Orion Health’s journey to become the first supplier conformant against PRSB’s Core Information Standard 

Today’s health and care is a team effort. Ensuring any member of a person’s care team can access the latest information about them is vital to providing joined-up care. PRSB’s Core Information Standard defines all the relevant information that should be shared for care in an integrated care system.   

Orion Health has achieved what no other supplier has yet accomplished; conformance with PRSB’s standard for shared care records. As a global provider of healthcare information technology, delivering over 55 shared care records in over 15 countries is an enviable accomplishment. But what are the benefits of sharing core information and how did Orion Health find the conformance assessment experience?  

When implemented in systems, the Core information Standard allows health and care professionals to view and share information such as a person’s demographics, allergies and medications, but also information that matters the most to them as individuals; for example, how to communicate with them.  

Orion Health has been delivering shared care records in the UK for 10 years, but finding the right expertise in the beginning proved challenging. Ben Wilson, Product Solution Director at Orion Health, says: “We would get into a room with clinicians or anyone we could find with some clinical input who would help define what needed to be included in shared care records – it wasn’t defined very well at that time.” 

Even now, not all systems share the same sets of information, and it’s also not collected in a coherent way. This lack of consistency makes it difficult to share information across the system for the benefit of patients. 

Ben highlights that one of the difficulties in building shared care records refers to communication, which can be improved by common information frameworks – standards. “We’re not always talking the same language with other suppliers. Standards help us achieve that common understanding on the exact information which needs to be part of shared care records.”   

To fully embrace the benefits of using standards, there needs to be a culture change – improving cross-organisational collaboration, attitudes and trust about information sharing. “It would be beneficial if we could shift attitudes among suppliers to get an appreciation of standards, and how we can share information in a more consistent way to support people as they move around the care system”, says Ben.  

Health and care leaders have an important role to play in facilitating the use of standards. This includes procuring systems that conform to them and supporting suppliers with their conformance journey. Ben explains: “These standards only become beneficial when there’s a critical majority of health and care systems conforming to them.” 

Orion Health has seen a lot of their customers implement the elements of the Core Information Standard, but not in a structured way. This was a motivating factor for Orion, and they decided that conformance assessment of their implementation of the standard would drastically help standardise clinical and non-clinical information within shared care records, making it available wherever and whenever needed across different health and care organisations. 

Speaking about the conformance process, Ben shares: “We worked with Annette and the PRSB team on a weekly basis, taking a strategic approach to the assessment process. Each week, we set an agenda to go through different sections of the standard. It was a delightful experience – we worked collaboratively and learnt a lot from Annette and the team around clinical practice, and I hope that they also learnt from us on how shared care records operate.”  

“It would be fantastic to see more suppliers follow our lead and become conformant against the Core Information Standard. They would do well to take a structured approach when going through the assessment. It is a big standard, incorporating a lot of information, but it’s essential to shared care records. We had to invest time on it, but the assessment helps you to put the theory into reality. The PRSB has done a lot of work on evidence-based practice and consultation, so we know it’s a trusted and needed standard.” 

With more system suppliers achieving conformance against the standard, they can achieve mutual understanding of what information should be in the record. However, the key to putting standards into practice is collaborative work. This includes working with customers, so that they can share their feedback with system suppliers.  

Orion Health is looking to continue to focus on PRSB’s standards conformance and test them with its clients. In addition to the Core Information Standard, the supplier achieved conformance against About Me. “At least seven more PRSB standards are relevant to us, so we would like to do more work around them”, says Ben.  

If you’re a health and care software supplier interested in achieving conformance against our standards and building more integrated care, find out more about our Standards Partnership Scheme.

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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.