Emergency Care Data Set (ECDS) General Show and Tell No.14, 7 March 2018 Peter Sherratt, ECDS implementation lead (NHS Digital) Aimee Haggas, Implementation and Business Change (NHS Digital) Tom Hughes, ECDS lead clinician (Royal College of Emergency Medicine) Bobby Pratap, National Mental Health Team (NHS England) Julie Clough, HES Secondary Care Team (NHS Digital) Neil Clark, HES Secondary Care Team (NHS Digital) Emma Fernandez, ECDS Project Manager (Royal College of Emergency Medicine) 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.

This is the last webinar in the series for Type 1 & 2 EDs Before we start We are recording the webinar for the benefit of others Send your comments & questions to “everyone” Slides etc. www.content.digital.nhs.uk/ECDS This is the last webinar in the series for Type 1 & 2 EDs A series is running for UTC + Type 3 & 4 EDs Send your comments to : ECDS@nhs.net

On this afternoon’s call: Case studies! Coding MH issues and self-harm Brief recap DQ inc. CQUIN Duplication ECDS development and maintenance General QA

>63% of Type 1 and 2 attendances now covered (141 sites) Quick progress update: >63% of Type 1 and 2 attendances now covered (141 sites) 50 sites are submitting data for Type 3 and 4

ECDS case studies presented by Aimee Haggas, Senior Communications Officer

Objectives Understand the holistic effect of ECDS Gather implementation lessons learned to assist with wider rollout in Phase 1 (Type 1 and 2 EDs) Focus on the impact of ECDS in different staff groups Assist the planning of implementation for Phase 2 (Type 3 and 4 EDs) To test implementation materials Implementation materials- crib sheets, reception guide, injury data guidance- if you haven’t seen these, they’re on the website

Approach Through initial engagement with the project, potential case study organisations were identified Using local knowledge, IBC staff selected five Providers based on expected go live, supplier readiness, geographic location, appetite Regional IBC staff worked with Providers to understand their project progress, any issues encountered and identified the right time to capture the case study Where it was required, IBC gave additional implementation support and guidance Attended project meetings Put in touch with clinical lead and attended consultants meeting. We took a decision not to mention suppliers. The case studies were about the project management and business change required within a hospital to implement ECDS and this was not about the pros and cons of a particular system.

Who we worked with Buckinghamshire Healthcare NHS Trust Countess Of Chester Hospital NHS Foundation Trust The Hillingdon Hospitals NHS Foundation Trust Nottingham University Hospitals NHS Trust Rotherham CCG Buckinghamshire – First non GDE to go live with collection and this was down to strong project management. We worked with them to understand how they delivered their project. Hillingdon – Initially this was looking at the affect on the service (4 hour target) and the service managers. But this evolved into more of an overall lessons learned as they took the decision to push back their go live. We focused more on why they took the step and the lessons that could be shared with others. CoC – Doctors – particularly consultant. Consultant led implementation. Looked at the ways they engaged theirs clinicians and wider team through things like facebook groups. Notts – Worked with the nurses at Nottingham to understand the impact on their role as they were asked to collect more data – for example the injury data. Useful feedback around engagement and understanding the bigger picture. While the project engaged with RCEM and the consultants were well aware, the message didn’t travel down as well to nurses. – This was replicated in other sites. Rotherham – to understand the whole picture we wanted the view of a commissioner. Alex Henderson –Dunk (performance and Intelligence) at Rotherham CCG was really qwell engaged with the project and was a good person to get this point of view from. He spoke about how the data could help them prepare for winter 2018, they were interested in streaming episodes and the pathway through UC and they will use alongside other datasets such as the national 111 dashboard and IAPT data.

Where are we now? Currently three are published www.digital.nhs.uk/ecds Potential follow up with Mid Essex who have analysed the ECDS data Exploring with Dr Brian Kennedy, Consultant & Informatics Lead  Emergency Medicine – how we can share wider The number of codes that do not meaningfully record diagnosis had dropped from 25% to 6% of attendances • Pre ECDS 6.5% had no diagnosis recorded, post this had reduced to 0%. If you are yet to implement or run a type 3 or 4 have a look Share with colleagues Any questions, email the ECDS mailbox

A&E and Mental Health National CQUIN Bobby Pratap, NHS England and Tom Hughes, RCEM

A&E and Mental Health National CQUIN – what was it? Full CQUIN specification here. Left, CNWL infographic of milestones. National webex, mini-conference, including: Service user perspective, Victoria McGowan Frequent user of A&E Cambridge & Peterborough First Response Service West London MH Trust, local CQUIN example Hertfordshire, local CQUIN example SIM High Intensity model Recording on the following hyperlinks: (Stream online) (Download) Slide pack here The SIM High intensity network is now employed by NHS England to provide direct implementation support to any area that wishes to learn about its successful model and join its learning network. More detail can be found here. Information sharing guidance to support the CQUIN Credit: CNWL

Measuring MH activity in A&E: the historic problem (1) Splitting patient data by condition has historically relied on a diagnosis to be made in A&E But we would not usually expect diagnoses to be made for mental health attendances to A&E This means it has been very difficult to know through national datasets how many MH attendances, admissions, waiting times for MH etc. e.g. currently 27% of acute hospitals report ZERO mental health attendances! (This includes some hospitals that we know for a fact have very busy core 24 liaison MH services)

A ‘definition’ of mental health attendances in A&E – new ECDS – hope for better data in the future! The definition of ‘Mental Health’ ED presentations include all ED patients with: a ‘mental health’ chief complaint OR a ‘mental health’ diagnosis (whether 'suspected' or 'confirmed’) OR an injury intent of ‘intentional self harm’

Quick recap - Diagnosis qualifier - Communicating diagnosis - ISTV Tom Hughes, RCEM and Pete Sherratt, NHS Digital

Diagnosis qualifier and communication The diagnosis qualifier captures the ‘uncertainty’ of diagnosis Qualifiers are (see 5.14.5 here): ‘Confirmed diagnosis’ – beyond reasonable doubt. ‘Suspected diagnosis’ threshold for proof not met Covers probable (= more likely than not), possible (feasible) In the GP letter (see 5.14.6 here) For a confirmed diagnosis : Diagnosis = “closed fracture neck of femur” For a suspected diagnosis: Diagnosis = “short of breath (chief complaint) : suspected diagnosis = pulmonary embolus”

Relationship to ISTV ECDS is complementary to ISTV ECDS does not replace existing arrangements to provide ISTV data A good implementation will meet both goals (ECDS and ISTV) ECDS is NOT ALLOWED to collect freetext ‘place of injury’ This must still be collected / shared locally for ISTV

Data Quality (DQ) and CQUIN DQ Neil Clark and Julie Clough, HES Secondary Care team, NHS Digital

Provisional Data Quality Report for ECDS Provisional information to assist with improvements to ECDS data quality: Number of attendances in ECDS and A&E, by activity month Completeness and validity of the following key fields: Chief Complaint Clinical Investigation Primary Diagnosis Secondary Diagnoses Treatment All information is reported at provider level Initial provisional report already available on the Supplementary Information page

Provisional Data Quality Report for ECDS Location of report and publication schedule Initial provisional report Activity from April 2017 to November 2017 Already available on the Supplementary Information page Second report (supersedes initial report) Activity from April 2017 to January 2018 (as at the M10 inclusion date - 19/02/2018) Published alongside the monthly ‘Provisional Monthly Hospital Episode Statistics for Accident and Emergency’ publication on Tuesday 13 March Available at https://digital.nhs.uk/article/191/Find-data-and-publications Future reports Will be published monthly alongside the associated ‘Provisional Monthly Hospital Episode Statistics for Accident and Emergency’ publications (as at the appropriate inclusion date for each month) Publication Timetable available at https://digital.nhs.uk/schedule-of-future-publications Visual representation of field coverage and validity (Power BI) is also being developed

ECDS CQUIN DQ Report Published onto the SUS+ DQ Dashboards SharePoint Online site Register for access here : http://content.digital.nhs.uk/sus/dqr Reports on the validity of the Chief Complaint and First Diagnosis fields Early Adopters and All Submitters Can be used to support CQUIN assessment

ECDS CQUIN DQ Report ‘ECDS CQUIN DQ Report – v2.0’ is now available Based on ECDS data extracted from SUS+ at the February inclusion date (19/02/2017) Early Adopters – Any ECDS activity up to and including 1st October. Looks at quality of data items for 1st-8th October 2017. All Submitters – Looks at quality of data items covering the period October-December 2017.

ECDS CQUIN DQ Report A final report will be released in early April based on data extracted from SUS+ on the March inclusion date (19/03/18) Any updates to records with invalid values made by providers prior to this date will be reflected in the final report New functionality is available in SUS+ that allows the records counted as invalid in the CQUIN reports to be easily identified

SUS+ Record Level ECDS CQUIN 7 March 2018 presented by Steve Fenner, Product Owner

Overview CQUIN on Primary Diagnosis and Chief Complaint 6 New fields added to represent data quality 3 fields for each submitted field 1 Should the field be populated on this record 2 Is the field populated Is the value in the field valid Each data quality field is Boolean Field 2 is only populated if field 1 is true Field 3 is only populated if field 2 is true

Extract Specification - http://content.digital.nhs.uk/sus/whatsnew On ECDS 6.2.1 sheet of PbR Extract Specification Chief Complaint CQUIN Expected Indicates if a value is expected in the field associated with the CQUIN rule. Boolean   Derived Chief Complaint CQUIN Completed Indicates if a value was expected and was present in the field associated with the CQUIN rule. This field is only populated if a value was 'expected'. Chief Complaint CQUIN Valid Indicates if a value was expected and a valid value was present in the field associated with the CQUIN rule. This field is only populated if a value was expected and present. If False, a value was present but invalid. Primary Diagnosis CQUIN Expected Primary Diagnosis CQUIN Completed Primary Diagnosis CQUIN Valid

Data Quality Rules The CQUIN rules for completing the Chief Complaint and Primary Diagnosis are available from: https://digital.nhs.uk/media/32513/ECDS-CQUIN-implementationguidance/doc/ECDS_CQUIN_Implementation_Guidance_for_Commissioners_and_Providers_v1-2

Suspension of the “Proactive and Safe Discharge” CQUIN The CQUIN containing ECDS was suspended (see 6.12) for 18/19 (not 17/18) The implementation of ECDS remains a key priority The information standard is still mandatory By end May 2018  we expect that there will be 100% compliance in Type 1 and Type 2 EDs If you do have any concerns then please speak to your regional NHSI team As you are aware, the ECDS CQUIN was suspended for 18/19. This is unfortunate and reflects changing priorities in terms of the use of CQUIN. However, this does not change the priority being given to ECDS implementation and it remains mandatory. The implementation of ECDS remains a key priority for the NHSE/I UEC transformation programme. This was confirmed by Pauline Phillip, National Director for UEC at NHSI and E, earlier this week. The information standard has been set and it is mandatory for all Type 1 and Type 2 A&Es to comply with this. We understand that there have been issues with suppliers and other difficulties around implementation. As such, not all Trusts were able to meet the October 2017 deadline. However, by end April 2018  we expect that there will be 100% compliance in Type 1 and Type 2 EDs and we will be working to support you in rolling out ECDS into UTCs. The national teams at NHSI, NHSE and NHSD are working through NHSI regional teams to ensure that we have full compliance in Trusts. Our regional teams will be reaching out to those Trusts who have not gone live to confirm your timetables. If you do have any concerns then please do speak to your regional NHSI team. NHSI will be following up with all Trusts with the expectation that all Trusts meet this deadline. Any that feel that they won’t, must have a discussion with NHSI region in advance. The regional teams have performance meetings with each Trust on a regular basis and through the regional calls that we are having this week, ECDS will be on the agenda.

Dual counting / dual submission ECDS This is when the same data has been submitted to both CDS010 and CDS011, causing duplicate records in the A&E HES data (due to SUS+ mapping ECDS data back to A&E) SUS+ now automatically identifies these records and deletes the duplicated records from ECDS, retaining only the A&E records in HES However still strongly recommend you delete one set of records locally, rather than relying on SUS+, if you are submitted the same data to both datasets Approximately 5 providers each month, all of which have been contacted

ECDS development and maintenance Emma Fernandez, Royal College of Emergency Medicine

ECDS maintenance Maintenance will be split: Data set structure will be managed by Data Set Development Service, within NHS Digital Data subsets (content) – including review of SNOMED-CT subset terms will be managed by a clinically led group (Technical Committee) in conjunction with UK Terminology Centre Where necessary smaller clinical subgroups will be convened to discuss specialty items e.g. eye diagnoses Your queries and suggestions: Issues identified and or suggestions for new items flagged through NHS Digital are all reviewed and responded to by Clinical Lead or Project Manager from Technical Committee All are logged and then (if required) are discussed at Technical committee as to whether amendment / new or removal of subset term is required SNOMED-CT terms within TRUD will be updated every 6 months

ECDS TRUD update All your suggestions and issues identified since October ’17 to January ’18 have been reviewed, discussed by Technical Committee and changes made to SNOMED-CT for April publication Next SNOMED-CT change will be in October 2018 This will mean that the TRUD and TOS will be out of alignment at present – please ensure you check the TRUD for latest SNOMED-CT codes

New SNOMED codes Spoken language Diagnoses: Improved ‘Eye’ diagnoses, addition of cranial nerve disorders, Rheumatology diagnoses, new anatomical sites for injuries Chief complaint: No symptoms, difficulty swallowing Injury: addition of new mechanisms, place, intent Safeguarding: Expanded list Investigation: No investigation, urine pregnancy Treatment: No treatment Referral service: Hyperbaric medicine

ECDS uplift Proposed changes: Replace the subsets with links to subsets held externally - this will allow us to maintain the TOS and TRUD together Minor changes to some of the definitions for mandatory data items Overseas Visitors data subset Closing loopholes in the XML schema Consider inclusion of frailty assessment Plan for uplift in July ’18

Send your comments to : ECDS@nhs.net Future webinars…. This is the last webinar in the current series aimed at Type 1 & 2 EDs – thank you all and well done! A series is running for UTC + Type 3 & 4 EDs Send your comments to : ECDS@nhs.net

Poll and General QA – your questions

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