A National Library of Clinical Templates for Nursing in the Community: a feasibility study

If this is all new to you, we now have a short video presentation summarising the project. (Flash format, 29MB)

The project will run for 18 months from November 2005, finishing April 2007.

It was commissioned by the Scottish Executive Health Department, funded by Primary Care, and sponsored by the Community Nursing Network and Paul Martin, the Chief Nurse for Scotland. The project will be delivered by the Glasgow Caledonian University Centre for Nursing Research, with Derek Hoy as lead.

What is a ‘Clinical Template’ ?

Many information systems now use forms (sometimes called ‘screens’) to collect or present information. By arranging the data on the screens, its easier to find what you are looking for, rather than read and type lots of text.

In this project, we consider a template to be what a form is based on: it describes all the data items that might be used, how they need to be grouped together, and possible values for items. Of great importance to healthcare professionals is not just what is in the template, but where it has come from, and how it should be used. For example, what is the evidence-base for an assessment template, and are there recommendations on how it should be used in practice? Who has developed it, and when was it last reviewed?

What benefits are there in developing Clinical Templates?

Forms are becoming the way that new information systems are developed. By developing the underlying templates under clinical ownership, we help ensure that new systems can be developed more quickly and successfully.

Beyond this, by sharing templates, we improve our ability to share and retrieve information. When data is scattered across different systems in different formats this is difficult, but templates could impose the required consistency and predictability.

Perhaps the most controversial benefit is the improvement of quality of care. Evidence suggests that there are times when structured data entry can improve outcomes, and times when it just gets in the way.

Existing tools will be used by the project, if they are clinically acceptable, before any new tools will be developed.

Why should they be standardised for Scotland?

It follows from the above that we can maximise the benefits of sharing if this is done at a national level. If we improve the consistency and usability of our information, then we require this to work across all NHS Scotland systems.
Issues of quality and evidence base are also best addressed by using all the expertise available across Scotland and beyond. Key to facilitating a library is the expertise available through NHS Information Standards activity- part of the National eHealth Programme. A key sponsor is the Community Nursing Network. We also have active involvement from experts in England, Netherlands, Australia and the USA.

How will the project work?

The project has three streams:

  1. professional development
    we will explore options for supporting clinical involvement in the process of development and maintenance of national standard clinical information tools.
    We plan to do case studies of previous similar activity, and to form new groups to work on tools.
    We will develop and test on-line collaboration for groups and anyone interested.
  2. library management
    We will collect examples of tools, and prototype architectures, modelling, publishing, and maintenance mechanisms. Relevant standards will be used where appropriate.
  3. implementation
    We will evaluate of user experiences with form-based systems at existing sites in NHS Scotland, for ‘professional’ acceptability. We will also do some additional work on importing schema from a library into local systems, and issues of localised form development and updating.

What about datasets- isn’t this just the same?.

Datasets define standards for data items that might be used in particular circumstances, for example referrals, and ensure that these items are defined consistently across other NHS Scotland datasets. Individual items are defined and stored in the NHS Scotland Data Dictionary. The National Clinical Dataset Development Programme (NCDDP) is initially working on Community Nursing data standards before it begins work on clinical datasets.

It is not feasible to define everything that might appear in a clinical record, so templates would include Data Dictionary items where appropriate, but any clinical terms might be included.

Because there is some overlap between clinical templates and NCDDP clinical datasets, the project prefers the term template to make clear that the products of this work extend the current approach to dataset development in desirable ways. As an added benefit, template is the term preferred in the informatics community beyond Scotland. In future, templates and datasets may become the same thing. The proposed work will run in parallel with the NCDDP, with shared activity and close communication.

What about other standards work?

International standards work is growing in this area. See the work on openEHR Archetypes, and HL7 Templates, for examples and further information.

There is related work in Australia and the Netherlands.

This diagram gives our working model of where templates fit with other standards work.

standards diagram

Why should we just develop Clinical Templates for nursing in the community?

The current project arose from a need to improve information for and about nursing in the community. However, the approach being explored is generic and could apply across other sectors and other disciplines. Existing work will not be ignored, for example SPICE Care Screens could be considered clinical templates. We will consider how a National Library can adopt a standard format allowing templates to be imported into different information systems from different suppliers.

Similar work in the Netherlands has been in acute nursing, and there is growing interest from England and the USA in what we are doing.

Oh no, not another national initiative- don’t we have enough?

Information plays a big part in health care- it is what we use to communicate our patients needs, what we are doing about them, and ensure service delivery that meets expectations. A project like this addresses the infrastructure of NHS Scotland- a key outcome would be developing something that other existing projects can feed there information tools and requirements into. Work on practice development, quality, workload and workforce are all potential sponsors and users of a National Library of Clinical Templates. It is best seen as an enabler of existing activity rather than a new activity in itself.

How can I get involved or find out more?

The Feasibility Study started in November 2005 and will finish in April 2007. It will involve consultation and active involvement with NHS Scotland staff at three levels: policy level; practitioner level (those with expertise and working involvement in information and quality); and participant level (clinical staff as system users).
Anyone with a strong interest in developing templates for a particular clinical purpose should contact the project as soon as possible.

Find some links to other work or sites of interest.

For further information, contact Derek Hoy, d.hoy@gcal.ac.uk

A Django site.