Improving Care through ICT

NWISBackground

In the past, information about patients - the illnesses they have had, when they had operations or injections, what medicines they are taking – was written down and kept in files at their general practitioner’s (GP) surgery and in hospitals where they have been treated.

The problem was that files sometimes got lost or information was split up in files in different hospitals or different departments so no-one could see the whole picture.

GP Practices and hospitals have increasingly been using computers to improve the way they keep information about their patients – but they have been using separate systems which often cannot exchange information very easily. 
 
Information systems are now being updated to help to improve healthcare services for all patients in Wales. In other words, to make sure that the doctors, nurses and other health professionals have the information that is most important to help them make the best decisions about the patient, their illness and their treatment . 

As part of NHS Wales Healthcare Reforms programme, the Minister for Health and Social Services approved the development of an integrated information service for Wales in May 2009.
 
On 1 April, 2010 the NHS Wales Informatics Service (NWIS), was established. It brings together Informing Healthcare (IHC), Health Solutions Wales (HSW), Business Services Centre (Information Management and Technology element only), Corporate Health Information Programme (CHIP) and the Primary Care Informatics Programme (PCIP).

The new organisation is under the overall direction of the Chief Information Officer of the Welsh Assembly Government (WAG).

The new NWIS organisation is responsible for both the strategic development of Information Communications Technology (ICT) to support the transformation of NHS Wales’ services and the delivery of operational services.

 

Policy Context

The ICT Strategy for the Public Sector in Wales sets out the technical approach, architecture, infrastructure and standards needed to implement Delivering a Digital Wales.
Informing Healthcare” (2003) established the Welsh Assembly Government‟s vision to transform healthcare in Wales through the introduction of tools and techniques appropriate to the information age. This has led to the formation of the NHS Wales Informatics Service and the concept of common ways of working with ICT across NHS Wales.

In 2005 the Welsh Assembly Government published its vision for world-class health and social care in Wales in “Designed for Life”. This strategy seeks to recast the role of all elements of health and social care in Wales and develop a more corporate approach within the NHS and with its partner organisations. The new ways of working envisaged in “Designed for Life” will be most effectively supported by and information and communications infrastructure that is also more corporate planned and managed.

The “Healthcare Standards for Wales” (2005) defined a series of standards to improve the quality of services for patients. Standard 12 requires that treatment and care “is
integrated to provide seamless service across all organisations that need to be involved, including social care organisations”. Standard 25 requires information technology to also be integrated.

 

Services

 

Programmes/Initiatives

The Individual Health Record is a Welsh Assembly Government initiative that allows important patient information to be shared between GPs, emergency care and out of hour’s services. It gives an electronic view of key information held on the GP’s practice computer system. You can find out more information from the links below:

 

 

My Health Online will give patients the opportunity to book GP appointments, order repeat prescriptions, update their general details such as change of address, keep a health diary and make it easier to organise their healthcare, all from the convenience of their home computer.

 

 

Doctors, nurses and health professionals working in hospitals rely on a combination of computer systems and paper records to record information about patients and their care. This helps them provide treatment to those in need of it. Historically there have been separate systems dealing with different information such as test results, discharge letters, referrals and administration details. These systems don't usually 'talk to one another', which means that doctors and health staff have had to log into different computer systems and refer to paper records during the course of the day. 
 
To address this, NHS Wales Informatics Service (NWIS) is developing the Welsh Clinical Portal. It is a secure healthspace uniting key patient information from the many computer systems and databases used in NHS Wales, such as those found in pathology, radiology, cancer and primary care settings.

An electronic referral system is being rolled out across Wales during 2010. Known as the Welsh Clinical Communications Gateway it allows clinical messages to be sent securely from the GP to the hospital.

 

The Enterprise Master Patient Index (EMPI) is a system that makes it easier to ensure patients are correctly identified and minimises the number of duplicate health records held for each patient.

A new national pathology Laboratory Information Management System (LIMS) will allow health professionals to see all previous tests conducted for a patient, and to request new tests, no matter where they are in Wales. It will reduce the number of duplicated tests and will mean that, no matter where a patient receives care, the results of tests will be readily available.

 

 

A new, fast health and drug alerts service for community pharmacies in Wales, was launched on1 October 2010. It replaces the previous system of postal and fax alerts and aims to improve patient safety by giving community pharmacies immediate information about drug recalls and hazard alerts.

To help deliver and drive improvements across Wales the Chronic Conditions Management Demonstrator Programme has been established to with an aim to provide and test a sustainable, affordable generic CCM service model, that supports people's needs locally and promotes independent living within the community in order to communicate and inform service change across Wales.

A Carmarthenshire Demonstrator project explored how telehealth technology can be used to detect changes in conditions at an earlier stage in order to reduce the impact of exacerbation on patients as well as on health care services.

The Cardiff Demonstrator has been making pro-active use of the Predictive Risk Stratification Model PRISM tool to identify high risk patients who will benefit from the Clinical Case Management Service and so improve outcomes and referrals management. Prism is a software tool that provides GP practices with a list of patients ranked according to their percentage likelihood of emergency admission to hospital within the next 12 months.

Diabetes is a complex condition, and therefore one that requires a multi-disciplinary team, working on different sites and often in the community. People living with diabetes expect clinicians to have timely and accurate access to their information, no matter what the setting, but this is often not the case.

 

 

Throughout treatment, a patient with cancer is cared for by a number of different specialists, and often in a number of different hospitals. Every time the patient sees their doctor or specialist — or has a test carried out — information is produced which needs to be stored and shared by all those providing care. 

The 1000 Lives Plus Campaign Patient Identifiers programme aims to support organisations to reduce harm through patient identification errors.

Publications

The NHS Wales Informatics Service website contains links to IT related publications and reports.

The presence of duplicate patient records on IT systems is recognised as one of the single biggest risks to patient safety. Therefore, minimising the presence of duplicate records and eliminating the opportunity for creating new duplicate records is essential in the provision of safer patient care. The 1000 Lives + Campaign has produced a guide to help reduce patient identification errors.

 

 

Research

NWIS and the Centre for Health Information Research and Evaluation (CHIRAL) at Swansea University are working together to create a world class Health Informatics Research Laboratory.