How digital records are changing NHS care in Wales
e-Health records are enabling pharmacists to make informed decisions about treating patients and relieve pressure on GPs, writes Gill Hitchcock
Credit: Yui Mok/PA Archive/PA Images
The NHS in Wales could have found a way to transform the treatment of minor illnesses by enabling community pharmacists to access digital healthcare records.
In a recently completed pilot, called Sore Throat Test and Treat, instead of waiting for a GP appointment for a niggling sore throat, patients can see a community pharmacist.
Crucially, access to e-health records means pharmacists can make an informed decision about treatment. For instance, the record will show them if the patient is undergoing other treatment, or has allergies to medications. And the pharmacist will use the e-record to note the treatment they have delivered, which could include a prescription for antibiotics.
The first step to Sore Throat Test and Treat is for the patient to register with a local pharmacy. They also need to give permission for the pharmacist to access their health record.
Three months after the service was launched in late 2018 at two health boards, Betsi Cadwaladr and Cwm Taf, 53 pharmacy practices had seen just over 600 patients. Of these, only four patients tried or went to see their GP after the consultation with the pharmacist.
A survey of patients indicated that an overwhelming majority (98%) were happy with the service and would use it again, according to the NHS Wales Informatics Service (NWIS), whose health record software underpins the initiative.
After further analysis, the next step will be to implement the service nationally across the country’s 700 community pharmacies.
NWIS is keen to use electronic NHS data to benefit the health service in other ways too. In partnership with the Life Sciences Hub Wales and the Welsh Government, it is holding workshops with companies to explore how they can use NHS data to create products which the NHS could buy.
Percentage of users who were happy with the Sore Threat Test and Treat service
Number of pharmacies across Wales to which the service is to be rolled out
Number of records available on the Welsh Clinical Portal
Year in which the Welsh Government aims to publish digital infrastructure and digital workforce plans for health and social services
“Essentially, what we are seeking to do is to say ‘these are all the standard data flows we have and that you could use, why don’t you think of some innovative ways of using that data to provide services to people’,” says Andrew Griffiths, chief information officer for NWIS.
“We have a group of companies, some are SMEs, that are involved in a programme of work, for example, looking at improving emergency department waiting times. We are still at a reasonably early stage, but we have published three or four APIs for that data. A couple of the companies have done pilot demonstrations picking up those APIs and using the data. This has not yet turned into anything commercial, but it is proving that the concept works.”
Like most of the UK public sector, the Welsh NHS is suffering through lack of funding. Only 2% of its funding goes on informatics, against the 4% recommended many years ago by the respected health and social care policy adviser, Sir Derek Wanless.
Last year, watchdog the Auditor General for Wales recognised that health boards faced a tough challenge to prioritise spending on informatics. In 2010-11 and 2013-14, most health boards had cut their spending ICT in real terms, it found.
The solution could lie with the Welsh Government, which needs to decide whether and how to provide the additional money. In October, health and social services minister Vaughan Gething commissioned four strategic reviews of digital health and care. The aim is that they will lead to a national digital infrastructure plan and a digital workforce plan in 2020.
“The minister has announced further funding for digitisation of health, but we have yet to have confirmation of how that money is going to be allocated,” Griffiths says. “But that has been a positive move. I think there is an increasing realisation that using information differently can allow us to come up with improvements to the way patients are treated.”
Ambitions for the digitisation of the Welsh NHS date back to 2003 and the launch of the Informing Healthcare Strategy. Since then, the health service has made significant progress in digitising primary care. Patients’ digital GP records are available in secondary care too.
Rather like England, however, Wales’ secondary care is lagging behind and services are still designed around paper notes. Griffiths thinks digital records would mean patients could be treated in a range of settings beyond, not just an outpatient department or hospital ward.
“We are increasingly storing secondary information digitally,” Griffiths says. “And that is all available through one platform, the Welsh Clinical Portal. We have 18 million records available on the portal, on top of 31 million pathology and test results which are going on every year.”
He adds: “Some 17,000 secondary care doctors are using the portal daily and they are looking at that digital information. Our vision is that wherever a person turns up on the health and care system, the clinician will have all that information available to them through the Welsh Clinical Portal.”
Every hospital in Wales has one ward where it is piloting a new digital way of capturing information so that it is automatically available through the Welsh Clinical Portal as part of that patient’s notes.
"Our vision is that wherever a person turns up on the health and care system, the clinician will have all that information available to them through the Welsh Clinical Portal"
Andrew Griffiths, NHS Wales Informatics Service
Meanwhile, NWIS is trialling an app version of the portal at Cwm Taf Morgannwg and Betsi Cadwaladr. Using two-factor authorisation, clinicians can use the app to access information about their patients from a range of locations via a mobile phone.
Griffiths recognises that these innovations need a culture shift too. He thinks it is human nature to run things as usual. As a way around this, NWIS has been developing digital champions to spread knowledge about how and where staff can work better using new technology.
Another hurdle is that people do not feel they have permission to work differently, he says. But Sore Throat Test and Treat, where pharmacists can access e-records and prescribe medications, seems a shining example of how new permissions can lead to improvements.
Griffiths adds: “As a result of information being available electronically, we are changing models of care and creating a huge level of satisfaction for patients.”
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