Section[ Introduction
Title[ Next Steps
This initial release of DEEDS is intended to serve as a starting point. Many data element definitions and coding specifications are new, and field testing is necessary to evaluate them. Systematic field studies are needed to gauge the usefulness of Release 1.0 for direct patient care and a variety of secondary purposes, identify optimal methods of data collection, and specify resource requirements for implementation. Prospective users of Release 1.0 are invited to contact Daniel A. Pollock, M.D., at NCIPC to discuss their plans for evaluating or using some or all of the recommended data elements. Lessons learned through field use and evaluation will be a valuable source of input for subsequent revisions, but all comments and suggestions for improving DEEDS
are welcome.
For some data elements in Release 1.0, additional research and development are needed to design coding specifications or to select a coding system from the available candi- dates. Work is needed on codes for emergency contact relationship, chief complaint, medication identifiers, clinical finding type, procedure indication, procedure result, referral, outcome observation, and patient satisfaction. Pending this additional work, users can select from available national or international coding systems, locally devel- oped codes, or descriptive text entries. Users also may introduce expanded versions of codes specified in Release 1.0 data elements to meet local needs for more detailed data. For example, users can expand the codes for patient ethnicity by subdividing
the two specified groups (Hispanic and Not of Hispanic Origin) into more detailed sub- groups. Users must make sure that subdivided codes can be combined into parent codes to avoid problems with data aggregation and comparison.
Another factor that will influence how DEEDS is used is the movement of many EDs to a paperless or nearly paperless patient record system, albeit at a pace that differs from facility to facility. Data entry technology is advancing rapidly, and the proportion of data entered by hand is decreasing. Direct electronic transmission, telemetry, and increasingly sophisticated dictation systems will become even more important factors in data entry. As advances in information technology are introduced, the burden of entering data will lessen, and the call for more timely, accurate, and useful ED data will intensify.
Although computerization of ED records offers opportunities to improve data collec- tion, linkage, and exchange, it also presents challenges to data security. The prospect of increasing the availability of ED data raises concerns about the unauthorized acquisition of data. Protection of patient, practitioner, and institutional confidentiality requires that persons responsible for implementing or maintaining computer-based ED record systems guard against unauthorized data access and disclosure (Office of Technology Assessment, 1993).
Further work will be needed to revise DEEDS as a result of field testing, new develop- ments in health data standards, advances in information technology, and changes in ED data needs. To assure that necessary changes are incorporated in a timely manner, CDC plans to coordinate a multidisciplinary review of DEEDS beginning 6 to 12 months after distribution of the initial release. The partnership and process used to develop DEEDS, Release 1.0 provides a valuable precedent for future review and revision.
Please send questions or suggestions for improving DEEDS to:
Daniel A. Pollock, MD
NCIPC (Mail Stop F-41) CDC
4770 Buford Highway NE Atlanta, Georgia 30341-3724
Telephone: (770) 488-4031
Fax: (770) 488-4338
E-mail: DAP1@CDC.GOV
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