Testing, testing

A bright red sofa and a coffee table holding a Christmas biscuit selection are not the first things you expect to see in an IT research lab. But this homely scene is what greets visitors to Informing Healthcare’s new labs at Swansea University.

The sofa is the centrepiece of the “patient’s home” section of the labs, which were opened this summer to test new devices and software and to model how they can be used to support existing services and new ways of working.

“This is where a patient might call NHS Direct, or their local Out of Hours service,” says Informing Healthcare’s public relations manager, Gill Friend, pointing out that the “pod” also holds a phone, laptop, TV, and remote monitoring devices. “Or perhaps they will want to book an appointment, using My Health Online.”

Looks familiar

Informing Healthcare is the organisation responsible for IT in Wales. It is headed by Gwyn Thomas, who was chief executive of the NHS Information Authority in England, before it was disbanded when the National Programme for IT was set up.

Informing Healthcare has taken a very different approach to “digitising” healthcare to that taken by NHS Connecting for Health. Indeed, Dr Thomas cheerfully admits that “the approach we have taken is very, very similar to the old Information for Health strategy.”

IfH was the 1998 blueprint for NHS IT that created the NHSIA, funded the first NHS network and demographic services, and set targets for electronic health and patient records that were supposed to be achieved through “local implementation.”

Ten years on in Wales, this has translated into a focus on improving communications, infrastructure and desktops and an incremental approach to creating, piloting and rolling out projects to create an Individual Health Record, improve workflow between primary and secondary care, and link acute systems.

A walk around the labs highlights some of the projects in hand. So, across from the patient’s home “pod” is the kind of workstation that might be used by someone at NHS Direct or an Out of Hours service. “The idea is that whoever is working here can try new systems, like the IHR,” says Friend.

Unlike England’s summary care record, the IHR is drawn from the records held by a patient’s GP. There is no role-based access; patients are asked to give their consent every time the record is viewed.

The IHR was first used in Gwent’s Out of Hours service and is now being rolled out to a further four health communities. It has also been extended to one acute site: the medical assessment unit of Newport’s Royal Gwent Hospital.

Portals all round

Patients will have access to the IHR through My Health Online, a secure web-service that is being trialled by five GP surgeries. Many patients will still end up needing to see their GP, so a treatment room is the next “pod” mocked up at the labs.

“Our GP is very fortunate,” says Friend. “He or she is one of the first to be using the care information gateway we are working on with Scotland.” The gateway is a national system to integrate primary and secondary care systems. It therefore allows GPs and hospitals to exchange messages electronically.

So far, two practices in the Cardiff and Vale area have agreed to take part in a “proof of concept” trial of an e-referral system. Since Wales is consulting on how to remove the internal market from its health system, there is no “choice” element as there is in England.”

Back across the lab again is a pharmacy and a hospital ward, complete with a bed, screens, uniforms, and, of course, a PC, laptop and other devices. “This is where we look at improving and linking up different hospital systems,” says Friend.

One of Informing Healthcare’s biggest projects is a Welsh Clinical Portal; a web-based system that will give clinicians across the country access to different hospital systems and to carry out tasks such as ordering tests and medications.

The very first versions of the portal were designed, built and installed on computers at hospitals in Cardiff and Carmarthen last year. New versions – with enhanced functionality – are being designed at the labs and will start to roll out imminently.

“The portal is our solution to the old EPR with all its levels,” says Dr Thomas. “It captures the information that is available in different systems, makes it available to clinicians, and will eventually let them order tests or do whatever they need to do.”

As such, it sounds rather like the mystaffspace portal promised in England’s Health Informatics Review. Dr Thomas beams at the suggestion that the English NHS might be looking to Wales for ideas for improving its IT. “I would say our portal is the model for theirs,” he says. “We have also been talking to CfH about consent.”

Factors for success

It would be too easy to say that Informing Healthcare is succeeding where NHS Connecting for Health has failed, however. After all, the IHR is still only available in a handful of services and many other projects are still at “proof of concept” stage.

Dr Thomas himself says that “we have projects up and running and we have clinician engagement, because we have something that people can touch and feel. So I think we are at proof of concept stage or perhaps a bit beyond that – at the crossroads between pilots and things going national.”

However, he argues that the focus on infrastructure and data cleansing will stand Informing Healthcare and trusts in good stead as projects roll out. And he argues that Wales is well-suited to something like the old IfH approach.

“There is something about size: Wales is 3 million population and there is research saying that health record projects work best at up to 5 million people,” he says. “There is something about having a relatively small service, with close working relationships.

“There is certainly something about politics: our context is very different to England. And there is something about money.” According to its website, Informing Healthcare was due to invest £91 million in its first three years of operation.

But Dr Thomas argues: “Investment is not about putting in IT, it is about changing care. One of the problems with IfH was that it was off in one place, and the same might be said of CfH. We want to be part of the change process.

“And because we are taking an incremental approach, in some ways we do not want tons of money. You can cope with small amounts of money if you have a good blueprint for spending it.”

Back to the lab

The labs fit into Informing Healthcare’s wider approach. Their servers can run all the patient administration and other IT systems now in use in Wales. Informing Healthcare can look for gaps and issues and test how new solutions might work with them; and healthcare communities can do the same.

“The labs have four functions,” says Dr Thomas. “The first is to act as an accreditation centre. Lots of suppliers have good systems and ideas, and we can look at their impact both before and after procurement.

“Then, we know there are gaps in our systems. So we will be doing software development to fill those gaps. And if we can do that in a clinical setting, we will increase our chances of getting it right.

“The third thing is more interesting. We have in place a simulation of healthcare. So, this morning, we had a meeting with people from Carmarthen about how to improve care for people with chronic conditions.

“We can simulate Carmarthen in the pods. We can get the clinicians in and say: ok, what information systems do you need to develop, in the patient’s home, or the pharmacy, or whatever, to do that?”

The labs were created out of some old “wet” facilities at Swansea University’s school of medicine. They have close links with its Centre for Health Information Research and Evaluation, and will therefore allow graduate students to hone their health informatics skills.

So their fourth function is training and professional development. “We can second people to do projects here and get them to bring their ideas to us,” says Dr Thomas. “This is going to be the hub of our wheel.”

More information about the labs is available on the Informing Healthcare website: www.wales.nhs.uk/IHC/home.cfm