New electronic discharge summaries save the NHS time and admin costs

Hospitals across England will soon be able to send secure and standardised clinical patient discharge summaries and outpatient attendance information electronically to GP systems.

This follows a successful first of type by NHS Digital, TPP and Dorset County Hospital working with Independent Systems Integrators.

During the trial Dorset County Hospital was able to send over 4,000 structured FHIR1 messages to four volunteer GP practices locally3, including outpatient letters, emergency care and inpatient discharge summaries.

The system saves GP practices time in processing and clarifying the information they receive, so changes can be tracked and necessary actions taken.

For example, updating information when a new or alternative medication has been prescribed for the patient or actioning an onward referral request.

It will also notify hospitals when messages have been delivered and have been actioned. GPs and hospitals benefit from a reduction in paper use, postal costs and time re-typing information into their computer system.

Traditionally GPs have had to enter information from patient discharge letters into GP systems, taking up valuable admin time. National transfer of care messages allow for the data to be easily extracted straight into GP computer systems.

Adopting clinical and technical standards2 in electronic healthcare records across the NHS in England, allows clinical information to be recorded, shared and accessed consistently to deliver better care and outcomes for patients.

Messages are sent using the Message Exchange for Social Care and Health (MESH) and have been built to HL7 FHIR standards, giving hospitals the possibility to send files that are much bigger than could be sent through email in the future.

Hospitals will also be able to send messages containing standardised coded clinical terminology, such as SNOMED-CT and dm+d.

Andrew Meyer, Director of Platforms at NHS Digital, said: “Improving transfers of care between hospitals and GP practices is a vitally important step to enhance patient care across different health and care settings.

“We have come a long way from the early days of sending discharge information through the post, fax and even email to now providing a standardised and reliable service.

“Hospital staff can be reassured that the messages they send to GP practices have been delivered, read and acted upon, without the need to follow up with telephone calls.

“Interoperability between different systems is key to reaching this target and we aim to work with other Trusts and GP suppliers to ensure that all GP computer systems can send and receive transfer of care messages in the near future.”

Dr John Parry, Clinical Director of TPP, said: “Enabling key information from ToC messages to be extracted automatically will make the process faster, less prone to error, and ultimately safer for patients.

“The interoperability we have achieved here is an essential step in the right direction to make all communication into General Practice digital.”

Waleed Al-Hussaini, founder of Independent System Integrators, said: “We’ve taken content from MS Word and Rich text format documents written by clinical professionals to construct FHIR messages for Outpatient Letters.  

“We’ve enriched and transformed HL7v2 messages to generate Inpatient discharge and emergency department discharge FHIR messages to send to GPs allowing the Trust the time and space to continue to deliver excellent services and improve systems while realising the tangible benefits of the ToC programme for patients and GPs, as well as complying with the national requirement today.” 

NHS Digital is now working with mental health trusts to develop a first of type for mental health inpatient discharge notices.