1. Emergency Care Data Set (ECDS)
Commissioner Show and Tell No.1, 28 April 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)
Martin Campbell, Head of Pricing (NHS England)
Alastair Hill, NHS Contract Lead (NHS England)
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 focused on Commissioners is 26th May
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 QA document
Most people will be 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 focused on Commissioners is 26th May
Send your comments to :

3. On this afternoon’s call we will be covering:
An introduction to the ECDS and its benefits
The inclusion of the ECDS in the CQUIN scheme
Considerations to do with Tariff and contracts
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 Peter 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
Initial Assessment Time – Decision to Admit
New data items
Chief Complaint
Diagnosis Qualifier
Acuity
Injury
Introduction of new concepts
ECDS will introduce a new CDS Type – CDS Type 011 ECDS.
SNOMED CT for some subsets
Weekly >> Daily data feed

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.
Data should improve as time passes – doesn’t have to be perfect for yesterday, but should be good after a week.
Very recent data won’t be used for Tariff – there will be at least a month to get data right.
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

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)
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. Trusts with multiple EDs
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)

11. Example Implementation Timeline (Sep-Dec)
ECDS timeline
The top row is the activities for ECDS
The bottom row is the CDS 010 activities
Colours denote data by month
The blue box is the latest date to make a CDS 010 submission assuming that a site goes live with ECDS on or before 1 October 2017 (except the HES end of year submission)

13. Other Useful Information
User Guidance will be available to help ED staff / Informatics staff / data coders to capture and submit better quality data
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

14. ECDS and the CQUIN
Presented by Peter Sherratt

15. The ECDS part of the 2017-19 CQUIN
Intro
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

16. The ECDS part of the 2017-19 CQUIN
High level overview
Part 1: Q1 17/18 – Providers submit demonstrable and credible planning for a 1 October 2017 Go-live.
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.

17. The ECDS part of the 2017-19 CQUIN
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

18. The ECDS part of the 2017-19 CQUIN
CQUIN Part 1 (Q1 17/18) (demonstrable & credible plans)
Plans to be submitted to commissioners by 30th June 2017
We recommend you share your plans with
Plans should be sufficiently detailed to give credibility – we have produced a template “model plan” (see CQUIN guidance document appendices)
Evidence of support and engagement should be sought from:
Senior management inc. Directors of finance, IT
EDIS supplier, XML broker etc.
ED staff (management, clinical, nursing, clerical)
Informatics staff

19. The ECDS part of the 2017-19 CQUIN
CQUIN Part 2 (Q3 17/18)
If there’s £50,000 available for this part of the CQUIN…
Priority 1: Going live with ECDS from 1 December 2017 (50%) (£25000 – data for the whole of Dec)
Priority 2: Data Quality (40%) (£20,000 available – Chief complaint and Diagnosis)
• Greater than 95% (Good) attracts 40% £20,000 of payment
• 90-95% (Medium) attracts 20% £10,000 of payment
• <90% (Poor) 0% No payment
Priority 3: Frequency and timeliness (10%) (£5000 available)
There are 13 weeks in this quarter – so you get 1/13th of £5000 (£385) for each weekly submission
More worked examples coming up….

20. The ECDS part of the 2017-19 CQUIN
Worked examples for CQUIN Part 2 (Q3 17/18)
Scenario
Go Live Date
Data Quality (Diagnosis & Chief Complaint)
No. of weekly submissions (out of 13) A
1 October 2017
96% (Good) 13 B
20 November 2017
94% (Medium) 6 C
1 December 2017
95% (Good) 1 D
2 December 2017
90% (Medium) 4
If there’s £50,000 available for this part of the CQUIN…
Scenario
Go Live Date
Data Quality
Weekly submissions
Total A
£25,000
£20,000
£5000
£50,000 B
£10,000
£2308
£37,308 C
£385
£45,385 D £0
£1538
£11,538

21. The ECDS part of the 2017-19 CQUIN
CQUIN Parts 3 – 6 (Q1 18/19 to Q4 18/19)
Split data quality and daily submissions 60/40
Chief complaint, Diagnosis, Acuity, Discharging Clinician, Referral Source and Discharge Status
Finally, achieving high quality data – please view the CQUIN guidance document appendices.

22. The ECDS part of the 2017-19 CQUIN
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

23. ECDS National Tariff Considerations
Presented by Martin Campbell, Alastair Hill and Peter Sherratt

24. 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

25. 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

26. 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

27. 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

28. 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

29. 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

30. 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

31. Do you have any questions?
Any further questions can be sent to:
NHS Standard Contract team at:
Pricing team at:

32. Future webinars…. Next webinar focused on Commissioners is 26th May
We plan to hold a 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
A focus for ED staff / managers [10th May 2017 at 2pm] – Registration Link.
Let us know anything particular you’d like us to cover again or in more detail
Next webinar focused on Commissioners is 26th May
Send your comments to :