E-discharge: standard clinical headings required by Dec

Image: All providers must use structured clinical headings in e-discharges to GPs by this December.


All NHS providers must send digital discharge summaries to GPs using standard clinical headings by December this year, the new draft NHS standard contract says.

The contract, which is out for consultation, also encourages providers to adopt structured messaging for discharge summaries, but this will not become a formal requirement until next year’s contract, NHS England head of enterprise architecture Inderjit Singh told Digital Health News.

The new General Medical Services contract will also make it a requirement for GPs to be able to receive discharges electronically from next month.

All four principal GP system suppliers now have the functionality to be able to receive structured documents directly, as specified under the latest GP Systems of Choice contract.

“The key message to the service is we are asking to move to clinically consistent headings, but also structured documents and that functionality is in place with all GP system providers,” said Singh.

The requirement to send electronic discharge summaries was included in last year’s NHS standard contract and was mandatory from last October.

According to the first round of results from NHS England’s new Digital Maturity Index, around two thirds of trusts are now sending the majority of their discharge letters to GPs electronically.

Singh said NHS England’s strategy has been to align contractual levers with professional buy-in and supplier readiness to ensure uptake is high.

The new draft NHS standard contract includes the requirement for provider organisations to use the Academy of Medical Royal Colleges clinical headings, published in 2013, for discharge summaries.

The contract says they must do this by December this year, by which time all GPs should be getting a standard set of information about their patients on discharge.

This year’s contract will also “strongly encourage” providers to start using structured messaging, although this will not become a formal requirement until 2017, Singh added.

Singh explained that while moving straight to structured messaging is not yet mandatory, by signalling it early trusts have a chance to “get ahead of the game”.

Structured documents will make it much easier for receiving organisations to send information, such as referrals, back into acute trusts and will also make it easier to share information with other care sectors such as social and urgent care, he said.

NHS England is looking for acute trusts and other providers that want support for local pilot projects to start using structured messaging.

Singh said some organisations have already expressed an interest and the national commissioning board is “keen to encourage other provider trusts to come forward and work with us on using the functionality that GP providers have now made available”.

The Health and Social Care Information Centre ‘transfer of care’ team have produced a toolkit to help local organisations adopt the Academy of Medical Royal Colleges headings and provide technical specifications for implementing the transfer of care domain messages.


 

Last updated: 14 March 2016 10:34


knaylor43 weeks ago

The target set by NHS England for 2016 is to move to address the business changes involved in adopting the standard Academy of Medical Royal College Headings. However, when deciding which technical route you should take be aware that the ambition for future years will include a move to HL7 CDA and to include SNOMED CT encoded diagnosis, procedures, allergies and dm d encoded medications.

Choose your solution carefully.

Reply
Flag
 +2 
Like

Follow

Post

 

Alan McLaren43 weeks ago

COMMERCIAL INTEREST

Derby and other Trusts have tamed many presentation documents used for clinical correspondence like discharge letters, diabetes wound reports etc for several years. This is enabled by pre-processing presentation documents produced in Word or PDF. They are routed via ICE, NHS email and soon Synertec Hybrid Mail each and all with full accounting and verification of receipt. Those GPs using ICE are presented with the correspondence in same manner as lab results and the same formatting as the originating document. They can then be filed or launched by opening GP applications like EMIS, System One, Vision etc...It requires a small investment and short time line to enable making it suitable as a temporary measure or a permanent solution.

Converting presentation documents to CDA is also is an option.

Check out summary: http://www.mdisolutions.com/clinical-correspondence/

Reply
Flag
 +1 
Like

Follow

Post

 

saywell43 weeks ago

At last.

But just using a word document with the headers in a template would be far from ideal. A structured document that is machine parsable is required, together with a way to make it human-readable and printable.

XML would achieve the former, and it would be easy to provide software for the latter. PDF probably wouldn't meet the former.

RTF might be considered - can use standard word processors, browsers etc to read it on any platform, and its open structured format [albeit a gift from M$] means that so long as standards are specified, it can be machine-creatable to combine data from other systems and free text entries. Similarly can be both human and machine read, and is a familiar format for users.

It would be much better to standardise the format right from the start, rather than introduce it in dribs and drabs, with different solutions from different bodies. Otherwise there will be standard headers but no other true interoperability, and getting that sorted out when the disparate systems have become established would be a nightmare!

William

Reply
Flag
 +1 
Like

Follow

Post

 

Badajoz43 weeks ago

This is an attempt to bring in a XML based document. It's very complicated and I've not met many developers who understand it enough to work with it. They can work with a PDF(/Word etc) and a bit of XML to move documents around. The XML standard is called CDA, has been a NHS standard for around 10 years with only minor uptake.

Reply
Flag
 
Like

Follow

Post

 

Andy H42 weeks ago

Its not complicated at all, the XML pretty much documents itself, and its the basis of interchange in many industries. The issue is more whether we jump CDA and go to the FHIR standards for future flexibility.

Flag
 
Like

Follow

Post

 

interop lurker43 weeks ago

Reply
Flag
 
Like

Follow

Post

 

interop lurker43 weeks ago

Laudable

This is as much about getting spine2/dts /mesh a key player in the system the pass through , patient/ practice identifier .?

Whilst the body layout is important there is a big process change to get clinicians to think about structured production.

What will be the format,one or many, what are the standards for Digital Vellum,

http://www.bbc.co.uk/news/magazine-35569281

As i look fondly at GP patient paper records that follow all NHS org changes, its starting to break up as scanning and digitsation does not have Gold Standards , in producing or on transfer of records

Meantime if it can aim to get system interaction around the metadata in the "letter/doc" header and build in "digital workflow " that works .

If the latter is a key focus it will fly off the shelves. One for @code4health ?

Reply
Flag
 +1 
Like

Follow

Post

 

Neelam Dugar43 weeks ago

Interoperability between systems requires use of open interoperability standards and coded content for the subheadings. It is not clear what standards are being used--I.e is it HL7 CDA? Will SNOMED CT codes be used for subheadings?

Reply
Flag
 
Like

Follow

Post

 

Badajoz43 weeks ago

Believe you don't need to use any IT standard for the basic version - layout the document correctly in MS Word. It would be sent to the GP as HL7 CDA (PDF Document Metadata).

Later versions would want full CDA with SNOMED for headings (but I doubt we'll get that far).

Reply
Flag
 
Like

Follow

Post

 

Techy44 weeks ago

This seems to impose a real burden on providers. Given the state of interoperability in England it would seem sensible to set the bar a bit lower.

Reply
Flag
 
Like

Follow

Post

 

von Bismark44 weeks ago

I beg to disagree, from a CCG-land perspective this is the level of drive and detail that's been badly missing for the last decade at least, and personally I applaud this move.

Reply
Flag
 +1 
Like

Follow

Post

 
  [1]  
Digital Health Jobs Plus Icon

 Jobs

Desktop Engineer
East Anglia / £160 - £175 per day
Personal Assistant
UK - Wide / £25000 - £30000 per annum
Software Tester
East Midlands / £20000 - £30000 per annum
Integration Specialist
South East / £45000 - £50000 per annum
Head of Information
West Midlands / £39,324 to £48,327 per annum