Andrew Griffiths readily admits that it was chance rather than planning that drew him into the NHS. “I shouldn’t use the word ‘accident’, but it probably was.”
After completing a degree in IT and computing, Griffiths found a job in a health authority, helping to implement a patient administration system at a number of hospitals.
He learned about medical records and how they were run by hospitals, while helping to deploy electronic records to organisations that were using them for the first time – gaining knowledge that he still puts into use today.
“I was really enthused about what IT could do for the health service, and I could see how much could be done; so it really grabbed me at the time.”
After a couple of years, Griffiths was moved into an internal promotion scheme, working with different departments to gain experience.
He then moved into a job looking after information and IT within a mental health trust, looking at how get information from community and social care to join up with the data it held.
After that, he became the deputy head of IT and informatics for an NHS trust, before making a move into the private sector, working for a company providing services back to the NHS.
While Griffiths hoped he would welcome the change of approach, he says the pull of the public sector was too strong to ignore.
“Although I really enjoyed it and got involved in a lot of good stuff, I always wanted to be back on the other side of the table, making change and reacting to the needs.”
Around the time he was making his plans to return, NHS Wales was putting the final touches on its Informing Healthcare programme, which set out a national approach to the use of IT based on incremental development.
Griffiths had helped to develop the programme strategy before his departure, and returned into a role heading up the strategy’s various projects.
Following that, he was promoted to become Informing Healthcare’s chief operating officer, before receiving opportunity to become CIO and director of the NHS Wales Informatics Service just over three years ago.
Griffiths says the healthcare system in Wales faces similar challenges to those in England, with financial pressures, an aging population and a need to re-organise services so they can respond to both challenges more efficiently, without a big impact on quality.
However, he says Wales’ planned approach to delivering health care, which was introduced to replace the market-driven focus in England almost as soon as the country gained its own Assembly, means it is in a better position to focus on integration.
By extension, he argues that it is also in a better position to use IT and information to improve patients’ care by breaking down organisational boundaries.
“You could have an operation at one health board, but then a follow-up in outpatients at another health board; so you have to join up information across these boundaries that are actually artificial in many ways.”
Building on the foundations
Griffiths says the Informing Healthcare programme “laid the foundation” for health informatics in Wales, introducing a platform of core infrastructure and systems including a national patient administration system, radiology information system, and picture archiving and communications system.
“We came out of it with the building blocks we needed to have in place as we move forward.”
Most recently, NWIS has deployed a laboratory information management system across five of the seven Welsh health boards, standardising clinicians’ working practices and test references so the results can be easily understood.
“If someone’s tested in one place, you can see the result everywhere, and you can understand the result because it’s to the same standards.”
While the systems in place are important, Griffiths says what underpins them is equally vital; citing the enterprise master patient index and underlying archive directory for identifying staff as examples.
“There’s a lot of unseen things that are easy to take for granted, but it’s vital that they were put in place.”
Despite these successes, Griffiths and the NWIS are not resting on their laurels. A current focus is expanding the use and functionality of the Welsh Clinical Portal, which is intended to provide universal access to patient information such as test results, discharge letters and referrals.
“Although we’ve got several instances in place, we’ve not got all the functionality to make the roll-out complete,” he says.
Expanding the IHR
There are also plans to expand the Individual Health Record, the “much richer” Welsh equivalent of NHS England’s Summary Care Record, with a patient’s personal details, their medications and medical problems, recorded allergies and results of all recent tests.
The record is currently being used by out-of-hours services, but Griffiths says there is “huge demand” for it to be used in secondary care for admissions units.
“There’s a huge demand for it, because people have seen how useful it is: at the moment in emergency admissions, when someone comes in with a list of drugs but they don’t know which and how much of the drugs they’re on, it can take 24 to 48 hours to contact their GP and find out.”
NWIS is already running pilots in secondary care for the record, while it is also procuring an audit tool to monitor access to the record and ensure that information governance rules are being followed by staff.
The service is also improving its imaging systems, having procured a vendor neutral archive and started piloting it as an imaging back-up.
However, Griffiths says one of the most significant projects currently being worked on is a single community care information solution to integrate social care, community health and mental health services across Wales.
The solution, which will include care pathways, assessments, referrals and workflow, is currently out for tender and is due to be completed in December.
Griffiths says while there are still decisions to be made around the implementation and footprint of the system in each health board area, he has been heartened by the collaboration between health providers and local authorities working on the tender.
“We had to get a business case together across health and social care, and you get arguments and challenges. If you asked me 18 months ago whether we’d be in the position where we are today, I’d have hoped so but I wasn’t sure we would be.”
He has already received positive feedback, receiving a strong response when he discussed the plans at a recent conference.
“I was almost mobbed with people saying it’s absolutely what we need. They all know somewhere where people work in the same building but they don’t have access to the same information.”
Now for document management
Griffiths is also helping to develop the Welsh Care Records Service, an electronic document management system to hold documents from various systems and provide an integrated view of the whole health record without requiring significant integration.
“We’ve got a lot of departmental systems, so what we’re saying is that, rather than organising a lot of integration of systems, we publish to PDF. Then, as long as you get the correct metadata, you can publish to Welsh Care Record Service within the Welsh Clinical Portal.”
Griffiths says a significant amount of work has already been done on indexing and metadata standards, with the hope that the system will help the Welsh health system to move away from its current reliance on paper notes.
“We see this as a way to start starving the medical record, starving it of the paper going in.”
While reliance on paper is a problem across much of the Welsh system, primary care is leading the way with many practices already paper-light.
NWIS is currently upgrading its GP systems and infrastructure, with the work expected to be completed by summer next year.
While there were previously three GP suppliers for practices to choose from, Griffiths says there is now a framework contract with two – both centrally hosted rather than individually deployed.
“It’s easier to deploy new services and upgrades because it’s only deployed once in the data centre, rather than at each practice,” he says.
Political backing, common purpose
Griffiths says political support has been key to the success of the health informatics agenda, with health minister Mark Drakeford chairing a portion of the National Informatics Management Board’s meetings.
Drakeford announced a refresh of the informatics strategy earlier this year, and Griffiths says a set of principles are set to be published soon before the full document is released next year.
“We want to get to a place where we’re constantly updating the document and it’s more of a living document.”
Griffiths is quick to point out that the work has not been without its difficulties, but says the sense of collaboration between different organisations is a key part of Wales’ past, current and future success in health IT.
“Working together is hard, and I’m not saying it’s easy. There have been tensions in working together, but there is a determination to work together and you need that when the going gets tough.”
Andy Griffiths will be one of the keynote speakers at EHI Live 2014, where he will be talking about how Wales has taken a national approach to its healthcare IT.
Full details of the keynote programme at EHI Live 2014, which takes place at the NEC in Birmingham from 4-5 November 2014, are on the show’s website – along with information about the co-located conferences, feature areas and exhibitors. free and open now.