A patient-centred route to NHS IT success

Friday, January 29, 2010

As Wales embarks on its plan to modernise its health service, Mike Lowe speaks to Dr Gwyn Thomas, the man leading the modernisation, about how his approach will deliver success with a lot less controversy

The Welsh NHS has a common problem. For a clinician to work well, he or she needs as much information as possible to make those important decisions regarding patient care.

Unfortunately information is currently "fragmented" and held in silos. But in this age of technological reform, the Welsh NHS is not standing on its laurels and is implementing a new system providing instant access to health records online.

Called the Welsh Clinical Portal it will help Wales's NHS staff care for patients better, by giving them instant access to much more information.

"The best way of describing the portal is to regard it as a sophisticated web service that works in a similar way to sites like Amazon. But it has been designed by doctors and nurses working in NHS Wales to help them in their day-to-day work," says Dr Gwyn Thomas, chief information officer for the Welsh Assembly Government.

Initially the portal will be used by those working in hospitals. Users will see information from the many different computer systems used in a hospital to support care, displayed as an electronic health record. In addition, users will be able to use the portal to advance their work, for example ordering blood or urine tests.

In the near future, clinicians will also gain access to a patient's individual health record, which provides a view of the patient's GP-held medical record. However information governance is yet to be sorted out; one of the bigger problems faced by the English National Programme for IT (NPfIT).

Yet when I address this potential pitfall, Thomas seems unconcerned, regularly repeating the fact that they have taken a user-centred approach – possibly also making a dig at England's unpopular and troubled approach.

"We've adopted an incremental strategy, which has been informed by learning from public sector programmes elsewhere," he says.

"Informing Healthcare in collaboration with healthcare professionals and patients, has developed a balanced model of individual consent that recognises the need to protect confidentiality while sharing information to improve the care each patient receives.

"Patients will be asked for their consent each time their medical information is accessed via the Individual Health Record. This has proved to work very well. The patient will have the option to 'opt-out' at this stage or at any time in the future, if they so wish. In Gwent, out of around 500,000 patients only 50 have asked to opt-out."

He adds: "It's important to note that our approach is to share information only within local health communities. The idea is to make sure necessary information is available to local health care providers, where it is most needed."

Thomas says that from the start Informing Healthcare's approach has been on delivering benefits for patients through small service improvement projects. This has allowed them to adapt and learn from new ways of using or linking information.

"Once we know they work and meet the expectations of both clinicians and patients we then move ahead with a national solution. This is the approach taken for the Welsh Clinical Portal, My Health Online and the Individual Health Record," he says.

The biggest surprise from Wales's NHS plans is not its user-centric approach, but its cost. The NPfIT's bill, although a far larger project for approximately 51 million people, comes in at £12.7bn. Whilst Connecting for Health could not confirm a figure for the patient records part, it is easy to assume it could be in the billions.

But the Welsh Clinical Portal, which will provide clinicians with a detailed record for three million people, has an estimated cost so far of just £2.5m.

Thomas says that the cheapness is explained by economies of scale, but he also believes the simplicity of the Welsh system is key.

"Wales is a country with a population of three million, which experts agree is the most suitable size to deliver a successful large-scale IT programme. Wales also operates a traditional model of the NHS. There isn't an internal market, there are no foundation trusts. The emphasis is on collaboration and participation, and the recent NHS re-organisation in Wales has put in place structures that will bring primary and secondary care together to achieve the overall objective of providing integrated care for patients," he says.

"As mentioned previously, we have taken a step-wise approach to delivering new systems. Our focus has been on small service improvement projects that allow us to adapt and learn from new ways of using or linking information. And we don't act alone; everything we do involves people who are working in the field delivering frontline care.

"It's also a cost-effective form of delivery that's quick, adaptable, reduces risk and ensures the people using the systems get what they want."

Thomas also believes that the new portal will help health professionals deliver a better experience for the patient. He explains that it should avoid duplication between health professionals, enhance patient safety with more information available, speed up the process of diagnosis without hindering quality and increase efficiency as many functions will be standardised to help staff perform at 100 per cent at whatever hospital they work.

Implementation planning to roll out the first phase of the Welsh Clinical Portal is now underway with all of the seven local health boards and Thomas expects these plans to be developed by March.

What plans the Welsh NHS have following the implementation are suitably vague however, with Thomas merely confirming that investment in IT will be led by the benefits delivered to patients and staff.

He says: "Over time the portal will enable staff to carry out an increasingly wide range of tasks and the scope and extent of its deployment will be driven by their requirements and the need to deliver benefits to patients."