Nuance looks to PRSB standards to help ease the burden on NHS staff

Although electronic patient records are essential to improving joined-up care, documentation can be a burden to hard-pressed health and care professionals. Marrying the AI-powered speech recognition of Healthcare AI technology pioneer, Nuance, and PRSB’s Standards Partnership Scheme is the kind of smart problem-solving that could help clinicians using Nuance technology provide more time to care.

Nuance has become the latest organisation to become a PRSB partner and for them, it was the focus on the delivery of quality solutions and the value of consistent recording of health and care information that convinced them to join the Standards Partnership Scheme.

Simon Wallace, Chief Clinical Information Officer at Nuance, explains: “Every hour a clinician spends on creating or locating clinical documentation is one less hour spent on patient care. To enable them to get back to doing what they trained for, we must find new ways to help ease the growing burden of administrative responsibilities.”

Nuance speech recognition technology plays a key role in the quality of clinical documentation generated by healthcare professionals. Its Dragon Medical One solution uses artificial intelligence to capture voice-generated content directly into clinical systems.

“As part of quality note creation, PRSB plays a similarly key role in the standards for the content and structure for that documentation. Therefore, Nuance joining the Standards Partnership Scheme allows us to support trusts in the NHS by providing the tools of AI speech technologies to help deliver the PRSB standards.”

“Standards and interoperability are a key component of documentation and Nuance has a range of tools that can support their adoption. From a standards perspective, one of those tools is template (autotext) creation and it is important that, when we are supporting trusts to build their templates, they conform with PRSB standards.”

Beyond the benefits PRSB standards will offer customers of Nuance, Simon is confident the Standards Partnership Scheme will deliver educational benefits to colleagues, helping them better understand the demands of the market and its regulators.

“The scheme will help our sales, pre-sales, deployment and transformation teams to be fully versed in the requirements of the PRSB standards, enabling more productive conversations with the NHS about how our speech solutions can support their adoption in the EPR.”

Lorraine Foley, PRSB CEO, said: “With so much focus on the challenges faced by NHS staff, it’s fantastic that Nuance appreciate the value PRSB standards offer in facilitating the delivery of more efficient, higher quality care. I look forward to hearing more about the positive impact the Standards Partnership Scheme has for their customers and staff alike, and I relish the opportunity to work more closely with them on their journey towards standards conformance.”

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Personalised care and support planning for people with severe mental illness

A review of a sample of current care plans, and the way they have been developed, may be helpful in identifying the priorities for this improvement. The PRSB Implementation Guide provides more detailed explanations about each element of the plan, including advice on how the planning process might be best conducted.
These questions might form a checklist for current plans to be compared with. 

1. Does the plan include an About Me section in which the service user, in their own words, can indicate the information they want to be available about their lives, their values, their interests, and priorities, available for all those who may care for them?
2. Is the approach to developing a care plan patient centred and engaging, allowing plans to be based on patient priorities goals, and aspirations, along with the actions they plan to take and the support that they will receive?
3. Is there space for a “formulation” to be recorded in which the person receiving care and the professionals who provide it, share and record the personal meaning and the origins of the person’s difficulties?
4. Are relevant procedures and therapies recorded?
5. Where relevant, are one or more contingency plans included for anticipatable disruptions, exacerbations, or deterioration, and do they include advice on what to do and points of contact for those called upon to respond?
6. Where relevant are additional supporting plans incorporated, (an example being an “educational and health plan” for someone with a neurodevelopment disorder)
7. Is a version of the plan available to a service user (if they wish to have it) in a form and format that they can understand and find to be of value?
8. How is a version of the plan available to the GP and other key parts of the health and care system?

Work conducted by PRSB and partners recently has looked specifically at the suitability of this approach to the development and documentation of care and support plans for people with Severe Mental Illness. This resulted in an updated version of the standard (v1.4), for use by any service and for any group of service users, but with some modifications to ensure that it meets the needs of this community. The approach to a patient centred process of identifying goals, hopes, and values, and the support needed to achieve them, is fully compatible with and can be conducted using, specific tools in use in mental health, such as DIALOG, DIALOG+, and ReQoL, for example. 

Where analysis indicates the need for improvement in the content and process of personalised care and support planning for patients with Severe Mental Illness, specific improvement projects should be instituted to co-design with service users and their representatives, and the relevant staff groups, new approaches, and documentation that would be of value in delivering improvement. The toolkit includes a range of existing resources that could be used to engage in this improvement work, including signposting to relevant existing approaches informed by patient experience-based design.

Moving to a single holistic plan

A review of a sample of current care plans, and the way they have been developed, may be helpful in identifying the priorities for this improvement. The PRSB Implementation Guide provides A key development, consistent with national policy on support for Personalised Care across all health and care sectors, is the move towards an individual with complex needs having a single, integrated, care plan, rather than a series of plans developed by different parts of the health and social care system in isolation of one another. For a patient with severe mental illness, the related concerns and challenges might form a very prominent part of such an integrated plan; many will also have concurrent health challenges and needs. The intention is that the relevant services work together to plan and wrap support around the patient and their family in an integrated way, rather than as a series of sequential or disconnected encounters in which the service user or their friends and family have to adopt the role of the integrator.

A starting point would be to agree priority groups of service users who may already have more than one care plan because they need care from more than one part of the system of health and social care. This could be initiated by looking at service users registered with some sentinel practices or PCNs. Alternatively, the approach might focus initially on people with defined co-morbidity or risk that entails collaborative care with agencies beyond specialist mental health services.

The focus here is on the process of care planning and agreement on what should be shared, rather than solely on the technology used;

1. What is the process to agree which professional will initiate care planning and act as the “lead point of contact” for the service user?
2. Will initial plans be agreed with the service user in joint consultations or sequentially? Where and how will they be conducted?
3. What will be the process to agree the elements of the plans which should be available to professionals and potential authorised users beyond the immediate care teams, (A&E services, Ambulance Services, Social services, etc.) with the service user’s consent?
4. How will elements of the plan be updated following consultations in a way which is proportionate, to allow contact and progress notes to be maintained by the service conducting the consultation, whilst avoiding unnecessary work for partners in care if there is no significant change to the personalised care and support plan?
5. What are the implications for workload, logistics, and administration arising out of these decisions?

The answers to these questions and others will best be elicited through focused joint working, grounded in real, or at least realistic examples. This will entail process mapping, and co-design with a range of professionals, service users, and families. Resources from the toolkit and outputs from the Simulation element of this project will be valuable. Some organisations would adopt an approach such as a Rapid Process Improvement Workshop, planned over several weeks and conducted over a number of sequential days, to develop prototype ways of working that could be tested in the field.