Lorraine Foley, CEO, PRSB

As the mercury spiralled, we knew it was going to be a tough week for health and care services, already under pressure from another increase in numbers of people with COVID-19 and the battle to restore services after the last two extraordinary years. It is now widely accepted that there is the potential for challenges such as these to be mitigated, at least to some extent, when all parts of the health and care system can communicate digitally, sharing data and pooling knowledge about each person’s needs and circumstances. The standards we develop at PRSB are all designed to contribute to that goal. But their use on the ground is not yet widespread enough to make the difference that we all believe they can.

The NHS England Transformation Directorate has designed a survey, asking valued stakeholders and organisations for their views on the impediments and blockers to widespread adoption of standards.

I would urge everyone to respond to the NHS England survey. They genuinely want to know what would help and we must all take the opportunity to respond when our views are sought. PRSB has responded already, but the weight of replies and real-life examples will add credibility and substance, helping to ensure the changes needed do finally happen.

The top three messages in our response would be alignment of regulatory regimes to standards, clarifying responsibility for widespread adoption and ensuring developers have all the components they need to implement. But in this piece, I would prefer to focus on two points less often made; recognition of the positive role of system suppliers in the drive for standards and interoperability and secondly, the widespread tendency to focus only on technical standards, rather than the content definition upon which they are based. In my view, both of these problems should be addressed.

PRSB has always worked closely with system suppliers as an important stakeholder and contributor in developing standards and their widespread adoption. Over the last 18 months, we have also worked more intensively with those suppliers who have signed up for our Standards Partnership Scheme, including working with them to assess their conformance with standards and working jointly with them to make the necessary changes. Our experience is that this is a sector that wants to work with us and do the right thing, but that needs consistency and a long-term view that provides the confidence to invest for the future, including making its systems standards-complaint. The centre, suppliers and standards organisations such as the PRSB need to learn to trust each other and find ways of working that promote (and measure) such trust and mutual respect, with feedback loops, transparency, and accountability. The sooner we learn to do that, the quicker we are likely to achieve our shared aims of standardisation and interoperability.

Secondly, all PRSB standards take as their starting point an agreement, forged in dialogue between people who deliver care, those who receive it and experts in professional records, as to what the content of a typical record should be. That could be a discharge summary, or a referral to a social work team, or the crucial information a person wants to share with their care provider prior to a consultation. Some of this content is in the form of data items, which need to be accurately and consistently recorded and, where appropriate, coded. And the correct protocols need to be developed to enable the record to be shared digitally, and to be accessed from a range of systems. But the starting point is the content; the part that can be read and understood by humans, not only by machines. The technical standards that are necessary to make those records usable and useful are also essential, but often they become the sole focus of discussion. This needs to change. If we want standards to be widely relevant, we need to take a more holistic view and consider all the component parts that are needed to implement as part of the package, from record content to FHIR profiles to APIs, meeting the needs of all with an interest and ongoing concern that the standard is right, not just the technicians.

This is not just a foible. There are solid reasons why this narrow technical focus is a barrier in itself – we need to break this habit if we want the standards to be widely relevant and widely used:

• We need standards that are human-readable and can be easily understood by those that use them – front-line professionals and people – or they will disengage.
• We need standards that evolve and change over time so that users can be confident they are supported and maintained – this requires that the enduring link between defined content and the technical standards that enable it must be maintained or the standards become out of date and start to lose credibility.
• System suppliers need the insight provided by the standards and associated documentation to help them design effective systems and interfaces that work for users.
• Standards define ‘best practice’ in the information required to support a given use – not all of this information may need to ‘flow’ and hence, generating profiles for everything can include redundant effort.
• Technically driven changes in the technical layer are more frequent but often of no relevance to clinical practice. We don’t need to burden non-technical users with frequent changes that do not impact them, and we need to adopt information standards that are consistently used across technology platforms.

Addressing all these issues that impede the adoption of standards is no simple task and PRSB is ready and willing to play our part in moving forward with this agenda, which is central to our work and essential to our broader collective mission of achieving the digital transformation. By participating in the NHS England Transformation Directorate’s survey, you will not only be sharing your valuable professional experience, but also contributing to building a digitally-enabled health and care system, in which standards are commonplace, for better, safer care. Make your voice heard.