Summary from final report

This report describes a project for the National Health Service in Scotland, titled 'a National Library of Clinical Templates for Community Nursing in Scotland: a Feasibility Study'. The project started in November 2005, and ended in May 2007. It was commissioned by the Scottish Executive Health Department, funded by the Primary Care Division, and sponsored by the Community Nursing Network and the Chief Nurse.

The project defined a clinical template as a clinical information model, which could be used to define a form in a health record system, for example a continence assessment.

NHS Scotland eHealth policy was to move towards national systems where appropriate, and these systems would both require and encourage national collaboration over content.

The potential benefits of national collaboration in developing clinical templates are:

• reducing development effort, particularly by clinical staff;
• promoting clinical standards by enhancing the evidence base in record systems;
• promoting implementation and supporting development of national data standards;
• increasing consistency of clinical system content, to enable the development of other tools, for example decision support or skill mix analysis;
• stimulating new information systems or enhancing existing systems, by making a library of clinical templates easily available to developers; and
• increasing consistency and usability of information for secondary purposes, such as caseload management, audit, locality profiling, or service management.

The project explored options for supporting clinical involvement in the process of development and maintenance of shareable clinical information tools. A project web site supported 109 subscribers in 15 clinical groups in developing 27 templates from new or existing sources. A more technical strand explored the development outputs to produce clinical domain models, candidate templates/archetypes, and prototype tools and architectures for maintenance and electronic publishing.

The recommendations were:

1. Further development should focus on agreement and use of standardised ‘building blocks’ which can be combined and re-used in templates. This should be based on the preferred data standards under development by ISD (eg archetypes, or compound clinical concepts).
2. Further work is required to ensure effective management and governance of large collections of templates.
3. Agreeing models for the clinical record suitable for NMAHP practice would help guide template development. These should reflect the differing requirements between differing levels of practice, and use by patients and carers.
4. Content in use in existing systems is an un-tapped resource and should be used as the basis for new template development.
5. Existing clinical groups and communities of practice should be the starting point for further clinical template development.
6. Clinical template development should be one source of content for ISD data standards development.
7. Templates developed by the project should be migrated to standards as agreed with NHS Scotland Data Standards.
8. Further development should use similar methods to the project web site, based on openness and transparency, and promoting peer review. It should be discipline and application-neutral (ie, capable of use in any system or on paper).
9. Clinical templates developed by the project should be indexed and integrated with the NHS Scotland e-Library.
10. National projects involving content development for NMAHP eHealth or clinical standards should be required to make that content available using archetypes or templates that are compatible with national resources.
11. It is essential that continuing work on clinical templates develop best practice in linking supporting guidance on use of templates, and in particular, any logic associated with decision-making.

Although there is growing interest in this area, with work by national and international standards bodies (such as HL7, CEN, ISO, OpenEHR), this project was unique in terms of its focus on clinical information standards, and the processes that were developed. It therefore attracted interest from related projects in the Netherlands, Australia, England and the USA.