February 2020
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More than a million digital patient records shared between health boards in Wales

Wales is now the first nation in the UK to enable digitised patient information to be accessed by healthcare professionals across all health board organisational boundaries, allowing information to follow the patient wherever in Wales care is provided.

In January, the millionth digital test result was viewed between health boards via Wales' digital patient record service, the Welsh Clinical Portal.  January was also the busiest month to date for viewing out-of-area patient information, with more than 49,000 test results shared between health boards.

This milestone comes a month after Cardiff and Vale became the final health board in Wales to adopt the digital radiology results reporting service, available through the Welsh Clinical Portal.
The move means that clinicians in all Welsh hospitals can now view both radiology and pathology test results from across Wales in one place.

Having access to results produced in neighbouring health boards saves time, informs clinical decisions and means fewer duplicate tests and scans are needed for patients.

"Reaching the milestone of one million test results viewed across Welsh health board boundaries demonstrates the scale of value that can be generated when a national product is fully implemented,"  said  Griff Williams, Project Lead for the Welsh Clinical Portal.  "Our plan for the Single Patient Record is to further increase the level of digitised healthcare available to NHS healthcare professionals, including endoscopy, lung function and genetics results."

The Welsh Clinical Portal is a national IT system created and built by NHS Wales. It shares, delivers and displays patient information from a number of sources with a single log-on, which helps to improve collaboration between clinicians, hospitals and other health centres in Wales.
NHS Wales at the forefront of data-driven care
 
New condition-specific data dashboards are being developed by NHS Wales to provide insight into patient outcomes, and to identify variations in care.

Analysts and tech experts from the NHS Wales Informatics Service are building the dashboards in support of the high-profile Value-Based Healthcare (VBHC) programme, working in collaboration with clinicians, Welsh Government and the Finance Delivery Unit.

The programme places Wales at the forefront of innovation to support value in health, which is about achieving the best possible outcomes for the patient with the resources available.

Dashboards are interactive and link different aspects of the patient journey, including audit data and patient-reported outcome measures (PROMS). This puts a greater focus on the interventions that work best for patients, taking into account their own personal circumstances, and highlighting variation in services and outcomes to reveal over-and under-use of different aspects of healthcare.

The National Lung Cancer Dashboard was released last year, and this will be followed in 2020 by dashboards for heart failure, knee replacements, stroke, cataracts and colorectal cancer.

Work is currently underway to develop a second-generation Lung Cancer dashboard, building on the success of the current dashboard, and evolving to meet more sophisticated user requirements.

"Data has the power to have a direct impact on the care and the care choices patients can make. For example, a patient should be able to use the evidence available to inform a decision on whether to have chemotherapy, or whether a replacement knee would improve their quality of life."

Sally Cox, NHS Wales Informatics Service Information Specialist

"To provide the whole picture needed to identify variations in care, we need to bring together all available data," explained  Information Specialist Sally Cox who is leading dashboard development at the Informatics Service. " Collecting data in isolation, or in silos based on geographic area, won't help us to provide the best possible outcomes for patients."

For the first time condition-specific data is being linked at a national level, enabling a data-driven approach to decision making for both clinicians and patients. It will provide the information needed to assess which interventions are effective and deliver quality care.
Digital supports bowel cancer screening
 
Software developed and supported by the NHS Wales Informatics Service is supporting the Public Health Wales bowel screening programme, which has launched a new campaign with Bowel Cancer UK to encourage more eligible people to take the test.
 
Currently, just over one in two eligible people in Wales take the test, recent data has revealed. Taking part in screening can reduce the risk of dying from bowel cancer, with patients nine times more likely to survive bowel cancer if it is found early.
 
The Bowel Screening Information Management System (BSIMS) is a secure web application that supports the whole screening process, by selecting people from the Welsh population for screening. P eople aged 60 to 74 years old are eligible for the free NHS bowel screening test every two years. 

Eligible people invited for screening are sent the home screening kit in the post which is returned and tested in NHS Wales laboratories. The labs use BSIMS to keep track of the kits, record the results and produce results letters. Anyone with a positive screening result is referred for further investigations and assessment by Specialist Screening Practitioners. BSIMS supports this process with a clinic booking module and provides a diary and online assessment form for specialist screening practitioners.
 
Bowel cancer is the second biggest cancer killer of men and women in Wales. Bowel screening detects bowel cancer at an early stage, often when there are no symptoms, and yet when treatment is most effective.
 
The bowel screening software developed in Wales is also used in Northern Ireland.
 
You can find out more about bowel screening by visiting www.bowelscreening.wales.nhs.uk.

Delivering for need: A Q&A with NWIS Business Change Facilitator, Nadia Simpson 
 
One of the most common questions staff in NHS Wales ask in regards to IT, is, "why do we need this?" or "what can this do that the old system can't?"
 
These are questions we take very seriously. When new systems are rolled out, or changes are made, NHS Wales Informatics Service has a team of Business Change Facilitators who go forth and connect with the people who use our systems and IT - developing plans, analysing needs, and most importantly, answering those very important questions.
 
We spoke with Nadia Simpson, NWIS Senior Business Change Facilitator about her role. 
 
Q: Business Change? Changing what?
A: Oh, changing many things! - people's mindsets, how they work, changing their perceptions of technology. For example, we look at different ways of working and how technology will improve their processes. We can be employed by a project team at any point in the project to be their arms and legs. It could be pre-implementation phase, implementation, or post implementation. At each stage we use different skills to help the Project manager baseline, roll out the project and gather feedback respectively.
 
Q: Can you give us an example?
A: Well, I work on the deployment of the Welsh Clinical Portal. So, take Electronic Test Requests (ETR). A health board will ask us to help increase usage. We'll learn exactly what the job of electronic test requesting entails - what types of tests need doing and where, what happens in the lab once the test comes in- and we'll go off to the wards and learn exactly what the users require. We'll look at statistics with the health board, analyse which departments need help and support, book training sessions for ETR, do on-the-spot training and demonstration meetings. Every Health board or ward has different needs.
 
Q: So, you will look where things can be improved and work with them?
A: Yes, exactly. We record all the issues they have. We talk with project managers, health board project teams and technical teams, because, so often it is hardware or IT needs that must be met. So our job is to make sure we work with everybody to find ways of improving the current situation.
 
Q: We'd imagine one of the most difficult aspects of the job is making sure everyone's on board and heading into a common direction.
A: It is! Sure, it's a little psychology and marketing.  But we aren't out selling. We aren't salespeople. This is about showing benefits of a project or demonstrating the benefits of the systems to the user. We work on the Welsh Clinical Portal (WCP) so, for example, we'll give staff tips on how to get the best out of it - the little pointers such as selecting your default landing page. We adapt our approach according to the user's needs and how WCP fits into their way of working. Ultimately, it's for the patient. They are our "customers."  All our benefits end with what it can do for the patient.
 
Q: How many projects are you working on at any given time with a staff of how many?
A: Altogether, we have a team of fourteen - going up to seventeen soon. We're working on numerous different projects across Wales, most of them linked to the Welsh Clinical Portal but the Welsh Patient Administration System and Cancer Informatics have their own teams also. For instance, there's a diabetes managment system that we're engaging with in Cwm Taf Morgannwg University Health Board at the moment, showing how the system will improve patient care. But, because it's relevant, we'll talk to them about the entire WCP portfolio and what other parts of WCP they might need.
 
Q: You must have built up a collection of success stories then?
A: Oh, we have loads of success stories. ETR for example? Well at the end of last year in Singleton [Hospital in Swansea], over twelve weeks, they've increased usage from 29% to 61%. In Princess of Wales [Hospital in Bridgend] usage increased from about 20% to 51%. There've been increases in [Abergavenny's] Nevill Hall too. We have lots of success stories. But we work hard to achieve that. Each month, we engage with nearly 200 people and this figure is growing every month! We're busy but enjoying every minute of it.
Diabetes care boosted by "Game-changing" Welsh Clinical Portal feature 
 
The Diabetes Consultant Notes tool, available through the Welsh Clinical Portal, is benefiting diabetes patients and their clinicians by streamlining appointments, reducing clinic waiting times and bringing patient notes together in one place.

Dr Gautam Das at Merthyr Tydfil's Prince of Wales Hospital calls the feature a "game changer." 
In our latest YouTube video, Dr Das talks with us about how innovative the feature is and how it helps his patients.
HaemBase Cymru goes live in Cardiff & Vale

The first part of HaemBase Cymru, the Outpatient Continuation Sheet (OCS), is now live in Cardiff and the Vale University Health Board. It started being used by Consultant Haematologist Dr Ceri Bygrave and the Myeloma team at University Hospital of Wales (UHW) on 12 December 2019.

Since then, the information collected during the outpatient consultation has become part of the single digital patient record, electronically accessible via the Welsh Clinical Portal, making the haematological care record available across Wales to all the clinical professionals who need access to continue the care of the patient.

HaemBase Cymru is a series of digital functionalities accessed via Welsh Clinical Portal, designed with haematologists and built by NWIS as part of the national architecture to ensure alignment with current national systems. It is a data solution for haematological malignancies that accurately gathers data during a patient's cancer treatment, putting the needs of patients first, assessing the impact of treatment on patient outcomes to enhance their quality of life.

After the initial evaluation at the Myeloma Clinic in UHW this January, further iterations of the OCS will be released to cater for all Haematological Malignancies and to be rolled out for adoption in other Haematology Clinics.

A first iteration of functionalities to be used in the Multi-Disciplinary Team (MDT) meetings is also being planned to be developed this year.

"This is a wonderful development for cancer services in Wales. What is being developed in myeloma will soon be available for all haemato-oncology patients, and will be the blueprint for solid tumour cancer services in the future too. This is exactly what clinicians have been waiting for and will hugely support communications between all professionals across the patient pathway. Ceri, NWIS and the wider development team deserve a huge amount of credit for developing this for Wales."
Prof. Tom Crosby OBE , Consultant Oncologist, National Cancer Clinical Director for Wales,
Clinical Lead Transforming Cancer Services
 
"It is great to start the new decade in a paperless fashion, collecting data electronically in the new patient clinic, and instantly sharing it with colleagues across Wales! HaemBase is a national solution for all haematological malignancies and will provide the data we need for all patients and clinicians."
Dr Ceri Bygrave , Consultant Haematologist (Cardiff and the Vale University Health Board)

We'll keep you updated as to the progress. For any queries on the project please get in touch with Alessandra Veronese - NWIS Project Manager - [email protected]