Progress on Healthcare IT Developments in Wales

Cheryl WayNational Pharmacy and Medicines

Management LeadInforming Healthcare

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ENGLISH WELSH

Department of Health (DOH) Welsh Assembly Government (WAG)

Connecting for Health (CfH) Informing Healthcare (IHC)

National Spine Welsh Clinical Portal (WCP)

Summary Care Record (SCR) Individual Health Record (IHR)

HealthSpace My Health on Line (MHOL)

1 Assembly

10 Trusts

22LHBs

135Hospitals

15,000Beds

81,000Staff

3,000,000Patients

~£3bnBudget

~2000 GP

Practices

NHS Wales

To make a shared view of clinical care available across NHS Wales:

An incremental approach – “the individual health record”

To support and coordinate the redesign of working practices to deliver patient benefits:

Service improvement projects

To create a ‘world class’ technical infrastructure so that information can be shared securely irrespective of organisational boundaries:

A national technical blueprint or architecture

Informing Healthcare - A national programme funded by the Welsh Assembly Government

GP systems (lifelong record)

Welsh Clinical Portal

Individual HealthRecord

e-referra

ls/

discharges

(SCI gateway)

My Health Online

Patient access-- over the internet

Current hospitalsystems

•Radiology IS•Laboratory IMS•Prescribing•Scheduling•Ordering

New hospital/community

systems

Clinician access-- where careis delivered

A Shared View of Care

Welsh Clinical Portal

A web “home-page” linking health computer systems

Will give healthcare staff a common way of accessing varied systems that support patient care in hospital

Will be standardised across Wales Version 1 being tested in Cardiff and Carmarthen Designed in consultation with health professionals Being built by trust developers

Individual Health Record (IHR) in out-of-hours (OOH) care

Started in Gwent (SE Wales) in November 2006 79 of 96 GP practices share information with OOH service Access via the Adastra system 462,983 records available > 1 in 7 people in Wales

Next Steps Anglesey/Gwynedd (NW Wales) Ceredigion/Pembrokeshire (SW Wales) Going Live 1st July 2008 800,000 patients by Summer 2008 All Wales 2010

IHR in out-of hours (OOH) care - Benefits

A survey of clinicians working in the Gwent out-of-hours service showed that:- >70% felt the IHR helped them provide tailored advice to

callers 80% felt this when dealing with older patients or those

with chronic conditions

It is helping out-of-hours GPs reduce the number of callers referred to A&E or for hospital admission

Individual Health Record (IHR) in Unscheduled Care

Extended coverage within Gwent Went live in the Medical Admissions Unit at

the Royal Gwent Hospital on 30th April 2008 Access restricted to MAU staff Includes MAU pharmacists Pharmacists “very excited” about the information

available to them on admission

My Health Online

Trials started at 5 GP surgeries in October 2007 Anglesey Bridgend Cardiff Llandysul Swansea

Patients can use the internet to Book appointments Request repeat prescriptions Access their own records (3 surgeries)

My Health Online Benefits – patient time estimates

Functions Phone Call-in Online

Prescriptions 8.9 mins 6.8 mins 4.7 mins

Appointments 15.9 mins 8.7 mins 4.8 mins

Queries 10.1 mins 8.4 mins 4.1 mins

My Health Online Benefits – GP surgery time estimates

* Feedback from 3 practices on MHOL pilot 2007-8

Prescription items per person p.a.

% of repeat items

Repeat items per practice (6000 list size)

Repeat prescriptions per practice – 10% take up

Minutes saved per practice (1 min per item)*

Weeks saved p.a.

% FTE saved p.a.

21 75 94500 9450 9450 4.5 9%

Pilot

Link EDS toTranscribing

Medicines strategic approach:Summary

Delivertranscribing

via the portal

E-Prescribing of Chemotherapy

Electronic Medicines Management System

Drug Coding

E-Prescribing Service Improvement Project

Central Hosting of EDS System

Conversion

Development

Drug Code

Mapping

Fact Finding, Specification &Procurement

Implementation

Fact Finding, Specification &Procurement

Implementation

Implementation

Portal Transcribing

Inform Business Case for

E-Prescribing inWales

Transcribing

E-prescribing

Pharmacy

Hospital Pharmacy System Upgrade

EDS pharmacy system used in all trusts except Swansea (JAC and ASCribe)

Trust servers last replaced in 1999, now failing System software rewritten in Cache in 2007 Hosted on three central servers at two sites,

managed by Health Solutions Wales (HSW) Now live in five of the eight affected trusts Roll out across Wales by mid 2008 Benefits – system resilience from back-up servers Risks - network failure

Pilot

Link EDS toTranscribing

Medicines strategic approach:Summary

Delivertranscribing

via the portal

E-Prescribing of Chemotherapy

Electronic Medicines Management System

Drug Coding

E-Prescribing Service Improvement Project

Central Hosting of EDS System

Conversion

Development

Drug Code

Mapping

Fact Finding, Specification &Procurement

Implementation

Fact Finding, Specification &Procurement

Implementation

Implementation

Portal Transcribing

Inform Business Case for

E-Prescribing inWales

Transcribing

E-prescribing

Pharmacy

Electronic Transcribing

Used by pharmacy staff to manage patients’ medicines from admission to discharge

Used as a reconciliation tool on admission (NICE, 1000 lives) Tracks changes to patients’ medication during in-patient stay Used to populate medication list at discharge

Sent electronically to GPs +/- community pharmacists?

Produces a reminder chart for patients Based on the e-script system developed in Shrewsbury using

FDBE’s Multilex drug file Will be accessed via the Welsh Clinical Portal Will be interfaced with EDS pharmacy systems

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Clinical Check

Medication Stopped on this Admission

Medication Status Reason Date

Bisoprolol 2.5mg tablets: Take ONE tablet TWICE DAILY Stopped Pt bradycardic 29/4/08

Current Medication

Medication Started Status CC SS CI

Irbesartan 150mg capsules: Take ONE DAILY 1/4/08 Continued DR 28

Atorvastatin 40mg tablets: Take ONE at NIGHT 28/2/08 Continued ! POD

Bendroflumethazide 2.5mg tablets: Take ONE DAILY 6/2/06 Continued DR

Allopurinol: 300mg tablets : Take ONE DAILY 1/2/98 Continued !

Clarithromycin 250mg tablets:Take ONE tablet TWICE DAILY 19/4/08 Started on admission DR 14 AC

Re-start

Note

Pharmacy Note

Date Drug Note Init

18/04/23 Atorvastatin 40mg tablets: Take ONE at NIGHT Consider stopping whilst patient is taking calrithromycin DR

18/04/23 Allopurinol: 300mg tablets : Take ONE DAILY Patient stated that they have stopped taking this Drug. Please review. AC

Pilot

Link EDS toTranscribing

Medicines strategic approach:Summary

Delivertranscribing

via the portal

E-Prescribing of Chemotherapy

Electronic Medicines Management System

Drug Coding

E-Prescribing Service Improvement Project

Central Hosting of EDS System

Conversion

Development

Drug Code

Mapping

Fact Finding, Specification &Procurement

Implementation

Fact Finding, Specification &Procurement

Implementation

Implementation

Portal Transcribing

Inform Business Case for

E-Prescribing inWales

Transcribing

E-prescribing

Pharmacy

Welsh Assembly Government Primary Care IM&T Programme

Community Pharmacy IM&T Programme Electronic Transfer of Prescriptions (ETP)

2DRx project for Wales

Connectivity to Health of Wales Information Service (HOWIS)

NHS e-mail address Electronic Transfer of Claims (ETC)

To the Prescribing Services Unit (PSU) of Health Solutions Wales (HSW)