Section[ Introduction
Title[ Purpose and Scope
DEEDS is intended for voluntary use by individuals and organizations responsible for maintaining or improving record systems in 24-hour, hospital-based EDs. DEEDS
is not a set of mandates, but rather it is designed to provide uniform specifications for data elements that decision makers may choose to retain, revise, or add to their
ED record systems. The purpose of DEEDS is not to establish an essential or minimum data set but to foster greater uniformity among individual data elements chosen
for use. If the recommended data elements are uniformly recorded and the data are made available with appropriate safeguards to numerous legitimate users, then prob- lems — such as data incompatibility and high costs of collecting, linking, and using data — can be substantially reduced. Concurrent with progress toward more uniform and accessible health data, existing methods of protecting the confidentiality of patient-, practitioner-, and institution-specific data must be strengthened (Institute
of Medicine, 1994).
To the fullest extent possible, the specifications for individual data elements in Release
1.0 incorporate existing health data standards, particularly standards for computer- based records. A major objective of the DEEDS initiative is to provide uniform data elements that harmonize with prevailing standards for electronic data entry and ex- change. However, many specifications also are relevant to paper-based records, which EDs throughout the United States are likely to use to a varying extent for years to come.
Release 1.0 is designed to serve as a compendium of data elements and as a technical reference on automation of ED data. The 156 data elements are organized into eight sections and numbered sequentially within each section. A structured format is used to document each data element: a concise Definition, a description of Uses, a Discus- sion of conceptual or operational issues, specification of the Data Type (and Field Length), a description of when data element Repetition may occur, Field Values that designate coding specifications and valid data entries, reference to one or more Data Standards or Guidelines used to define the data element and its field values, and Other References considered in developing the data element. Data types and field lengths used in Release 1.0 conform to specifications in Health Level 7 (HL7), a widely used protocol for electronic data exchange (HL7, 1996), and ASTM’s (formerly known as the American Society for Testing and Materials) E1238-94: Standard Specification for Transferring Clinical Observations Between Independent Computer Systems (ASTM,
1994). The Technical Notes at the end of this document provide a detailed description of data types and conventions for addressing missing, unknown, and null data as well as recommendations for dealing with data elements that are not applicable to selected groups of patients. The Appendix outlines how the data elements can be mapped
to HL7 data fields and segments. Readers may refer to the Technical Notes and Appen- dix as needed to answer specific questions.
Release 1.0's scope of coverage comprises data elements that can serve multiple secondary purposes once they have been used for immediate patient care and adminis- trative functions. Among the most important of these elements are those diagnoses of patients’ conditions that practitioners typically record at the end of visits. Because of the clinical services they provide, ED practitioners often make diagnoses that call for preventive countermeasures at the individual and population levels. For example, when some conditions are diagnosed (e.g., suspected child abuse), ED staff are man- dated by law to communicate findings to agencies that protect the safety of at-risk individuals. With other ED diagnoses (e.g., meningococcal disease), staff must transmit data to public health agencies responsible for preventing and controlling disease outbreaks.
Additional data elements, beyond the scope of Release 1.0, are needed to ensure that records of individual ED visits are complete. These data elements include documenta- tion of patients’ informed consent to disclose person-identifiable data to authorized users. The multidisciplinary process that produced Release 1.0 can be used in the future to develop specifications for additional data elements.
Several data elements in Release 1.0 are not routinely recorded in EDs, but interest
in their use is mounting. For example, more routine collection of observations about ED patient outcomes and patient satisfaction is on the horizon. The patient outcomes and patient satisfaction data elements in Release 1.0 provide a framework for data entry, but further work is needed to develop methods of gathering and analyzing rele- vant observations.
The scope of Release 1.0 is not limited to data recorded by physicians and nurses. Patient identifiers entered by registration personnel, clinical data recorded by allied health professionals, and medical codes assigned by health information specialists also are included.
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