Position Statement: The Professional Record Standards Body (PRSB) on AI and Health Information Standards 

The Professional Record Standards Body (PRSB) recognises the transformative potential of Artificial Intelligence (AI), machine learning and natural language processing in reshaping health and care. Interoperability is key to enabling the potential benefits of AI to be realised more fully. It must be possible to exchange information between systems, to understand the context of the information being exchanged and information must be structured and coded in a way that it can be analysed. But interoperability has been a major challenge.

AIDespite the drive to structure and code data in a way that it can be used to support analysis for both direct care and secondary uses through the development and promotion of standards, we are some distance behind where we should be. Information is still commonly being shared in formats that require additional interpretation and coding. There is a huge opportunity to advance interoperability using AI to interpret and organise certain data held in clinical databases into standardised formats in suitable circumstances. This would enable better sharing of data between systems and make more data available for AI tools supporting clinicians in their practice for example for diagnosis, triage, clinical decision support and interpreting vast amounts of data from medical devices such as continuous glucose monitors augmented with other data from the electronic record.  

  

As we embrace this digital evolution, it is imperative that information standards evolve in tandem to ensure safety, accuracy, and interoperability. This position statement deals specifically with AI as it relates to our information record standards.  Our position is captured in the following points which will be used to guide our work: 

 

  1. Commitment to Safety and Accuracy: As AI algorithms become integral to people’s care, from diagnosis to treatment recommendations to support for daily living, the PRSB emphasizes the need for rigorous health and social care information standards. These standards must ensure the accuracy and reliability of data inputs and AI-driven outputs. 
  2. Interoperability: The PRSB champions the development and adoption of universally recognised standards. This facilitates safe and seamless data exchange between systems, ensuring that AI tools can function effectively across different platforms and care settings. The PRSB believes that AI can support interoperability by organising complex data against standard specifications. 
  3. Ethical Use of Data: AI applications rely on vast amounts of data. The PRSB upholds the need for standards to be implemented in a way that respects patient confidentiality, ensures informed consent, is transparent about how the data will be used in AI applications, supports professionals by providing clarity about accountability for AI outputs and clinician decisions based on those outputs and maintains data security. 
  4. Inclusivity: AI models should be trained on diverse datasets to avoid biases. The PRSB promotes standards that advocate for data inclusivity, ensuring AI tools are equitable and effective for all patient groups. 
  5. Personalisation and person-centred care: PRSB recognises that the experience of care is as unique as every individual.  The strength of our standards in promoting and encouraging personalised and person-centred care will not be lost or diminished through the introduction of AI. 
  6. Continuous Learning and Adaptation: AI in care is a rapidly evolving field. The PRSB commits to periodically reviewing and updating health and social care information standards to remain aligned with technological advancements.  This will include exploring how AI can help improve our processes to produce ever better information standard products. 
  7. Collaboration: The PRSB believes in fostering collaborations with technology developers, healthcare providers, and other stakeholders. Joint efforts are crucial to shape health information standards that cater to real-world needs while maintaining the highest standards of care. 
  8. Education and Advocacy: The PRSB and its members will play a pivotal role in educating health and care professionals about the significance of information standards in the realm of AI and related technologies. Moreover, we will advocate for the broader adoption of these standards across the sector.  Similarly, we have a role to play in educating the public about the relationship and impact of AI on our work in information record standards. 
  9. Evaluation:  PRSB will commit to regularly evaluating the impact of the ongoing spread of information standards on AI and vice versa. 
  10. Regulation: PRSB supports the development of a regulatory framework that ensures safety and efficacy of AI applications but does not stifle innovation and aligns with the nature of AI to improve and learn over time. 

 

Conclusion: 

As we stand on the cusp of an AI-driven revolution in health and care, PRSB is committed to remaining forward looking and open-minded to ensure that information standards and AI jointly deliver the most rapid advances and the best and safest outcomes for people. Our aim is to harness the potential of AI while ensuring the safety, integrity, and equity of the care people receive. 

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“If someone’s been working for a period of time, in a form of therapy, for instance, where there’s an agreed plan for the locality when they may present in an emergency situation … then it’s really important for us to be able to see that that information and be able to act appropriately according to that because, you know, there isn’t and there shouldn’t be a stock response to that. These plans are designed to be individualised and personalised.  All services should be giving that personalised approach to care wherever possible. And a standard such as [PCSP standard] definitely moves us closer towards being able to do that. [Not acting on agreed plans] is a key finding in terms of emergency responses over the years where responses have been inappropriate.” – Mental Health Nurse

“Following a particular plan that’s been put into place will result in much better outcomes and prevent the sort of poor outcome which would otherwise be leading to an unplanned hospital admission.” – General Practitioner

Successful teams have the functional skills to lead a task, benefit from diversity, and are led in a way that creates time and space for reflection; the ability to take stock periodically, of the task and of the way in which the team is engaged in delivering it. Your stakeholder analysis [HYPERLINK] should help you assemble the most appropriate team and identify how the team interacts and relates to other stakeholders like sponsors, services users, etc.

The variation in the size, both in terms of population served and numbers of constituent organisations, and of complexity, between Integrated Care Systems, precludes the possibility of any prescriptive guidance on the way in which this team is assembled.

Engeström’s expansive learning cycle of learning actions explains how there are 7 stages of learning actions;

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.