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BMA guidance on Informing Healthcare Wales

August 2007

This guidance note provides information on Informing Healthcare Wales. A series of guidance notes is available on the National Programme for IT in England. Guidance on developments in Scotland and Northern Ireland will be available shortly. The Informing Healthcare Programme is under development so this guidance represents the current position and will be updated to reflect future changes.

Overview – Informing Healthcare
Informing Healthcare is the National Information Technology Programme in Wales working for greater integration of information across health and social care, to deliver a better standard of care to patients. The programme structure is based on a series of improvement projects and increased investment including:

• An Individual health record for each patient (initially in out-of-hours and emergency care)
• Clinical Portal – an electronic ‘window’ to give a single-point of access to the many different computer systems in use in hospitals. Should support hospital-based clinicians in recording and organising care
• Replacement of some Patient Administration Systems, needed to support Access 2009 waiting time targets
• My Health on Line – to enable patients to have access to their own Individual health record
• Access to Knowledge (A2K) – to give staff equal access to knowledge and evidence through a national e-library (www.wales.nhs.uk/ehl or if you are a HOWIS user at howis.wales.nhs.uk/ehl)
• Referral and Discharges – to improve the quality, timeliness and completeness of referral and discharge information by setting up electronic processes (integrated through the clinical portal)
• Results requesting and reporting – to improve pathology and radiology processes (a labelling system using 2D bar-coding for pathology specimens are now operational in all GP surgeries in Wales but is not yet fully integrated with secondary care)
• Telemedicine implementation (histopathology)
• Cancer Network Information System Cymru (CANISC) – to provide a single summary care record for people with cancer
• Shared information for people with diabetes – to support seamless care for people with diabetes
• Network improvements and data quality improvement projects

An incremental approach to implementation has been adopted with a gradual rollout over a ten year period building on current systems. This approach is supported by the BMA and we are particularly pleased to see that clinicians have been involved from the start.

In January 2006, the second edition of the National Case for the Informing Healthcare Programme was published following the National Architecture Conference in September 2005 and a summary of the third edition followed swiftly in November 2006. A fourth edition of the National Case is due to be published in August 2007.

This paper provides further details about the projects, their progress to date and a signpost to further information.

BMA Welsh Council IM&T Subcommittee
The BMA has established a cross craft Welsh sub committee to consider Welsh IM&T developments. The main issues considered by the group have included funding, data quality, integration of systems, consent, dealing with sensitive data and the interface with the rest of the UK.

The membership of the committee is as follows:
Dr Tony Calland – Chairman
Dr Eddie Coyle – Welsh Council
Mr Richard Hatfield – Deputy Chairman of Welsh Consultants Committee
Dr Ian Millington – GPC Wales
Dr Richard Lewis – Welsh Secretary
Dr Martin Murphy - Clinical Director, Informing Healthcare Wales
Mr Martin Dickinson - Programme Director, Primary Care, WAG
Dr Mark Scriven – Clinical Director, Informing Healthcare Wales

Welsh Clinical Portal
This is a secure, private, national web page which will give doctors and other healthcare staff a common entry point into the varied systems that are used to support patient care in all NHS settings. Healthcare staff will be able to log in from anywhere in the NHS in Wales and will have appropriate access to the patient’s record and a range of system results according to their professional need. It is due to be piloted in autumn 2007 in a hospital setting and developed as necessary through five versions. Specification is driven by prototype rather than contract. A phased migration to the new portal is planned. It is expected that more clinicians will be involved in the development in Wales to ensure the portal meets their expectations.

Individual Health Record
It is intended that the Individual Health Record (IHR) will contain key information as follows:

• Personal details – including demographics and eventually details such as special needs, primary language, relevant friends and relatives etc
• Care relationships – carers contact details
• A copy of the important, coded information from the GP record needed to ensure each contact and consultation with the patient is safe

The record is intended to be a ‘snapshot’ of the individual’s current health and care’ rather than an all inclusive record. Initially, focus will be on making the record available to support out of hours GP services and a pilot is currently in progress.

Informing Healthcare's newly-appointed programme board, a representative group of stakeholders, has agreed at its first meeting to oversee future development of the electronic individual health record. Programme board members have been drawn from a wide range of NHS and associated organisations, including a representative from the BMA.

The pilot for Out-Of-Hours electronic access to health records in Gwent has reportedly been a great success. This is an important first step in the development of the Individual Health Record for Wales. Nearly 80% of practices in the area have taken part. There have been very few dissenters under 40 out of 400,000. Patients seem happy to have the data kept in the local health economy. Informing Healthcare is looking to have more rollouts including North Wales and West Wales. The roll out will be undertaken on a patch basis maintaining the successful approach piloted in Gwent. Requests have been received to extend it to A&E clinicians, the Medical Admissions Unit and intermediate care services in Gwent. IHC have confirmed that there will be no extension of users without further discussion with local GPs and BMA Wales and the other stakeholders involved in this work. Increasing access would have security and practical implications that would need further consideration.

The Programme Board have agreed to define national principles for sharing patient information based on lessons learned from the use of the GP health record shared with the Gwent Out-Of-Hours Service.

Cross border issues
The issue of IT links between the home countries has been raised several times at various BMA meetings. The particular issue concerns patients who live close to borders and ensuring that they are not disadvantaged by the non compatibility of IT systems. The Chairman of the BMA NHS IT Working Party has written to Richard Granger (Director General of IT for the NHS) as well as IT leads in Scotland and Wales to seek clarification on the issue.

As the NHAIS (Exeter) system is very slowly turned off there seems to have been some progress in Wales. The NHAIS Functionality Verification Project has now completed all its objectives and clarified the issues facing Wales with the decommissioning of the NHAIS (Exeter) system. The Welsh Assembly Government (WAG) is negotiating with NHS Connecting for Health (NHS CfH) to use the Personal Demographic Service from England via a Welsh gateway with its own security system. NHS CfH has encouraged Wales to take on the whole CfH English system including the demographic service the spine record and security system Instead, Informing Health Care is proposing a Welsh demographic service that interfaces with the English system through a controlled “gateway”. This will allow demographic data to flow between the UK home countries without the need to adopt wholesale the English system and security.

Choose and Book/Electronic Booking
The Informing Healthcare team have recently met Dr Tony Calland, (Chairman of Welsh Council IM&T Subcommittee) and it was reported that patients on the border may soon be able to have their appointments booked through Choose and Book. This would be an advantage for a small number of patients in the Chester and Shrewsbury areas.

However the Welsh Assembly Government is considering implementing a different electronic referral system in Wales which will speed up the referral and discharge system (assuming that Local Health Boards will allow electronic referrals). The national solution being considered in Wales will be implemented to allow GPs and hospitals to exchange accurate, complete and appropriate referral and discharge information. This will make use of the Scottish system called the Scottish Care Information (SCI) Gateway, which has been successfully deployed in Scotland since 2001. Cardiff and the Vale have been selected as an early adopter for this solution. A technical proof of concept will be completed by November and it is hoped that the large scale feasibility project will be underway by July 2008, involving all of Cardiff and the Vale practices. If this proves successful this will put Wales in a good position to scale up the solution to a comprehensive all Wales referral system.

GP2gGP
This is the system that will allow GP record transfer between GP practices and has been a popular innovation in England. This will be progressed in Wales as in England as the standards and service to achieve this have been finalised this year.

Information Governance
Wales currently has a permanent representative on the Care Records Development Board in England and was asked whether they want the suggested National Information Governance Board to cover Wales as well as England. The Welsh Assembly Government have decided instead to form a separate Information Governance Group and the Welsh BMA Council has been asked to put a representative forward to the group.

Digital Health Library for Wales
The digital health library service began in spring 2006 and seems to have been a success in Wales. It was a development of the previous health library and allows unlimited access to health information for NHS staff.

This will be complemented by the Map of Medicine which is already available throughout Wales and an improved NHS Direct site for patients.

Shared Diabetes Health Record
The Shared Diabetes Health Record was launched in February 2007 in Carmarthen to share records between primary and secondary care and allow access by the full range of professionals involved in the treatment of diabetes. It will also allow patients to see their own record and assist them in self-care. It is due to be fully operational by July 2007.

Email
Informing Health Care has also developed a national e-mail service that will give each health professional an e-mail address ‘for life’ that can be used wherever they work in the NHS – even if they change jobs. E-mail will be encrypted to strengthen security against any unauthorised access to personal information sent via the new service. The BMA hopes to see more information on this in order to assess the security. A number of NHS Wales organisations will be acting as ‘early adopters’ of the new service later in 2007, and they will be followed by a full national roll-out during 2007/08.

This will also include a messaging and directory service.

Myhealth on line
This service will allow patients to see their online health records over their home internet connection. Patients will be able to use the service to request repeat prescriptions, book appointments and eventually see their medical history. This will be developed over the next year. The security of access will be a key issue that we hope will be delivered appropriately. It has been confirmed that the BMA will be advising on security options.

Development has so far been informed by a pilot web portal for maternity patients but a more extensive pilot, giving patients access to ordering repeat prescriptions and eventually to the health records held by their GP, has started in Bro Morgannwg. Further volunteer pilot practices are being sought.

Radiology and Pathology System Upgrades
Procurement is planned for late 2007 for new pathology laboratory information management systems (LIMS) for Wales. This will have a nationally agreed standard for test submission and reporting.

Radiology system enhancements, the Radiology Management System, will allow for future integration with the Picture Archive and Communications System (PACS) which allows electronic access to x-rays and images and has proved popular in England. Currently the RADIS 2 product is being rolled out in Welsh Hospitals to enhance the radiology services. Further work is underway to enable the sharing of PACS images from the various systems across Wales to support collaborative clinical working and existing clinical networks

Links

• Informing Healthcare
• Informing Healthcare Strategy (3rd edition summary
• Informing Healthcare has published a report of their achievements to June 2007

For more information on NHS IT, see the BMA webpages (clicking on the BMA Wales link at the top to see WBMA pages) or email the BMA Working Party on NHS IT: info.nhs-it@bma.org.uk.