Health Service Focus

Unlocking the benefits of standardised records

What’s the point of having digital records if they are not interoperable? Professor Iain Carpenter, chair of the Professional Record Standards Body (PRSB), talks to NHE.

A fully digitised and standardised system of health records in this country has obviously been a long time coming, and there have been many false dawns – but real progress does now seem to be being made. The benefits of such a shift have been well-rehearsed – greater accuracy and quality of care, reduced waiting times and huge cost efficiencies to name just some – and recent arguments have been more about implementation, ethics, and, crucially, information governance.

The new Professional Record Standards Body (PRSB) has highlighted concerns about how records are created in the first place, with variation in input challenging the smooth transfer of huge swathes of data.

Chaos in IT

NHE spoke to chair of the new body, Professor Iain Carpenter, about the need for standardisation, and designing guidance for the real world, not just ‘computer world’.

Professor Carpenter – who is associate director of the Health Informatics Unit at the Royal College of Physicians (RCP) and emeritus professor of human ageing at the Centre for Health Services Studies, University of Kent – highlighted how doctors all write notes in their own esoteric way, which “leads to chaos in the electronic world”. There is no formal training or precision in recording patient symptoms, history and diagnosis – it is a skill that is picked up in practice, based on the traditional quirks of individuals rather than an easily transferable set of criteria.

He added: “If you’re going to have electronic health records, there has to be some sort of order in how the information will be recorded.

“We’re going to have something in place that reflects the way clinicians work, rather than the way computer systems work – because computer systems in healthcare start out by being administrative and financial systems and the clinical piece gets added on last – which means they very often don’t work.

“They’re all very good in ‘computer world’, but you try to put them into a hospital setting and the clinicians just go nuts.”

Mustering staff buy-in

There would be no point in developing a standardised structure for health records if doctors did not support it. But polls clearly demonstrated a strong appetite for the standards, and as Carpenter said: “The benefits of electronic records; you can’t argue against it.”

It is clear that a single blueprint for how records should be created and updated would simplify the process of sharing information, allowing the NHS and patients to benefit from best practice and greater freedom to move around the system, and even around the world.

Standardised records also offer immediately available data that can support outcomesbased commissioning.

The new record standards have been “phenomenally successful” since approval by the Academy of Medical Royal Colleges (AoMRC) in 2008. Professor Carpenter cited clear enthusiasm and the need for a standardised structure for medical records, which can now be expanded into medical specialities.

Carpenter said: “Changing the way information systems work is a big challenge. Typically they’ll take a while to develop.”

Fixing the context problem

The main need to provide standards for health and social care records stems from the current struggle to accurately share records between different parts of the NHS. This has significant implications for integrated care and for patient choice.

“[Standards] also fix a massive problem in interoperability,” Carpenter said.

“If you’re going to send a medical record from one hospital system to another, the data has to be able to come straight out of one computer system and straight into the other, otherwise what’s the point of the computer? Someone’s got to do it manually.”

Certain clinical terms can only be accurately understood in context, such as whether a symptom pertains to the patient, their relative, or indicates a high predisposition to a disease. But this is difficult to transfer digitally over different IT systems. If the whole NHS used a standard structure for all its records, information could be automatically transferred into the right place.

This could help clinicians make the right diagnosis for patients, and can be linked to NICE guidelines to demonstrate best practice and monitor whether guidelines specific to record headings are being delivered. Data can then be collected on a larger scale, as Carpenter explained: “If you link those guidelines specifically to record headings, you can push it out and because the record systems all have the same structure, you can immediately tell what the performance is in all the different hospitals.”

The key to digital health

Research will also benefit from record standards, by making use of shared information on all patients, rather than having to run multiple, expensive clinical trials.

Once a patient has control over access to their own records, they can give permission for it to be used for clinical trials, audits, and reimbursements.

Carpenter said: “If the whole health service had the electronic health record structured the same way, you have the same information on all patients. Suddenly it transforms it.”

Other benefits include records assessing quality of living in daily life, boosting outcomes.

An e-discharge summary toolkit containing this data can be sent into the GP system to allow commissioners to offer funding for hospitals that manage to send people home walking after hip operations, for example.

Allowing patients to access their own records from around the world increases the usefulness of a standardised system by matching up data as patients move around the health system, coordinating care.

He said: “You can take information from NHS data to your personal record without having to type it in and you can add details. You have control.”

E-health technology is “like a Ferrari”, Carpenter added, with the latest technology that is the height of our medical progress. “These standards are the key to start the engine.

“It fixes this context problem. Suddenly you are able to transmit health record data all around the world, straight from one computer to another.”

The more of the NHS that hears about the standards means the more that can follow them, leading to a safer, more accurate record system.

Carpenter concluded: “We’re keen it’s known about as widely as possible, as soon as possible. All the key professional bodies are signing up.”

The PRSB

A joint working group was established by Connecting for Health to look at how the standards could be broadened to involve other clinical disciplines, allowing information to be transmitted and shared between hospitals. This group recommended the establishment of this PRSB, which was launched on April 16.

The PRSB will be the first point of call for professionals, professional organisations, service providers, commissioners, policy makers and system suppliers for expertise and all matters relating to care records. It aims to reflect best practice, enable good outcomes and embed safety and security in information systems.

Overall governance will be provided for the structure and content standards for records, professional assurance of standards and advice for organisations and guidance for those working on the technology implementation of records.

Founding members of the PRSB include National Voices; Royal College of Physicians; Allied Health Professions Federation, Royal College of Nursing; Association of Directors of Adult Social Services; Royal College of General Practitioners; The British Computer Society; BCS Health; Academy of Medical Royal Colleges; Royal College of Pathologists; Royal College of Psychiatrists; Royal College of Surgeons of England; Royal College of Paediatrics and Child Health.

It will have direct links to the NHS in England, Scotland, Wales and Northern Ireland, to ensure a joined-up approach to record standards development.