Syndromic Surveillance Revolution? Public Health Benefits of Modernizing the Emergency Care Patient Health Record in England

Emergency medicine is a recognized specialty in the United Kingdom (UK), with formal training and accreditation conducted and governed by the Royal College of Emergency Medicine. Health care in the UK is publicly funded and provided by the National Health Service (NHS) through a residence-based (rather than insurance-based) system. Emergency care within emergency departments (EDs) is currently provided free at the point of delivery for everyone, including non-UK residents. Although emergency care in the UK is under the control of a single-payer provider (the NHS), there is currently no single, clinically driven, standardized data set for emergency care in the UK. Each ED manages the collection and storage of data related to its patients, as required for their care, through locally developed processes for electronic data collection, format, and storage. These processes may still include the use of paper records during treatment, to be transcribed to an electronic patient record at a later date. Numerous electronic clinical information systems are currently in use, with many differences in data formats by location, even those running the same software. In England, a subset of the data for each ED visit is collected nationally, to monitor activity and for payment purposes, in the Accident and Emergency Commissioning Data Set (hereinafter, CDS), currently type 010. Created in the 1980s and maintained by NHS Digital (as required by NHS and the UK Department of Health), the CDS is not collated centrally in real time. Each hospital submits data more or less monthly after a series of completion and validation processes. In certain circumstances, an anonymized extract of the CDS is made available through the NHS Secondary Uses Service for further reporting and analysis to support the delivery of NHS health care and for public health purposes. Emergency Department Syndromic Surveillance in England