Standards in action: electronic notification helps GPs track flu vaccine uptake

Doctors will be able to quickly identify patients who have not had their flu vaccination, thanks to a new NHS Digital scheme which uses PRSB standards to send vaccine information electronically from pharmacies to GP practices.

The scheme has meant that electronic notifications for patients who had their flu vaccination in a pharmacy using the PharmOutcomes system were sent securely to their GP practice, if it used SystmOne. This saved time for GP practices and pharmacies, helped to improve data quality and reduced the possibility of errors.

Because the details can be added from GP systems to the patient’s medical record as soon as the notification is received, information will be more up to date. This prevents patients who have already had a flu vaccine from being contacted unnecessarily to arrange a vaccination appointment and means those who are still at risk can be more quickly identified.

A successful pilot of the initiative took place in Leeds in October involving 113 community pharmacies using PharmOutcomes and 83 GP practices using SystmOne. Following that, the service was expanded across England for pharmacies and GPs using those systems. Other suppliers will commence their rollout later this year, following similar pilot schemes.

The content of the electronic notification is based on our pharmacy information flows data standard, which covers the information that needs to be shared about vaccinations, the emergency supply of medicines and other community pharmacy services. NHS Digital has dev

eloped technical standards using a clinical language called SNOMED CT, to ensure this information can be accurately and safely shared between systems. These technical standards are known as FHIR standards. Eventually, the service will be expanded so that information about other community pharmacy services can also be shared with GPs.

Professor Maureen Baker, chair of the Professional Record Standards Body, said: “The Leeds pilot is an early example of the benefits of digital information sharing between GPs and pharmacies that our standards help to deliver.  For GPs, getting up to date information about patient’s pharmacy treatments is key to their ongoing care. And sharing the information digitally saves GPs’ precious time, while making care better and safer.”

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CHAT theory also explicitly addresses five areas which if addressed systematically will help overcome stakeholder differences in pursuit of the common goal:

1. Understanding the artefacts that characterise the group and its activity.
• The artefacts might be clinical settings or the forms and templates used to capture and share information. During the pilot we heard about hard copy Dialog response forms; locally generated templates for collating information from different systems; letters and emails to GPs; images, poems or other non-text artefacts that service users might want to include in their ‘about me’ or care plan.

2. Understanding the multi-views of the group. Such groups are always a community of multiple points of view, traditions and interests. 
• Different participants in the group will have different roles and will bring to the group and their roles their own histories, language, and ‘rules’. During our Stocktake preparations and workshops we worked with psychiatrists, mental health nurses, occupational therapists, social workers, transformation leads and voluntary sector representatives, all professions and interests with their own language, approaches professional ‘rules’ but united in their interest in care plans, care planning.

3. Activity systems (like the ICSs) take shape and get transformed over periods of time. ‘Historicity’ is a term coined to express how the group’s problems and potentials can only be understood against their own history. 

 

• ‘We’ve always done it this way’, ‘that didn’t work before’, ‘it’s always like this’, ‘it wasn’t always like this’, ‘they are changing things again’, are all typical statements that often frustrate those charged with overseeing change initiatives. Without addressing the experiences that lie behind such comments you risk repeating mistakes of the past, alienating your stakeholders or just not understanding the real starting point for your transformation project. This is particularly the case for the implementation of the PCSP standard, the success of which will be largely reliant on point-of-care practices and information protocols as well as having systems which are user friendly and appropriately configured.

4. The central role of contradictions as sources of change and development. Contradictions are not the same as problems or conflicts. Contradictions are historically accumulating structural tensions within and between activity systems. Collectively addressing contradictions in how policy, practice, culture and technology interact will empower teams to find genuinely novel solutions for apparently intractable challenges, like interoperability and shared care plan/planning. 

This links to the fifth principle that:

5. the possibility of expansive transformations in activity systems. As the contradictions of an activity system are aggravated, some individual participants begin to question and deviate from its established norms. In some cases, this escalates into collaborative envisioning and a deliberate collective change effort. “An expansive transformation is accomplished when the object and motive of the activity are re-conceptualised to embrace a radically wider horizon of possibilities than in the previous mode of the activity.”