Progress on Healthcare IT Developments in Wales Cheryl Way National Pharmacy and Medicines Management Lead Informing Healthcare

Language Lesson ENGLISHWELSH Department of Health (DOH)Welsh Assembly Government (WAG) Connecting for Health (CfH)Informing Healthcare (IHC) National SpineWelsh Clinical Portal (WCP) Summary Care Record (SCR)Individual Health Record (IHR) HealthSpaceMy Health on Line (MHOL)

1 Assembly 10 Trusts 22 LHBs 135 Hospitals 15,000 Beds 81,000 Staff 3,000,000 Patients ~ £3bn Budget ~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 Health Record e-referrals/ discharges (SCI gateway) My Health Online Patient access -- over the internet Current hospital systems Radiology IS Laboratory IMS Prescribing Scheduling Ordering New hospital/ community systems Clinician access -- where care is 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 1 st 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 30 th 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 FunctionsPhoneCall-inOnline Prescriptions8.9 mins6.8 mins4.7 mins Appointments15.9 mins8.7 mins4.8 mins Queries10.1 mins8.4 mins4.1 mins

My Health Online Benefits – GP surgery time estimates * Feedback from 3 practices on MHOL pilot Prescri ption items per person p.a. % of repeat items Repeat items per practice (6000 list size) Repeat prescri ptions per practice – 10% take up Minutes saved per practice (1 min per item)* Weeks saved p.a. % FTE saved p.a %

Pilot Link EDS to Transcribing Medicines strategic approach: Summary Deliver transcribing 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 Portal Transcribing Inform Business Case for E-Prescribing in Wales 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 to Transcribing Medicines strategic approach: Summary Deliver transcribing 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 Portal Transcribing Inform Business Case for E-Prescribing in Wales 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

Transcription (Create) Next > CancelAdd Edit Stop Counsel Clinical Check Medication Stopped on this Admission MedicationStatusReasonDate Bisoprolol 2.5mg tablets: Take ONE tablet TWICE DAILYStoppedPt bradycardic29/4/08 Current Medication MedicationStartedStatusCCSSCI Irbesartan 150mg capsules: Take ONE DAILY1/4/08ContinuedDR28 Atorvastatin 40mg tablets: Take ONE at NIGHT28/2/08Continued!POD Bendroflumethazide 2.5mg tablets: Take ONE DAILY6/2/06ContinuedDR Allopurinol: 300mg tablets : Take ONE DAILY1/2/98Continued! Clarithromycin 250mg tablets:Take ONE tablet TWICE DAILY19/4/08Started on admissionDR14AC Re-startNote Pharmacy Note DateDrugNoteInit 01/05/2015Atorvastatin 40mg tablets: Take ONE at NIGHTConsider stopping whilst patient is taking calrithromycinDR 01/05/2015Allopurinol: 300mg tablets : Take ONE DAILYPatient stated that they have stopped taking this Drug. Please review.AC

Pilot Link EDS to Transcribing Medicines strategic approach: Summary Deliver transcribing 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 Portal Transcribing Inform Business Case for E-Prescribing in Wales 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 address  Electronic Transfer of Claims (ETC)  To the Prescribing Services Unit (PSU) of Health Solutions Wales (HSW)