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

2. 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

4. 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

5. 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

6. 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

7. 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

8. 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

10. 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

11. Health Checks+

12. Health Checks+

13. Health Checks+

14. Health Checks+

15. Health Checks+

16. Health Checks+

22. Stop a Stroke - Screenshot from Pilot Site

23. Stop a Stroke - Screenshot from Dummy System

24. Stop a Stroke - Screenshot from Dummy System

25. Stop a Stroke - Screenshot from Dummy System

26. 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

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

28. The Primary Care Information Portal

29. 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

30. The Primary Care Information Portal

31. The Primary Care Information Portal
- Access

32. The Primary Care Information Portal
- Access, Feedback etc

33. The Primary Care Information Portal
- Access, Feedback etc

34. The Primary Care Information Portal

35. The Primary Care Information Portal

36. The Primary Care Information Portal

37. The Primary Care Information Portal

38. The Primary Care Information Portal

39. The Primary Care Information Portal

40. The Primary Care Information Portal

41. The Primary Care Information Portal

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

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

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

45. The Primary Care Information Portal - QOF Registers (Stroke)

46. The Primary Care Information Portal
- QOF Registers (CHD)

47. 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

48. 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

49. 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)