New standards for maternity records

The Professional Record Standards Body (PRSB) is seeking views from women who use maternity services, parents, health and care professionals and industry representatives on what clinical information should be recorded and shared in maternity records.

Your participation in this survey will help us develop a standard for the clinical and care information that should be shared in a maternity record during the antenatal period of care before a woman gives birth. The standard we produce following this consultation will help people involved in women’s maternity care and women themselves to share information quickly and easily.

The standard is being developed in partnership with the Royal College of Physicians’ Health Informatics Unit on this project as well as the Royal College of Obstetricians and Gynaecologists, the Royal College of Midwives, The Royal College of GPs and NHS Digital.

The draft standards have been developed following a workshop and informed by a consultation workshop held at the Royal College of Physicians on 9 November 2017.

Survey details
(survey now closed). Please see our project page for more details

The results will inform the final draft of the maternity record standard. The Professional Record Standards Body will seek endorsement of the final draft from its membership, which is made up of patient and carer, health and care professional and industry organisations.

If you have any questions regarding this project, please contact:
Nicola Quinn, Project Manager
Email: informatics@rcplondon.ac.uk

New innovation to improve child health information

An innovative way to share important information about a child’s health has been launched today and will support the prevention of childhood illness, improve health and wellbeing and involve parents more closely in their children’s care and development.

The information standards will make it possible for children to receive appropriate care by setting out what information on screening tests, immunisations and developmental milestones should be accessible to health and social care professionals, and parents/guardians for their treatment and care.

It also means that everyone involved in a child’s care, including parents, will have access in the future to a standardised set of paperless, digital child health records. Standardised records will save time for health and care professionals and parents by ensuring they have the necessary information to make the right decisions for safer care.

The standards have been developed in consultation with parents and health and care professionals, and support the Healthy Child Programme.

The Professional Record Standards Body have published a report on the standard, as part of a programme of work by NHS England and NHS Digital to improve the health of children by using digital technology that promotes better information sharing. The programme aims to deliver the goals of the Healthy Child Programme by transforming secure information sharing between professionals and parents, which will enable more personalised care.

Speaking about the standard, newly appointed PRSB chair and GP, Professor Maureen Baker CBE, said: “Every child has the right to a healthy life and I am convinced that this new way of sharing standardised information digitally will support this goal by enabling safer and more efficient care, as well as better support for children and their families.”

Dr Andy Spencer, who was the clinical lead on the project on behalf of the Royal College of Paediatrics and Child Health, said: “It is important that we empower parents to get involved in their child’s health and development. When these new standards are implemented, parents will have the same access to their child’s personal health record as health and care professionals, and they will always know who the records are being shared with and why.”

Dr David Low, Consultant Paediatrician and adviser to the Digital Child Health Programme, said: “Creating these standards for digital exchange of health information is a significant step towards achieving the goals of the Healthy Child Programme.

“It is a great example of collaborative working as parents, carers and health professionals have all been involved in creating this information standard and we will all benefit from the changes it brings. It will save time for health professionals by cutting back on paperwork and giving them access to a standardised set of health information.

“Both health professionals and parents will have greater assurance that a child has received all the preventative care needed to ensure the best start in life.”

ENDS

Follow us on Twitter: @NHSDigital @ProfRecordSB

Notes to editors

1. NHS Digital is the national information and technology partner of the health and care system. Our team of information analysis, technology and project management experts create, deliver and manage the crucial digital systems, services, products and standards upon which health and care professionals depend. During the 2016/17 financial year, NHS Digital published 292 statistical reports. Our vision is to harness the power of information and technology to make health and care better.

2. The Professional Record Standards Body (PRSB) is a body responsible for the development of standards for clinical record sharing across health and care. The body was commissioned by NHS Digital (NHSD) to consult with parents, healthcare professionals, suppliers and public health professionals to ensure that the digital child health strategy information standard meets their needs.

3. The work was undertaken in three ‘work packages’, comprising: events around the birth, up to and including the initial six to eight week GP screening check; routine health visitor, school nurse and primary care events (including immunisations) and developmental checks, developmental firsts and personal information.The structure is intended to be flexible to accommodate multiple uses and changes in practice. Whilst the focus has been the Healthy Child Programme, the information models developed may support recording for other purposes within the child health record.

4. Clinical leadership was provided by the Royal College of Paediatrics and Child Health (RCPCH) and the Royal College of General Practitioners (RCGP), and the work conducted in partnership with the Royal College of Physicians (RCP) Health Informatics Unit (HIU).

5. NHS England Section 7a has statutory accountability for commissioning the Child Health Information Services (CHIS) until 2020

6. For media enquiries please contact media@nhsdigital.nhs.net or telephone 0300 30 33 888.

PRSB publishes new standard for sharing child health information

Every child deserves a great start in life and the PRSB’s new standard for recording child health events will help professionals to achieve this, by ensuring that everyone involved in a child’s care has access to the right information.

Part of the Healthy Child Programme to improve the health of children and prevent illness, the standard spells out what data on screening tests, immunisations and other developmental milestones should be accessible for parents and professionals to ensure they have the necessary information to make the right decisions for safer care. From GPs to school nurses, children often receive care from a wide range of different health and care services.

For these services to work well together, they will need to share the right information between their IT systems, which can only be done if it’s recorded in a standardised way. Developed in partnership with NHS Digital and NHS England, the standard will enable better information sharing.

The information standard has been developed in consultation with parents and health and care professionals and will help professionals and parents to make the right decisions about their child’s care. Standardised and comparable information provides the foundations for future innovations and improvements in health and care.

Speaking about the standard, newly appointed PRSB chair and GP, Professor Maureen Baker CBE, said: “I am convinced that this new way of sharing standardised information digitally will support this goal by enabling safer and more efficient care, as well as better support for children and their families.”

Dr Andy Spencer, who was the clinical lead on the project on behalf of the Royal College of Paediatrics and Child Health, said: “It is important that we empower parents to get involved in their child’s health and development. Once implemented, this new improved way of sharing information will give parents the same access to their child’s personal health record as health and care professionals, and they will always know who the records are being shared with and why.”

The PRSB boosts presence in Scotland

The PRSB met with senior clinicians and Scottish government officials in Edinburgh’s historic General Register House, the oldest public record archive in the British Isles, to discuss closer working across the four nations.

Lorraine Foley, CEO, and Helene Feger, director of strategy and communications, met with clinical leads and managers from Scottish Government, National Services Scotland and several NHS Scotland boards for a lively discussion of opportunities to work jointly. We agreed that there is a vital need for widespread engagement of clinicians and professionals to use PRSB standards to promote standardisation of health and care information to make it easier to share digitally.

Marina Copping, NHS Lothian, updated the meeting on ongoing work to re-procure child health programmes across Scotland. ‘We must not miss the opportunity to introduce standardisation,’ she said. Blythe Robertson policy lead from Scottish government, talked about developing a more personalised approach to care, particularly for people with long-term conditions or at the end of life, that is innovative, manages risk well and ensures better outcomes. Standards and digitisation have a key role to play in delivering this kind of transformation of services he said.

Meanwhile, Ian McNicoll, from Fresh EHR Clinical Informatics Ltd, said we need to develop new methodologies for standards that reflect the fast-changing world of digital technologies. During the meeting, we agreed to develop digital tools for RESPECT, the UK-wide initiative to help guide treatment during emergencies or at the end of life, which the PRSB will consult upon.

PRSB appoints new Chair

The Professional Record Standards Body (PRSB) has announced the appointment of Professor Maureen Baker CBE as chair of the organisation.

The PRSB sets professional standards for the content of health and care records to improve the quality and safety of patient care.

Professor Baker is immediate past chair of the Royal College of GPs and has spent her career championing quality improvement and patient safety through better use and sharing of clinical and professional care information.

Professor Baker takes up the chair in September following the retirement of Prof Iain Carpenter, the founding chair of the PRSB.

“We are delighted that Prof Baker has agreed to chair the PRSB,” said Lorraine Foley, chief executive officer. “Her national leadership experience, clinical expertise, and her passion and drive for improving quality and safety will guide the PRSB as it works to embed standards in practice throughout health and social care.

 

“The PRSB is enormously grateful to Prof Iain Carpenter whose vision for standards and commitment to driving their uptake in health and care was instrumental in establishing the PRSB.”

On her appointment Prof Baker said: “Throughout my career as a clinician and medical leader I’ve been utterly committed to improving patient care and I believe information plays a critical part in this.

“I am delighted to take up the role of chair of the PRSB, as their work on developing and implementing standards is fundamental to improving quality and safety. This is an exciting time to be joining the PRSB and I am looking forward to helping it to increase its role and influence within the system and embed standards into the grain of good practice across health and care.”

Putting pharmacy information sharing into action

Spotlight on Wales: Sharing information on patient medications with community pharmacists after hospital discharge is helping to improve care, according to NHS Wales Informatics Service.

Following the implementation of the e-discharge summary standard, many hospitals are sharing specific discharge information on medications with community pharmacists, provided they have the patient’s permission.

This means that pharmacists can have access to information on a patient’s discharge medication to reconcile with their GP’s prescription and resolve any issues with the treatment after they have been discharged from hospital. In Wales, the number of differences between medication at discharge and that prescribed by GPs have been found to be consistently around 16%, according to data collected from community pharmacists providing the discharge medicines review service.

Flagging differences quickly is reducing errors and improving the overall safety of care for patients. Pharmacists are able to answer questions about medication and ensure that patients are taking them properly. This has improved communication between the pharmacy and the hospital.

The information sharing is part of a wider initiative called Choose Pharmacy, which is also indicating a reduction in out of hours appointments for emergency repeat prescriptions, and aims to establish community pharmacies as the first port of call for common ailments.

“Information sharing with pharmacists leads to safer care”

This month we have spoken to Stephen Goundrey-Smith, The Royal Pharmaceutical Society (RPS) informatics advisor and PRSB advisory board member, about the challenges of information sharing in pharmacy.

What challenges does the pharmacy profession face?

At present, there are around 11-12,000 community pharmacies in England, and some 54,000 pharmacists in England, Scotland and Wales. While a large number of these professionals work in community pharmacy, around 15-20% work in hospitals, and a small number also work in other areas such as primary care, industry or within GP practices. Hospital and community pharmacies do excellent work. As well as providing medications, they also offer clinical support to help people get the most out of their medications. However, pharmacists, particularly those working in the community, have been marginalised from the rest of the health and care services and information sharing has been lacking.

How is the role of pharmacy changing?

Over the past 20-30 years, pharmacists have taken on a greater range of clinical services. This includes medicines use reviews (MURs), to help patients understand and get the most from their medications and, more recently, the New Medicine Service, which educates patients on their latest medication to help them understand how it works and why it’s important to keep taking it. Pharmacists are also branching out to offer additional services such as help to quit smoking, disease screenings and flu jabs. This means that information sharing is more important than ever as pharmacists seek to gain more clinical data about the patients they’re helping to treat, and also record the interventions that they are making. Several systems are now in place to help hospital pharmacists communicate with community pharmacists concerning patients discharged from hospitals to ensure continuity of care. The summary care record has also been important for pharmacists, as it gives them access to the GP’s prescribing record out of hours. However, while there has been some work to improve communication, we have a lot more work to do and pharmacists require more detailed records to enable them to provide extensive clinical services.

What areas would benefit from improved information flows?

As the remit of pharmacy increases, we are faced with other challenges. For example, people who aren’t entitled to a flu vaccine on the NHS are able to have one in a pharmacy. But we are still looking for a standard solution for sending information on vaccines given back to the GP so that they have a record of their patients receiving the jab.

As well as poor information flows, there is variation in different areas in terms of how services are commissioned. I believe that better record formats and the widespread adoption of standardised information will put us in a better position to justify the provision of national service specifications. In addition, better records will lead to more consistency in care processes, which will enhance quality of care. A growing number of pharmacists are working in GP practices. Better records can also help to support information sharing between them and community pharmacies, which will be of benefit to the whole primary care sector.

In addition to communicating with GPs and hospitals, it is also important that we are able to share records with, and access records from, care homes, as many elderly patients have a set of complex needs and medications, which are regularly updated. At the moment, information flows are still limited and we would like to see this improve through the adoption of standardised records.

The PRSB is working hard to deliver standards for clinical records, which is essential for facilitating this information sharing. We have been keen to support the organisation from the outset and see its work as integral for the facilitation of good care across the whole health and social care sector.

“The digital revolution is here and we must embrace it”

Keith McNeil, chief clinical information officer for health and social care talks to the PRSB about why setting standards are essential to the digital health strategy


Q: What is your vision for digital health and care and what is your role as CCIO?

The vision is to join up all the information available and to collect it in a standardised and structured way and mine all the information out of that and feed it back in as close to real time as possible to everybody who is making decisions so we have better informed decision-making right across the system – at the point of care between a patient and clinician, by a business manager or by a researcher. That way we will embed better outcomes, patient experience and sustainability in the health system as a whole. My role is defining the strategy for what is the digital revolution across the NHS and social care.

Q: What do you mean by structured information?

We need information to be collected in a structured way and according to standards. It makes it much easier to aggregate and mine that information.

Q: What is the role of PRSB in enabling both the development and implementation of standards for information?

The role of the PRSB is to help set the standards by which data will be collected. The PRSB’s role is to get consensus that the standards it develops are the right standards to apply but also when we have agreed standards the PRSB helps people abide by them, align to them and implement them as business as usual.

Q: Given the pressures clinicians and professionals are under, how would you convince them to adopt standards as part of the digital transformation. Is there anything we can do to ease the burden to make adoption easier?

Clinicians do have very busy lives and this is really an opportunity to reduce the burden of collecting all this information. Clinicians collect information on the basis of clinical interaction with patients. We should be aligning the system – this comes back to standards – so that whatever we collect in terms of that clinical interaction is what is used for the rest of the system so we are not adding to the burden by additional collections of information that is outwith that clinical interaction. If we collect information in a standardised, structured way we won’t need to keep going back and asking for it to be re-cut in another spreadsheet or another form to go off for another decision-making point. So if we collect it once and we collect it right, in a standardised way, that is enshrined in the clinical interaction, the burden will be taken off the clinicians of having to re-cut that data time and time again which is what happens now.

Q: How can we ensure that the vendors’ systems are compliant with standards? How is this being addressed and can we give confidence to local health and care organisations that this is being addressed?

The vendors are really important in this whole equation as they will provide the means by which important information is collected. It isn’t if but when we align the vendor community to accept standards and embed them into the systems they build for hospitals so that they are embedded into patient pathways, codes for diagnoses, pathology, radiology etc My sense is that they are looking for these standards so they can tune up their offerings toward this agenda.

Q: How are you involving other national bodies to support adoption of standards and the digital agenda?

We are having conversations across the whole system involving all the arms-length bodies like the CQC, NHS Improvement and others. We are single system and need to be aligned and one of the best ways to align the system is through information flows. If you have consistency in the way the information flows and the types of information and data that flow, then we can begin to align inspection, regulation and commissioning into a single system.

Q: What role will global digital exemplars play and how will others follow their lead?

We want GDEs to showcase what the art of the possible is in terms of the digital agenda – what it can do for patients and clinicians on the ground. GDEs are expected to be at the cutting edge in terms of digital capability and maturity and we want them to share that learning across the system. We want that to spread out like ripples across the NHS.

Q: Will each GDE have specific digital goals that they must achieve that are both technical and clinical or patient focussed?

The GDEs range from big, complex tertiary teaching hospitals down to hospitals which are largely place-based in communities with large community services. Some will be saying how can we make the whole of our system better by upping digital maturity across the system, others like tertiary hospitals who see different sorts of patients will be saying how can we cover the patient pathway before they come into hospital and after so we can minimise the impact on acute services.

Q: How can others further behind get moving on the digital agenda?

There are things that every organisation can do and should be doing and one of them might be implementing the E-discharge summary standard that has been agreed and is part of tariff and is agreed with GPs. Electronic prescribing is another area that is really important and a big National Institutes of Health Research study will show that even rudimentary electronic prescribing systems can reduce medication errors by 50%. Every single board across the country will say we can no longer afford not to invest in this because it is so important and we will try and help them do that.

Q: What role does digital maturity play in delivering improvements in cancer, mental health and genomics as outlined in the Five Year Forward View and the refresh?

We can really change outcomes in a quantum leap – this really depends on information. We need to make sure the information flows are there to support the sort of transformation in service this will bring about. We also know there is a big opportunity to use digital techniques and tools to provide services to patients with mental health problems – particularly in patient empowerment. We need the entrepreneurial community to get involved, and patients to get involved so we can maximise the benefits of all this.

Q: What notable innovations have you found across the country that could be shared elsewhere?

Shared care records across health systems are starting to be developed and there are individual initiatives at the level of intensive care where linking up automatic sensors to provide fast early warnings of deterioration, much faster than we can pick up as humans by doing intermittent observations. So we can make early interventions, preventing deterioration or the need for admission or the need for intensive care.

Q: How do you encourage local innovation but strike a balance and ensure national standards are adopted?

Wherever we do things that are place-based we do need to agree a consolidated or national standard. STPS will need to look at how their individual organisations collect information so they can compare information and we want to compare STPs. We want to make sure this works locally because this is about local provision of care. But we want to do things nationally where it is appropriate.

Q: What role will chief clinical information officers and chief information officers (CCIOs and CIOs) play in the transformation to digital and how can we make sure we have enough CCIOs and CIOs?

CCIOs and CIOs are pivotal to this. They are going to provide the leadership within organisations that enables this transformation. They have a dual role – making sure the technology is right to provide what clinicians and patients need on the ground but they will also bring them along to transform the way they work. It’s very important not to think it’s the technology which is going to change what happens in practice, It’s the adaptive change – using the technology to transform the way we work that is going to provide the power from the digital revolution. It is going to create different ways in which we treat patients, different ways we approach planning our treatments and looking at patient pathways in different ways. We need more CCIOs and CIOs to attend to this agenda.

The digital revolution is here and now. We have to embrace it and adapt to it and we need people who will help us do it. So we need to train up more people in digital capability including analytics, informatics and transformational leadership across the board- this is really important.

PRSB interview – Ian Turner

This month we published the Care Home Information Flows Report, which analyses the information gaps between care homes and health care providers. The report, which can be found online, shows that nine in 10 care homes are still getting paper records, while others are getting inadequate information.

One of the main challenges for us is to get away from fax communications. They’re very insecure and can go anywhere. The standard route for discharging someone to social care is via fax- so it’s still one of our biggest challenges. We definitely need to move towards a more secure system.

Another big challenge for us surrounds transfers of care. We need to make sure we have accurate information about a person’s care, particularly about medication. There are often last minute changes to a person’s medication as they come out of hospital and this needs to be communicated properly. The other issue is knowing where these medications are actually available, particularly end-of-life care drugs which aren’t always available from every pharmacy, such as morphine.

There’s a lack of standardisation between hospitals and GPs. Ideally, we would want to have access to GP records for up-to-date medication information, but this can take up to 24 hours after the transfer of care because we aren’t using digital information. As well as information on medication, we need to know whether someone has an infection and needs ongoing treatment. For older patients with weaker immune systems, there’s a higher risk of infection when in hospital. These infections can spread quickly and it’s important that we’re aware of these issues, to protect both the patient and other care home residents.

What steps do we need to take to move forward?

We need more standardisation in information, so that everyone involved in care planning is clear what care is needed and who is responsible for it. The next big step towards this will be the development of the digital integrated care and support plan standard. There are so many different services involved in a care plan, with many different views on what should be included. We want to get to the point where we have structured data, that can be shared easily between different areas of health and social care. In recent years, self-care and patient autonomy has become a more pressing issue. In the care sector, we need to have access to information, and know who the information should be available to, particularly for people who have problems understanding their care and needs. For more information go to www.theprsb.org/projects.

Update on care planning project

We are currently gathering evidence and good practice examples and seeking contributions from professionals across health and social care.

The PRSB is working in partnership with North West London Collaboration of Clinical Commissioning Groups (CCGs) to develop the Integrated Care Planning Standard, so that care plans can be effectively shared between patients, carers and all the health and care professionals involved in that person’s care.

Developing a standard for generic care planning, including end of life treatment, will contribute towards the creation of a more joined-up health and care system. Standards will also help to enable people to manage their own care, with the support of a wide range of services including GPs, hospitals, occupational therapy and social care. Once the standard is agreed, NHS Digital will develop technical specifications, based on the standard. The plan is for these specifications to be incorporated into standard clinical IT system contracts to build capabilities into acute hospital, GP, community, mental health and social care systems, to enable sharing of care and support plan information. When a generic care plan is agreed it will be possible to create more specific care plans for a range of conditions including chronic conditions and end-of-life care.

We are currently gathering evidence and good practice examples and seeking contributions from professionals across health and social care. If you’d like to contribute, please contact us at info@theprsb.org. The second phase of the project will include a consultation process and workshops, before the standard is put together ready for review.