In the vault

Quin Parker

For the programme director of a national healthcare IT project, Dr Gwyn Thomas is surprisingly wary of talking about technology.

"We are trying to keep that in the vault," he says. "We currently don’t want that to be leading the programme."

Informing Healthcare, the Welsh health IT strategy, is coming up to its second anniversary since its official launch. Every six months, the implementation plan is to be revised and a new national case published.

Each revision of the implementation plan comes after a national conference; the December update is due after the second September National Architecture Week conference, at which over fifty senior clinicians and fifty senior healthcare IT professionals were in attendance.

"We are regularly going though a series of events over two or three days and we will make them regular decision-making events," explained Dr Thomas. Groups of people are sent away to investigate and report back to delegates on various issues.

"We set up straw men. We set up a number of working groups who then come back and tell them how that can be improved."

Contents of new strategy

The imminent December update of the Informing Healthcare strategy will be one of the most important yet in the programme as it will reveal some of the first target dates for implementations.

Dr Thomas stresses that the dates will not be set in stone and will depend heavily on individual sites: "What determines the timescale is the scalability of the local organisation."

Another key element of Informing Healthcare agreed at the National Architecture Conference will be the content of the Individual Health Record. Originally built from GP records, it will not contain everything that has happened to the patient but will contain agreed important information.

The patient will have access to their own IHR through a branded site called ‘My Health On-Line’, and be able to see who has viewed their health records – the "patient’s way into the system", says Dr Thomas.

Prototypes are already being built and the first people to receive access to the IHR will be new mothers. "We are going to start off with mothers. They are used to have the paperwork given to them at the moment. We want to use them to trial the approach to the consent model."

"Its biggest payoff in the short term will be in emergency care."

One thing that will not be included in the implementation plan yet will be costings. "The national case will be the implementation plan," said Dr Thomas. "That national case will be supported by a business case. I want the investment to be determined by the business case." IHC has to give good value for money for the people of Wales, he says.

From local to national

Informing Healthcare is aiming to apply local plans and local ideas, under a scheme of ‘common by design, common by agreement, local by agreement’. This will be backed up by a National Design Authority for NHS, agreed overwhelmingly by clinicians and IT staff at the National Architecture Conference. The National Design Authority, which will comprise of healthcare IT design experts, will decide on how the architecture will work consistently across Wales.

If IT has solved a healthcare problem for a group of clinicians in Wales, Dr Thomas wants to know about it and find out ways to apply it across the country. "This is our attempt to exploit what has already been done. It’s not the information systems that people have delivered that we are after. We are after their understanding of the healthcare problems."

Service improvement projects are to be set up, based on these local groups and ideas, in order to focus on individual healthcare problems. The first, says Dr Thomas, will be in diabetes. "There are 5% of the population who are directly affected by diabetes," he says. "We can do a lot of good by better information and better deployment of technology."

IHC will be talking to suppliers soon – February is a possibility, says Dr Thomas – about working locally in these service improvement projects, through a series of supplier events.

"We want to make Wales commercially attractive," he says. "We want to try and strike a balance between innovation and standardisation." Too much standardisation and the programme will not be right for the people of Wales. Too much innovation will end up with unrealistic systems.

What happens if something doesn’t work in the way it should? Dr Thomas explains that problems ought to be nipped in the bud because of the senior clinicians and IT professionals regularly reviewing progress: "The way you manage this risk is that you take small steps but make them as rapid as possible."

"I don’t know of any other programme that revises its implementation plan every six months," says Dr Thomas.

Progress so far

So far this year, Informing Healthcare has spent around £28m. In the first two years of its existence, around 75% of its budget has been spent on improving local services and preparing the ground for electronic records and new processes.

For instance, Dr Thomas says, data quality of records held at GP surgeries has been improved, and infrastructure projects have been set up such as Access to Learning, where all healthcare staff in Wales being offered free ECDL training, and Access to IT, where new IT systems are being put in place in care environments.

According to Dr Thomas, a key part of administering in the programme will be to know at what pace to carry it out.

Dr Thomas will not be drawn on comparisons between Informing Healthcare and England’s National Programme for IT (NPfIT). As the last chief executive of the now-dissolved NHS Information Authority (IA), he had a close view of the programme’s genesis and eventual absorption of some of the IA’s work.

"The first important point is we do not want to be defined by what we are not. This is a home-grown solution. We are doing it that way because it works for Wales."

"There are significant differences between what Wales want to do and what England wants to do and that sets the tone for all of the programme," he says.

However there would not be any disadvantage to patients who are having care delivered in both countries, he said – as often happens with patients in both north and south Wales being referred to hospitals across the border in Chester and Bristol. IH is in regular touch with the National Programme for IT, says Dr Thomas.

Informing Healthcare will not be delivering Choose and Book, however. "We’re not doing the market approach to the healthcare problem," said Dr Thomas, adding that the main driver is and has always been patient safety.

Measuring success

This is how, therefore, the success of the programme will be measured – and indeed, how the programme will be formally announced and marketed to the Welsh public next year. "We are trying to get some measurable patient benefits. We want this programme to be measured by the delivery of benefits not the deployment of systems."

The success of the service improvement projects, and indeed the whole programme, will be judged by improvements in patient health, stressed Dr Thomas. And a public information campaign is being planned around the Individual Health Record "focused on the benefits of sharing patient information."

"We have appointed a clinician to set up a national patient identification and safety project," added Dr Thomas.

The IHC programme head is adamant that clinicians and healthcare staff who are not technically minded must be included in the programme, pointing out that both clinicians and IT staff are involved in the architecture conferences.

"This isn’t about technology," he says. "It’s a change management programme in which we’re using information and technology to support service improvement."

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