Taking stock and planning
Before embarking on a change programme to implement the Diabetes Record Information Standard, organisations need to understand their starting point including readiness of the workforce, any current or planned systems and the local priorities for change.
This will help inform a route map where changes can be delivered in small, achievable steps, building confidence and momentum, and increasing chances of successful change. Progress can be measured against the priorities and goals agreed by local stakeholders.
This section takes you step-by-step through assessing your readiness to change, taking stock of your current position and planning implementation of the Diabetes Record Information Standard. There are three phases consisting of:
There are three phases:
- Assess your readiness: The current state from clinical, technical and operational perspectives
- Plan the changes
- Agree how you will measure and evaluate the change programme
Assess your readiness
The following tools will help you at the beginning of your project to evaluate the readiness of your organisation:
Planning a stock take
Follow the steps below to start planning your stock take.
Schedule events and meetings to tell people about your standard implementation plans as part of digital transformation and encourage them to join in the project.
Check your understanding of the problem you might be trying to fix and consider how your sense of the situation is different from the view other stakeholders might have based on their different knowledge and experience, for example as point-of-care professionals.
Offer an opportunity to bring representatives from different stakeholder and professional groups together to find out what they might have in common, how they are different in their approaches, culture, and language, and how they can work towards a shared objective.
Remember that the implementation of the PRSB (Professional Record Standards Body) standard is a people-based cultural endeavour and cannot succeed without the hearts, minds and professional expertise of all your stakeholders.
Holding a stock take workshop
The table below illustrates how you might plan a stakeholder workshop to take stock of your local system’s readiness to adopt the Diabetes Information Record Standard.
It outlines your potential participants, the purpose of the stock take and what materials/questions you may want to include in the sessions.
Systems and data flows
To understand how diabetes process and outcome information is currently recorded in each of the stakeholder organisations it is recommended that an information gathering exercise is undertaken.
The grid below can be used to capture how each stakeholder group currently captures and shares diabetes process and outcome information:
Process mapping
To help us understand each step in the capturing and sharing of diabetes information a process mapping exercise can be undertaken by your organisation.
The ‘to be’ process maps should then be developed for each of the systems that will be implementing the Diabetes Record Information Standard and should take a whole service (patient pathway) design approach.
Conceptual architecture
The conceptual architecture report documents how current and proposed national IT infrastructure and services can be used to support people with diabetes and those who care for them. (Note this document was drafted in early 2023).
It is intended to inform those developing local and regional digital diabetes solutions, showing how they can use national capabilities now and in the future. It also advises those developing and maintaining national digital capabilities about the requirements, pain points and opportunities for delivering value to the diabetic community.
It should be used by those developing national clinical and operational policy for diabetes to understand how digital capabilities fit. To meet these intended uses the document needs to live and be actively maintained, with engagement and testing for relevance, accuracy and usefulness. It should form the cornerstone of digital diabetes policy.
Baselining
To baseline a project you will need to consider four elements; milestones, budget, schedule and scope.
- Milestones: These are the key points in a project you expect to reach by a specific date or range within the project’s start and end dates.
- Budget: Your budget is how much you plan to spend on the project.
- Schedule: When planning any project, you and your team members need to know its duration. The schedule baseline is your project’s planned timeline.
- Scope: Scope is the expected project outcome, any deliverables, and the problem they solve.
Beyond these four elements, you may also want to include other project documents like the work breakdown structure (WBS), activity or task list, and more, to add detail to each of these steps.
Your organisation’s Project Management Office (PMO) will have project management templates to support you to baseline and deliver you project. However as the Diabetes Information Standard is best implemented in partnership across multiple organisations (e.g Integrated Care System) it may be that each organisation has its own project plan which feeds into an overarching programme plan.
Assessing current conformance to the standard
How your system supplier can conform to our standard
The PRSB team work closely with system suppliers and health and care providers to implement the standard and also provide robust and independent evidence of their implementation with the award of the PRSB Quality Mark. Systems which have undergone this process can be found on the Quality Partner section of our website.
Your can ask system suppliers to provide evidence of their level of compliance including whether they have been independently assessed and achieved the PRSB Quality Mark. Even if the supplier system is compliant, you will still need to check that your local implementation is compliant. For help and support with assessing compliance with standards, please get in touch with the PRSB help desk.
If a supplier system is unable to reach compliance, a procurement exercise may need to be undertaken.
System suppliers should provide evidence that they conform with the standard. More information can be found in the standards conformance process section.
Procurement
If, as part of the stock take, a system procurement is identified the choice of system procurement route is a local decision and driven in part by the proposed option (for example an extension to an additional service or system vs. a completely new procurement).
There will be national and local procurement protocols that will need to be followed in relation to the PRSB standard implementation.
Understanding governance requirements
It is important to engage the local care system Information Governance team early in the project. They will confirm what activity must be done prior to any data sharing.
Regardless of the system being used for sharing information, Information Governance is a key requirement. If your area has a shared care record in place you may find an over-arching Information Sharing Agreement (ISA) has already been signed by the data sharing partner organisations.
Data Protection Impact Assessment
If the sharing of diabetes process and outcome information involves a new set of data about a person or significantly changes the way in which the data is processed, you will need to carry out Data Protection Impact Assessment (DPIA). The DPIA is a structured assessment of the potential impact on confidentiality, privacy, and data protection. The data items to be shared or processed are included. Your Information Governance team will have a DPIA template for you to complete.
Clinical safety and risk management
It is recommended that you make contact with your local care system clinical safety officer or clinical safety management team early in the project. They will be able to advise you on the clinical safety management process that is in place and advise on the development of the clinical safety management process and fulfilling DCB0160 (see below).
Organisations embarking on deployment of health IT systems are required to apply clinical risk management for the deployment, use, maintenance or decommissioning of Health IT Systems within the health and care environment NHS England standard DCB0160 expands on the DCB0129 clinical safety standard applied by the manufacturers of the health IT system.
Health organisations must establish a framework within which the clinical risks associated with the deployment and implementation of a new or modified health IT system are properly managed.
See NHS England’s Clinical risk management guidance
Building a roadmap
Taking all the baseline evidence and material gathered, develop your local roadmap for change. Focus on all aspects of change including staff readiness.
Work with key stakeholders to develop the plan to ensure commitment and buy-in.
Here is an example roadmap that you may want to follow as a guide.
Checklist and questions to consider
The following checklist will help you determine whether you have the right leadership, governance and controls in place for a transformation programme to succeed. The set of questions that follows will help you gauge your readiness to take stock and plan your transformation programme.
CHECKLIST
Clear senior management ownership and leadership
Appropriate skills for the programme/project team
Clear roles and responsibilities
Effective financial control
Success criteria that clearly link objectives to outcomes, and clear links with the organisation’s key strategic priorities
Effective risk management
Sound commercial knowledge of the supplier marketplace, linked to the requirement and management of the supplier over the contract term
Involvement of key stakeholders throughout the programme/project
Breaking development and implementation into manageable steps
Effective project team integration between clients, the supplier team and the supply chain
QUESTIONS TO CONSIDER
What are the ‘fixed’ points – e.g. system upgrades, procurements etc.?
What activities must take place to achieve change? Awareness raising, training, information governance agreements, clinical safety assessments, system changes, testing etc.
What have stakeholders identified as the biggest priorities for them and when could those changes be delivered?
What are the dependencies? What must happen before other changes can be achieved?
Which changes could be achieved relatively quickly and achieve tangible benefits for staff and patients?
What are the opportunities for piloting the new system (or parts of the new system) on a small scale and who needs to be involved?
Should organisations join the process in a phased way? What is the preferred phasing for organisations joining in?
What needs to happen to ensure smooth running of existing systems during the transition?
What needs to happen to ensure smooth running of existing systems during the transition?
Desired outcomes and measuring
The review of the systems and data flows across the organisations, may provide an opportunity to review the current diabetes key performance indicators (KPIs). The KPIs should be used to develop a baseline measurement to be used to evidence improvement upon implementing the standard. However, current KPIs may not be agreed across the whole system and may require further work to reach a common set of indicators.
There will already be nationally reported metrics which will be monitored and are noted in the business case as a driver for change and these could be used as the basis for KPIs.
For diabetes there is a family of audits conducted under the National Diabetes Audit Programme for England and Wales (National Diabetes Audit Programme – NHS Digital). The audit measures the effectiveness of diabetes healthcare against NICE Clinical Guidelines and NICE Quality Standards.
Example measures below are taken from the Core National Diabetes Audit but there are other measures from the suite of diabetes audits that could also be used:
Aim | Outcome | Measures (SNOMED CT) |
NICE recommends that people with type 1 diabetes should have HbA1c checks every 3 to 6 months (or more often if the person’s blood glucose control is suspected to be changing rapidly) | Improvement in percentage of people diagnosed with T1 diabetes that have a record of having two or more HbA1c tests within a year. | ( (<< 1003671000000109|Haemoglobin A1c level| OR << 43396009|Haemoglobin A1c measurement| OR << 371981000000106|Hb A1c (Haemoglobin A1c) measurement – IFCC (International Federation of Clinical Chemistry and Laboratory Medicine) standardised|) ) MINUS ( (<< 1010951000000100|Haemoglobin A1c (diagnostic reference range)| OR << 1010941000000103|Haemoglobin A1c (monitoring ranges)| OR << 1971000237103|haemoglobin A1c diagnostic reference range molar concentration in blood| OR << 6181000237109|Haemoglobin A1c monitoring range molar concentration in blood| OR << 1049321000000109|HbA1c (haemoglobin A1c) level (monitoring ranges) – IFCC (International Federation of Clinical Chemistry and Laboratory Medicine) standardised| OR 1049301000000100|HbA1c (haemoglobin A1c) level (diagnostic reference range) – IFCC (International Federation of Clinical Chemistry and Laboratory Medicine) standardised|) ) |
NICE recommends that people with type 1 diabetes should be offered structured education 6 to 12 months after diagnosis. | Improvement in percentage of people diagnosed with T1 diabetes that have a record of being offered structured education, by year of diagnosis | (<< 415270003|Referral to diabetes structured education programme| OR << 1103691000000102|Diabetes structured education programme offered| OR << 306591000000103|Diabetes structured education programme declined| OR << 977201000000107|Recommendation to self-refer for diabetes structured education|) |
| Improvement in percentage of people diagnosed with T1 diabetes that have a recorded structured education programme attendance, by year of diagnosis | (<< 755491000000100|Diabetes structured education programme completed| OR << 413597006|Attended diabetes structured education programme| OR << 308421000000103|Diabetes structured education programme|) |
NICE recommends that smoking should be assessed annually as it is cardiovascular risk factor. They also recommended that adults with type 1 diabetes who smoke should be given advice on smoking cessation and use of smoking cessation services. | Improvement in percentage of people with T1 diabetes that have their smoking status checked annually | ^ 999000891000000102 |Smoking simple reference set (foundation metadata concept)| |
NICE recommends that blood pressure should be measured at least annually as it is cardiovascular risk factor. | Improvement in percentage of people with T1 diabetes that have their blood pressure measured annually | ( << 75367002|Blood pressure| ) MINUS ( (<< 37087001|Arterial wedge pressure| OR << 165077006|Intracardiac pressure| OR << 386533006|Invasive blood pressure| OR << 1036531000000108|Non-invasive central blood pressure| OR << 252076005|Venous pressure| OR << 276764003|Wedge pressure – a wave| OR << 276766001|Wedge pressure – v wave| OR << 276765002|Wedge pressure – x trough| OR << 276767005|Wedge pressure – y trough| OR << 276763009|Mean wedge pressure| OR << 252077001|Venous mean pressure| OR << 852281000000108|Target mean blood pressure|) ) |
NICE recommends that serum cholesterol (blood test for cardiovascular risk) is tested at least annually.
| Improvement in percentage of people with T1 diabetes that have their serum cholesterol tested annually | ( ( (166836002|Serum cholesterol studies| OR << 77068002|Cholesterol measurement| OR 1026441000000100|Serum cholesterol studies| OR << 850981000000101|Cholesterol level| OR << 1030411000000101|Non high density lipoprotein cholesterol level| OR << 1024231000000104|Fluid sample cholesterol level| OR << 1106531000000105|Cholesterol substance concentration in plasma| OR << 1022191000000100|Serum low density lipoprotein cholesterol level| OR 1015701000000106|Serum cholesterol/low density lipoprotein ratio| OR << 1031421000000101|High density lipoprotein/total cholesterol ratio| OR 1015681000000109|Serum cholesterol/high density lipoprotein ratio| OR << 1005681000000107|Serum high density lipoprotein cholesterol level| OR 1015721000000102|Serum cholesterol/very low density lipoprotein ratio| OR 1028551000000102|Total cholesterol:HDL (high density lipoprotein) ratio| OR << 1010581000000101|Plasma HDL (high density lipoprotein) cholesterol level| OR 1015711000000108|Plasma cholesterol/LDL (low density lipoprotein) ratio| OR 1015731000000100|Plasma cholesterol/VLDL (very low density lipoprotein) ratio| OR 1014501000000104|Calculated LDL (low density lipoprotein) cholesterol level| OR << 1010591000000104|Plasma LDL (low density lipoprotein) cholesterol level| OR 1110421000000107|VLDL (very low density lipoprotein) cholesterol substance concentration in plasma| OR 5691000237109|Cholesterol/VLDL (very low density lipoprotein) molar concentration ratio in plasma| OR 30031000237102|Vitamin E/cholesterol molar concentration ratio in serum| OR 1015271000000109|Serum high density lipoprotein:non-high density lipoprotein cholesterol ratio| OR 6841000237107|Phospholipid/cholesterol molar concentration ratio in serum| OR 3911000237107|Cholesterol/LDL (low density lipoprotein) molar concentration ratio in plasma| OR 101000237105|Cholesterol/VLDL (very low density lipoprotein) molar concentration ratio in serum|) OR ( ( < 271244005|Measurement of serum lipid level| ) MINUS ( (<< 313768006|Serum apolipoprotein A-I measurement| OR << 313769003|Serum apolipoprotein A-II measurement| OR << 313770002|Serum apolipoprotein B measurement| OR << 412989000|Serum long chain fatty acid measurement| OR << 391341007|Serum phytanic acid level| OR << 269868008|Serum sodium valproate measurement|) ) ) ) ) MINUS ( (<< 13644009|Hypercholesterolaemia| OR << 238091006|Lecithin cholesterol acyltransferase deficiency| OR 11751000237106|Cholesterol molar concentration in fluid| OR << 413359005|7-Dehydrocholesterol level| OR << 25511000237107|7-Dehydrocholesterol molar concentration in plasma| OR << 121751004|Cholesterol sulphate measurement| OR 391291008|Fluid sample cholesterol level| OR 1024231000000104|Fluid sample cholesterol level| OR << 30031000237102|Vitamin E/cholesterol molar concentration ratio in serum|) ) |
NICE recommends that serum creatinine (blood test for kidney function) is tested at least annually. | Improvement in percentage of people with T1 diabetes that have their serum creatinine tested annually | (<< 54610007|Kidney panel| OR 371361000119107|Comprehensive metabolic panel| OR 866146005|Serum metabolic panel| OR << 1000731000000107|Serum creatinine level| OR << 113075003|Creatinine measurement, serum|) |
NICE recommends that Body Mass Index (measurement for cardiovascular risk) is measured at least annually. | Improvement in percentage of people with T1 diabetes that have their BMI measured annually | (<< 301331008|Finding of body mass index| OR << 60621009|Body mass index| OR << 698094009|Measurement of body mass index| OR << 446974000|BMI (body mass index) centile| OR << 1162544002|Body mass index prime ratio| OR 914721000000105|Obese class I (body mass index 30.0 – 34.9)| OR 914731000000107|Obese class II (body mass index 35.0 – 39.9)| OR 819948005|Obese class III|) |
NICE recommends that Urine Albumin/Creatinine Ratio (urine test for risk of kidney disease) is tested at least annually. | Improvement in percentage of people with T1 diabetes that have their Urine Albumin/Creatinine Ratio tested annually | (<< 250745003|Albumin/creatinine ratio measurement| OR << 1028271000000109|Albumin/creatinine ratio|) |
NICE recommends that foot risk surveillance (examination for foot ulcer risk) is carried out at least annually | Improvement in percentage of people with T1 diabetes that have their foot risk checked annually | (<< 870681000000109|In-house diabetic foot screening| OR << 394683006|Diabetic foot risk assessment| OR << 367011000000100|Diabetic foot screen| OR << 401191002|Diabetic foot examination| OR << 407672007|Seen in diabetic foot clinic| OR << 980371000000101|Assessment using Young Townson FootSkin Scale for Diabetic Neuropathy| OR << 713130008|Assessment of diabetic foot ulcer| OR << 980351000000105|Young Townson FootSkin Scale for Diabetic Neuropathy| OR << 1099121000000104|Young Townson FootSkin Hydration Scale for Diabetic Neuropathy level| OR 980411000000102|FootSkin scale risk level 1| OR 980431000000105|FootSkin scale risk level 2| OR 980451000000103|FootSkin scale risk level 3 high risk| OR 980471000000107|FootSkin scale risk level 4 high risk|) OR ( ( << 164480009|O/E – foot| ) MINUS ( (<< 416178005|O/E – abnormal foot colour| OR << 164481008|O/E – equinovarus| OR 164480009|O/E – foot| OR << 164482001|O/E – foot abnormal| OR << 164486003|O/E – in turning feet| OR << 414891006|O/E – left dorsalis pedis normal| OR << 417749006|O/E – Left foot colour normal| OR << 308104009|O/E – Left foot deformity| OR << 414895002|O/E – left healed foot ulcer| OR << 416854003|O/E – normal foot colour| OR << 414907000|O/E – right dorsalis pedis normal| OR << 308103003|O/E – Right foot deformity| OR << 414911006|O/E – right healed foot ulcer| OR << 1033261000000109|O/E foot callus present|) ) ) |
NICE recommends that digital retinal screening (photographic eye test for early detection of eye disease) is carried out at least annually | Improvement in percentage of people with T1 diabetes that have their eyes tested annually | ( (134395001|Diabetic retinopathy screening| OR << 390847009|O/E – no retinopathy| OR << 408311002|O/E – retinopathy| OR << 282096008|Retinal photography| OR << 163983009|O/E – retina normal| OR 274798009|Examination of retina| OR 163982004|O/E – retinal inspection| OR 414902006|O/E – No retinal laser photocoagulation scars| OR 394718001|O/E – Laser photocoagulation scars| OR 775841000000109|Diabetic retinopathy detected by national screening programme| OR << 721103006|Diabetic retinopathy of eye not detected|) ) MINUS ( 275899002|O/E – colour blindness| ) |
NICE recommends that people with type 1 diabetes should aim for a target HbA1c level of 48 mmol/mol (6.5%) or lower, to minimise the risk of long-term vascular complications. | Improvement in percentage of people with T1 diabetes that have an HbA1c level of 48 mmol/mol (6.5%) or lower | ( << 1003671000000109|Haemoglobin A1c level| ) MINUS ( (<< 1010951000000100|Haemoglobin A1c (diagnostic reference range)| OR << 1010941000000103|Haemoglobin A1c (monitoring ranges)| OR << 1010951000000100|Haemoglobin A1c (diagnostic reference range)| OR << 1971000237103|haemoglobin A1c diagnostic reference range molar concentration in blood| OR << 6181000237109|Haemoglobin A1c monitoring range molar concentration in blood| OR << 1049301000000100|HbA1c (haemoglobin A1c) level (diagnostic reference range) – IFCC (International Federation of Clinical Chemistry and Laboratory Medicine) standardised| OR << 1049321000000109|HbA1c (haemoglobin A1c) level (monitoring ranges) – IFCC (International Federation of Clinical Chemistry and Laboratory Medicine) standardised|) ) |
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Assess your readiness
Plan the changes
Measure and evaluate
PRSB Standards Explained
Why we need standards to record our health and care information in a consistent way so that it can be made available whenever it is needed.
Making change happen
Transformation programmes need clear goals, the right leadership and engaged staff and stakeholders. Get started by reading our information on transformational change.
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