Presentation on theme: "The Individual Health Record in Wales"— Presentation transcript:
1The Individual Health Record in Wales Cheryl WayPharmacy & Medicines Management LeadInforming Healthcare, WalesWith thanks to Farzana MohammedMedical Admissions Pharmacist,Royal Gwent Hospital
2Content What is the Individual Health record (IHR)? Evaluation in a Medical Admissions UnitFuture roll-out plansI’d like to talk about the following today…
3Language Lesson ENGLISH WELSH Department of Health (DOH) Welsh Assembly Government (WAG)Connecting for Health (CfH)Informing Healthcare (IHC)Summary Care Record (SCR)Individual Health Record (IHR)The project is the result of close collaboration between GHNHST which includes x number of hospitals and X no of practicesInforming Healthcare Informing Healthcare is a Welsh Assembly Government programme set up to improve health services in Wales by introducing new ways of accessing, using and storing informationBMA and LMC involvement along with clinicians from Gwent trust and the Community Health Council
4GP Systems / Community nursing records A Shared View of CareIndividualHealthRecordWelshClinicalPortalE referralsDischarges -Welsh ClinicalCommunicationsGatewayGP Systems / Community nursing recordsCurrent hospital SystemsNew hospital & community ServicesMy Health OnlineORDERINGRADISLIMSPRESCRIBING
5What is the IHR?The IHR is an extract of the patient’s GP record held on a central repository.The IHR is a view only product.The IHR is an extract of the GP record. It is uploaded on a nightly basis into a secure data repository.Those able to view the IHR are not directly accessing the GP record but are viewing the extracted data using the GHNHST trust’sown Clinical Workstation.The data included in the IHR was agreed following consultation with clinical staff and patient representation.
6What is in the IHR? Name, address and contact details Current problems or diagnosis , medical historyCurrent medication, repeat medicationAllergies or contra-indicationsTest results (haematology, biochemistry, microbiology)Examination Findings (blood pressure, ECG)GP encounters, referrals/admissions, operationsVaccinations/immunisationsStaff user survey – the information accessed most often highlighted
7Individual Health Record (IHR) in out-of-hours (OOH) care Started in Gwent (SE Wales) in November 200683 of 94 GP practices share information with OOH serviceAccess via the Adastra system503,192 records available (85% of Gwent pop.)> 1 in 7 people in WalesNext StepsPlans for roll out across Wales approved Jan 2009Ceredigion/Pembrokeshire (SW Wales), DecemberAnglesey/Gwynedd (NW Wales)
8Individual Health Record (IHR) in Unscheduled Care Extended coverage within GwentWent live in the Medical Admissions Unit at the Royal Gwent Hospital in May 2008Access restricted to MAU staff, Including pharmacistsGet info from Frazana on use in practice
9and up to 20% of adverse drug events in hospital Why do we need it?IHI research has shown that poor communication of information at transition points is responsible for as many as 50% of all medication errorsand up to 20% of adverse drug events in hospital(IHI 2004)An IT solution to overcome the difficulties in getting drug/medical histories from patients in emergency careGwent trust involved in phase 2 SPI projectNICE guidance – only trust in Wales to have all 3 NICE solutions in placeNb a solution to the problem of medicines reconciliation – not an answerThe key is the prescriber using the tools available
10Clinical staff in RGHMAU can view an extract of the GP patient record providing the practice is onboard and the patient gives their consent. In RGHMAU the portlet is Clinical Workstation10
11Security ADMISSION VIA A&E, BED MANAGEMENT ROBUST AUDIT Patient must be currently admitted on MAUUser must be on MAU computerUser needs CWS loginUsers require a log on to the hospital computer system.Users are limited to consultants, doctors, nurses and pharmacists working on RGHMAU.Users can only log onto the IHR if they are on a designated computer within the RGHMAU.Users can only access an IHR for a patient who had been admitted onto the RGHMAU.Users must seek the consent of the patient before accessing the IHR. (Emergency/Persistent Consent available)Users are able to view those users who have previously accessed an IHR and flag any suspicions to GHNHST Head of Information Governance.There is a robust automated audit checking every access to the IHR. The weekly outputs are scrutinised by the GHNHST Head of Information Governance.Opt-out of patients are checked to ensure compliance.VIEW LAST 10 USERSPATIENT CONSENTROBUST AUDIT
15Benefits Feedback from Users Staff SurveysAudit trailPharmacy data collectionVideo interviewStaff surveys:Better documentation in patient notesMore complete drug histories in clerking notes – less omissionsMinimal requests for drug history information on PTWRLess pressure on patients to remember drug doses/strengthsWhen can we have IHR on medical wards?
16Access ratesAccess rates do not differ between weekdays and weekend days.Access is more frequent overnight/early morningIncreased access due in part to +72 hrs – end June 08
17Improvements Expand access time from admission to 72hrs Add persisting consent
19Two week data collection periods: Pre- Go LivePost- Go Live3 months- Post Go Live6 months- Post Go LivePharmacy visit ward 8.30am-1pm Mon-Fri8.30am-10am Sat and 9.30am am on SunMAU 11 TrolleysWard D1W 24 BedsAccess for all patients with an IHR available
20The data collection undertaken by pharmacy showed both benefits and issues Pre- Go Live – Base line dataPost- Go Live – Introducing system saved 1hr of time to phone GPs3 months- Post Go Live – 72 hr access increased use of IHR and reduced 50 min time (static number of calls – due to IHR unavailable)6 months- Post Go Live - static number of calls due to drug history taking technician making calls (more practices signed up, less IHR unavailable)
21Problems / Resistance Resistance from GP practices to opt in Secondary care clinician engagement in trainingInterpretation of data on IHRNavigation of system – Two foldersQuality of IHR dataNo access for Pharmacy TechniciansThere are still some issues to be resolved.....Resistance from GP practices to opt in – was mainly an issue in Welsh/ English border counties and now 'No' practices are relatively very few (more practices joined as concerns are addressed) – can lead to high levels of IHR unavailableDifficulty in training clinicians – suboptimal use of productQuality of data – What is put into an IT system is reflected by what you get out!GP records – housekeeping issuesMedicines reconciliation at transfer of care settings – quality of data sent from secondary care to primary care will reflect on Quality Of IHR data for future admissions
23Future Plans for Roll Out Plans to roll-out the IHR system were approved by Health Minister Edwina Hart on 7th January 2009.Initially, the information will be shared between local GP surgeries and local unscheduled care providers.
24IHR National Update IHC is working with GP system suppliers in Wales Demonstrator tested products from EMIS, INPS and i-SOFT – all invited to provide a solution for IHRINPS have been awarded an extension to contractTo deploy in GP OOH in SW Wales in DecemberIHC continues to work with all 3 GP system suppliersIHR content model defines data requirementsGwent project continues until national solution available
25Further Information“When Pharmacists in MAU gained access to patients’ GP records”, Farzana Mohammed, Clinical Pharmacist, September 2009, p 370Cheryl WayNational Pharmacy and Medicines Management LeadInforming HealthcareTelephone