1. Emergency Care Data Set (ECDS)
Emergency Department Show and Tell No.1, 10 May 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)
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.

2. Before we start Next webinar for Providers is the 16th May 2017
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 webinar (provider, supplier and CCG) 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/Pete Sherratt
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 for Providers is the 16th May 2017
Send your comments to :

3. On this afternoon’s call we will be covering:
An introduction to the ECDS
Clerical data items
Clinical data items
Acuity
Chief Complaint
Diagnosis & the diagnosis qualifier
Clinician details
Injury and Information Sharing for Tackling Violence (ISTV)
Tariff & HRG’s – Investigations and Treatments
The ECDS in the CQUIN scheme
Quick progress update:
The ECDS Information Standard has now been published here

4. Why do we need ECDS? An introduction
Presented by Dr Tom Hughes and Aaron Haile Questions to Pete Sherratt

5. ‘Flying Blind’ – Health Select Committee, 2013
Reason for attending
*Other patient group includes:
Assault – 0.65%
Deliberate self-harm – 0.56%
Firework injury %
Brought in dead – 0.01%
NHS Digital Hospital Accident and Emergency Activity, Accessed 01/02/2017. Available at

6. Diagnosis
NHS Digital Hospital Accident and Emergency Activity, Accessed 01/02/2017. Available at

7. 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
New data items
Chief Complaint
Diagnosis Qualifier
Acuity
Injury
Introduction of SNOMED CT for some subsets

8. 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.
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
Potential early adopters scheme, implementation from August 2017

9. 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)
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)
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)

10. ECDS Data items
Presented by Dr Tom Hughes and Aaron Haile Questions to Pete Sherratt

11. ECDS – Clerical data items
Revised data items, code sets uplifted:
Arrival mode
Attendance category
Attendance source
New data items, to provide more information regarding equity of access and demographics:
Accommodation status
Spoken language and interpreter required

12. ECDS – Mental Health Act
Start data/time, Expiry data/time and Mental Health Act Legal Status Classification Code
To support better understanding of activity relating to patients brought in by Police under Section 136.
A ‘Required’ data item – but only relevant to patients under section 136.
May collect in the department already, now need to capture some of this information in the ED system

13. ECDS - Acuity
A ‘measure of the urgency & severity of the condition with which the patient presents to the ED
Defined by the first clinician who assesses the patient.
The initial assessment of acuity.
Represented as a number between ‘1’ (most serious) and ‘5’ (least serious).
ED’s may already use an existing scoring system e.g. Manchester, Australian or Canadian triage or an early warning score e.g. NEWS, PEWS.

14. ECDS - Acuity Where an existing acuity assessment in use 1-5 score
No existing acuity assessment, then acuity defined by physical area of treatment:

15. ECDS – Chief Complaint Patient’s chief complaint
as defined by the clinician first assessing the patient.
Does not require a triage process
may be collected as part of a triage process.

16. ECDS – Diagnosis Approx. 750 SNOMED CT values
Expanded RCEM Unified Diagnostic DAta Set (UDDA)
Design principles:
Exhaustive: conditions commonly seen in EDs
Exclusive: should be one and only one best answer.
No symptoms.
No vague items e.g. ‘unwell’

17. ECDS pilot – Diagnosis Pre & Post
Pre = 74% of the top 10 patients = meaningless
Post = all diagnosis meaningful

18. ECDS – Diagnosis, common questions
1. Where is the code for ‘non-specific abdominal pain’ / ‘back pain’?
There isn’t one
2. Where is the code for ‘generally unwell’?
No abnormality detected
URTI
Influenza

19. ECDS – Diagnosis, common questions
3. How can I code ‘diagnosis X excluded’ e.g. pulmonary embolus excluded?
Prohibited under NHSD rules due to clinical risk
e.g. danger ‘brain tumour excluded’ -> ‘brain tumour’
In the diagnosis field : what you suspect
Write ‘XXXX excluded’ in the clinical narrative
4. Where is the diagnosis code for [rare condition]
50 Clinician years to develop + testing in pilot sites 250k / year
pseudopseudohypoparathyroidism = ‘other endocrine condition – free text’.
No symptoms, no fluffy terms
5. I believe diagnosis [ ‘XYZ’ ] should be included in DDS, what should I do?
please send request to

20. ECDS – Diagnosis qualifier
Capture the ‘uncertainty’ of diagnosis, qualifiers are:
‘Confirmed diagnosis’ - beyond reasonable doubt.
‘Suspected diagnosis’
threshold for proof not met
Covers probable (= more likely than not), possible (feasible)
In the GP letter
For a confirmed diagnosis : Diagnosis = “closed fracture neck of femur”
For a suspected diagnosis: Diagnosis = “short of breath (chief complaint) : suspected diagnosis = pulmonary embolus”

21. ECDS – Care Professionals Tier
Treating AND REVIEWING clinicians
Code
Description
Example 1
Require complete supervision / All patients must be signed off by a senior before admission or discharge.
F1 doctors, trainee practitioners 2
Require access to advice or direct supervision, or practice independently but with limited scope of practice
ENPs, ANPs / ACPs, PAs, ESPs, F2 doctors, CT1-2 doctors, some primary care clinicians 3
More senior / experienced clinicians, requiring less direct supervision - Fewer limitations in scope of practice
CT3 in EM, junior Speciality Doctors, senior ANPs / ACPs / PAs, some primary care clinicians 4
Senior clinicians able to supervise an Emergency Department alone with remote support. Possess some extended skills. Possess some extended skills - Full scope of practice.
CT4 and above, senior Speciality Doctors 5
Senior clinicians with accredited advanced qualifications in EM. Full set of extended skills - Full scope of practice.
Consultants in EM

22. ECDS – Care Discharging clinician
Clinician who discharges patient
responsible for making sure that all treatment is complete
responsible for completing coding and discharge documentation.
Automatically populated by the emergency department IT system:
at the time patient discharge OR
When the GP discharge documentation is completed
Only one clinician must be responsible for the patient’s discharge.

23. ECDS – Injury
Consistent, integrated and more efficient method of recording data.
date/time, place, intent, activity, mechanism, drug/alcohol involvement
‘Required’ when attendance from injury (via CC / Diagnosis flags).
Collected by clerical staff
ISTV
ECDS code sets developed to support collection of ISTV
ECDS does not stop flow of ISTV data via local data sharing agreements
Free text (place and mechanism) must be collected – not part of ECDS.

24. ECDS pilot – Leeds Teaching Hospitals
Implemented in two parts:
July 2016: Clinical (chief complaint, acuity, diagnosis)
August 2016: Clerical and other
Challenges
More “specific” diagnosis
Changing processes
Nurse triage tool
Chief Compliant

25. ECDS pilot – Leeds Teaching Hospitals continued…
What went well
Implemented before junior doctor changeover = ‘change was easier’
Staff engagement
Involved the information team early
Floor-walker on go - live
Enabler to upgrade working processes
Diagnostic dataset improves data collection
Fall-back plan – triage
Learning points
Short time frame to implement
Communication
can never have too much
Before / during / after

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

27. ECDS – HRGs and Tariff
Presented by Peter Sherratt Questions to Aaron Haile

28. 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 map to the old codes for payment.
Pete

29. 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

30. 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

31. 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

32. ECDS and the CQUIN
Presented by Peter Sherratt Questions to Aaron Haile

33. 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

34. High level overview
Part 1: Q1 17/18 – Providers submit demonstrable and credible planning for a 1 October 2017 Go-live, end of June 2017.
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.

35. 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

36. The CQUIN Guidance Document
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

37. ECDS Poll
Questions:
1. The first CQUIN is on having a plan for implementing ECDS.
How confident are you that your organisation will have a plan by the end of June?
2. Have you had contact with your IT supplier regarding ECDS?

38. Next steps….
Make sure colleagues in the department are aware of ECDS, specifically Clinical Directors/Leads
Make sure that trust informatics/business managers are aware and find out who is leading ECDS implementation for your department
Familiarise yourself with the data set, and work with colleagues to identify where changes to the data set may impact ED processes or trusts systems.
Familiarise yourselves with the code sets particular Chief Complaint, Diagnosis, Investigations and Treatments.
ECDS User Guidance and FAQ’s will be published wc 15th May 2017

39. Send your queries/comments to : ECDS@nhs.net
Future webinars….
Would further ED focused webinars be useful or shall we merge with others from the 16th May?
We plan to hold a ECDS 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
Let us know anything particular you’d like us to cover again or in more detail
Next ECDS webinar is 16th May. 14:00-15:30
Next webinar focused on Commissioners is 26th May. 14:00-15:30
Send your queries/comments to :