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This month we discussed how standards are working in action at Health Plus Care Online. You can find a list of sessions below:

Reimagining innovation and delivery  
Sam Bergin Goncalves, citizen lead on the PRSB’s social care project, and Professor Adam Gordon, president elect of British Geriatrics Society, discussed the publication and implementation of new social care standards. Sam shared her experience of using a care passport with her son Shane, and the impact standardised information is having on their lives. Watch here.

Residential and care home 
Katie Thorn, Digital Engagement Manager, Registered Nursing Home Association and Lucy Mcculloch, care home digital integration consultant for NHS South West London CCG joined forces to talk about the implementation of the PRSB’s standards for sharing information from care homes to hospitals in an emergency. They shared the benefits and challenges of standards adoption. Watch here.

Digital transformation 
Our chair, Professor Maureen Baker, joined panellists to talk about how the pandemic had changed the face of primary care. You can find the recording here.

Blog: How the new Standards Partnership Scheme will improve the drive for health and care data   
Prof Maureen Baker, Chair of the PRSB

“Since the pandemic began, many countries have struggled to provide data in near real-time in order to act swiftly to combat the virus. The recent WHO SCORE report estimated that while 60% of the participating countries have systems to review progress and performance of their health sector, only half have the capacity to monitor quality of care, and a third have the capacity for a national digital health strategy based on recommended standards. 

Although the UK government has responded to the challenge by rapidly creating a single place to gather and analyse data and feed it back across the health and care system, it still highlights the need for robust information, both for direct care and planning of care.  to manage the pandemic in real time. This was also confirmed in our latest report Health and Care and Covid 19, which analysed the ways we need to tackle digitisation.   

For the past five years, the PRSB has been developing standards and guidance for the content of health and care records to support the collection and sharing of high-quality data. Where standards have been adopted, we’re already seeing positive benefits, including increased efficiency for professionals and better personalised care. But adoption of standards and sharing information between systems remains a huge challenge in health and care that needs to be addressed urgently.   

The new Standards Partnership Scheme will visibly recognise and support vendors across the UK that are implementing professionally endorsed record standards. By offering a targeted, practical support programme for partners that focuses on co-production and learning, we can help vendors access the skills and expertise they need to deliver a truly integrated system. We also hope that the Quality Partnership, where vendors test conformance to PRSB standards, will help to support adoption and spread of standards. In turn they should demonstrate best practice to other organisations, helping all sectors of the health and care system to come together and be able to deliver this shared goal of integration. Later this spring we’ll be expanding the partnership scheme to work with NHS and social care providers to help them adopt standards, to complement the vendor offer we have just introduced. We’ve always said that we need collaboration across the board to make this happen, and we’re pleased that we can give people the tools to support this.  

By working together we can make the changes necessary to ensure information is at the fingertips of everyone in the health and care system whether they are caring for someone at the bedside or planning care at a national level.”   

The Professional Record Standards Body (PRSB) has launched the Standards Partnership Scheme to visibly recognise and support vendors across the UK that are implementing professionally endorsed record standards to improve and integrate care through interoperability.  

The scheme, which is supported by NHS and social care system leaders, enables Partners to send a strong signal to customers and stakeholders that they are at the forefront of the drive toward standards and interoperability in the NHS and social care.   

The Standards Partnership Scheme offers a targeted, practical support programme for partners that includes tailored workshops, briefings and guidance, as well as networking opportunities for Partners to contribute and influence standards development and priority setting. An annual fee will entitle organisations to access responsive advice and guidance on implementing standards and learn more about our standards and future priorities from the experts who develop them.  

Our scheme is about co-production and mutual learning. Vendors will improve, local adoption of standards will improve, and the standards themselves will improve as we learn from real experience of implementing – so that they are useful, usable and used.  

Vendors that want to demonstrate organisational best practice and standards conformance should apply to be a Quality Partner. For Quality Partners we will set an achievable bar for conformance with standards that is safe and delivers clinical value, recognising that best practice may take a little longer. The bar will move upwards over time as the system matures and we all learn. The scheme is designed to be developmental and will flex to meet the needs of different health tech organisations, no matter what their size or level of digital maturity.   

PRSB will also shortly be introducing a local provider partnership offer that includes training, support and advice for implementing standards and using them to support information sharing within their organisations and for continuity of care across settings and services. 

Partners will join one of the largest professional networks in health and care across the UK that is committed to ensuring that standards are useful, usable and used to support better and safer health and care.   

Professor Maureen Baker, Chair of the PRSB, said: “Clinical standards enable health and care professionals to swiftly access the crucial information they need to support the delivery of good quality, personalised care. “Through our new partnership community, vendors will get the chance to work closely with clinical and professional leaders, system leaders and patient advocacy groups to make these standards work in action.”  

David Turner, Chief Technology Officer at NHSX added: “At NHSX we work closely with the PRSB and other partners to drive the adoption of standards to support better care and improved interoperability. This new partnership scheme is an important contribution to developing a truly joined up health and care system. Now is the time for vendors, clinicians, social care workers to join forces and adopt standards for a future focused on better, safer and more integrated health and care.”   

We were deeply saddened to hear that our advisory board colleague, Dr Julian Costello, passed away recently following a non-covid related illness.

A hardworking and committed member of the Professional Record Standards Body since its inception, Julian was one of the early pioneers of informatics, introducing computers to his GP practice in the 1980s. He was a highly respected GP in the South Wales region, a PRSB representative for the Royal College of General Practitioners’ Health Informatics Group and a member of the Joint General Practice Information Technology Committee (JGPITC). In addition to his numerous career successes, he was a friendly and sociable colleague who will be very much missed by our own team, as well as others who worked closely with him.

Professor Maureen Baker, chair of the PRSB, said that his work in informatics in general practice had paved the way for the future of digital health and care across the board. “He was always an active and engaged member of our advisory board, with lots of insight and supportive comments to make. He remained committed to the advancement of digital health and care throughout his career.” Meanwhile PRSB CEO, Lorraine Foley praised his contributions to the organisation. “Julian has played a key role in so many of our standards over the years. I will remember him for being unfailingly helpful and constructive, whatever the problem. These are rare qualities, and we will really miss him.”

Annette Gilmore, project lead and analyst, who has known Julian since the early days of PRSB, said he was a lovely, easy going character, who was approachable and friendly to everyone in the team. “He was a true believer in the work of the PRSB and has been with us on our journey since the beginning. He was always beavering away in the background making things happen. He was great fun at social occasions and will be missed by everyone who knew him.” Fellow advisory board member, Stephen Goundrey-Smith added: “I was very sorry to hear the sad news about Julian. He was a great supporter of the medicines and pharmacy work.”

NHS South West London CCG is putting into practice the standard it developed with PRSB for sharing information for an urgent referral from a care home to hospital. This work was part of NHS Digital’s social care pathfinder programme and PRSB published several new social care standards to support the pathfinders’ work. 

Previously shared in a physical “Red Bag”, the standard covers the information that needs to be shared from a care home to a hospital in an urgent situation, where a person needs swift access to care. The staff at NHS South West London CCG have worked with care homes of all sizes and at various stages of digital maturity to implement the standard and they have seen huge benefits as a result. In interviews with care homes all said they were able to share information across system boundaries in a timely fashion, and that better communication with family members was happening as a result. Unlike physical red bags, digital information was less likely to get lost, including advanced directives which share information about what sort of treatment a person wants to have or wants to avoid, such as intubation.  

Care homes believed that sharing information in a standardised way meant the support people received was more personalised to their needs. This is enhanced by the ‘About Me’ standard, which is also being implemented alongside the urgent referral from care home to hospital standard. Outlining all the personal information that care professionals need to know, care home managers felt that sharing this put the minds of both residents and their families at ease. For example, if they had to have an injection but feared needles, the care staff would have that information and could put extra support in place.  

Meanwhile the project is highlighting the importance of information governance and cyber security, and is supporting care homes to meet required standards. In interviews, the management team at NHS South West London CCG was commended for its commitment to working collaboratively across different groups, including software suppliers, Healthwatch, care homes and ambulance services to make the standard work in action. If you have questions about implementation of any of our standards, please contact support@theprsb.org.  

Self-care, self-management, illness prevention and personal goals are a vital part of wellbeing for many patients and carers. That’s why the PRSB is building a Patient and People Network, in order to support them in influencing the information that is prioritised for care and decide how it’s shared. 

Covid has changed health and care priorities permanently and we know that digital is here to stay. Our goal is to ensure this can be done in the best way possible to maximise patient benefits and minimise any risks. To do this we have established a people priorities team, made up of patients and engagement specialists, and developed a strategy to help us deliver a programme of work that puts patient needs and priorities at its heart. We will be aiming to expand the team of patients and carers we currently work with, to address the issues that they feel are most pressing as well as work closely with our members’ and partners’ user networks. This will include challenges such as health inequalities, lack of access to information and sharing in decision-making. We appreciate that people’s information needs may be different to the professionals who treat them, but are equally important.  

Our goals will be to work with a more diverse network of people on projects and better support people in sharing their views and concerns. We will be re-evaluating current processes to ensure that topics are accessible and that people feel they can get involved and share their views in a meaningful way to support change within the system.  The new network will also offer support and training where needed. If you’re a carer or someone who has used services in the past and would like to get involved, please contact us on info@theprsb.org.

The PRSB is working with NHS Digital to provide clinical assurance on the UK’s ‘core FHIR profiles’, which are the technical standards (based on the PRSB standards) that support the sharing of patient information between different computer systems.    

The goal is to ensure that the right clinical information can be shared between systems in the NHS and social care, using the Fast Healthcare Interoperability Resources technical standards, so we can improve the way health and care is provided for people.  

To participate in the first phase of this clinical and technical assurance process please read the guidance material. The content to be reviewed is contained in the UK Core Snapshot.  

There are also training materials  https://simplifier.net/guide/ClinicalandTechnicalAssuranceSprint1DocumentationPack/Training for clinicians who would like to learn more about these technical standards and how they can support their work.   

If you are interested in helping to shape the UK core FHIR profiles from a clinical perspective, please visit the website to provide feedback. The review period is three weeks from 7 December 2020 – 8 January 2021. A call will be held on 22 January from 9:30-11:30 to discuss your feedback.   

There will also be a series of calls taking place in February to specifically discuss the allergies profile (the technical standard that determines how information about allergies is shared between systems, and is based on the PRSB allergies module). These will take place on 23 February from 11am to 1pm, 25 February from 11am to 1pm, and 2 March from 11am to 1pm. There will also be an external consultation call on 9 April from 9.30am to 11.30am and a session on lessons learned on 16 April from 10am to 11am.

Please contact info@theprsb.org if you would like to join any of these sessions. 

In the early days of the pandemic, much of the effort of the health and care services was focused on people with severe symptoms of Covid-19, many of whom required hospitalisation. Initial data indicated that approximately 80% of cases were deemed to be mild, with people expected to make a full recovery, as they would from seasonal flu or a common cold. But over the past few months it’s become increasingly clear that not all ‘mild’ cases of Covid-19 resolve themselves easily as previously thought.  

According to recent data, up to one in 10 people under 50 can suffer with symptoms for longer than a month, with patients reporting a vast and wide-ranging array of ongoing symptoms. For others who make a recovery relapses are common, with an increase in reported fatigue and breathlessness on a long-term basis. Many of those who became unwell early in the first wave are still feeling the effects of the disease now, and it’s something scientists are still trying to understand. 

While patients have informally named the condition ‘long covid’ and set up social media support groups, new guidelines developed by NICE, the Scottish Intercollegiate Guidelines Network (SIGN) and the Royal College of General Practitioners (RCGP) define the condition as post-COVID syndrome. This will become a recorded diagnosis when a person has the signs and symptoms that develop during or following an infection consistent with COVID-19 for more than 12 weeks and they are not explained by an alternative diagnosis. The condition usually presents with clusters of symptoms, often overlapping, which may change over time and can affect any system within the body. Many people with post-COVID syndrome can also experience generalised pain, fatigue, persisting high temperature and psychiatric problems. In the most severe cases patients are being seriously debilitated by their symptoms, and are unable to live their day to day lives without assistance. Specialist services are being set up to support people with the condition, but with information about the disease still evolving, there is not always a clear referral pathway for the patients who continue to have symptoms but test negative for post-covid complications, such as organ damage.  

After publishing guidance on COVID terminology earlier this year, the PRSB is now in discussions with NICE, the colleges and NHS Digital about terminology and guidance around post-COVID syndrome so that the data can be recorded and shared between relevant professionals. In the short-term this can help to ensure that patients access the right care where applicable, for example, if neurological damage has occurred. Standardisation of this data may also help to support research into the condition, helping people to get swifter referrals when better information exists, and additional treatment options become available. Information about post-COVID syndrome will also be relevant to professionals providing rehabilitation services, such as physiotherapists and occupational therapists, who can work more effectively with access to a full picture of a person’s health. Ultimately the more standardised information we can record, the more effectively it can be used in both frontline care and research. In a situation where the medical professions are playing ‘catch up’ with. a new virus, the information will become vital to both support patients who are unwell now and those who may contract the virus in future. 

There’s no doubt that 2020 was a strange and challenging year, but health and care services have done an impressive job of adapting quickly to rapid change. The pandemic has led to increased innovation, particularly around digital and while there has been a lot of difficulties, we’re also hopeful that this renewed focus on ‘digitisation’ can continue into 2021. From online consultations to increased interest in self-care apps, COVID-19 has ‘sped up’ the process of digitising health and care. 

• In 2020 we published new social care standards, which will connect health and social care services. We will be excited to see these put into action in 2021, so that people can benefit from more personalised care. A key part of this has been standardising the ‘about me’ section of records, the crucial information that helps professionals providing care and support to understand who the person is and their individual needs. At Oxleas NHS Foundation Trust plans are underway to incorporate the About Me standard into its new person-held record system, to try to ensure that people are able to access the personalised support they need to meet their own individual health and wellbeing needs.
     
• In addition to About Me, we’re excited to see growing support for more integrated care systems, alongside more personalised care and shared-decision making in health and social care. This will be an important area of work for us in 2021, and we look forward to working with a wider group of people and carers to support the development of more personalised health and wellbeing. As well as the shared-decision making standard we’ll be working on, plans are underway to expand our people network, to help us better ensure that the needs of patients and carers are truly being met through information sharing.
  
• Getting standards used in action was a big push for us this year, and we’ve seen great results. Pharmacy standards are already supporting community pharmacies in sharing vital information with GPs up and down the country. We hope to see this continue as we roll out the next phase of the standards in this year, with more community pharmacy services, for example testing for certain conditions and support to quit smoking, being covered. Meanwhile we’re also seeing greater adoption of other standards, such as the outpatient letter standard, across the country where clinicians write directly to patients. We expect to see this grow this year, with a great focus on standards adoption.  

NHS Digital has expanded its electronic flu notifications service, which is based on our pharmacy information standard and ensures that information about flu vaccinations can be shared digitally by pharmacies with GP practices.

Last year, a new service using electronic notifications to inform GP practices when a patient has a flu vaccination at a pharmacy was launched, saving time for GP practices and pharmacies. The service helps to improve data quality and reduces the duplication of invitations for vaccinations.

Electronic notifications have now been introduced for pharmacies and GP practices using Sonar and EMIS Web, following the service launch with PharmOutcomes and TPP SystmOne last year. With more providers using the service, a greater number of flu vaccination notifications will be transmitted this flu season. This is especially important while we continue to battle the pandemic, as more people are being offered an NHS flu vaccine.

Because details can be added to a patient’s medical record as soon as a notification is received, information will be more up to date. This will help to make sure patients who have already had a flu vaccine at a community pharmacy are not contacted unnecessarily to arrange an appointment.

Dr Simon Eccles, chief clinical information officer and deputy chief executive of NHSX, said: “This is an excellent example of how to solve a national problem by building on existing technology. This change will greatly improve care for patients by ensuring their family doctor and team are kept informed of their flu vaccinations.”