3 System Definition / Overview / Scope (page 32 of 18) in Clinical Safety Case Report (chapter 3 of 5) within Core Information Standard: Reports

Local care records will consist of data from multiple sources in both health and social care settings. It will not include all data from all sources and is intended to be information which is felt to be important to share.

The data will be shared with the LCR using FHIR resources and APIs. It will then be normalised and de-duplicated before being stored in, in most cases, a database. The design of the database is expected to be informed by the logical data model, for the LCRs, being developed by NHS Digital. This will define the provenance, context and relationships of data items.

Some LCRs may dispense with the database and pull data when it needs to be viewed.

The LCR Core Information Standard is a set of “Concept” sections under which users need to be able to view the data. This is not necessarily a physical entity and data may be rendered in that view at time of access.

There are currently in excess of sixty local shared care records in operation across the country. NHS England has established a programme, the Local Health and Care Records (LHCR) programme, to expand the coverage of local shared care records to cover larger populations. This will make important information available to health and care professionals and people using services across wider geographic areas, covering populations of three to five million, to improve the quality of care and care co-ordination. In order to realise these benefits, the core information standard was developed which defines and standardises the type of information that should be shared by systems that will talk to one another across health and social care, with the right safeguards in place.

The original standard was developed in two phases: the first phase reviewed evidence from existing standards and shared care records in order to produce a draft core information standard. This was achieved by mapping NHS England’s definition of the core information set, the Greater Manchester core dataset and the PRSB Standards for the Structure and Content of Health and Care Records (PRSB 2018) against the national and international standards and records. These are all referenced in the CIS final report [Ref.4]. The second phase developed the standard in key areas where it was seen that further work was needed (e.g. mental health and social care). The PRSB carried out broad and in-depth consultation and engagement across health and social care using online workshops, a national deliberative face to face workshop, social media (to obtain more diverse input from the public), expert reviews, an online workshop for vendors and an online survey. This allowed the content of the information standard to be refined and started to build awareness and support among all the key groups with an interest in information sharing in health and care.

This update to the standard includes Digital Social Care Information, which consists of a standard for data being shared from local authority records into the CIS, a revised standard for the “About Me” section, which is now much more structured than previously and guidance on a “Care Homes” view of the data. These additions were developed in the same manner as the main CIS, with a review of the evidence then wide stakeholder consultation.

The standard does not define how the data is viewed in individual systems, which will be down to the individual GUI of each system. The data items under each section will retain information about the date the item was recorded and the author of it. However other pieces of contextual data such as which encounter, problem or document it was a part of, are not be part of the standard. The logical data model is expected to manage these links; other views of the data based on that are expected to be created to show more provenance and context but are not a part of this standard.

3.1 Illustration of shared care record creation

This is a graphical representation of the process involved in creating the local shared care patient record. It illustrates the interdependencies in the LCR creation and deployment. The PRSB CIS is one component in the process. The scope of this clinical safety case includes the PRSB CIS component only.

Shared Care Record Creation diagram showing GP, Hospital, Social care systems feeding into Data normalisation and de-duplication, then Local Care Record, Core Information Standard, Other Data Views e.g. Care Homes View, Logical Data Model, GUI Rendered Views, and End-user.

Diagram A: Local shared care record creation

3.2 Inclusions to Scope

The following are included in the clinical safety case:

• The LCR CIS set of “Concept” sections (under which users can view the shared information);
• The definitions of the sections and descriptions of the data to be stored and viewed under the section;
• The data attributes of the sections.
• Guidance on the sections to be included in the Care Homes view

3.3 Exclusions to Scope

The following are out of scope of this clinical safety case:

• The source of the data and structure of data being shared;
• The normalisation and de-duplication process;
• The logical data model and database design; The graphical user interface (GUI) and the way in which the data is rendered in that view.

3.4 Use

Initially the LCR is intended to be a read only interface. Writing to the record has not been included in this clinical safety case.