Creating different views of PRSB standards

Using PRSB standards

PRSB record standards are designed to work with any system; for example, electronic patient record systems (EPRs) in hospitals and specialist applications, such as maternity or diabetes management systems.

The standards are used to inform what information should be available, how it should be recorded and what information should be shared. If a shared care record, GP record and an EPR record hold information that is standardised, it can be shared with different systems across different settings without loss of meaning.

On these pages

Different health and care systems

These are some of the different record systems in use across Health and Social Care. They should all align to information record standards. 

Electronic patient record

An electronic patient record (EPR) is used in the care and support of a person by professionals, or by the person themselves. The information held in an EPR should be shareable across the system and accessible by professionals with a legitimate reason to access the information. A person may have more than one electronic patient record; for example, their GP and a hospital may have a record about them.

Shared care record

A shared care record brings together health and care information about a person using services from multiple electronic records, held in different organisations, across an area.

This means that the information about a person may come from the GP record, hospital records, local authority or care home systems, and is brought together in a record that is shared across the area with professionals with a legitimate reason to access the information. 

Person-held record

A person-held record is the information about a person’s health, care and wellbeing. It is managed by the person whom the record is about, and they can add to it.

Health and care professionals can also add to the record. It must be secure, usable and online.

Find out more about Personal Health Records definition by NHS Digital.


How is the information displayed? 

Local systems implementers decide how the information is displayed, based on how the users want to view it. This means that the standard is not tied to any one system, and is flexible and resilient to change. Which systems are implemented and used within an organisation or across an Integrated Care System, and how they are used and interact, is determined locally. Here are some examples of how information may be displayed in different systems:

testresults

Information, e.g., investigation results could be displayed in date order or grouped by types of test result, e.g., HbA1c, Cholesterol and Liver Function Tests.

filter

Information could be filtered or ordered based on the professional’s requirements.

heightweight

Observations such as height and weight could be graphed; for example, as growth charts for children. 

graphics for standards explained

Summary information could be displayed with drill-down to more detailed information.

Who uses PRSB standards?

Health and social care professionals

To ensure that health and care professionals have the information they need to provide safe, joined-up care that is responsive to a person’s preferences and needs. 

IT systems and medical technology suppliers

To design systems that enable professionals to record, send and receive the right information for care using  their systems.

Developers and implementers

To guide their system design.

Creating different views of standards

When we develop our standards, we consult with a wide range of professionals and people who use services. This ensures that all relevant information that should be recorded for care purposes is defined in the standards.   

Certain users, such as podiatrists, optometrists and care home staff, may only need a part of the information recorded about a person. The definition of the information needs for a specific group of users are “views” of the standard and would be guidance for using the standard, rather than a standard in its own right. This is an example of how information in a person’s record may be shared in a care home. Staff could see different levels of information in a person’s record depending on their role. 

Lower-level access
This is the minimum information set for all people working in a care home, including both registered health and social care professionals and unregistered persons.

Higher-level access
This is the information that may be accessed by registered health and social care professionals based on their role in the care home, or where the care home authorises a higher level of access for unregistered care home staff.

Information governance

Sound principles of information governance and respecting the privacy of people and their information is paramount. 

The implementation of PRSB information standards is dependent on the national and local information governance frameworks which will determine information access and sharing controls between health and care provider organisations.  

NHS England has published a National Information Governance Framework which must be considered when planning implementation. 

Local agreements should be drawn up between organisations to define information requirements for sharing confidential personal health and care data.  

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.”