NHS Wales Informatics Service

ANNUAL REVIEW
2015
Foreword
Working Together
I am very pleased to be able to share with you the
breadth of our work programme and the progress
we are making to improve information and
technology for health professionals, patients and
citizens.
Our approach is based on collaboration with Health
Boards to put national technology and information
systems safely to work for the benefit of patients
and staff.
Wales now has a
consolidated and integrated
set of national information
services, using modern web
based technologies and
standards - a significant
achievement that provides
the foundation for future
development.
I am very pleased that we now have national
technology services to underpin patient care. We
now have one system to manage the growing
workload at our diagnostic laboratories, a single
service for x-rays and digital scans and images, an
electronic service to manage hospital referrals and
discharges, a single email service for staff and new
next generation computer systems in all our GP
practices.
This has been a complex task and work is ongoing
to support the practical adoption of national
services, to ensure we exploit fully the benefits of
information available where and when its needed.
Looking ahead, we will continue to work
collaboratively with Welsh Government, health
boards, trusts and other partners to support
patient care through the provision of high quality
information systems and services.
Andrew Griffiths,
Director of Informatics
Services and Chief Information
Officer for Health
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We have achieved a number of
significant targets and continue
to build and deliver the national
services needed to support 21st
century health and care for
Wales.
Andrew Griffiths
Use of digital technology to support better and more
efficient health and care services for patients and the
citizens of Wales is at the heart of the NHS Wales
Informatics Service.
We are:
Working in partnership with health boards,
clinicians and providers to deliver new
integrated digital information services required
for improved quality and outcome of care,
providing better cost efficiencies, reduce harm,
waste and variation.
Supplying over seventy operational ICT services
to the NHS in Wales, including the technology
infrastructure that is as important to our health
service as road and rail networks are to national
transport systems.
Analysing NHS data and making it available in
easy to use formats to support planning and
decisions.
Collaborating with our NHS Wales partners to
set the direction for robust and integrated
primary and community care systems.
Setting the standards for health informatics
professional development and leadership.
We aim to give care providers the information they
need to deliver better outcomes, more safely and
more efficiently, and Welsh citizens improved access
to information they need to support their own health
and wellbeing.
One Patient, One Record
Single and secure
NHS Wales exists to improve the health outcomes
for all people in Wales - to make sure every patient
has the best care possible.

When you visit your GP or hospital, you expect the

clinicians who treat you to have the right training
to care for you.

But you also expect them to have all the

information they need - who you are, your medical
history, what medication you are taking, any
allergies you may have - all the information they
need to treat you safely and effectively. You expect
them to have the information they need at their
fingertips.
Whether in a GP practice, an emergency unit, a
pathology lab, an MRI room, a cancer clinic or any
other healthcare setting, healthcare professionals
need to access your medical information.
To make that information accessible and secure,
NHS Wales Informatics Service is committed to
providing a single electronic health record for each
patient throughout Wales, bringing together their
relevant medical information from a variety of
sources.
Not only does a single record contribute to your
care, it helps ensure your medical information is
accurate and up to date. And that information can
be accessed immediately anywhere within Wales,
by the clinicians who are directly involved in your
treatment, when and where they need it.
A secure, comprehensive, web-accessible health
record will provide information to support clinical
decisions in whatever setting you are being
treated, only allowing health professionals who
need it to access your information.
Case Study
Individual Health Record
When Now
Means Now
The Unscheduled Admissions Ward A4 at
Cardiffs University Hospital is always busy and
the beds are always in demand.
In 2014, Ward A4, along with several other
unscheduled admission sites throughout Cardiff
& Vale and Aneurin Bevan university health
boards became a pilot ward for the Individual
Health Record or IHR, allowing doctors and
pharmacists immediate access to a summary of
their patients record held by their GP.
Safe decisions can often only be made with
knowledge of what medicines a patient has been
taking prior to admission, says A4s Ward
Pharmacist, Sarah Gage.
Accurate information at this time can be vital to
ensure that the best prescribing choices are
made, and give sick patients the best chance of
recovery. The IHR allows us to see this
information as soon as the patient is admitted.
Its made a massive difference in the way we are
able to treat patients.

Other health boards are scheduled to rollout the

IHR in 2015.

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One Patient, One Record

Master Patient Index

It wasn't too long ago when every time a patient
visited a different healthcare setting, their
information would be recorded into each setting's
computer system.

Even within their own health board, a patient could

have multiple health records. Worse still, patient
identities could be mixed up.

Correct identification and up-to-date patient

information is essential to today's health service.
It's not just about smart management. It's a matter
of patient safety.

The Master Patient Index (MPI) is a system that

makes it easier to ensure patients are correctly
identified, and minimises the number of duplicate
health records held for each patient. Regardless of
where the patient is being treated - at A&E,
radiology, or in a specialised clinic - their identity
Welsh Clinical Portal stays accurate.
Computer systems that deal with areas such as
patient administration, radiology, pathology, work Using key criteria such as
name, address, date of The MPI manages the
best when they can talk to one another.
birth and sex, the MPI demographic details of
collects all the data 17.5 million patient
The Welsh Clinical Portal unites key patient
surrounding every patient registration records from
information from many computer systems and
registered held across their 22 separate patient
databases used in NHS Wales.
health board to create one information systems.
This year, on average, the Welsh Clinical Portal was gold standard patient
accessed more than five hundred times every hour identity record that best
by doctors, consultants, nurses, midwives, represents the individual.
therapists, lab staff, pharmacists, radiologists,
clinical administrators - all searching for the most Then, when a clinician uses the Welsh Clinical
up-to-date and most accurate information about Portal to find the patient, they are shown that
their patients. gold standard record, but also alerted to the fact
there are possible other identity records for that
Designed and tested by doctors and healthcare person, and where to find them.
professionals in NHS Wales, the Welsh Clinical
Portal provides fast access to information about
medication, referrals and discharges, allows health
professionals to request tests and results from
various sources and ultimately improves patient
safety and a reliance on paper records.

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 One Patient, One Record

IT for Radiology
More health boards in Wales are using the all Wales
Picture Archiving and Communications System
(PACS) to store, retrieve, and distribute radiology
images like x-rays and ultrasound scans.

Tens of millions of images are now being managed

by the new, integrated national PACS system in six
Welsh health boards. These images can be shared
between clinicians across locations when ever they
are needed.

Velindre NHS Trust is the latest NHS site in Wales to

IT for Pathology
Over the past year, a national Laboratory
Information Management System (LIMS) has rolled
out across six health boards blood sciences and
microbiology departments.
The new national LIMS replaces the 13 separate
computer systems that had operated in the
eighteen main pathology laboratories in Wales and
provides quick access to test results regardless of
where the patient receives care.
And because it integrates with other systems, the
new LIMS also provides added patient safety,
reducing the number of duplicated tests.
go live with the all-Wales Picture Archiving and
Communication System (PACS).
It is an intuitive and easy to navigate system, says
Velindres Senior Radiographer, Simon Lawrence.
This new PACS is of critical importance to Velindre
as more than 40% of our PACS database is other
hospital imaging used for comparisons and MDTs
(multidisciplinary teams)."
Imaging sent from other hospitals is instantly
viewable and allows out of hours access without
the need to call staff in or compromise the security
of the live database.

Later this year, the new LIMS will be rolling out

across a number of histology, cystology and blood
transfusion departments.

Record Collection
Patient records are collected in an electronic
document repository called the Welsh Care
Records Service (WCRS).

The NHS in Wales produces nearly 100 million

documents each yearreferrals, discharges,
letters, assessments, clinical notes, care plans,
contact lists and much more.

The WCRS standardises these documents and

allows them to be accessed and viewed by
clinicians across health sector boundaries as well
as being audited more easily.

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One Patient, One Record
National Patient Administration System
The National Patient Administration System (NPAS)
was developed by staff in Hywel Dda Health Board
and has evolved to become the NPAS for Wales.
Hospitals use the NPAS to hold patient ID details,
outpatient appointments, letters and notes.
Currently, there are more than 22,000 NHS NPAS
users in six out of seven health boards.
Recently, NPAS was launched in Powys for use by
midwives working within the community. It allows
them to review and update mother and baby
details on a laptop during home visits, or they can
input details later back at base. Following a birth,
the baby is given an NHS number, generated
within NPAS and a full episode of care is recorded
for mother and baby.
Midwives, support workers, obstetric doctors and
other relevant staff working on or with
the maternity wards have also begun to access
the NPAS maternity module on a daily basis to
record and view information faster.
This data can then be collected into reports
capturing the specific information required for
each user, both on a national and local level, says
midwife Sarah Aston. We now also have the
option for medical and family history to be visible
to other clinicians which can be especially useful
in emergencies.
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The introduction of this system
now allows us to collect data
more accurately.
Betsi Cadwaladr University Health Board
Midwife, Sarah Aston
Emergency systems
A new Emergency Department Clinical Information
System (EDCIS) called Symphony will be introduced
to emergency departments in Betsi Cadwaladr and
Abertawe Bro Morgannwg health boards to deal
with managing emergencies and triaging patients.
The aim is for the departments using the system to
work completely paperless.
The system will be used on mobile wireless devices
as well as fixed IT stations. Emergency department
staff will be able to tell which patients haven't been
triaged, are in the most serious condition or are
waiting for test results, specialist review and
medication.
It will also support patient management by having a
dashboard function showing where patients are in
their journey through the department, while
simplifying auditing.
In North Wales, the system will be used to support
a local pub safety scheme as well as pinpointing
spots of higher-than-normal clinical activity of
illnesses such as pandemic flu, norovirus or
diarrhoea and vomiting.
It will link into the National Patient Administration
System, the Master Patient Index, the Welsh Clinical
Communications Gateway and the Welsh Clinical
Portal.
Information Technology in Primary Care
Connecting GPs
Every day GPs in Wales use computer systems to
record thousands of interactions with patients.

So its essential they have high-quality systems and

connections that support new digital services and
integrated care.

A national refresh programme which began in 2013

completed on schedule this summer, providing
next-generation computer systems to all 460 NHS
GP practices in Wales. Over 8,700 new PCs and
4,800 printers (capable of printing 2D barcodes)
have been installed.

To increase security, reliability and the speed of

services the storage of electronic information is
now hosted centrally at large off-site data centres
in Wales. This removes the burden of IT
management from the GP practice. A central
service desk takes ownership of IT queries and can
contact third party suppliers on the practices
behalf.
Benefits include better value for money with a 50%
reduction in revenue costs and fewer reported
connectivity and hardware faults.
Broadband services have also been upgraded with
bandwidth in many locations increased from 1MB
to 10MB.
Doctors and practice staff can now send and
receive electronic information quicker and more
reliably.
Sending referrals from practice to secondary care
has never been more straightforward. Tens of
thousands of e-referrals are sent every month from
GP computer systems using the Welsh Clinical
Communications Gateway (see right). This replaces
paper-based referrals for outpatient appointments.
Case Study
Welsh Clinical
E-referring
Communications Gateway
Nearly 45,000 electronic referrals are sent every
month in Wales, replacing paper referral letters
with secure clinical messages sent in an
electronic format, streamlining the whole
referral process.
GPs in Cardiff and Vale are referring directly into
the University Hospital Wales Physiotherapy
Department using the Gateway.
"It's far and away the most efficient way of
sending a referral," says Physiotherapy Manager,
Adrian Broad. "It's got all the information. It's
clear and it's quick."
The system offers a full audit trail so referrals
cannot get lost between primary and secondary
care," says Sian Richards, Head of Health
Records at Abertawe Bro Morgannwg University
Health Board. "The process is now more
efficient.
It is forecast that ten years after its rollout,
e-referrals will save NHS Wales 28 million in
administration costs.

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Information Technology in Primary Care

GP 2 GP Record Sharing
This summer, the first digital GP to GP medical
record transfer in Wales has been successfully
completed between two GP surgeries in Cardiff.
It is part of a pilot being run in collaboration
between NHS Wales Informatics Service and GP
computer systems provider INPS.
Digital transfer (known as GP2GP) enables a
patient's medical record to be transferred
directly and securely between practices and
improves patient care as the new GP will have
the patient's full medical record available for the
first consultation.
GP medical record transfers take place when a
patient moves from one practice to another,
usually because they have moved house.
"The results page is great," says Prestatyn's
Pendyffyn Medical Group Health Care Assistant,
Darren Thomas. "It easily allows bloods to be
checked and prevents unnecessary requests. The
simple connection between primary and
secondary care requests helps a great deal."
The practices now piloting the application are
Clarence Medical Centre and Pendyffryn Medical
Group in North Wales and Meddygfa Tywi,
Coalbrook Surgery in Hywel Dda.
My Health Text
GP practices in Wales have started piloting a new
texting service called "My Health Text" to remind
patients of appointments and provide health
alerts.

The current process involves the
patient's previous practice printing out the
patient's record and sending a paper copy to the
new practice. The new practice then has to
summarise and key in the information onto its
own system. It can take weeks for the whole
process to complete.
Texts might also be used to aid chronic disease
management, promote services and clinics, and
advertise practice open hours.
Several practices are currently piloting the
service and are seeing appointment attendance
improve.

The digital transfer of a patient's notes as part of After the pilot ends, the service will be made
the GP2GP pilot between a practice in the more widely available to all practices in Wales.
Gabalfa area in Cardiff to another in the Cathays
area took around thirty minutes to complete.

Following the pilot, the service plans to expand

to more practices.

GP Test Requesting
Four GP practices have started using a GP Test
Requesting application to place pathology test
requests for patients.

The application (using the electronic referrals

system called the Welsh Clinical Communications
Gateway) acquires accurate information from
the GP patient record and includes a results page
which easily allows bloods to be checked and
prevents unnecessary requests.

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 Information Technology in Primary Care

Managing referrals
The Welsh Clinical Communications Gateway has
made the process of sending referrals more efficient
between GPs and hospital referral centres. E-
referrals are now being sent from the patients GP
directly to the relevant consultant making the
process even faster.

The Hospital e-Referrals Phase 2 (HeRs2) pilot

began this spring in Cardiff and Vale Health Board's
cardiology and neurology departments. The pilot
routes e-referrals to consultants desktops for
online prioritisation using the Welsh Clinical Portal. Case Study
Referrals can be put on hold while the consultant My Health Online
seeks further information from the patient's GP Why Queue?
through the system.
From Trellech, the nearest pharmacy is miles
This clinical dialogue between secondary and away in Monmouth. So for the thousands of
primary care clinicians is seen as a considerable patients of Wye Valley Practices Trellech Surgery
benefit to patients, not only speeding up workflows deep in rural Monmouthshire, its a good thing
but also providing referrals that cannot be the surgery has its own dispensary. It distributes
misplaced. thousands of items every month. Most patients
order repeat prescriptions over the phone.
It is hoped HeRs2 can expand into other
departments, such as Child Health, Dermatology, But more and more are contacting their practice
Diabetes, Obstetrics and Gynaecology. online, using the national portal that is now
available at all GP practices in Wales - My Health
Online.
My Health Online
Weve had great feedback, says Viv Kent, Wye
Both patients and GP practices in Wales are Valleys Practice Manager.
benefiting from My Health Online.
Lots of patients say how they work all day and
This new digital service is available to all practices
cant get to the end of a phone. Now they can
and allows patients to book appointments or order
access My Health Online and
repeat prescriptions online.
order prescriptions from their
Future enhancements to My My Health Online has really made a home computer.
Health Online will include the difference to our practice. It has
creation of a mobile app for reduced the phone calls into the Patients find it a useful tool, not
use on smart phones and practice which frees up the only to order repeat
online registration. receptionist to do other tasks. prescriptions, but most recently
to book online appointments.
Riscas Wellspring Medical Centre
Practice Manager, Barry Davies My Health Online has also
proved a hit among Vivs staff as
well. She says it saves time on
phone calls, cuts down on administrative steps
and keeps tabs on patients prescriptions.

Weve had nurses saying its brilliant, Viv adds.

Its been a big bonus in managing procedures.

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Community Care Information Solution
Linking with health and social services
With people living longer and a rise in chronic
long-term illness a more integrated network of care is
needed that will help people live independently and
avoid unnecessary hospital admissions. NHS Wales,
social care and voluntary sectors will need to
collaborate as a necessity.

To support these changes and make sure our

nations care is fit for purpose, Welsh Government Moving away from individual
has invested in a new Community Care Information
Solution (CCIS), which will allow information to be stand-alone systems will be of
shared between different health and social services particular use in supporting
instantly, helping to deliver improved care and
support for people across Wales. emergency and out-of-hours
The new technology will enable health, social services, and will enable health
services, mental health, therapy and community and social care services to work
services to ensure services and support for
individuals, families and communities are more in a closer, far more effective
effectively planned, co-ordinated, and delivered. It
will support information sharing requirements, case manner."
management and organisational workflow. Councillor Mel Nott OBE,
Leader of Bridgend County
The CCIS will interface with a range of different
systems across local authorities and NHS Borough Council
organisations. It covers processes undertaken by
community health and social care workers, and
across primary, community and secondary care
settings, to show where a patient is within their
treatment journey and alerting health professionals
to key data, which will aid efficient treatment.

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Responsibility and Accountability
Quality, safety and security
As the organisation with overarching responsibility
for many of the critical technology services used by
NHS Wales, we put clinical risk management and
patient safety at the heart of all we do.

When new products are developed they are tested

throughout the design, development and testing
stages to ensure they are safe for release to NHS
Wales.

Led by our Clinical Team, we run safety workshops

where health professionals are invited to review
products under development and undertake a risk
assessment.
"Modern healthcare needs
Keeping information safe is a top priority. A number
of measures are in place to ensure the right balance
information to be instantly
between the benefits of sharing information to available where and when it's
support better care and maintaining patient
confidentiality. needed. At the same time it's
As technical security of information grows in
important that patients'
importance and value each year, we are making sure confidential and sensitive
that our networks and systems remain safe by
making sure NHS Wales conforms to the highest information remains secure."
standards. Darren Lloyd,
We continually raise security awareness with all NHS
Information Governance Lead
staff and ensure that there are secure hosting NHS Wales Informatics Service
environments that stop unauthorised access.

More than just certificates on a wall

Internationally-accepted recognition achieved through
obtaining certification from the International
Organisation for Standardisation (ISO) provides
assurance to the public, patients, stakeholders and
Last year, everyone involved in how NHS Wales Informatics Service
information operates, that we take the business of developing and
security supporting high quality IT systems and services seriously.
experts from
NHS Wales It ensures all possible steps are taken to deliver services
Informatics professionally and securely.
Service, led by Over the years, we have achieved (and maintained) ISO
Head of Security Design John Taylor, were certificates for Quality, Environmental and Information
shortlisted twice for Best Security Team in Security management systems, showing we meet or
the prestigious SC Magazine Awards 2014 exceed internationally-approved standards.
Europe.

10
 Web Services and Software for healthcare
Providing the tools
Information technology may consist of lines of code
written by computer programmers and compiled into
computer programs. But that doesn't tell the half of it.
The technology can gather, measure, organise and
protect. It can make tasks easier and help people
faster.
NHS Wales IT engineers have developed valuable
software tools, accessible on the web, to help
clinicians do their job more efficiently and to provide
better healthcare for patients.
Take for example, the Patient Episode Database - a
national online tool that provides statistical data on
patient stays. This has been updated to be more
specific to get local health board views of patient
figures. It records all episodes of inpatient and
daycare activity in NHS Wales hospitals. This includes
planned and emergency admissions, minor and major
operations, and hospital stays for giving birth.
Screening systems
NHS Wales Informatics Service works in partnership
with other NHS Wales organisations to develop and
provide a variety of vital screening services, helping to
identify people at risk, manage their results and in
many instances, save lives.
The Bowel Screening Information Management
System is used to identify and invite people eligible
for bowel screening, tracks their response to the
invitation and keeps a record of their screening
results. Bowel cancer is the third biggest 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 system was originally developed for Bowel
Screening Wales. Its success has seen it adopted by
Northern Ireland to support its bowel screening
programme.
We support and locally develop the Cervical Cytology
Screening module on the UK-wide NHAIS -Exeter
system used in all Primary Care organisations in
England and Screening Services in Wales. Targeting
women between the ages of 20 and 64, the module is
an early detection tool toward preventing cancer by
locating and treating early abnormalities.
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Working with Public Health Wales, a new system to
support Abdominal Aortic Aneurysm screening has
been completed. Around 8,000 people in the UK
die each year due to these aneurysms, it is
estimated that 50% of these deaths could be
prevented by high quality screening.
A replacement system for Community Child Health
2000 is currently being developed that will cover
child registration and demographics, immunisation
scheduling and results and record all children with
special developmental, physical or social needs for
scheduling reviews.
Providing the data at crunchtime
Other tools provide clinicians and analysts with
organised and trackable data. For example, the Bed
Data Reporting Tool is an information system giving
managers real-time hospital capacity and occupancy
information to make resource decisions regarding
unscheduled care.
The NHS Wales Data Quality System helps GP
practices manage patients during flu seasons or
provide latest diabetes figures and acts as Public
Health Wales eyes on the front line during an
outbreak.
An integrated unscheduled care dashboard,
created by NHS Wales software teams, displays the
information coming from A&E systems with a
refresh rate every ten minutes so managers can
see the number of ambulances waiting at an A&E
department across Wales in nearly real time.

It also displays a wealth of other data showing
whether there are any bottlenecks from
admission through to discharge. This includes
highlighting care for over 85s as it is recognised
this patient group has complex health and social
needs which need managing.
It is the first time that managers have been able
to build a bigger picture of both winter pressure
and unscheduled care information across Wales,
bringing together data from primary and
secondary care.
HOWIS and web services
NHS Wales Informatics Service Web Service and
Software Development teams also provide
specialist expertise in intranet and internet
technologies to NHS Wales staff to help them
work more efficiently and get their messages out.
HOWIS, or the Health of Wales Information
Service is an intranet warehouse developed by
web services drawing together information
sources covering the health and lifestyle of the
population of Wales, as well as resources for
staff, into a simple electronic-based service.
Websites are created via an in-house publishing
tool called Cascade, which allows NHS
organisations in Wales to easily publish health
information and get important messages seen.
More than 600 websites throughout NHS Wales
carried by and developed on the Cascade Web
Content System are visited more than 1.6 million
times every month.
Web services have also created E-learning sites
to develop health informatics skills in NHS Wales
and which are also being used to train staff in
other areas. Learning@NHSWales carries more
than seventy courses, some in partnership with
the education sector and Welsh Government.
Web Services and Software for Healthcare
Case Study
Add to Your Life A Health
Self-Assessment
A free NHS Wales health and wellbeing
assessment was launched last year for people
who are 50 or over in Wales - an estimated 38
per cent of the Welsh population.
Addtoyourlife.co.uk is a confidential and
easy-to-use self-assessment which can be
undertaken online or by telephone. It provides
tailored health and wellbeing information,
advice, and signposting to sources of support in
response to the answers they provide in the self-
assessment.
The service has been developed jointly by Public
Health Wales and the NHS Wales Informatics
Service. A large number of charities and other
organisations have also been involved in
developing the service.
"As people get older, they are more at risk of
developing cancer, heart disease, kidney disease,
diabetes and other long term conditions," says
Chief Medical Officer for Wales, Dr Ruth Hussey.
"The earlier risk is detected, the greater the
chances of taking action to prevent that risk from
becoming a reality. It improves access to the
most effective public health services and sources
of support."
I had help doing the service the first time," says
Lyn Price from Cymmer who undertook the self-
assessment with support from Communities
First.
"I found it really good and very helpful. It really
prompted me to make changes to my life, and
Im feeling the benefits of it now. Ive gone from
being virtually sat in a chair to being able to walk
around without my stick, and my confidence has
grown because of that."
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 Information Services
Compasses and measuring tools
Clinicians may use data to help treat individual
patients. But data can also be used to project trends,
analyse performance, and improve wider
organisational decision making.

Our information service teams collect and process the

facts and figures that help NHS Wales run effectively.
The data we collect is stored in the NHS Wales data
warehouse, in accordance with national standards and
Information Governance policies. Collected data is
analysed and converted to useful information that
helps staff across NHS Wales and the Welsh
Government in their work.

Our Clinical Classifications Team has recently

completed work for the first ever audit of NHS Wales
clinical coding accuracy. This audit helps pinpoint
areas where the quality of data needs to improve. We
also provide a clinical coding helpline to clarify current
classification rules and ensure data is recorded
consistently and accurately.

Getting all the facts and figures

To give health boards and Welsh Government access to
the information they need in the way they want it, we
produce a range of web apps including dashboards,
data quality indicators, health maps and various on-line
reporting tools.

Making sure demographic data, the information about

patients administrative details, is safe and used the
right way is the job of the Welsh Demographic Service.
Demographics can be used for many purposes, such as
the management of patient's paper medical records
between GP practices, the call and recall of women
into the cervical and breast screening programmes,
the allocation of NHS numbers for patients and
babies, payment of contractors such as pharmacists
and GPs and ensuring blood and organ donor details
are maintained.
To power and monitor the high volume
of information used by NHS Wales
every minute of every day takes
powerful computers that must be
reliable and safe.
That information is now housed in two
secure all-Wales data centres used in
partnership between NHS Wales and
other public sector organisations.

As the demand for better information across Welsh

health services increases, so does the importance of
data quality. Our Data Quality team makes sure
systems are fed proper and accurate data.

The National Reference Data Service is used to

support the rollout of national IT applications,
ensuring the data used by those systems is consistent.
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Pharmacy Services
The Right Medicine
IT in pharmacies is one of the three key
departmental systems used in hospitals, along with
radiology and pathology.
These pharmacy systems, developed or delivered
through NHS Wales Informatics Service, allow stock
to be ordered and invoiced electronically, records
and labels all medication, downloads details
automatically from the National Patient
Administration System and links to various robots
to pick the medicines to be dispensed and delivers
them to the stock room.
This technology is not only used in
secondary care but also in your
neighbourhood pharmacy.
Using systems developed by NHS
Wales Informatics Service, the
paper prescriptions given out
by family doctors in Wales now
contain a small square barcode
which is scanned in at the
pharmacy.
These barcodes are being used for
prescriptions at all 700 high street
and local pharmacies in Wales, making it
easier and safer to dispense medicines. With over
1.5 million prescription items processed each week
by community pharmacies, barcodes help rule out
errors that can occur when information is keyed in
from the paper prescription.
The barcode contains all the prescription
information as well as the unique drug codes for
each of the medications or preparations
prescribed. Each barcode can hold information for
up to four prescription items and the patient's
name and address.
E-lists and e-letters
Several health boards are now using a new module
of the Welsh Clinical Portal called MTeD.
MTeD (Medicines Transcribing and e-Discharge) is
an electronic way of recording a list of medications
for a patient and adding them to an electronic
discharge advice letter (e-DAL). The e-DAL is then
sent to the patients GP as soon as they leave the
ward, via the Welsh Clinical Communications
Gateway (WCCG).
Previously, it could take several weeks for a typed
or hand written discharge letter or summary to
reach the GP, long after the patient had been
discharged from hospital.
The e-DAL does not just include the medicines that
have been prescribed in hospital but also clearly
sets out other information that the GP needs to
know such as diagnosis, medical progress, advice to
GP, follow-up action and test results.
Community pharmacists are also
benefiting from improved access to the
medicines section of a patient's
electronic discharge advice letter.
A new application is being piloted
across Wales called Choose
Pharmacy.
Choose Pharmacy enables e-DALs
produced in hospitals in Wales and via
MTeD to be shared electronically with
nominated community pharmacies,
subject to patient consent. It provides timely
and accurate information to community
pharmacists post discharge and allows them to
perform an electronic discharge medicines review,
checking the medications a patient has been
prescribed against any changes that were made to
their medications during their stay in hospital.
These reviews should reduce harm and avoidable
re-admissions to hospital caused by medication
errors.
Any discrepancies between the discharge
medicines list on the e-DAL and the GP prescription
can be clarified with the GP practice before the
medicines are dispensed.
NHS Wales Informatics Service experts
developed the software for the Choose
Pharmacy minor ailments service that
encourages patients to consult a
participating community pharmacy, rather
than their GP for common ailments.
14
 Network Knowhow
Building the connections
Networking means connecting. And thanks to
improvements in public sector broadband, Welsh
healthcare systems can connect faster than ever.
Websites, telephones, email and many other
essentials can connect, interact and provide a quick
reliable service.

Technical support is vital to keeping IT functioning.

It ensures that the important clinical systems used
in healthcare can run day and night all year round
and that best use is made of capacity.

Handling approximately 45,000 incidents and

various service requests every month, ServicePoint
is a complete Service Management toolkit Case Study
Video Conferencing
designed, developed and maintained by NHS Wales Remote Control
Informatics Service.
Junior doctors in Wales are benefitting from a
It provides a secure, effective and efficient call national video conferencing service allowing
management system to all NHS Wales IT service them to train over distances.
users - 24 hours a day, 365 days a
year. This includes all seven LHBs, More than a dozen hospitals
NHS Wales Shared Services ServicePoint has been considered and 16 participating centres
Partnership, Welsh Blood Service and so practical that last year, it was are using the service for
Welsh Ambulance Service. implemented in its first non-NHS teaching and to develop
Wales organisations. stroke services. Lead
NADEX physicians in one centre will
Gwent Police, Torfaen County interview a patient while
A secure national directory and email Council and Monmouthshire junior doctors can call, ask
service (known as NADEX) replaced County Council are now using it questions, and suggest
the previously fragmented approach for their IT support through the diagnoses.
to security and email management. Shared Resource Service based in
Blaenavon. The service has also had a
The national directory service allows beneficial effect on treatment
users to log on to systems and for stroke patients. The
services regardless of where they access a weekly meetings are held using VC technology,
computer, while a national email service provides a bringing together clinicians to review the
single up-to-date address book and allows health anatomy and pathology of cerebrovascular
professionals to share diaries with colleagues disease and examine the latest clinical and
across organisations within NHS Wales. radiological techniques.

It also provides an email address "for life" for as
long as staff remain within NHS Wales.
It also provides a unique identity for staff that is
used to authenticate users to national electronic
systems.
"The interaction of the stroke teams using video
conferencing has facilitated the development of
the hyperacute stroke interventional service,
where patients are transferred to the University
Hospital of Wales for therapy to treat their
stroke," says Dr Yogish Joshi, Cardiff & Vale
Consultant Neuroradiologist.

15
 Network Knowhow

Face-to-Face Technology
The Welsh Health Video Network (WHVN) can link
GP practices, hospitals and specialist facilities. It
supports over a thousand video conferencing
devices and uses secure encryption between video
equipment as an additional way to protect patient
confidentiality.

Video conferencing is successfully used in rural

Patients have directly benefitted
areas where multi-disciplinary team members can from treatment as a result of
meet for assessments of patients over vast
distances. having VC technology.
Reaching further out Dr Yogish Joshi
In an agreement with Microsoft and funded by the Consultant Neuroradiologist
Welsh Government's Health Technologies and Cardiff & Vale University Health Board
Telecare Fund, a new service called Lync is being
made available to Welsh health boards. It enables
video conferencing and instant messaging between
NHS Wales colleagues, and their patients, carers and
support workers.

One of the benefits Lync brings is its ability to host

online conferences with users outside of NHS
Wales.

Lync will be able to include other organisations,

such as community services, care homes, charities,
etc. Many clinicians will be able to include patients
in those calls as well, provided their patients have a
broadband connection where they live. The service
can be used with laptops, smart phones and tablets
and can support multi-disciplinary teams working in
the community.

16
 Health Informatics
Developing the workforce
Across NHS Wales the delivery of care increasingly Because last years apprenticeship scheme was so
relies on reliable computer systems and accurate successful, a new intake of apprentices has been
up-to-date information. recruited this year.

As a national organisation, we are supporting the
professional development of people employed in
informatics, and working with doctors, nursing and
health professionals to advance how they use
informatics to support care.
Powys IT Apprentice Ryan Hewson, who completed his
AS levels in 2014, says the scheme is "life-changing and
provides an opportunity to further develop your skills."

Over the last two years, NHS Wales Informatics

Service has run a wide variety of knowledge sharing
events covering informatics in healthcare,
management and performance, informatics
developments and people and relationships.

And to provide a focus for professional

development, the Hi-Profile website offers a
central point for information about career
development, jobs and events.

Getting started Apprentice and IT Support Technician Sion Rees, monitoring NHS
Last year, seven apprentices successfully completed Wales IT infrastructure in the Support Operations Centre.
the first apprenticeship in Health IT to be run by
NHS Wales Informatics Service and the first
apprenticeship scheme of its type. All have now "It is a step in the right
secured full-time jobs.
direction and something you
Wendy Dearing, Head of Workforce and can take the experience from
Organisational Development at the NHS Wales
Informatics Service, said the scheme, is where the for the rest of your life."
career path begins and Im proud to say that all Scott Newton
seven have completed their 18 months
apprenticeship and have the skills they need to NHS Wales Informatics Service
take forward their career. Business Administration Apprentice
NHS Wales Informatics
Service has been
awarded the core NHS Wales Informatics Service,
Investors in People T Glan-yr-Afon, 21 Cowbridge Road East
Standard, demonstrating
CARDIFF
a true commitment to
realising the potential of CF11 9AD
staff. Tel: 02920 500500
Investors in People is the accredited UK standard
to lead improvement through people Visit our website at:
management. www.wales.nhs.uk/informatics
17