Pathway and Referral Implementation SysteM

PRISM is a support tool that compliments primary care clinical systems, (such as SystmOne and EMIS web). It has a range of features designed to benefit the GP, provider organisations of secondary care and most importantly the patient through the care pathway and referral journey. Referral pathways created through PRISM ensure standardised, consistent referral letters for the referrer and provider. Pathways include helpful prompts and response driven questions specifically tailored and agreed by both the GP and the onward provider’s requirements. Complimenting features of PRISM include a resource library with a wealth of information such as patient leaflets, guidance notes and useful web links for both the GP and patients to benefit from; all resources are held in one convenient location ensuring that the most up-to-date information and the right version is to hand for reference and printing where required.

Working with PRISM made so much sense for us, as we could quickly see the positive impact it has on all stakeholders involved in the referral process, providing supporting documents around this ultimately provides a ‘One-stop-shop’ for referral needs.


In 2012 the East Leicestershire and Rutland Clinical Commissioning Group (ELR CCG), and West Leicestershire Clinical Commissioning Group (WL CCG) in partnership with NHS Leicestershire Health Informatics Service (LHIS) set out to develop a GP support tool to enable better quality referrals for patients requiring secondary care either in the community or acute setting.

NHS Leicestershire Health Informatics Service were approached by a GP on behalf of the East Leicestershire and Rutland, and West Leicestershire CCGs to create a bespoke package to suit local needs and then later Leicester City CCG (LCCG) came on board. PRISM works with both clinical systems used by LLR GPs (SystmOne and EMIS Web) and aims to act as a central hub of information; which in turn provides clinicians with easy to access referral criteria, linked into local and national referral guidelines and simple access to information and resources for both clinicians and patients.

The PRISM team continue to work with both GPs and providers to ensure good quality referrals are hosted and updated in line with local and national guidelines. The three CCGs continue to support PRISM’s development which is also seen as a key enabler for local Sustainability and Transformation Plan (STP). Every GP practice in Leicestershire and Rutland (LLR) now have access and use PRISM referrals to support the creation of consistent and quality referral letters.

Benefits to your service

  • Consistent approach to referral letter creation, using a standardised, high quality referral letter
  • Allows practice staff access to referral related resources in one central system
  • Ensures all required clinical tests and relevant patient responses are taken prior to referral
  • Greatly reduces provider “bounceback” of referral letters. Meaning that referrals are processed without the need to contact busy practices for additional information
  • Provides a wide range of referral resources that are fully searchable
  • No patient information is stored outside of the EPR so there are no additional governance considerations
  • Document management within PRISM gives you peace of mind that you are using the most up-to-date pathways and resources

Our core PRISM services are shown below, along with their LHIS product and service code for ease of reference.

Module 1
Clinical Pathways and Referral Support

Aimed at Whom? Predominantly used by primary care but is available and beneficial to any health provider that would like to onward refer a patient to another clinical setting or provider of care or supporting services.

Why and What? PRISM in its simplest form is there to support clinical referrer’s, such as primary care GP’s to make better quality, consistent and efficient referrals, providing the right information on the referral letter for onward providers of secondary care. This speeds up the pathway of care and ensures that the patient or service user is furnished with the right information in relation to their particular needs, within a typical 10 minute primary care consultation. PRISM is based on dynamically led questions, provides pre-qualification criteria and uses algorithms to produce appropriate clinical scores, such as the Oxford scoring for Knee. Pathways include helpful prompts and response driven questions specifically tailored and agreed by both the GP and the onward provider’s requirements.

Fields within a PRISM pathway can be made mandatory or provide drop down lists of options for the clinician to select within a consultation to ensure that the right information is captured and included on a referral letter. This support tool signposts referrers to the right secondary care service, so that the patient is referred to the right service in the right area, with the right information required.

PRISM ensures that all required clinical tests and patient responses are all completed prior to the referral being sent so the patient is sent to the right service with the right information. The system advises the referrer of any inclusion or exclusion criteria by condition (pre-referral information) and any signposting to alternative care settings where required. Against each pathway, during the referral process, there are direct links embedded to the resource library module, providing access to useful links, relevant patient leaflets of clinical guidance. PRISM is a support tool that compliments primary care clinical Systems, (such as SystmOne and EMIS web) but ultimately supports referrers in making better quality and consistent referrals.


Module 2
Directory Of Services / Service Directory

Aimed at Whom? The audience for the Directory of Services data is all care settings, including primary and secondary care but also service users / patients. The data entry side of the Directory of Services module is aimed at secondary care, voluntary sector, charities and any provider of supporting services of healthcare.

Why and What? As a clinician finding and informing patients of the right supporting services available to them in their locality can be a huge logistical challenge when supporting services may not be always provided by the same NHS organisation and are managed and maintained by different organisations on different platforms, such as websites/content management systems, lntranets, other systems and even paper service directories. Having multiple databases of service information means that any one snapshot or version of that data, can soon become out of date and can mean multiple versions of services available can be made publically available quite easily. A website might be promoting a support group based at a location that they had moved from many months prior, this will be because they don’t have the most up-to-date information being provided to them on location changes or service provider changes.

The health economy wide DOS concept within PRISM from a viewing perspective, allows a single place where referrer organisations can search and provide up to date contact and sign post information to their patients, easily and effectively. The Service Directory provides access to a wide range of clinical service information and associated support groups, including points of contact, locations and clinics which allow referrers to quickly contact services and direct patients accordingly. The primary care estate can have access to Social, Acute, Mental Health and Community Services from a secondary care setting. From a data entry perspective, any provider of healthcare is able to have access to the data entry admin system to enter their own provider, or services data so that the data being shared with other clinicians and patients, is kept up to date and refreshed with any updates. The DOS includes fields to enter Google map co-ordinates, address, telephone number, opening times, free text for specialist service information and details around parking and disability access, however this isn’t a full definitive list. PRISM DOS information can be presented to provider websites and other on-line solutions via our PRISM API functionality.


Module 3
Resource Library

Aimed at Whom? PRISM’s resource library provides a safe, single repository for all referral related resources for a referrer to access. This can include resources for clinicians, providing clinical guidance, useful weblinks, patient leaflets and provider service related information. The library hosts patient leaflets which would be provided to a patient within a consultation to support their knowledge, awareness around what to expect and any self-management information, self-referral information, useful website addresses (web links) and even multi-media content such as video content to support certain conditions, such as exercise videos. The information entered into the resource library will have been provided and clinically signed off by the secondary care, provider of care that the patient will be referred onto.

Why and What? The resource library hosts not only patient leaflets, multi-media files, useful web-links but it also holds self-referral information for services that offer this facility. Referral criteria is also hosted as an additional resource to allow clinicians to review this information outside of clinical referral pathways. Resources are held in the following formats, PDF, word, HTML links and image files including GIF, JPEG, PNG.

All of these resources are fully searchable and can also be keyword tagged to ensure that valuable resources are located efficiently and can be accessed against a key marker on the relevant clinical pathway, (i.e. Have you provided the patient with the patient leaflet? Click here to access and print leaflet) or users can search the resource library if searching for guidance outside of a clinical referral process. Resources have now been made accessible to patients, where appropriate via mobile apps and websites, via the use of our resource library API, presenting the latest patient facing resources out onto the world wide web, to support self-care and management. PRISM resources are uploaded with review dates to ensure that they are regularly reviewed and the versions are regularly refreshed with up to date information


Module 4
PRISM Referrer Portal

Aimed at Whom? The Referrer Portal module provides a safe, encrypted and secure mechanism for referrers such as primary care / GP practices, to SEND referral letters electronically where eReferrals (eRS) is not in place, negating the need for faxing or emailing letters to onward providers.

Why and What? The PRISM referral letter is created via PRISM and saved onto the clinical system. PRISM then provides a web based, secure portal that provides a secure paperless referral transit system, which is linked to the clinical pathway so the referrer is not required to select the onward provider, this is pre-configured to ensure the referral letter is sent to the correct care setting. The portal allows referrers to track and audit when the referral letter was sent and by whom and where it went to and whether it has been processed by the onward provider. The portal can handle multiple file types, .TIF, Word and PDF format.


Module 5
PRISM Provider Portal

Aimed at Whom? The Provider portal module provides a safe, secure, encrypted and auditable mechanism for provider organisations to RECEIVE referral letters electronically where eReferrals (eRS) is not in place, negating the need to receive faxed or emailed referrals in a provider or triage setting. Referrers will need to user the referrer portal to send the letter across to the provider, the provider will be alerted via the portal’s email / alert system, when a new referral lands into the portal for processing. The providers can filter by type of letter, referrer organisation and can update the status of that record, including an archiving feature. The portal can handle multiple file types, .TIF, Word and PDF format.


Module 6
API Suite

Why and What? With the way in which the PRISM platform has evolved, numerous APIs have been developed to provide the option for the rich content and data that is held, to be presented to different audiences and platforms, if appropriate. LHIS have an API ready to go to present service user (patient / carer) relevant content from the service directory (DoS) and the resource library to other digital platforms, in particular websites and mobile apps. This content includes presenting clinical multi-media videos (such as exercise videos), patient leaflets and other condition specific patient information to a webpage on a website or an android or IoS (Apple) device either providing both on-line or with off-line capabilities if there is no internet connection. There are a full library of APIs ready to either plug-in to pre-existing live health care sites or systems in that are new and in development.


Module 7
Mobile Applications, websites and intranets

Aimed at Whom? Here at LHIS we pride ourselves on our ability to use the latest technology available to help our health and wellbeing sector customers and the public we serve, make improvements and efficiencies, in their organisation or to the consumers. Mobile application development is a prime example of that ethos. Mobile application technology may seem out of reach to many services, however this doesn’t have to be the case. The patient facing apps we have launched onto the Apple and Google Play Store working in partnership with clinicians, has transformed the way in which we interact from simplifying and improving business as usual activities, patient resources, health education and self-care resources, to enabling tools such as on-line diaries, questionnaires and patient communication. There is a definite growth area in this industry, people want to access information when and where they want to, and mobile apps allows you to target an audience directly, in the comfort of their own home or as an additional tool to be used in consultation with a customer/patient either using their own consumer device or corporate devices for business / clinical use. However, responsive websites and corporate intranet technologies still have their place, of which we provide the consultancy and support to ensure the right tool is used for the business need.

Why and What? Utilising the APIs available in Module 6, access to the wealth of patient facing information that is stored in the PRISM modules can and is feeding, multimedia health care related mobile apps, NHS, Social Care and other health and wellbeing related websites and intranet sites. On-line Service Directories, multimedia content such as condition specific self-help videos, patient leaflets and useful website and resource links stored within PRISM feed the world wide web in a tailored interactive and intuitive on-line digital apps. Any content added or refreshed in the PRISM modules (such as patient leaflets, videos, website links and service directory information) will automatically refresh the mobile app content, presented in the mobile apps available on the app stores, pretty much instantaneously. The apps, aimed primarily for use by patients, carers and clinicians provide more convenient access to services and health information for patients supporting the NHS Long Term Plan. Access to our development services for new mobile apps, websites and staff Intranet services is available under this module for specific health conditions or health services, supporting both patient self-care, self-help and the patient journey through their condition or treatment. Use of existing website or mobile apps already available for download on the app stores can also be requested for use for your organisation.


What PRISM means to our customers

Catherine Headley (Head of Services for GPs, UHL), on PRISM’s impact on UHL patient referrals.

Ensuring the interfaces between Primary and Secondary Care are robust, mutually supportive and effective is key to delivering good patient centred care. As Head of Services for GPs it is part of my role to support the various interfaces between GPs in LLR and UHL and, with the teams involved, address issues and achieve resolutions. One of the mutual historical issues has always been ensuring that Practices are updated with changes to pathways and services to support clinical referrals. The development of the PRISM system by LHIS has made a significant difference to the way the Trust approaches dissemination of this information. Having a centralised resource that reaches each practice in the LLR, which can hold clinical pathways, guidelines and referral forms has, and will continue to be, a strong asset.

We are promoting the utilisation of PRISM by services within the Trust, ensuring that the most up to date guidelines, pathways and referral documentation are included and readily available to Primary Care. There is still much more collaborative work which we can do with LHIS and PRISM and I’m looking forward to being able to take this forward with the PRISM team.

Rosey Spence (Team Administration Manager: 2 Week Wait Administration Team), on how PRISM has impacted her team: 

The 2WW administration team are based on The Leicester General Hospital site. The six strong team are responsible for processing over 600 Cancer referrals every week.
The number of PRISM referrals received by the 2ww team are growing every day but the team still receive a significant amount of non-PRISM referrals that creates additional workload, and quite often the need to chase GP practices for additional information.

Having our cancer two week wait referral forms on PRISM has a number of benefits. Rather than receiving different versions of forms that may be years out of date, we can ensure that the most up to date NICE compliant version is available to all referring Practices. We anticipate that PRISM will help to reduce the number of referrals returned to GPs and reduce avoidable delays in two week wait patients being seen with the required information being available at point of referral.

Download a copy of the PRISM Product and Service Catalogue today!

Click the image to view or download the PDF.

  • What our customers say about us!

    PRISM Product - The facility to be able to find a wide range of resources and guidelines, all located within one single IT system which can be accessed immediately is long overdue- and most welcome!


    Dr Tom Rowley,

  • What our customers say about us!

    Having access to PRISM has streamlined my referrals in the 2 week wait pathway. I know I’m sending the patient to the right service with the right information. As we put more resources onto PRISM, I am confident that this will make the life of the busy GP easier, and patient care will benefit as a result. The patient will be seen in the right clinic by the right clinician first time and everyone  will benefit.


    Dr Tony Bentley,

  • What our customers say about us!

    The team listened to the requirements, took time to understand the national and local requirements needed to ensure the feedback was captured appropriately. We had early design meetings to ensure we were happy with the app display and function. For the roll out of the app to services we had very comprehensive support and understanding from the team, great communication on updates, technical issues, user errors and general queries. As a service we have made changes to the questionnaires throughout the process and these changes have been quickly and efficiently managed. Teams ‘on the ground’ have also benefited from the fantastic support from the team, when they have had queries with the app and the devices. The database behind the app has also improved the efficiency of collating the feedback. Working with Sarah, Kerry, Mo and Rachelle from HIS has been a great piece of partnership working, and a I have learnt from them and the experience.


    Sara Lowe,
    CHS Patient Experience and Learning Manager, CHS Governance team

  • What our customers say about us!

    I am very impressed by the support and quality of work delivered by LHIS. They were very friendly and approachable in addition to their high standards of professionalism throughout the project. The team is very motivated, dynamic and enthusiastic and went beyond their limits in completing the tasks and sticking to the project deadline. they were quick in amending/ updating the content based on expert suggestions and involved clinicians in designing and developing the app. They helped in project management ie: writing the proposal, strategic planning, approval process and exploring publicity and awards. More importantly LHIS were heavily involved in marketing the app to various healthcare organisations, presentation in various academic conferences and producing the leaflets. My special thanks go to Sarah Ost who lead the project on behalf of LHIS, Kerry Cyster and Gemma Clayton. All of their input resulted in the app being nominated for the PEN (Patient Experience Network) National Awards in March 2016. I wish LHIS much success and would recommend them to anyone considering developing similar apps.


    Dr Girish Kunigiri MBBS, MD (Psy), DNB (Psy), MBA (Quality Management),
    Consultant Psychiatrist in General Adult, Clinical Director East Midlands Mental Health Clinical Networ

  • What our customers say about us!

    I greatly appreciate the support; quality and professionalism of the entire team at LHIS who helped with YOD app. They were very friendly and approachable.  The team is very motivated and enthusiastic and would go beyond their limits in completing the tasks. Although it was new venture for us as clinicians and them to be working in such an area, they were quick in understanding our clinical needs, they attended patient and care focus groups for improvising the App, amended and updated the content based on expert suggestions and were great team players to work together in designing and developing the app. More importantly LHIS supported immensely in marketing the App, presentations in various academic conferences, and producing the leaflets/pamphlets. My special thanks to Sarah Ost, Service Delivery Manager, who lead the project on behalf of LHIS; Kerry Cyster, Product & Customer Support Officer, for designing and for vigorous quality check; and Gemma Clayton, Business and Marketing Manager, for compiling/editing videos and further enhancement of the overall design making it user friendly. I wish all the success to LHIS team


    Dr Latha Velayudhan MBBS, DPM (Psy), DNB (Psy), MD (Res),
    Consultant Psychiatrist in Old Age Psychiatry Senior Clinical Lecturer (Hon), Institute of psychiatry, psychology and Neuroscience, Kings College London Reader (Hon), University of Leicester

  • What our customers say about us!

    This is coming with appreciation re the ECT app you and colleagues developed. It is comprehensive and the availability of written , visual and audio information is very useful. I also think the information for professionals if read by a patients is not daunting , which allows for ECT to be destigmatised and seen as a medical procedure which we take seriously. I am the only accredited ECT Psychiatrist for this district where I  work in Australia and recently managed to wrangle more Consultant time for ECT which will allow me to streamline the service and train Registrars. For a service which did not have trained ECT nurses, we now have them and the nurses section will be useful there. I  see this app as an useful resource and see my team using it. Wishing you the best and congratulations again to you and your team.


    Anila Jacob,
    CMC Vellore Trained Psychiatrist

  • What our customers say about us!

    I would like to thank the Leicestershire Health Informatics Service worker for sorting out all my laptop problems. Colin came out to Whitwick last week (on the same day that I phoned!). He was so helpful and sorted out several problems. Even more importantly, as far as I’m concerned, he didn’t once make me feel like a complete incompetent!! He’s friendly, knowledgeable, patient and has a great sense of humour! I do hope that you can identify him through looking at the call out log for last week. He really does deserve to get a Customer Service Award.  


    Sharon Gregory,
    Health visitor

  • What our customers say about us!

    Your IT accounts administrator, has provided prompt, efficient and effective support to us, not just over the last year but for as long as I have known him. He is unfailingly polite, cheerful and approachable – significant qualities for those of us who are less than ‘experts’ and very much appreciated. It goes without saying that his advice and expertise is accurate and reliable and this, added to his admirable attitude, makes him a staff member Leicestershire Health Informatics Service should be proud of.


    Julie Glover,
    Resource Manager