EHI interview: Gwyn Thomas

Gwyn Thomas

Informing Healthcare is taking an incremental and collaborative approach to delivering an electronic patient record for Wales. The strategy has won many plaudits, but progress can seem agonisingly slow. Sarah Bruce talks to chief executive Dr Gwyn Thomas.

Informing Healthcare recently published an achievements report, detailing how information and technology is providing better patient care in the NHS in Wales.

On first glance, the Welsh NHS IT agency seems to be taking the lead with innovative technologies that will build into a single electronic record. But a closer look shows that while projects are in place for all the elements of the record, roll-out is happening at a snail’s pace.

“Incremental, incremental, incremental,” says Dr Gwyn Thomas, its chief executive. “Everyone has an obsession with deadlines, but you need to understand that Informing Healthcare doesn’t work that way.”

IHR changes announced

Informing Healthcare started piloting one component of the single electronic record, the Individual Health Record (IHR), in Gwent in May 2007.

The IHR is similar to England’s Summary Care Record, in that it contains a patient’s personal details and limited clinical information including current medication, major problems and referrals. However, it draws information from GP systems and patients give their consent every time it is viewed.

Unfortunately, the wider adoption of the record was stopped almost as soon as it started, when CSW, the company contracted to deliver it to the North West and South West Wales, went into administration in November 2008.

“The credit crunch hit us and that was completely unforeseen, so that affected us and cost us time,” says Dr Thomas. “What we’ve had to do is recover from that position. I’m amazed we’ve done it so quickly when you look at the timescales for these things.”

Days after EHI talked to Dr Thomas, Informing Healthcare was able to announce a new approach to delivering the IHR, based on GP system suppliers delivering it to their customers.

It disclosed that it had reached an agreement with INPS (formerly In Practice Systems) to develop a proprietary IHR for its customers. Similar deals with other system suppliers are expected, although there will be a common model of data extraction and a common user interface.

No dash to deadlines

Even so, Dr Thomas says Informing Healthcare will not lay down deadlines to get the project moving faster. A number of INPS practices will start using the IHR next month. Others will follow, with roll out managed through the GP framework contract.

“The people who determine the deadlines for the IHR are by and large the users. What better way of going about it than saying ‘what suits you?’ ‘This bit is ready, when would you like to take this?’” Dr Thomas says.

“The roll-out deadlines are determined by the end user and that’s exactly how it should be. This is not an NHS Connecting for Health model, where there’s a big national roll-out. As we roll-out more gradually, we can learn things and we might change them,” he adds.

Yet even a panel of international experts that Informing Healthcare has invited to assess its progress said recently that it should draw up a formal evaluation strategy, and put performance metrics and benefits realisation approaches in place.

The panel also called for a risk management strategy, particularly around the Welsh Clinical Portal. This is being developed to provide clinicians with a common point of access into acute clinical systems.

The first version identifies and locates patients and also includes a pathology handbook for decision support on ordering tests. The portal also deals with the electronic ordering of tests and results requesting within a pathology lab.

“The power in that means that we don’t have to rip out all our existing systems it just sits across them all just takes the information needed out and makes it available,” Dr Thomas says.

An early version of the portal is already being piloted in a number of hospital settings across Wales, including Gwent, Cardiff and Vale and Hywel Dda and will again be rolled out further using an “incremental approach.”

Furthermore, a business case for My Health Online is in the hands of the Welsh Assembly Government. The online service is similar to England’s HealthSpace, and will allow patients to access health services on the internet.

However, after carrying out a “significant amount of market research”, Informing Healthcare is keen to differentiate between England’s offering and its own.

“What we found from the 2,000 people that we asked was that the priorities they had were ordering repeat prescriptions and booking appointments with their GP online – rather than having direct access to their medical records.”

The component that links the primary and secondary care elements of the record is the Welsh Clinical Communications Gateway. This was originally pioneered in Scotland to link core systems together and manage messages for “any to any” setting not just “point to point.”

Leading IT for the WAG

If there wasn’t enough to do in his Informing Healthcare job, Dr Thomas has recently taken up a new post as Chief Information Officer for the Welsh Assembly Government. He acknowledges this means the Informing Healthcare team is increasingly responsible for taking its projects forward.

“One of the reasons I can do this job is because I’ve got a very good team in Informing Healthcare and in the NHS generally.”

Dr Thomas’s new brief, as he describes, is twofold. He represents Wales in the UK CIO Council and also uses his experience to develop other IT strategies.

“The second part of my remit is to use the experience that we’ve developed in Informing Healthcare as a foundation for developing an IT strategy for Wales that goes across all sectors. It is very much a question of co-operation and working together with the other sectors to pull it together.

“The first thing we will do is something around the national architecture and the next is likely to be working out our response to Digital Britain.”

The CIO is also keen to promote professional standards within NHS IT. “We need to be serious about professional registration. When I was working at the IA [NHS Information Authority] in England, I helped to set up UKCHIP, so it makes sense to me to encourage people to join that as a professional body,” he says.

“We are talking about whether we should set-up a Welsh branch of UKCHIP. We need to be clear that it’s not something that we’re enforcing – it’s just the collective approach towards working together.

Like everything else, Dr Thomas says that there is “no timescale for this.” But he reiterates that he thinks an obsession with deadlines is unhealthy. He says: “If you read any report on IT projects, one of the top three causes of problems is being tied to unreasonable deadlines, which have not been thought through properly.

“In Wales it’s a different world. It’s a different way of doing business. I’m not saying that it is right, I’m saying that it suits our culture.”