Technology Enabling Primary Care Simon Scourfield Primary Care Operations Lead Information Services Directorate

Technology Enabling Primary Care Audit+ Supporting the bigger picture What Audit+ is Simple schematic Audit+ and Stop a Stroke Healthchecks+ Inverse Care Law work in Cwm Taf The Primary Care Information Portal Making comparative data accessible

Audit+ Supporting the Bigger Picture in Wales Patient Care Clinical Governance / Clinical Audit Public Health Health Needs Assessment / Health Planning NICE Guidelines NSFs Research Quality & Outcomes Framework

Audit+ - What it is… GMS funded support tool to support General Medical Practices in: Delivering clinical care Improving data quality Supplying data for national reporting requirements* Undertaking clinical governance activities etc Standardised cross-GP system tool Independent of GP system suppliers development/deployment timescales Enables rapid and coordinated national deployment of modules Read code driven - ‘Apples with apples’ As a by-product, a tool that has the potential to support: Local Health Boards and GP Clusters Public Health Wales Welsh Government Academia Deployed to every Practice in Wales Installation and use is voluntary 3-4 years ahead of England GPES

The Data Quality System - Simple Schematic GP Practice based tool Central Repository Primary Care Aggregate Data Repository Automated aggregated data extract Automated software updates National Diabetes Audit National COPD Audit SAIL & PRISM External data transfer utility

Audit+ Some Current Modules QOF prevalence (registers) Age/sex standardised Data ‘Tidy Up’ searches In collaboration with Insight Solutions Example - Patients with CABG and no diagnostic Read code of CHD QOF 2017/18 Support QOF active/inactive reporting and peer review Diabetes DES Diabetic Retinopathy (DESW) PHW – Vaccination programmes Flu, Pneumococcal, Shingles and Meningitis ACW&Y PHW – Surveillance Communicable Disease Reporting PHW Post-viral complications QOF prevalence (registers) Age/sex standardised Used in PHW Observatory practice profiles Supporting GP systems data migration validation Incidence section recently added Retaining retired QOF registers Data ‘Tidy Up’ searches New module in collaboration with Insight Solutions Part of training (seminar or 1-1) New suggestions from Practices are always welcome NB Not all suppliers have a wide range of ‘Tidy-up’ searches Diabetes DES GPC Wales mandate Incorporates QOF Exception codes Standardised approach across Wales Can support a Diabetes LES To be updated if/when revised DES requirements provided DRSSW Retinopathy Newly diagnosed diabetics and referrals for retinopathy Standardise search Reduce burden on Practices PHW Flu vaccination reporting 100% practices electronically submitted for 14/15 & 15/16 Module developed is in line with HPA specification Pertussis vaccination added for pregnant patients PHW use same HPA definition for pregnancy PHW Sentinel Reporting Scheme Weekly communicable disease reporting: Measles Mumps Rubella Shingles chicken pox Influenza Pneumonia Heat stroke Gastroenteritis Acute asthma attack / emergency admission due to asthma Daily pandemic swine flu surveillance in 2009 Monitored the effect of tyre depot fire in Fforestfach Reported on the measles outbreak in Swansea & surrounding areas PHW monitoring during the Ryder Cup & NATO summit Request to add more ‘conditions’ to align to PHE

Audit+ External Data Transfer Utility - Current National Audits Supported National Diabetes Audit 100% Participation Practice Support Module deployed for day-to-day support Supported RCGP continuous quality improvement sessions National COPD Audit 62% Participation – Year 1 94% Participation – Year 2 Practice Support Module being developed for day-to-day support Aim is to help support Cluster Network Domain CND012W National CKD Audit 72% Participation HQIP/Informatica Practice Support Module deployed CKD ‘Counts’ Module also deployed providing full coverage National Diabetes Audit 97% of practices participated in 2014/15 data collection 100% of practices participated in 2015/16 data collection LHB Report released January 2017 3 years worth of data available in Portal National COPD Audit Wales undertook pilot in 2015 62% of practices agreed to participate LHB and Cluster reports released by RCP in November 2016 Data available in the Portal HQIP Chronic Kidney Disease Audit 72% of practices activated module Report 1 – released 17th January 2017

Inverse Care Law - Healthchecks+ / LWLL Practice based initiative Supported by Health Care Assistants using Healthchecks+ Cwm Taf lead for national specification for Healthchecks+ Piloting/learning lessons from reporting via Healthchecks Central Living Well Living Longer Community based approach using Health Diagnostics software Data as a result of health check is transmitted to GP Systems Extract in Audit+ to identify cohort for call/recall via Health Diagnostics software Validation module in Audit+ to be developed to improve accuracy of cohort prior to initial invite Support to be provided to Aneurin Bevan, ABMU and Hywel Dda Supporting reporting/monitoring Module to be developed in Audit+ for reporting number of health checks etc irrespective of approach Reporting via Primary Care Information Portal

Health Checks+

Health Checks+

Health Checks+

Health Checks+

Health Checks+

Health Checks+

Stop a Stroke - Screenshot from Pilot Site

Stop a Stroke - Screenshot from Dummy System

Stop a Stroke - Screenshot from Dummy System

Stop a Stroke - Screenshot from Dummy System

Stop a Stroke - Screenshot from Dummy System List of 7 patients on no treatment that have not had a review from clicking on bar chart. As before: F6 – will take you to the clinical record if you are already logged in to Vision or EMIS Web F10 – will produce the following view to highlight why patient has been included in particular search

Stop a Stroke - Screenshot from Dummy System Output highlights that only diagnostic code of AF is recorded on clinical system

The Primary Care Information Portal

The Primary Care Information Portal Accessed via NHS Wales network only Level of access controlled by a User’s NADEX ID Analysis at the following levels: All-Wales LHB Cluster (default position for reporting) Practice (where data is available) Can only be seen by the Practice in the first instance 57% of Practices have submitted access requests URL Primary Care Information Portal

The Primary Care Information Portal

The Primary Care Information Portal - Access

The Primary Care Information Portal - Access, Feedback etc

The Primary Care Information Portal - Access, Feedback etc

The Primary Care Information Portal

The Primary Care Information Portal

The Primary Care Information Portal

The Primary Care Information Portal

The Primary Care Information Portal

The Primary Care Information Portal

The Primary Care Information Portal

The Primary Care Information Portal

The Primary Care Information Portal Practice X Cluster X LHB X Wales

The Primary Care Information Portal - QOF Registers (Atrial Fibrillation)

The Primary Care Information Portal - QOF Registers (Atrial Fibrillation)

The Primary Care Information Portal - QOF Registers (Stroke)

The Primary Care Information Portal - QOF Registers (CHD)

The Primary Care Information Portal - QOF Registers (CHD) All QOF registers will be displayed Hypertension Heart Failure COPD Asthma etc Available in v3.1 of Portal (currently v3.0) Feedback welcome on any aspect of this section of the Portal or any other section

The Primary Care Information Portal -Putting the Pieces Together Data from General Practice systems General Practice Data from other sources Analytics & presentation of comparative data Ease of accessibility to comparative data

Supporting LHB/Cluster Requirements Final Message… Discuss your requirements with NWIS first Before purchasing software tools that: May require a procurement process May require centralised hardware May be expensive May require local support/facilitation/analysis resource May not be responsive to required developments Will allow intra-Cluster comparison but not inter-Cluster comparison Module may already be in the pipeline Module could be developed depending on demand from Clusters Module could be supported with training (e.g. Insight Solutions)