This draft implementation guidance was developed between February and March 2023 as part of the NHS England Virtual Wards Interoperability Discovery. It is provided for information only and is not currently being updated.
If you are not participating in the Discovery, you are advised not to develop against this guidance until a formal announcement has been made. The team can be contacted by emailing england.virtualward.interoperability@nhs.net.
Contents
- Background & Use Case
- Architecture
- Data Model
- Data Transfer Mechanisms
- Assurance
- Help & Support
1. Background and Use Case
1.1 Background
In Autumn 2022 an NHS England team undertook discovery research into the issues surrounding interoperability for virtual wards. The full Discovery report is available on NHS Futures, and provides the context to this draft Implementation Guidance.
The discovery research found that there is a large variety of integration options, and many virtual wards are at different levels of technical maturity. The variety of integration options for virtual wards is creating a demand for a standardised approach to data transfer. We have engaged with a select number of sites to develop a draft set of standards for sending a data package from the remote monitoring platform used in the virtual ward, to a chosen clinical IT system destination in another organisation.
We are looking to support the development of a 'first of type' which demonstrates the technical feasibility of a standards based approach to interoperability, and builds momentum for future phases of development.
Sharing timely and accurate data strengthens patient care, reduces clinical risks and reduces inefficiencies. This guidance is the first step towards resolving the wider virtual wards interoperability and data sharing problems identified in the discovery. Our intention is to iterate this standard over time, facilitate improvements in data sharing for virtual wards models of care with the ultimate aim to enable the sharing of fully structured data.
1.2 Use Case
Our focus use case is the transfer of the “Supplementary remote monitoring data from a virtual ward stay”. In the rest of the guidance we will refer to it as “the Supplementary RM Data”.
The aim is to share this supplementary data from remote monitoring (RM) platforms to external clinical IT systems. This is not a discharge summary, nor it is a replacement for the official Professional Records Standards Body (PRSB) discharge summary.
The intention is that when a patient would be discharged from a virtual ward the Supplementary RM data would be generated in a PDF or other format which could then latterly be transferred to an external clinical system, or to a regional/national solution like a Shared Care Record or the National Record Locator (NRL). This transfer should ensure that the appropriate data from the virtual ward stay is made available at the point of discharge for clinicians in other organisations who go on to care for the patient. This data will be supplementary to the official discharge letter issued at the end of the virtual ward stay.
The content of the Supplementary RM Data document will be defined locally, in the first instance, and standardised in future. It is likely to contain key information such as patient demographics, virtual ward stay details, thresholds for alerts and details of any key observations which took place during the stay. It may also include free-text clinical notes, responses submitted via symptom questionnaires, messages received and sent to patients and graphical images or other charts that do not have a standardised structured format and would need to be interpreted by a clinician.
The destination systems for transfer of the Supplementary RM Data document and organisations are visually represented in the figure below and can be grouped as follows:
- A - Data stays within the RM platform and not transferred to any other clinical systems
- B - Data is sent from the RM platform to the clinical system in the NHS organisation hosting a virtual ward
- C - Data from the RM platform is sent to clinical systems which sit outside the NHS organisation hosting the virtual ward but are local to this organisation
- D - Data from the RM platform is sent to or viewed in external clinical IT systems via regional initiatives such as a Shared Care Record
- E - Data from the RM platform is sent to or viewed in external clinical IT systems via national initiatives such as National Record Locator
Our focus is getting the Supplementary RM Data from the Remote Monitoring platform and/or host clinical system (in destination A and/or B) and developing a standard for sending that data to the local and/or regional platforms (in destination C and/or D).
We recognise that sending data to the national platforms such as NRL (destination E) is important, but for this piece of work it is out of scope and recommended that this work feeds into this in the future.
As mentioned previously, we are looking to use this as a starting point to get data flowing in a standardised way. Our aim and intention is to build on this standard, with the ultimate goal being a fully structured transfer.
More information can be found in the Architecture Overview section.