The Individual Health Record in Wales Cheryl Way Pharmacy & Medicines Management Lead Informing Healthcare, Wales With thanks to Farzana Mohammed Medical Admissions Pharmacist, Royal Gwent Hospital

Content What is the Individual Health record (IHR)? Evaluation in a Medical Admissions Unit Future roll-out plans I’d like to talk about the following today…

Language Lesson ENGLISH WELSH Department of Health (DOH) Welsh Assembly Government (WAG) Connecting for Health (CfH) Informing Healthcare (IHC) Summary Care Record (SCR) Individual Health Record (IHR) The project is the result of close collaboration between GHNHST which includes x number of hospitals and X no of practices Informing Healthcare Informing Healthcare is a Welsh Assembly Government programme set up to improve health services in Wales by introducing new ways of accessing, using and storing information BMA and LMC involvement along with clinicians from Gwent trust and the Community Health Council

GP Systems / Community nursing records A Shared View of Care Individual Health Record Welsh Clinical Portal E referrals Discharges - Welsh Clinical Communications Gateway GP Systems / Community nursing records Current hospital Systems New hospital & community Services My Health Online ORDERING RADIS LIMS PRESCRIBING

What is the IHR? The IHR is an extract of the patient’s GP record held on a central repository. The IHR is a view only product. The IHR is an extract of the GP record. It is uploaded on a nightly basis into a secure data repository. Those able to view the IHR are not directly accessing the GP record but are viewing the extracted data using the GHNHST trust’s own Clinical Workstation. The data included in the IHR was agreed following consultation with clinical staff and patient representation.

What is in the IHR? Name, address and contact details Current problems or diagnosis , medical history Current medication, repeat medication Allergies or contra-indications Test results (haematology, biochemistry, microbiology) Examination Findings (blood pressure, ECG) GP encounters, referrals/admissions, operations Vaccinations/immunisations Staff user survey – the information accessed most often highlighted

Individual Health Record (IHR) in out-of-hours (OOH) care Started in Gwent (SE Wales) in November 2006 83 of 94 GP practices share information with OOH service Access via the Adastra system 503,192 records available (85% of Gwent pop.) > 1 in 7 people in Wales Next Steps Plans for roll out across Wales approved Jan 2009 Ceredigion/Pembrokeshire (SW Wales), December Anglesey/Gwynedd (NW Wales)

Individual Health Record (IHR) in Unscheduled Care Extended coverage within Gwent Went live in the Medical Admissions Unit at the Royal Gwent Hospital in May 2008 Access restricted to MAU staff, Including pharmacists Get info from Frazana on use in practice

and up to 20% of adverse drug events in hospital Why do we need it? IHI research has shown that poor communication of information at transition points is responsible for as many as 50% of all medication errors and up to 20% of adverse drug events in hospital (IHI 2004) An IT solution to overcome the difficulties in getting drug/medical histories from patients in emergency care Gwent trust involved in phase 2 SPI project NICE guidance – only trust in Wales to have all 3 NICE solutions in place Nb a solution to the problem of medicines reconciliation – not an answer The key is the prescriber using the tools available

Clinical staff in RGHMAU can view an extract of the GP patient record providing the practice is onboard and the patient gives their consent. In RGHMAU the portlet is Clinical Workstation 10

Security ADMISSION VIA A&E, BED MANAGEMENT ROBUST AUDIT Patient must be currently admitted on MAU User must be on MAU computer User needs CWS login Users require a log on to the hospital computer system. Users are limited to consultants, doctors, nurses and pharmacists working on RGHMAU. Users can only log onto the IHR if they are on a designated computer within the RGHMAU. Users can only access an IHR for a patient who had been admitted onto the RGHMAU. Users must seek the consent of the patient before accessing the IHR. (Emergency/Persistent Consent available) Users are able to view those users who have previously accessed an IHR and flag any suspicions to GHNHST Head of Information Governance. There is a robust automated audit checking every access to the IHR. The weekly outputs are scrutinised by the GHNHST Head of Information Governance. Opt-out of patients are checked to ensure compliance. VIEW LAST 10 USERS PATIENT CONSENT ROBUST AUDIT

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Medication History (last 2 years) 14

Benefits Feedback from Users Staff Surveys Audit trail Pharmacy data collection Video interview Staff surveys: Better documentation in patient notes More complete drug histories in clerking notes – less omissions Minimal requests for drug history information on PTWR Less pressure on patients to remember drug doses/strengths When can we have IHR on medical wards?

Access rates Access rates do not differ between weekdays and weekend days. Access is more frequent overnight/early morning Increased access due in part to +72 hrs – end June 08

Improvements Expand access time from admission to 72hrs Add persisting consent

User profile by user group

Two week data collection periods: Pre- Go Live Post- Go Live 3 months- Post Go Live 6 months- Post Go Live Pharmacy visit ward 8.30am-1pm Mon-Fri 8.30am-10am Sat and 9.30am- 10.15am on Sun MAU 11 Trolleys Ward D1W 24 Beds Access for all patients with an IHR available

The data collection undertaken by pharmacy showed both benefits and issues Pre- Go Live – Base line data Post- Go Live – Introducing system saved 1hr of time to phone GPs 3 months- Post Go Live – 72 hr access increased use of IHR and reduced 50 min time (static number of calls – due to IHR unavailable) 6 months- Post Go Live - static number of calls due to drug history taking technician making calls (more practices signed up, less IHR unavailable)

Problems / Resistance Resistance from GP practices to opt in Secondary care clinician engagement in training Interpretation of data on IHR Navigation of system – Two folders Quality of IHR data No access for Pharmacy Technicians There are still some issues to be resolved..... Resistance from GP practices to opt in – was mainly an issue in Welsh/ English border counties and now 'No' practices are relatively very few (more practices joined as concerns are addressed) – can lead to high levels of IHR unavailable Difficulty in training clinicians – suboptimal use of product Quality of data – What is put into an IT system is reflected by what you get out! GP records – housekeeping issues Medicines reconciliation at transfer of care settings – quality of data sent from secondary care to primary care will reflect on Quality Of IHR data for future admissions

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Future Plans for Roll Out Plans to roll-out the IHR system were approved by Health Minister Edwina Hart on 7th January 2009. Initially, the information will be shared between local GP surgeries and local unscheduled care providers.

IHR National Update IHC is working with GP system suppliers in Wales Demonstrator tested products from EMIS, INPS and i-SOFT – all invited to provide a solution for IHR INPS have been awarded an extension to contract To deploy in GP OOH in SW Wales in December IHC continues to work with all 3 GP system suppliers IHR content model defines data requirements Gwent project continues until national solution available

Further Information “When Pharmacists in MAU gained access to patients’ GP records”, Farzana Mohammed, Clinical Pharmacist, September 2009, p 370 Cheryl Way National Pharmacy and Medicines Management Lead cheryl.way@wales.nhs.uk Informing Healthcare Telephone 01656 678124