ECDS – An introduction
The Emergency Care Data Set (ECDS) is a new national data set for urgent and emergency care.
The new dataset will be implemented across all type 1 and type 2 Emergency Department (EDs) in England and types 3 and 4 as defined by the NHS Data Dictionary as being ‘The type of Accident and Emergency Department according to the Activity performed’(see below).
- Type 1 – Emergency departments are a consultant led 24 hour service with full resuscitation facilities and designated accommodation for the reception of accident and emergency patients.
- Type 2 – Consultant led mono specialty accident and emergency service (e.g. ophthalmology, dental) with designated accommodation for the reception of patients.
- Type 3 – Other type of A&E/minor injury activity with designated accommodation for the reception of accident and emergency patients. The department may be doctor led or nurse led and treats at least minor injuries and illnesses and can be routinely accessed without appointment. A service mainly or entirely appointment based (for example a GP Practice or Out-Patient Clinic) is excluded even though it may treat a number of patients with minor illness or injury. Excludes NHS walk-in centres
- Type 4 – NHS walk in centres
The ECDS will replace the current Accident & Emergency Commissioning Data Set (CDS type 010) with a data set that can properly capture and represent the full extent and granularity of emergency care activity across England. The ECDS will be implemented via a new version of the A&E CDS and will be represented as CDS 6.2 Type 011.
The implementation of the EDCS across all emergency departments will mean that all data collected can be compared and aggregated to provide an accurate picture of the complexity and acuity of all emergency attendances.
The data set brings together many disparate local initiatives and practices from across the UK and is informed by collaboration with national and international emergency care colleagues. The scope of the project includes providing support and guidance to emergency department information systems (EDIS) suppliers to ensure systems are updated to facilitate the collection of data via the ECDS and also includes working with providers to support the implementation and operationalisation of the data set following the issue of a formal Information Standard.
Why is a new data set for emergency care required?
The Commissioning Data Sets (CDS) are the primary mechanism for the national reporting of secondary care activity which is either NHS funded, and/or provided by NHS organisations. CDS are securely submitted to the Secondary Uses Service (SUS) and form the basis of the Hospital Episode Statistics (HES) data.
Secondary users use the CDS data sets to support a variety of services, these include to:
- monitor and manage NHS service agreements
- develop commissioning plans
- support the Payment by Results processes
- support NHS Comparators
- monitor Health Improvement Programmes
- underpin clinical governance
- understand and predict the health needs of the population
The Accident and Emergency Commissioning Data Set (CDS type 010) was developed in the early 1980s. At that time the work of the ED was largely minor injuries and occasional major trauma and CDS Type 010 was developed to capture these attendance. Since then there has been a sustained and rapid increase in the volume, scope and complexity of emergency care. This change has been attributed to changes in the health needs of the population (e.g. an increasingly aging population), the system’s ability to respond to these changing needs and also how the population makes decisions on where to access the care that they require.
The Accident and Emergency Commissioning Data Set (CDS Type 010) has not been developed to keep pace with these changes in health care practice and it is recognised that this has resulted in an ‘information gap’ in the data collected from Emergency Departments.
Issues that have arisen due to this information gap include, but are not limited to:
- Poor quality data undermines the utility and integrity of secondary user information (SUS/ HES) that relies on data collected currently via CDS.
- System capacity and demand management are impossible to determine accurately locally or centrally.
- Current metrics of healthcare do not consistently measure inputs or outputs, making comparisons of ‘value added’ or different modes of healthcare delivery (Minor Injury Unit, Walk-in Centre, etc.) impossible.
- Use of multiple current coding systems with inconsistent implementation means data are not valid nor reliable. This renders the information insufficient for either clinical use or policy-making.
- HSCIC data has shown that a valid, coded diagnosis exists for less than half of all ED attendances.
- Commissioners of healthcare, who rely on information obtained through the Secondary Care Use Service (SUS), cannot accurately plan or monitor emergency care.
While the primary purpose of any clinical data collected in emergency departments must always be to improve the quality and safety of patient care, there is a clear responsibility to the wider NHS and to the public to demonstrate that money spent on acute healthcare is well spent. Better quality data is key to this and there is recognition that there is a cost to collect this data. We believe that the cost is vastly outweighed by the benefits to the patient and to the wider NHS by communicating accurate clinical information, and being able to commissioning the right services for population healthcare needs.
Benefits of a new dataset for emergency care
The ECDS project team, with support from NHS Digital and colleagues from across the emergency care system have been working to identify the benefits of implementing a new data set for emergency care. The benefits to be enabled by the ECDS by 2021/2022 are anticipated to amount to £28 million. The bulk of the benefits are likely to be realised by local commissioners who will use the ECDS data to reconfigure services to ensure that patients are directed to the right care, at the right time, in the right place.
It is anticipated that the implementation of the ECDS will support an improvement in emergency department data quality and provides an opportunity to support consistency in recording which in turn will ensure greater completeness of the patient record.
High level benefits that will be realised through the implementation of the ECDS include the following:
- Improved quality of data collected in Emergency Departments relating to patient presentation, diagnosis, discharge and follow up will support a better understanding of the value added by the introduction of new models of care and ensure that patients are receiving care in the most appropriate care setting.
- The information generated will allow commissioners to accurately fund demand, and implement strategic changes, e.g. through payment and CQUIN mechanisms.
- Support for future healthcare policy and strategy to ensure an improved quality of patient care, such as that articulated in the “Keogh Review” of Urgent and Emergency Care, and the NHS England “Five Year Forward View”.
- Improved data access, research and audit in emergency healthcare to support service improvement initiatives.
For further information on the ECDS anticipated benefits, the expected business change and ECDS capabilities please request a copy of the Benefits matrix by emailing: email@example.com.
The ECDS is currently under review as part of the Standardisation Committee for Care Information (SCCI) process with a view to gaining full approval of the data set as an Information Standard in March 2017, with ISN publication planned for April 2017. Further information regarding the SCCI process can be found here.
The draft Technical Specification and supporting documentation (e.g. Draft ISN Change Request and Draft Requirements Specification) will be published as an Advanced Notification in mid-January 2017.
The anticipated date for implementation of the ECDS in type 1 and type 2 emergency departments, via an uplift to CDS 6.2 Type 010 is from October 2017, with types 3 and 4 in a further phase of implementation in 2018.
The October 2017 time frame is supported by the inclusion of ECDS implementation the NHS England CQUIN scheme for 2017/2019. The level of incentive will be dependent on a trusts annual contract value. For example, for a Trust with an annual contract value of £400m the amount available for the ECDS component of the 2017/2019 CQUIN scheme is £200,000 per financial year for the next two years.
Please refer to the NHS England CQUIN pages for further information, specifically CQUIN 8a, ‘Supporting proactive and safe discharge’.
The ECDS consists of a number of ‘new’ data items and data items which originate from the current A&E CDS. The majority of the new’ data items are already collected in departments but do not flow centrally or are not captured consistently across the country.
The draft technical specification for ECDS v5.1 can be accessed below. This draft specification includes the current data item groupings, item headings, information relating to the requirement for submission of each item and the draft code sets where appropriate.
The proposed ECDS introduces the use of SNOMED CT codes to capture relevant information, specifically the clinical data items. This is being introduced in line with Nation Information Board policy objectives found in Personalised Health and Care 2020.
The ECDS Information Standard Notice (ISN) Advanced Notification has been published by NHS Digital. The Advanced Notification documentation, includes the draft ECDS Technical Output Specification.
ECDS Summary Technical Guidance
Data will be submitted to NHS Digital via the Commissioning Data Set (CDS) in XML format. A new version of the A&E CDS, CDS Type 011, will be announced to enable the ECDS to flow. Submission will be supported via SUS+, which will replace the Secondary Uses Service (SUS) and will be subject to quality checks and validation in a similar way to current submissions.
The ECDS (CDS type 011) will apply to ALL emergency department types 1, 2, 3 and 4, although implementation timeframes are phased. Providers will only be obliged to send one version of the A&E data – either CDS 010 or CDS011 – at any one time. SUS+ will continue to be able to receive CDS 010 and this will be the case until all sites have migrated off CDS 010.
Senders will be required to submit data more frequently than they do at present, initially submitting on at least a weekly basis but moving to daily submission as they get used to the new process.
The introduction of a daily feed enables a number of benefits, although it is recognised that this may be a challenge for providers to implement.
The ECDS data will be available for extract by SUS users on a daily basis via the ALI portal.
- Royal College of Emergency Medicine
- PRSB, Standards for the clinical structure and content of patient records
- National Information Board
Equality and Health Inequalities Statement
Promoting equality and addressing health inequalities are at the heart of our values. Throughout the development of the policies and processes cited in this document, we have:
- Given due regard to the need to eliminate discrimination, harassment and victimisation, to advance equality of opportunity, and to foster good relations between people who share a relevant protected characteristic (as cited under the Equality Act 2010) and those who do not share it; and
- Given regard to the need to reduce inequalities between patients in access to, and outcomes from healthcare services and to ensure services are provided in an integrated way where this might reduce health inequalities.
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