1. 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

2. 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…

3. 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

4. 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

5. 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.

6. 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

7. 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)

8. 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

9. 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

10. 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

11. 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

12. 12

13. 13

14. Medication History (last 2 years)14

15. 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?

16. 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

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

18. User profile by user group

19. 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 am on Sun
MAU 11 Trolleys
Ward D1W 24 Beds
Access for all patients with an IHR available

20. 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)

21. 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

22. Video

23. 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.

24. 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

25. 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
Informing Healthcare
Telephone