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After an exhaustive examination of NHS Wales’ progress in IT by a panel of international experts, the man in charge seemed pleased with the reports coming back to him last week.
Gwyn Thomas, chief executive of Informing Healthcare, NHS Wales’ national IT programme, said: “Generally we appear to be getting the balance right between doing things ourselves and looking to external suppliers to do things for us. My take on that is that we’re in a good position to build the foundations for being the intelligent customer.”
He was speaking during a two-day meeting of Informing Healthcare’s International Advisory Group in Cardiff last week. The meeting came at the end of a week of visits to Wales’ six health communities by a distinguished international group of experts who provided feedback on what was going well and what could be improved.
Being an intelligent customer is high priority for Thomas; the NHS has faced accusations in the past from IT vendors that the service lacks a clear view of what it wants and that problems flow from this.
Thomas’ background in industry gives him an insight into the issue and he says that many industries build their role as an intelligent customer on a firm R&D base.
In the NHS, he feels the emphasis is more on the D than the R; in his terms, this means doing quite a lot of work to establish what the service needs, develop prototypes and test them – vigorously. Only then does a development progress to external procurement with suppliers being used to add the capacity needed for a full rollout.
“We’ve based that really on the fact that we understand health and healthcare,” he says, but adds that there’s a need to understand software development as well as what clinicians do on a day-to-day basis.
He describes the process the programme has set in place as an incremental approach but emphasises: “Incremental does not mean slow. We have to have something hitting the clinicians that they value and that brings benefits every six months.”
Individual Health Records in Gwent
An example of this style of development has been happening in Gwent where individual health records (IHRs) have been piloted. The IHR contains patient’s personal details and limited clinical information including current medication, major problems and referrals – rather like England’s summary care record.
The information comes from the patient’s GP record system and the immediate aim was to benefit patients in out-of-hours (OOH) and emergency consultations, improving safety, efficiency and the clinical and cost effectiveness of healthcare delivery. It was decided that the information would only be available to clinicians working in OOH and emergency settings.
After a planning and consultation period from May to November 2006, Gwent went live with the system on time and within budget and by the end of May this year patient information from the majority of GP practices in Gwent was included.
Thomas comments: “We’re just beginning to bridge the gap between primary and secondary care with individual health records. We’ve got an orderly queue of communities who want what we’ve done in Gwent.”
Gwent along with the other five Welsh health communities – North Wales; Mid and West Wales; Bro Morgannwg and Swansea; Cardiff; Ponypridd and Rhondda – came under scrutiny from IAG members during visits to the communities and in feedback sessions at the conference afterwards.
E-Health Insider sat in on Gwent’s feedback given by Johan Beun, ambassador for the Dutch National ICT Institute for Healthcare, who declared himself astonished by the preparation for the event and the openness he had encountered. “We admire your transparency,” he said.
Beun praised Gwent’s pragmatic approach to moving information across clinical boundaries and its approach to difficult issues of information governance.
But he was not uncritical and urged a greater effort towards a reduction in ‘bricks’ – hospital buildings – and more home delivery of care services, supported by information systems.
Welsh Clinical Portal
Keeping up the pipeline promised by Thomas, in the coming weeks, version one of the Welsh Clinical Portal, developed through a similar process, will be launched. This will offer authorised staff the facility to:
– request pathology tests,
– view pathology results,
– view scheduled inpatient and day cases
– view patients specific to them (My Patients)
– view patient demographic details
– view previous care events.
Further information and features will be added as each new version of the portal comes online.
Open door to the policymakers
On the broader canvas, Thomas says that the Gwent development and others fit well with NHS Wales’ health and social care strategy, Design for Life. He has a relatively small central programme costing £20m in revenue annually and bids for capital through the general capital planning process
He says he finds an ‘open door’ when taking plans to the policy makers.
“The whole of the healthcare policy is really in that direction and we’ve got to be ready…when people come to me – as they are beginning to do – we have got to be ready with a solution that’s tried and tested,” he said
The biggest challenges lie in supporting the management of long term conditions and minimising hospital admissions, he says, providing a familiar analysis of the issues facing most Western health systems. Wales does, however, appear to have a clear development route to provide some of the solutions.
“It’s not a spend on IT – its on healthcare; the real business case is the case for changing healthcare,” says Thomas.
Linda Davidson