With increasing pressure from NHS England towards digital discharge summaries, Technical Director Gareth Butt examines what needs to be done to make the mark.
As reported by Digital Health this week NHS England (NHSE) are turning the screw with regards to digital discharge summaries:
So what does it all mean and what do you need to do if you are a NHS Provider? NHSE are adopting a staged approach in terms of the levers being applied and also what they want providers to achieve.
In the first instance they are hoping to move all providers to use a common set of headings on discharge summaries and are pushing for this to happen by December this year.
The headings have been approved by 50 different clinical associations and Royal Colleges so probably do cover most if not all eventualities.
The order of headings is up to you as a provider and all sub headings are optional.
So far so good – however - there are 22 headings in total, of which 8 are Mandatory, 7 are “Required” i.e. if the information is available it should be sent and 7 are optional. Across all the headings there are circa 80 sub headings.
Each subheading can be thought of as a field in a form that needs to be completed. Nobody – especially in an already overstretched NHS is going to complete an 80 field form. In designing our transaQt product this was one of the first hurdles we sought to overcome through auto-populating as much of the form as possible and by tailoring the form to the care setting such that only relevant headings and sub headings are shown.
So as a provider looking to your system supplier, these are features I would be looking for. If as with transaQt the system hooks into PDS then you can auto populate a large part of any discharge summary.
In this first stage how you send the discharge summary is fairly flexible in that it can be emailed or sent via DTS/MESH. Use of fax, as of last October, is frowned upon.
So this is the first stage of what NHSE are looking to achieve, hot on its heels, i.e. part of the 2017 NHS contract, is a move to using structured messaging.
What this means is that you will no longer be able to create a PDF with the correct headings and email it to the relevant GP. Instead whatever system you use will be required to produce the discharge summary as a CDA document (CDA is a HL7 standard based on XML so not something want to author by hand) and send it using an ITK transport mechanism to the correct GP system.
This stage represents a bigger hurdle than the first as more system development is required. If NHSE have their way then the CDA documents that get sent will in addition to carrying the text entered by the completer of the form also be fully coded using SNOMED. This as comments on the Digital Health article suggest is not easy as it requires the user to search for and assign the relevant SNOMED code to certain fields. A realistic target however is to send the CDA document containing only the textual representation and not the coded equivalent and this is permissible.
The dilemma facing many CIOs / CCIOs is whether to go for an interim solution that gets them past stage 1 or to jump straight to a solution that enables Stage 2. My thoughts would tend towards the latter but only look to send the textual representation of the CDA document,at least until the GP systems are able to do something with the coded section, which I suspect will be later rather than sooner.
In choosing a way forward it is also worth noting that eDischarge is part of the Transfer of Care initiative which aims to ensure that patients are safely transferred between episodes of care and which will once eDischarge is addressed, turn its attention to other transfers such as acute to social care, etc. so any system considered for eDischarge should also have this capability.