Prior to the establishment of ISB
There is a substantial history of work in the field of data standards to support management information dating back at least as far as 1980, but the first attempts at adopting a formalised approach are associated with the establishment of the Committee for Regulating Information Requirements (CRIR) in 1987.
CRIR was set up initially to consider changes to the standards that had been established by the steering group on health services information ("Körner"). These standards were described formally through the first issue of the NHS data model (The Körner data model report) and implemented from April 1987.
There is also a history of technical standards that were originally selected and adopted on behalf of the NHS by the technical wing of the Information Management Centre (IMC), later to become part of the Information Management Group (IMG), which was the immediate forerunner of the NHS Information Authority (NHSIA). De facto technical standards emerged through this route, for example the use of EDIFACT for messaging.
There is no discernible history at all in the field of clinical information standards, i.e. those used by doctors and other healthcare practitioners directly to record, monitor, and plan clinical care. Each Royal College / Profession-specific organisation followed its own path which meant that de facto standards emerged that were not necessarily compatible with each other or with prevailing management or IT standards.
There was a clear need for an organisation to bring together clinical, technical and management information standards.
The Initial Approach (2001 to 2003)
The ISB was established by the NHS Information Authority (NHSIA) to govern information standards. It was recognised early on that the ISB would need to be at arm's length from the development areas of the NHSIA to ensure there was not a conflict of interest.
The ISB set up three sub-boards - Management, Technical, and Clinical. The three groups met quarterly, generally at the same time and at the same venue. The sub-board chair then took the views of his / her board members to the subsequent ISB board meeting for the final decision. The profession-based regulators saw membership as helpful to the protection of the public mandate they worked within.
Three main issues emerged with this approach.
- There was no direct dialogue between the presenters of the proposals and the board members, and consequently the process could become protracted as communication with the developers only took place outside of board meetings.
- Some issues were of interest to more than one sub-board, and sometimes the emerging advice conflicted. The structure allowed for cross-fertilisation between the three sub-boards, but it was not always adequate.
- With a growing workload, the frequency of meetings was inadequate.
The Second Approach (2003 to 2005)
During 2003, the three sub-Boards were merged into a single but large Information Standards Advisory Board (ISAB). Each monthly meeting comprised sequential discussions on each standard in turn in closed session. Each submitter and supporting staff was invited to present the key points of the proposal and to answer questions to the whole of ISAB.
Two main issues emerged with this approach:
- It was seen as very intimidating by the submitters and their teams, and the feedback was therefore very negative.
- It was not a cost-effective way of using the time and expertise of valued individuals.
The Third Approach (2005 to 2009)
The ISAB structure was disbanded, but its membership was reviewed and several members formed the basis of the ISB Reference Group.
This approach expanded the domains of expertise from three to six, namely:
- Social Care.
- Information Governance.
- Public Health & Statistics.
The third improvement in this approach was the change from episodic assurance to continuous assurance. This approach is intended to provide not only continuity but a more focused, efficient, and effective appraisal process, which is very much less intimidating and more constructive from the perspective of the submitters. It also enables better team working and integration across standards; using appropriate appraisers from different domains on an appraisal panel ensures all perspectives are covered. Feedback to date has indicated that these aims have been met.
A 5 year review was published in 2008. The report is available online. The majority of the recommendations were incorporated into the ISB service.
The Information Standards Management Service (2009 - present)
In July 2009 the role of the team supporting the ISB was recognised by the formation of the Information Standards Management Service (ISMS). The ISMS is a permanent team within the Department of Health Informatics directorate that manages the assurance of information standards on behalf of the ISB. The approach has not changed from that introduced in 2005. The introduction of the ISMS is more an indicator of the growth in its importance.