PRSB publishes new outpatient letter standards
- 10 August 2017
Patients and professionals who provide care are set to benefit from new standards for the drafting of outpatient letters, produced by the Professional Record Standards Body (PRSB).
The standards aim to improve communications between hospitals, other professionals and patients following outpatient appointments.
Outpatient letters are often the main method of communication between outpatient services and a GP surgery. They are sent to the GP practice following appointments at hospital, community hospitals, health centres or online assessments such as Skype.
“The new standards define the content and structure of outpatient letters so that professionals, patients and carers receive consistent, high-quality information”, a PRSB spokeswoman said.
Jonathan Brown, informatics lead for gastroenterology at the Royal College of Physicians and clinical lead on the project, said: “The importance of standardised outpatient letter headings will grow as the number of patients living with long-term conditions increases and they access care in a wider range of settings – including the home.”
“By creating data structure definitions for the content of outpatient letters we can ensure that GPs can focus on the relevant information they need to provide safe and efficient continuity of care.”
Its need comes at a time of importance particularly when West Suffolk Hospitals NHS Foundation Trust recently identified technical problems with its Cerner EPR leading to inaccuracies in discharge letters automatically sent to local GPs.
The trust has launched an on-going investigation into the data errors in discharge letters, which it initially rated as a potentially ‘catastrophic/major harm’ risk.
The trust told Digital Health News at the time that the discharge letter problems stemmed from inaccuracies in information contained within some discharge summary letters issued to GPs, which were created by unspecified technical issues.
During the outpatient letter standards project phase, PRSB consulted with patients and service users, carers, GPs and primary care professionals to ensure that the outpatient letter standards meet the needs of the authors and recipients and are easy for outpatient clinics and vendors to implement in IT systems.
The focus of the project included identifying what information GPs and patients require in outpatient letters and what information it would be preferable to have in a coded form.
It also identifyed what structured (and coded) information it is feasible to include in outpatient letters and how this may change with the implementation of more integrated electronic patient record systems.
The project was conducted according to the editorial principles for the development of record standards, developed by the RCP and adopted by the PRSB.
The PRSB develops standards for digital health and care records, based on research evidence and agreed by professionals and patients. It promotes the use of standards so that people can receive safe, effective care.
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How will the outpatient standards benefit professionals and patients?
- Ensure the right information is passed on to the GP in an outpatient letter
- Currently outpatient letters can be varied. Standardising them will mean that GPs always have full access to the right information, improving continuity of care for patients
- The standards have been developed with patients and professionals to ensure outpatient letters meet the needs of those who will be using them to enable their widespread adoption
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11 Comments
This is important, and it is key that we move quickly beyond email as the mechanism. GPs that I work with hate receiving email as much as paper and fax, because it provides poor workflow, can be attached to the wrong patient record, and lacks the structure to enable them to update the relevant information in their systems.
Brevity and maintaining at least the structure of medical training working to SOAP (Subjective, Objective, Assessment, and Plan) surely helps the baton of care to be passed efficiently, though I have known Paediatricians and psychologists who want to write lots of detailed nuance. And Out of Hours GPs who just want the bottom line .
I hope the output can be visualised in 2 sides of A4 and compactly without looking like a data dump. I recently received a referral letter – 40 pages of data feed with no useful referral information.
I worry when the information transfer is meant for making sure the data is readable by machines and more data than necessary is collected. A discharge or clinic letter should be no more than that. Any superfluous information collected is expensive for the writer as well the reader. Too much information also harms patient safety, by people skip reading through 40 pages of data dump.
This is about content, not the method of transmission. Much as I love a well-crafted letter, the problem I face is reading th 60-100 letters a day that arrive and spotting the key facts ( drug and dose changes, requests for follow-up etc) which sit somethere in the middle of the 7th paragraph. Moving to a standard approach will speed up processing whilst improving safety.
It says “letter”. Lets not pretend that means anything more what it says. And whilst the priority may be content it should come with a “by the way there is something called email and you might want use”.
Actually you would hope that email has soon had its day ín terms of an effective solution for information exchange.
I have been closely involved in this project and it is intended to cover all forms of document exchange which includes e-mail and other forms of electronic exchange. There is also an expectation that it could also carry coded data which can be used by receiving systems in the future, once the capability has been developed to make use of such data
I would suggest we go beyond expectations and say a requirement. Coded data is certainly necessary when it comes to GDPR and data portability. Was this a driving factor I wonder?
I guess the IT bods have finished tinkering with email, failed to make it work and something newer and shinier has come along. So now they are off to play with that having failed to deliver any benefits to patients.
So before we write off email and spend the next decade failing to adopt some other technology why don’t we should use what is already there and accessible to everyone. Anything else can be developed in parallel?
The longer we delay the more patients who suffer and die. Yes really.
I like it’s concentrated in the structure of the letter (which in Theory can be email, paper, fax or fhir composition).
Far far too often us technology people get told we want in done in HL7v3/cda without the content being specified.
For the majority of us – we need to PDF and a little bit of fhir, this will take time. Yes some of us can move to structured content (a bit more fhir?) and aim for the majority to do this also.
we definaltey shouldn’t be looking at the 1% super complex.
Sod standards, we have email and PDF. Do that! Now! don’t people realise patients die and suffer because you can’t quickly get data from A to B?
We have to be more agile and sensitive to needs of patients. What is going to deliver significant value today? A letter in PDF format with the patient’s history emailed in front of the doctor when they need it? YES!
How much delay will pontificating about standards introduce? LOTS!
Will it add significant value beyond this? NO, at least not in the short-term.
So is it better for patients that we get on with email and figure this stuff in the background. Of course, it bloody is!! It has been that way for over a decade.
Where are we today?
Still debating how to do this stuff.
Good god, after only 69 years of the NHS. Thankfully none of this was a problem before. Bravo.
No mention of email?
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