Putting the standard into practice
Having agreed your roadmap with stakeholders, you can now begin making the changes and putting the standard into practice, managing the impact on people and processes as well as the technology.
To implement the standard, your completed Taking Stock analysis and Getting People on Board work will have assessed your current situation and identified what improvements you aim to deliver and when, positioning your starting point for change.
Develop a detailed timetable
Based on your high-level roadmap, develop a detailed timetable for change with dates and responsibilities clearly identified. This will signal to stakeholders when the change programme will begin, how long it will take and prepare them to fulfil their role in making it happen.
Consider the following when pulling together your timetable:
Phases
A phased approach to implementation is often helpful to manage systems and stakeholders. It also reduces the risk of issues accumulating, as you can address them at each phase.
Piloting
A small-scale trial at the start of a project can help to refine your plan and test systems and requirements.
Stakeholder management
Share your timetable for change as early as you can and provide regular updates to stakeholders, so they are engaged in whether progress is being made with implementation and how they can contribute, as needed.
Plan and procure system changes
The outputs from your analytical activities will support the development of a requirements specification needed for your IT team or system supplier. If a re procurement of one or more systems is needed, this specification will be submitted as part of an invitation to tender.
- If you have a bespoke system, it needs to be updated to comply with the PRSB eDischarge Summary Standard.
- If your system is purchased off the shelf, you are responsible as a provider to check that it complies with the standard. Look for the PRSB Quality Mark.
Procure the system changes needed ensuring that systems will be delivered that are conformant with the standard. See NHS England procurement guidance.
Agree how the team will be involved in testing the software to ensure it is conformant and meets local requirements.
Technical message standards can be found in the NHSE API catalogue. New APIs will be required for sharing data generated by the person as part of their self-management with electronic records.
The PRSB Standards Partnership Scheme was established to support providers and suppliers in demonstrating compliance with PRSB standards. Further information on requirements can be found in the information standards notice (ISN) and PRSB standards conformance guide.
Implement the standard
To implement the information model and associated business rules of the eDischarge Summary Standard, it must be incorporated into your clinical systems.
IMPLEMENTATION CHECKLIST
Make sure you have a data model for your application.
Map this model to the PRSB eDischarge Summary Standard.
Identify and map any reusable data components e.g. diagnoses, procedures, allergies to the standard.
Identify and develop the missing components into the data model.
For interoperability, identify the APIs supported by your application and map these to the PRSB standard.
Implementing the standard in your system will contribute to the development of your applications, so that they can record, display and share data that is human and machine readable, and cross-organisation usable.
Human readable: data that is structured to make it more useful, readable, and unambiguous for end users i.e. the narrative for the patient. Human readability typically refers to the narratives shown to an end-user/clinician.
Machine readable: data that can be sent out easier for computers to parse, sort, index, etc. Machine readability refers to the discrete elements of a record or the metadata sent with documents to be reconciled into a patient’s record.
Cross-organisation usable: data that is sent in a way that is easy for the receiving party to accurately interpret and derive value from.
Discharge summary design
Whilst the eDischarge Summary Standard itself does not specify the design or layout of the final discharge summary output, it is good practice to incorporate the requirements of the standard into a user-centred design.
Taking a whole system approach, work with your intended recipients so that the layout is structured in a way that is most useful to them. This will ensure a consistent user experience, reduce the time taken to process the data and also reduce the risk of errors.
- Download: Here is an an example of a discharge summary (based on a patient case study).
- In the boxes below, we have listed best practice guidance for structuring data.
Medications
- List medications alphabetically.
- Map medications to dm+d.
- Include all TTOs.
- Clearly indicate which medications are new, continued repeats or discontinued.
- Changes to medications must include reason.
- Clearly indicate if there are no changes.
- Include medications administered during hospital stay.
Actions and care plans
- Detail a clear plan of care for the patient.
- All actions for the specified professional should be made clear.
- Include actions for hospital staff e.g. checking test results.
- Primary care should not be actioned to follow up on tests requested by the hospital.
- Include all referrals to other services and the required timeframe for response
Diagnoses and procedures
- All confirmed and working diagnoses must be included.
- All procedures carried out in hospital must be included.
- Any planned procedures must be included.
- All diagnoses and procedures must be unambiguous and SNOMED CT coded.
SNOMED CT
To achieve a single reliable source of data for multiple purposes, record keeping and data definitions must be standardised including the implementation of SNOMED CT on all clinical systems.
Acute hospital trusts should aim to have all relevant systems using SNOMED CT to record structured data at the point of care.
Benefits to the discharge process of using SNOMED CT include:
The discharge summary is immediately populated with structured and coded data.
Clinical decision and resource planning is well supported by clear, consistent, unambiguous data.
Improves systems interoperability, data sharing and data security.
Required SNOMED CT Knowledge
- Essential: PRSB’s ‘Electronic Record Keeping and SNOMED’ course available on the e-Learning for Healthcare (e-lfh) platform (https://portal.e-lfh.org.uk/).
- Helpful: SNOMED CT Foundation course provided by SNOMED International (SI) available at https://courses.ihtsdotools.org/product?catalog=FCE (approximately 5 – 10 days effort).
The UK edition of SNOMED CT member national release centre (NRC) is managed by NHS England and more information can be found on their website.
Download a one-page guide, outlining the necessary data, skills required and potential training needed. Using clinical terminology.
Hospital discharge process
In addition to the implementation of standard, improvements to the operational discharge process and the creation and processing of discharge summaries will significantly contribute to the benefits.
Here is a table of suggested changes to the discharge process that could be considered in the context of your local needs and priorities. This will be dependent on your workforce and clinical record systems in place.
Piloting
We recommend piloting a small-scale trial; implementing the information standard for a small number of users or in a small locality. After these users have been trained, the project team can make charts of the processes involved – these charts will form the basis for training all users to access and utilise the information standard.
There are several advantages to running a pilot:
Reduces the risk of a full-scale implementation as adjustments and modifications can be made as a result of the pilot.
Improves processes through evaluation of the process charts produced during the pilot.
Clinical safety
Manufacturers and health and care organisations are both required to comply with standards in clinical risk management, mandated in England and adopted in Scotland and Wales.
The standards describe a coordinated set of activities to analyse and mitigate clinical risk in health IT systems.
There are two clinical risk management standards:
- DCB0129 which includes the standard specification and implementation guidance for manufacturers
- DCB0160 which includes the standard specification and implementation guidance for healthcare organisations.
PRSB use DCB0129 guidance and all PRSB standards include a safety case and a hazard log. Your system suppliers will also need to comply with the requirements of DCB0129 and you should request evidence of this from them.
Why use a safety case and hazard log?
The purpose of the safety case and hazard log is to identify the hazards which could cause a person harm by using the standard, along with how that hazard can be mitigated. There are different types of mitigation – through system design, testing, user training or business control processes.
- Develop your own safety case and hazard log, using NHS DCB0129 guidance.
- Have registered clinical safety officers to ensure the systems implemented are safe for clinical care.
- Run risk assessments to determine the likelihood and consequence of a risk happening.
As part of ongoing clinical risk management, it is recommended that regular clinical risk assessments are undertaken. This can be done using a recognised tool e.g. SWIFT or BOW TIE.
Monitor, measure, adjust
Once you have implemented the eDischarge Summary Standard, you’ll want to measure the success of your project.
Consider establishing a reporting mechanism, such as a discharge metrics dashboard, to monitor, audit and evaluate the ongoing performance of all your discharge pathways.
- Are the expected benefits being achieved?
If not why not and how could this be improved? - What has been learnt that would improve the process and outcomes?
Download and use the dashboard metrics dashboard.
- The dashboard must be owned by the system as a whole rather than by one particular organisation.
- The dashboard would display data extracted from your secondary and primary care systems for advanced analysis, reporting and visualisations of the transfers of care.
Make use of your skilled data analysts / BI teams to design and operate the dashboard.
Work with them to define the queries required to interrogate your clinical systems, match and blend and psuedonymise the data, and present that data in a usable and appealing way.
Start small; agree a dataset that is robustly and repeatedly tested so that it can be trusted. In time, the dashboard can be developed to give a system-wide view of the state of patient flow, capacity and demand.
You should expect to go through iterations to get your implementation right over time. This gives you a chance to review data on the effectiveness of the changes.
Make sure that Data Protection and Information Governance requirements are taken into account.
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.
PRSB Support Available
If you have a question for PRSB, please contact our support team. We have an expert team who can help you find the answer, or direct you to the right place.
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