1. 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.

2. 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 2pm
Send your comments to :

3. 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

4. Compliance / Assurance process
Presented by Nick Hunt

5. 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

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

7. 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 May 2017

8. 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 May 2017
Mini Flu Conference – 1 Feb 2017
Mini Flu Conference – 1 Feb 2017

9. 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 May 2017
Real-time Syndromic Surveillance – CIDSC from science to practice and policy

10. 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 May 2017
Real-time Syndromic Surveillance – UoW Big Data and Google Flu

11. 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 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

12. 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 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

13. 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 May 2017
Mini Flu Conference – 1 Feb 2017
Mini Flu Conference – 1 Feb 2017

14. “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 May 2017

15. 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 May 2017

16. 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 May 2017

17. 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 May 2017

18. EDSSS outputs Acute respiratory infection Asthma
Daily analysis and interpretation of data
Weekly reports
Ad hoc responses to local national public health emergencies.
ECDS Webinar No May 2017

19. 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 May 2017

20. Thank you Questions?
ECDS Webinar No May 2017

21. ECDS User Guidance
Presented by Aaron Haile

22. 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

23. ECDS – User Guidance
Data group:

24. ECDS – User Guidance
Data item:

25. 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

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

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

28. 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

29. 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)

30. 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

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

32. Information Standards Notices
SNOMED CT®
Commissioning Data Sets: Emergency Care Data Set
Information Sharing to Tackle Violence Minimum Dataset
Accessible Information

33. 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

34. SNOMED CT downloads from “TRUD”
UK Edition of SNOMED CT
International
UK Clinical
UK Drugs
SNOMED CT subset pack (including descriptions) – Emergency Care

35. 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  , RF2 ID ) 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 ID , RF2 ID )
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.

36. Supporting use in Emergency Care
Specialist resources to inform design choices

37. SNOMED CT specialist resources
SNOMED International Technical Implementation Guide
SNOMED International has links to SNOMED CT browsers
Practical Guide to Reference Sets

38. SNOMED CT Education and Training resources
NHS Digital
SNOMED International
(registration and enrolment required for some resources)

39. Contacts Information Standards Service Desk call 0300 303 4777

41. SQL Scripting
Presented by Tim Ireland

42. 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

43. Wrapping up – a few final points
Presented by Peter Sherratt

44. 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….

45. 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 2pm
Send your comments to :