From development to implementation: Standards in action

In August, PRSB did a deep dive into three cases where our standards are being used in practice to support information sharing and promote joined-up care.

Instant covid vaccine information shared digitally with GPs

More than 40 million adults have had a first dose of the COVID-19 vaccination and over 38 million have been fully immunised, which means the government’s plan is on track to have all adults immunised by October 2021. Behind this astonishing performance by the NHS is an equally inspiring feat of logistics that relies on fully integrated digital systems to share real time information on progress with the vaccination programme.

The COVID-19 vaccination is being offered in some hospitals and pharmacies, at local centres run by GPs and at large vaccination centres. Information about who has received the vaccination and who needs a reminder to get a jab is being coordinated between more than 1,700 vaccination centres and GPs, who hold the most comprehensive set of health records for people living in the UK.

Most covid vaccines are taking place at vaccination centres, which are all required to document vaccinations at the point of care, so that it can be shared directly with GPs. This information is recorded in line with the Professional Record Standards Body’s pharmacy standard, so that it can be coded in the right way and shared between systems. Most vaccine centres record into the Pinnacle system, with daily reports signed off by each manager and collected by 2pm each day for a 24 hour period, to ensure the data is always up to date and any pressures or concerns can be managed. By sharing information through a system directly with a GP, both vaccination managers and GPs are saved time and the process is made safer for patients. They will know that, with their permission, their GP knows they’ve had the vaccination. This means they won’t be contacted again for vaccination until a booster is needed and it reduces the risk that someone could be vaccinated more than once due a system error. 

The PRSB standard was originally developed to ensure information about pharmacy services that people receive could be shared back with GPs. The same approach to recording and coding data in systems is being used for COVID vaccination information, supporting the UK’s drive to get the population vaccinated as quickly and efficiently as possible. The standard can be used to record all vaccination information, including childhood vaccines such as the MMR, and adult immunisations as well. Sharing vaccine updates digitally supports safe, integrated care, by ensuring up to date information is available to those who need it.

Flu vaccine case study

Flu causes an average of 8000 deaths a year in the UK, and the annual vaccination programme plays a vital role in protecting people. Around 25 million vulnerable people are eligible for immunisation on the NHS, while many more choose to pay for the vaccine at a local pharmacy. It’s crucial that information about who has had the vaccine is recorded and shared with health professionals to ensure that people can keep up to date with their jab and stay healthy in the community. During the pandemic it’s been even more important to keep track of vaccines, to encourage eligible people to take up the offer and avoid additional pressure on NHS services.

The flu vaccination notification was successfully digitised in 2019, based on the pharmacy standard published by the Professional Record Standards Body the previous year. Information is now shared directly between pharmacy and GP systems, which saves time for GPs, increases accuracy and improves patient confidence. This is part of a wider NHS England/NHS Digital programme to expand community pharmacy services and bring them into the system more fully.  

As well as saving GPs up to five minutes of time per vaccination and decreasing the risk of error, it means patients can be assured that their information is being properly recorded and shared (with their consent). This reduces the chance that they’ll be accidentally vaccinated more than once or receive multiple calls about booking an appointment. As the role of community pharmacists continues to expand, it’s crucial that important information can be shared back with GPs for a better, safer and more integrated health and care system. Following the adoption of the standard there has been no additional work for pharmacists and they can now be sure that the information has reached the GP. In addition to flu vaccine notifications, information about emergency medications supply is also being sent directly to GP systems. The PRSB standard covers numerous other pharmacy services, and digital notifications for all these will be rolled out in the next few years. This includes testing for specific conditions (e.g. hypertension), quit smoking services and many more.  

The PRSB’s information standard was produced with the help of patients, pharmacists, GPs and other professionals. When it was developed, the technical messaging (FHIR) was commissioned alongside it, so that the information could be shared between systems. Having these FHIR specifications ready at the same time as the information model meant a digital notifications system could be quickly adopted and rolled out across the country. It was originally implemented by NHS Digital in Leeds during a pilot phase which involved with one community pharmacy supplier, one GP system supplier, 113 community pharmacies and 82 GP practices. Since the pilot another major pharmacy supplier and one more major GP supplier have adopted the standard. Their systems have been assured (NHS Digital for spine access) and roll out is now happening across the whole country. System suppliers and users were engaged throughout the development of the standard. The standard was also endorsed by professional bodies, which is likely to have helped adoption.  

Sharing information from care homes is reducing hospital admissions and personalising care

To provide good care in the community for vulnerable and older people, health and social care services need to be fully joined up. New social care standards published by Professional Record Standards Body in 2020 are supporting this by enabling  information sharing between health and social care services, to support better personalised care for individuals. The standards help information to be transferred between systems across different areas of social and health care, including transfers between care home and hospitals in urgent situations. This is vital for ensuring that the treating clinicians have all the information they need about the person who is arriving for care, including what the individual wants. (For example, they may have a DNACPR decision in place). It means that professionals from different services can work together and provide seamless care and support for people who need it.

When transferring patients from care homes to hospitals, NHS South West London CCG has been using a simple initiative called the Red Bag, that keeps important information about a care home resident’s health and personal effects such as eyeglasses in one place, so it is easily accessible to ambulance and hospital staff. With the support of the PRSB’s standard, the information has been digitised so it can be shared directly between systems, and now covers almost 500 beds in the area. By having adequate and up to date information about a person’s wishes to hand, hospitals have seen an 11% reduction in emergency department attendances, and an average of 1.5 days reduction in lengths of stay. There’s also been a 12% reduction in ambulance conveyances and time savings for staff and care homes. The information shared from care homes to hospitals includes a person’s wishes for their care, meaning people are also experiencing better and more personalised support that is in line with their individual needs. PRSB’s standards mean that this way of sharing information between systems can be replicated in other parts of the country.

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