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Development and Evolution of Hospital Discharge Report Guidelines

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In early 2023, the eHealth Network (eHN) commenced work on developing a guideline for Hospital Discharge Reports. The semantic subgroup had previously developed the Patient Summary guidelines, and this guideline would complete a set of five guidelines, the others being e-prescribing, medical imaging and laboratory reports. There are 115 invited members in the semantic subgroup with a typical attendance of 30-35 attendees. A specific HDR task force group was established with 15 members, and typically approximately 8 participated in developing the guidelines.

In June 2023, the eHealth Network approved a broader consultation of stakeholders about the draft guidelines on Hospital Discharge Reports (HDR). The initial draft document was based on the patient summary document as a blueprint for formatting, etc. Once the initial draft was completed, the document was shared with representatives from all member states and other stakeholders. This took place from June to August 2023. The broader consultation involved reaching out to eHN member countries, the eHealth Stakeholders Group, and eHMSEG. This consultation was successful, with more than 700 comments.

This resulted in a very collaborative effort for the team to incorporate all of the feedback, with each member of the team tasked with reviewing sections of the comments and working together in bi-weekly online meetings to discuss the comments and make decisions on how to resolve them. The outcome was approximately 450 suggestions integrated into the consolidated text, approximately 180 comments resulting in additional clarifications, and approximately 70 earmarked for potential enhancements in future versions.

Some of the key changes implemented include the revision of the use case description, with many comments identifying that the use case was not clear or well-defined enough, requiring rewording for clarity. The definitions, initially based on what was included in the Patient Summary, had to be further added to include specific definitions for HDR. However, defining a hospital stay became a topic for discussion in the group, as there were different interpretations, with most indicating that it should include an overnight stay. For the HDR, the definition needed to include anyone who had a hospital stay, including day cases. A compromise was reached, and it was identified that further work needs to be addressed in the future, specifically on definitions.

A new data element (A.2.0) was added for the full tree-text form of the Hospital Discharge Report. To address the extensiveness of the data set, it was decided to divide the document into core and full sets, requiring much discussion with the group. The initial draft only had a full dataset. Much of the feedback included comments indicating that the full dataset could be difficult for some MS to manage and may not be required in every HDR, overburdening health professionals. Separating what would be considered core and what would be included in the full dataset required compromise, collaboration, and lengthy discussions. The outcome was to include section 4.2) the core set of elements (mandatory) and 4.3) the full set of elements (additional optional elements).

Overall, there were several key clarifications required. The interplay between Hospital Discharge Reports and Patient Summary led to many comments reflecting the need for a clear explanation of how each document would be used to ensure there would be no duplication of effort or information. Advanced guidelines on identification, authentication, and authorization are out of the scope of the document. An explanation of the content of the dataset and its use in implementation settings was added.

There were some key changes to be considered in the next version of the guidelines. Harmonization between all guidelines will require an overall approach to the suite of guidelines. It became obvious during discussions that as one of the five guidelines, there was some divergence on the headings, format, and even some information. It was agreed that once this first version was published, there needs to be an overall review of all the guidelines to ensure alignment so that they can be read as one of a suite of guidelines. Discussions on the inclusion of other health professional discharge information into the general discharge report, e.g., nursing, were also considered.

In conclusion, it was agreed that while this document was agreed upon and published, further iteration and elaboration would be required over time.

About the author:

Theresa Barry
Theresa currently works with eHealth and Disruptive Technologies in HSE Leading out on Data & Terminology services in particular SNOMED CT, and the HSE Data Dictionary. She is the Member Forum Chair and representative for Ireland in the SNOMED international group. Her role is to facilitate local projects to leverage and develop SNOMED for their systems whilst giving input to and accessing the international body of knowledge. She facilitates input to the international community and works in Ireland with HIQA and the Department of Health on the SNOMED agenda. Her role includes the management of the National HSE Data Dictionary, ensuring that all data is standardized in a format that can be used in eHealth solutions.
She has been the Chair of the Hospital Discharge Report subgroup on semantics which was adopted in Brussels on Nov 28th 2023. She has also co-chaired the SNOMED International Member Forum group 2021-2023.