Emergency Care Data Set (ECDS)

The Emergency Care Data Set began flowing to SUS+ in October 2017. It is the new Commissioning Data Set (CDS) Type 011 introduced in CDS Version 6.2.1. It will eventually replace the existing CDS Type 010 - Accident and Emergency CDS.

Introduction of the CDS 6.2.1 Type 011 ECDS brings with it changes to the submission frequency from monthly to weekly and eventually to daily.

Providers are expected to start with weekly submissions, moving to daily submissions as their business process and systems allow.

Daily submissions are incentivised from 1 April 2018 via the ECDS CQUIN.

There are a number of differences in the way ECDS is constructed and in the way it is received and processed by SUS+.

ECDS uses the MESH submission mechanism. This still requires end points to be set up (MESH mailbox IDs) and registration of the flow using an SR1.

ECDS is an XML submission. MESH does not enforce a schema check at site to make sure an interchange is well-formed and therefore valid for submission. The XML is checked on landing at SUS and errors that do not conform to the XML schema will cause rejection of the file. It is therefore recommended that senders apply their own check to ensure compliance with the schema before submission.

ECDS introduces data items that follow the SNOMED-CT coding schema.

Clinical codes that previously used the accident and emergency specific schemas are now submitted in SNOMED-CT.

Deriving and assigning Healthcare Resource Group (HRGs) uses codes translated back to their equivalent A&E code from mappings supplied by the Royal College of Emergency Medicine. Submitted SNOMED-CT codes will be used when the grouper has been updated to consume them.

The Royal College has also specified an approved list of SNOMED-CT codes for each item that uses this schema. It is possible for EDs to submit codes outside the proscribed list, but these will be marked as errors by SUS+ and will not be output in user extracts in accordance with Royal College instructions. In these instances, the extract column for the code will be blank and a related “IsItemCodeApproved” column will carry the value “FALSE”.

To offer consistency during the transition between A&E CDS Type 010 and ECDS Type 011, new extracts have been created to carry ECDS data.

• Backward_Compatible_Main
• Backward_Compatible_Supplementary
• CDS62_EC_Backward_Compatible
• Backward_Compatible_Error
• CDS621_EC_Supplementary
• EC_Repeating_Supplementary

The backward compatible extracts all retain the format and structure, including column names, of existing EM extracts. Where an item has carried across from A&E to ECDS without change, it is presented in the equivalent position without change and is handled by the same internal process by SUS+ in both existing and new extracts. Where an existing item is now submitted using SNOMED-CT, a mapping has been supplied by the Royal College and the new item is translated into the existing Type 010 value set. New items appear in the EC Supplementary extracts. Where a single value applies per attendance these items are in the CDS621_EC_Supplementary extract. New items in repeating groups appear in the EC_Repeating_Supplementary. Records in the repeating groups extract follow a generic “group, sequence, code and date” structure where this is applicable.

All derivations are common to EM and ECDS extracts and use the same functionality in SUS+. In some cases, it is necessary to facilitate this with translation from the submitted SNOMED-CT code.

A backward compatible extract for SEM has also been created. This only contains those items where the direct equivalent item is found in CDS 010 and 011. As for PbR, derivations are applied in common with the A&E equivalent extract.

A ‘streamed’ attendance has been triaged away from the ED following initial assessment as the patient should be treated in another more appropriate setting such as by their GP or a pharmacist or by a service related to their condition. Streamed attendances do not qualify for payment under PbR and are treated as exclusions.

SUS+ checks the Emergency Care Discharge Status. If the patient was streamed:

• a PbR exclusion reason of ‘STREAMED’ is added (in addition to any other exclusion reasons that may have been triggered)
• grouping is bypassed – no HRG is assigned
• pricing is bypassed

The SEM extract will have a blank HRG but will not contain any other indication that the attendance has been streamed.