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.  

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.