- Version 3 of the ECDS is now being piloted and is available for comment.
ECDS – An introduction
The Emergency Care Data Set (ECDS) project will develop and implement 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 potentially types 3 and 4, replacing 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 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 Users 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 User 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 colleagues from across the emergency care system, are working on identifying the benefits of developing and implementing a new data set for emergency care. This work will not only highlight the benefits brought by implementing the ECDS but will also apply metrics to measure the impact that the ECDS has on the quality and value of emergency department data, including the development of exemplar case studies.
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. This will facilitate improved healthcare commissioning and the effective delivery of emergency care.
- 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.
- Minimisation of the burden on Emergency Department staff (administration and clinical) who enter data by recognising and promoting the importance of usability in IT design, and facilitating decision support technologies.
Development process and time frame for delivery
The ECDS project has been set up a collaborative project between the Department for Health, Royal College of Emergency Medicine, NHS England HSCIC, Monitor, NHS Providers and Public Health England. The project is governed and directed by a project board which is chaired by Professor Jonathan Benger (National Clinical Director for Urgent Care, NHS England) and includes representatives from the organisations listed above and also lay representation. The ECDS project board will focus on overseeing and directing the project throughout the project lifecycle.
You can access the ECDS Project Board Terms of Reference and Board meeting minutes here.
In order for the ECDS to replace A&E CDS Type 010 a thorough investigation of how the data will be collected and used is required by both HSCIC and NHS England. There is a need to ensure that existing secondary uses of the data can be delivered by the Emergency Care Data Set and that the implications for commissioning and other functions are fully understood.
The ECDS Project Board and Department of Health has requested that the HSCIC completes an impact assessment and options appraisal of the replacement of A&E CDS type 010 with the ECDS. The outcome of the scoping/impact assessment work will enable the Department of Health and the ECDS Project Board to agree how to progress the ECDS project and to develop a full end-to-end solution to facilitate the implementation of a new data set for emergency care. Once the best way to proceed has been agreed, the ECDS project can continue through the SCCI progress for approval as an Information Standard Notice (ISN).
The HSCIC Impact Assessment work was initiated on the 1 December 2015 and the final report on the Impact Assessment is due in September 2016.
The ECDS is seeking approval via the Standardisation Committee for Care Information (SCCI) as an Information Standard to be implemented during 2017. Further information regarding the SCCI process can here.
The Data Set
An excel version of the document is also available but when considering the data set please read the introduction and background as this describes the reasoning behind the development of the ECDS and the format of the ECDS document.
The ECDS also includes a revised diagnostic data set call the ECDS Diagnostic Data Set (DDA), previously referred to as the Unified Diagnostic Dataset (UDDA). The DDS is the code set which specifically relates to data item reference 2.3.6 EmCare_Diagnosis.
You can download the ECDS DDS v3.0 here.
Following the consultations on v1 and v2 we have put together some frequently asked questions which should be read alongside ECDS v3.
May 2015 ECDS version 1
The Emergency Care Data Set was released for public consultation on the 26 May 2015 for a period of 7 weeks. The consultation was made available to interested parties via a HSCIC managed online consultation hub.
In total the ECDS consultation received 73 responses, with 37 (51%) coming from organisations and 36 (49%) from individuals and patients.
Responses have now been reviewed and work has taken place to review the data set based on the responses to the consultation.
It is anticipated that further consultation will be required during the development of the ECDS and that consultation will include clinicians, data users and patients key to understand how data should be collected, how data should be used to support the delivery of healthcare services, how data should be stored and extracted.
The ECDS Stakeholder Engagement Group (SEG) was held on the 12 May. The purpose of the SEG was to:
- To advise the ECDS project board on the current performance and on-going developments of the ECDS project.
- To identify and prioritise areas for the on-going development of the ECDS.
- To advise the board on specific areas of work as required in the delivery of the ECDS project.
- To represent the emergency care community and offer advice and feedback to the ECDS project board to ensure that the project continues to meet its requirements and objectives.
The SEG is comprised of representatives from the various types of Emergency Department type, commissioners, trust IT leads, trust business intelligence leads, system suppliers, representatives from the Ambulance service, representatives from Ambulatory Emergency Care, patients via the Royal College of Emergency Medicine Lay Committee and education establishments. Please see the SEG terms of reference for more information.
You can access the SEG Terms of Reference here.
We hope to hold another SEG meeting in the Autumn.
- Impact assessment including phase 2 pilot and structured questionnaires, April – Sept 2016
- ECDS benefits identification and planning, April – Sept 2016
- Impact assessment mid point report, 19 May 2016
- Impact assessment full report, Sept 2016
- DH sign off ECDS implementation plan, Oct 2016