Emergency Care Data Set (ECDS) Healthcare Provider Show and Tell March 2017 Aaron Haile, ECDS engagement lead (Royal College of Emergency Medicine) Peter Sherratt, ECDS implementation lead (NHS Digital) Paul Twigg, Pricing Development Manager (NHS England Pricing Team) Alastair Hill, Standard Contract Lead (NHS England) Version: v0.1.3 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 Providers is 28th 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 The Provider webinar on 7th Feb is available at: Streaming recording link: https://hscic.webex.com/hscic/ldr.php?RCID=10daca36e540e82e04721f19b33def09 Download recording link: https://hscic.webex.com/hscic/lsr.php?RCID=ad193fdf42c96d872d6217d58c9007ab We’ll be going through some things in more detail on this call Implementing ECDS and the Tariff Data set specification and common queries Most people will be muted – please send your comments and questions via the WebEx chat function We’ll be running a simple 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 Providers is 28th 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 We’ll re-issue the draft XSD files as some people had problems with the original .RAR file

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

How this relates to the groupers 4 Helpful to local site if it cannot do local mapping or to check their local mapping HRGs will match exactly if local mapping is done correctly Exact same mapping logic* 1 Report confirming mappings (from SUS+) Data Dictionary Investigations Treatments A & E patient group Age Mapping / Processing (central)* Central Grouper Care Provider CDS 011 ECDS 2 3 Data Dictionary Investigations Treatments A & E patient group Age SNOMED-CT Investigations (expanded) Treatments (expanded) EmCare_Attendance_Type, EmCare_Diagnosis, EmCare_Discharge_Status Arrival date Person birth date Mapping / Processing (local)* Local Grouper * Simple mapping logic made publicly available Pete

Mitigations If your coding is good already, there’s little to do. “Other” will only exist in the background – review your use of “other” – notify us if for any reason the new code sets don’t contain the right codes for your activity. Familiarise your 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 – you’ll need 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

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 Your feedback – survey How many of your ED’s do you think you could have up and running for October 2017? Assume for now that your IT suppliers are ready, willing and able On the next call we expect to have more detail about the early adopters scheme Consider: how much can be done with configuration Tell us what’s driving your timescales and what could potentially be done to help if necessary 2. We are looking to identify early adopter sites which would start collecting ECDS locally from early August 2017, and make first submissions during September. Come back to us if you’re interested in the ECDS early adopters scheme 3. Are there any particularly difficult parts of the spec you’re struggling with? 4. Do you see any differing issues for Type 3 and 4 departments? 5. Have you been discussing this with your suppliers already? Send your comments to : ECDS@nhs.net

Send your comments to : ECDS@nhs.net Future webinars…. We plan to hold a webinar every 3 weeks They’re totally open – invite anyone Future topics will include: A focus on the early adopters scheme The CQUIN scheme (next session) Implementation support – materials that will be available Benefits case studies performance management / SitRep / 4 hour Let us know anything particular you’d like us to cover again or in more detail Next webinar focused on Providers is 28th March @ 2pm and it will focus on the CQUIN scheme in detail Send your comments to : ECDS@nhs.net