10 November 2016

The e-discharge summary standard: A litmus test for digital transformation and interoperability?


Lorraine Foley

The e-discharge summary standard

The e-discharge summary standard:

A litmus test for digital transformation and interoperability?

Many of you will be aware of the target for electronic discharge summaries conforming to the PRSB structured record standard by next month (December 2016) and a fully coded version that should go automatically from hospitals to GPs by April 2018.

A recent audit by NHS Digital of local digital roadmaps (LDRs) indicates that 37% of trusts are implementing the headings in their e-discharge summaries and another 31% have plans to achieve the target. If those figures are right, that's already a tremendous step forward that should be celebrated as over time benefits for patient safety, quality of care and efficiency will flow from these changes.

But we believe there is significantly more to be done to understand the experience of trusts implementing these changes and to learn and refine the standards themselves and the best approaches to embedding them in clinical and professional practice. This is new territory and things will not go perfectly the first time - we need to anticipate that and we need to commit ourselves to learning, adapting and refining how we implement standards in electronic health records.

Of course the real prize occurs in April 2018 when fully coded discharge summaries are automatically received by GP systems, reducing manual intervention and enabling real improvements in quality and safety through, for example reconciliation of medications.

The PRSB and its members are clear that clinical and professional leaders must be at the forefront in adopting standards and changing working practices from the outset with all that implies :

  • we are clear that clinicians and professionals must be in the driving seat - if we just impose technology we will fail
  • there is a significant gap in the understanding and buy-in of many clinicians and professionals at the grass roots of what we are trying to achieve, how it relates to care of patients and their role in making it happen - we need to fill this gap and provide this group with the understanding, belief, tools, support and inspiration they need to step forward and lead the charge for change
  • Chief Clinical Information Officers are a critical lynch pin and we need to provide them with every ounce of support to shoulder the leadership task in local health and care systems - the PRSB members (royal colleges and professional bodies) are mobilising their considerable resources to provide further support

But whilst clinical and professional leadership is critical to success, it's not enough on its own. In order to pull off the extraordinary and transformational change we are striving for, we will need to have every lever and incentive in the system pulling in the same direction, for example innovation funds for early adoption and pilots, NHS contractual requirements, professional development, education and training and regulation.

We should not under-estimate the scale of the task, it is Herculean. But we must stay focussed on the benefits to care and safety for patients because they are great.

Achieving successful e-discharge summaries is an achievable step for everyone and will start us on the journey to working differently across care settings, sharing information, and exploiting technology. The opportunity to build on our early steps and learning and share e-discharge summaries and other key documents and data with community pharmacies and care homes at the earliest opportunity is exciting and already being discussed. For now, let's focus on the small achievable steps and build towards the 'giant leap for mankind'!

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