Implementing the Outpatient Letter Standard - Frimley Health case study

Outpatient letters are the main method of contact and communication between hospital staff and GPs and are often the sole record of the consultation held by the outpatient department and hospital. 

Best practice for most outpatient letters is writing directly to people using services, so that they can better understand what’s been discussed with their healthcare professional, including their treatment and results.  

Background

The PRSB’s Outpatient Letter Standard allows relevant clinical information to be recorded, exchanged and accessed consistently across care settings, and shared with people who use services, in plain English. This results in improving the continuity of care and people’s overall experience of healthcare services.

This case study shows how Frimley Health NHS Foundation Trust worked with two system suppliers, Microsoft and Epic, to implement the standard and identifies the benefits that it will have on the efficiency of healthcare services and people’s experience of care. 

The Outpatient Letter Standard is one of the standards that could be soon mandated to be implemented by health and care organisations and system suppliers – the case study shows why it makes sense to start the implementation sooner rather than later.

Nurse using computer to record health information

The process

Nurse speaking into phone - voice recognition

Frimley Health NHS Foundation Trust uses Microsoft’s Dragon Medical Once solution, which captures voice-generated content directly into clinical systems. Dragon voice commands can also be used to navigate electronic health records and to insert customised templates, also known as auto-texts. 

When Frimley implemented their EPR system supplied by Epic, they decided it was a great opportunity to utilise the PRSB’s Outpatient Letter Standard, as it’s widely endorsed and would allow them to build the letters using a clear, standardised structure. 

Standardisation of information is important as it helps improve interoperability between different systems. 

All Frimley’s departments have been involved in the project. The organisation also worked closely with primary care providers, such as GPs, who were supportive of standardising letters and adhering to the PRSB standard. It was reasonably straightforward to build the letter templates to the standard, concentrating on implementing the mandatory fields first. 

Almost all letters are transcribed using Dragon Medical One, and Frimley encourages clinicians to use auto-texts and voice commands to make the letter creation more efficient while also making it easier to share standardised templates. 

Further work is planned to allow the solution to automate these processes even more.  

 

Lessons learnt

During the implementation process, Frimley identified that it can be challenging to include some of the fields marked ‘required’, and collection of structured data in the EPR is required, so that recorded data items are brought into the letter.

To make the adoption of Outpatient Letter Standard easier, Frimley is currently working with Epic, to ensure that the PRSB Outpatient Letter Standard becomes an integral part of their UK Foundation System and making the configuration more standardised for new NHS customers. 

In the near future, the Frimley team will begin to review the current build to increase the number of optional PRSB fields that might be present in the body of the letter.

Lessons learnt

The benefits

Improving communication with patients
Better communication with patients is one of the perceived benefits of the standard implementation – over time Frimley believes that it will enable people to receive letters about their appointments, treatment and results in a way that is easy to understand, helping them become more empowered and knowledgeable about their ongoing care.
Better quality information for GPs
It is also expected that the implementation of the standard will help improve the quality of the information received by GPs, supporting them in working more efficiently, and improve the ability to facilitate more shared decision-making conversations.

Feedback

Graham Smith, Consultant Orthopaedic Surgeon and Chief Clinical Information Officer at Frimley Health NHS Foundation Trust, has useful advice to organisations and system suppliers looking to implement the standard:

“Take the opportunity when you are making a change in your system or working on a new project. Our outpatient review process served as a great occasion to encompass the PRSB standards – we’re glad we did it, as it made the whole implementation process so much easier than doing it as an isolated project.”

Resources

The Outpatients Letter Standard
View the full standard and supporting documentation, examples and other resources.

Why use the standard?
In our short film, Dr Ian Logan from The Freeman Hospital, explains how the standard has benefited his patients receiving regular kidney dialysis.

Support services
Proactive support for our standards and ongoing maintenance and release management of published standards.