International https://elearning.ihtsdotools.org (registration and enrolment required for some resources)

Contacts Information Standards Service Desk call 0300 303 4777 email information.standards@nhs.net

SQL Scripting Presented by Tim Ireland

SQL Scripting We have created generic SQL strawman to help the creation of ECDS tables for data warehouses etc. Please give us your feedback Is it useful? How could it be made better? Provided with no formal warranty With many thanks to Dan Taylor at Countess of Chester

Wrapping up – a few final points Presented by Peter Sherratt

Wrapping up We are looking for volunteers for an AEC pilot – please get in touch if interested HRG / Tariff – full guidance available soon Clinical lead contacts in every ED CQUIN for each ED – pro rata based on £ income Do not flow out-of-range SNOMED codes The fun bit – the survey….

Future webinars…. Next webinar focused is 6th June @ 2pm We plan to hold a webinar roughly every 3 weeks They’re totally open – invite anyone Future topics will include: Detail on the technical guidance (next session) Data quality dashboards / validation Local XML validation A focus on the early adopters scheme Implementation support – materials Performance management / SitRep / 4 hour Benefits case studies Let us know anything particular you’d like us to cover again or in more detail Next webinar focused is 6th June @ 2pm Send your comments to : ECDS@nhs.net