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 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 ECDS will be implemented via an ‘uplift’ to the current 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 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.
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.
The ECDS Project Board commissioned NHS Digital to deliver an impact assessment and options appraisal of the replacement of A&E CDS type 010 with the ECDS.
The Impact Assessment was delivered in September 2016. We are currently working with colleagues to develop an implementation plan based on the findings of this work.
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 October 2017 (with types 3 and 4 in a further phase of implementation in 2018).
We will provide further detail regarding the ECDS implementation approach and timeframes in early December 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
We are currently working to develop the ECDS so that it is represented in the form of a CDS specification. We hope to be able to share a draft of the specification in early December 2016.
Following the consultations on v1 and v2 we have put together some frequently asked questions which should be read alongside ECDS v3.