Life outside NPfIT: Wales

While the spotlight remains on the English NPfIT, massive IT reforms are also taking place on the other side of Offa’s Dyke.

The Welsh health IT strategy, Informing Healthcare, was officially launched in December 2003, after the Welsh Assembly consulted stakeholders about how the previous information strategy, ‘Better Information – Better Health’, could best be improved.

The new information strategy for improving health in Wales became government policy, and the Informing Healthcare programme was introduced after the Wanless Report recommended its implementation.

One of the most important characteristics of it, according to its owners, is that it concentrates more on the information than the technology – it views technology only as a tool for improving access.

The project is overseen by the Strategy Implementation Programme (SIP). Board members are weighted quite heavily towards clinicians and healthcare professionals; also represented are the volunteer sector, unions and patients through the Community Health Councils that Wales decided to keep.

Informing Healthcare is structured into five key areas, all with the focus on actually delivering benefits to the Welsh health service and its patients: the Single Record (the Welsh electronic health record), workforce empowerment, patient and carer empowerment, service improvement, and knowledge management.

Bob Grindrod (right), the interim programme director of Informing Healthcare, told E-Health Insider that his own focus was on the spread of information rather than the march of technology.

“I have very mixed feelings about the word ‘e-health’,” he says, explaining that it gives the impression that healthcare can be delivered by technology alone. Instead, people are the key building blocks. “It’s a democratisation, by trying to encourage people to take more control of their lives, their health, their relationship with the health service. We’re really providing people with the tools."

However, for people to use the tools, they must be empowered. The Strategy Implementation Programme, under the leadership of Ian Kelsall, has done its utmost to involve as many stakeholders as possible; even through electronic voting. The ‘All Wales Clinician Survey’ is taking place to canvass opinions on projects such as the Single Record, and a Stakeholder Engagement Strategy is currently in consultation with a closing date of November.

If consultation takes place in this way, Grindrod says, then more people co-operate: “It works because you get ownership. The problems in change management actually require you to understand deeply what goes on every day. The best people to do that are actually clinicians.  You can’t just send the systems analyst in there to research. We do have to empower our own people."

“We have quite a big emphasis on empowering the workforce, and an emphasis on empowering patients – to help them engage in the decision making process, to see their own records, to start to feel part of the team."

“We are very committed to trying to engage people. We have got some expert project management in the Informing Healthcare team."

Patient concerns over confidentiality have been noted, according to Grindrod, and this is closely linked in with access to their own information – after all, what use is an information strategy if the main stakeholders, the patients, can’t get to the information? “We all passionately believe that everybody should see their own health record," says Grindrod.

The Single Health record is most likely to have audited access: “Nobody should see the information without the patient knowing that people have seen it," asserts Grindrod.

Adverts and literature for patients explaining the issues around electronic records are being planned, so they can make informed decisions, as well as continuous surveys to map how people’s views change.

This is why it’s still early days for procuring the technology – a business case for all five areas has yet to be completed, although work has begun on an outline for the Single Record. But as Grindrod points out, the structure of the project is a special case for suppliers. "You are collecting quite deep information. It’s not that easy to extract it with a stock IT system. We have open data structures, and so on.

“The information is owned by us, and suppliers are providing applications into that. That’s a tall order, and that’s asking for something potentially different to what’s gone before."

Training

The European Computer Driving Licence (ECDL) is becoming part of training for healthcare staff under the new project. “We are aiming to get everybody trained to the standard,” says Grindrod. “At some point in the future we would hope that it becomes an entry qualification."

However, in tandem with the aim of the strategy – to improve healthcare through information as well as technology – training does not stop there. “Using the computer is one thing, but teaching people about the best ways of collecting, ordering and analysing information is quite critical," says Grindrod.

“One of the biggest culture changes is that you are no longer collecting information for you to keep but for the team to use in the future. Healthcare is a team game now. Nobody gives healthcare on their own."

A concern many people have with different IT strategies in each British country is that transfer of data and integration of services, particularly electronic health records, will be difficult. Bob Grindrod, however, is adamant that the Single Record system in Wales will be portable.

"We are not going to build something in Wales that makes it difficult for you to receive healthcare in England, and vice versa. You can rest assured that in all the procurement and planning processes we will be making sure that doesn’t happen.

“We need to make sure that information about patients in Wales is directly transferable to wherever it’s needed."