Standards explained

What is a PRSB Standard?

Every time we interact with health or social care services, people make a record of what happens. Over a lifetime, this information forms our health and care history.

These pages explain what standards are and why we need them to record our health and care information in a consistent way so that it can be made available whenever it is needed, such as when we attend a hospital appointment or order medication from the pharmacy. 

On these pages

Why do we need information standards?

Our health and care information isn’t all recorded in a single system but in many different systems. When we go to hospital or to a GP surgery, a record of the conversation between the person and clinician is made, including any decisions and actions taken. Records are created in other settings too, such as care homes. 

The fact is that people access care in many more settings today than ever before, and for professionals and people themselves to have a complete picture of a person’s health and care, we need to join all these many records together.

Recording information consistently

In health and care, agreed national standards and definitions must be used so that any system can share and interpret information consistently, preserving its meaning across services.

Right place, right time

When information is recorded consistently across different settings, it can be shared with the right professionals at the right time, supporting informed decisions about a person’s care.

Information tailored for different needs

Not everyone we interact with needs to see all the information in all these records to advise us on what tests we might need, or diagnose a condition, or meet our care and support needs, but they might need to see some information from more than one record. 

Different types of information standards

Different types of information standards are needed for information to flow between computer systems. 

Information record standards

PRSB standards are information record standards. They define the information needed in a person’s health and care record, such as their allergies, vaccinations and medications. They also include information that is important to the person, such as how best to communicate with them, how to help them feel at ease or details about how they like to take their medication.

Data and terminology standards

Terminology standards include SNOMED CT, a clinical vocabulary used for capturing clinical terms for example for diagnoses and treatments in electronic patient records. Find out more about SNOMED CT.

Data standards set out how information should be formatted such as birth date DD-MM-YYYY and what values (or codes) can be used; for example, Ethnic Categories, A (White – British) or M (Black or Black British – Caribbean).

Technical standards and specifications

Technical standards specify how information defined in a record standards is to be held or moved between systems. These can be based on Fast Healthcare Interoperability Resources (FHIR). Application Programming Interfaces (APIs) are examples of technical standards that enable communication between two systems. Examples include FHIR UK Core APIs, Transfer of Care Inpatient Discharge – FHIR API (API catalogue – NHS Digital)

How do we create standards?

Early research ensures our work is evidence based, and then developed through consultation with our members and other relevant stakeholders, focusing on frontline staff and people who use the services.

Everyone agrees what information should be recorded at any stage of a person’s treatment to ensure high quality care can be provided. It also means that IT systems can be designed to share and retrieve the relevant information when it is needed across multiple services and care settings.

Methodology wheel

CHAT theory also explicitly addresses five areas which if addressed systematically will help overcome stakeholder differences in pursuit of the common goal:

1. Understanding the artefacts that characterise the group and its activity.
• The artefacts might be clinical settings or the forms and templates used to capture and share information. During the pilot we heard about hard copy Dialog response forms; locally generated templates for collating information from different systems; letters and emails to GPs; images, poems or other non-text artefacts that service users might want to include in their ‘about me’ or care plan.

2. Understanding the multi-views of the group. Such groups are always a community of multiple points of view, traditions and interests. 
• Different participants in the group will have different roles and will bring to the group and their roles their own histories, language, and ‘rules’. During our Stocktake preparations and workshops we worked with psychiatrists, mental health nurses, occupational therapists, social workers, transformation leads and voluntary sector representatives, all professions and interests with their own language, approaches professional ‘rules’ but united in their interest in care plans, care planning.

3. Activity systems (like the ICSs) take shape and get transformed over periods of time. ‘Historicity’ is a term coined to express how the group’s problems and potentials can only be understood against their own history. 

 

• ‘We’ve always done it this way’, ‘that didn’t work before’, ‘it’s always like this’, ‘it wasn’t always like this’, ‘they are changing things again’, are all typical statements that often frustrate those charged with overseeing change initiatives. Without addressing the experiences that lie behind such comments you risk repeating mistakes of the past, alienating your stakeholders or just not understanding the real starting point for your transformation project. This is particularly the case for the implementation of the PCSP standard, the success of which will be largely reliant on point-of-care practices and information protocols as well as having systems which are user friendly and appropriately configured.

4. The central role of contradictions as sources of change and development. Contradictions are not the same as problems or conflicts. Contradictions are historically accumulating structural tensions within and between activity systems. Collectively addressing contradictions in how policy, practice, culture and technology interact will empower teams to find genuinely novel solutions for apparently intractable challenges, like interoperability and shared care plan/planning. 

This links to the fifth principle that:

5. the possibility of expansive transformations in activity systems. As the contradictions of an activity system are aggravated, some individual participants begin to question and deviate from its established norms. In some cases, this escalates into collaborative envisioning and a deliberate collective change effort. “An expansive transformation is accomplished when the object and motive of the activity are re-conceptualised to embrace a radically wider horizon of possibilities than in the previous mode of the activity.”