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a dr at computer with patientJanuary 17 2018

Delays and issues with functionality in the electronic patient record are causing frustration, the Wales Audit Office has warned. It is also unclear whether intended benefits are being achieved, the WAO said in its review, ‘Informatics systems in NHS Wales’ published last week.

The report warns that the NHS is spending only around 2% of its budget on funding IT, half the level recommended in the 2003 Wanless Report. It highlights delays around elements including medicines supply and management. The WAO said that in 2016 it had noted “the NHS has had an intention to implement an electronic prescribing system since 2007.”

Since then, “progress has been slower than anticipated, partly because other pharmacy-related IT projects in NWIS [NHS Wales Informatics Service] have taken precedence. Although a business case for a national electronic prescribing system has been drafted by NWIS, the rollout of the system is not due until 2023.”

The WAO report also highlights issues around the uptake of My Health Online programme. “NWIS reports emphasise that the system has been rolled out to 100% of GP practices and that 222,000 patients have registered. Taken in isolation those numbers seem impressive but the underlying story is more mixed.” It notes that as of July 2017:

  • 90% of practices were offering online repeat prescriptions;
  • 51% were offering online appointments;
  • 9% of practices were not offering any part of the system to their patients;
  • having 222,000 registered patients is significantly below the figure of 872,000 set out in the 2009 business case and represents just 7% of the Welsh population;
  • an average of 44,000 prescriptions are ordered each month through the system, less than 1% of prescriptions across Wales each month;
  • around 12,000 appointments are booked each month on the system, less than 1% of GP appointments booked across Wales.

The report also noted concerns that NWIS considers projects are regarded as completed at too early a point. “Health board staff identified concerns about another system called GP2GP, which was being discussed six to eight years ago but is still not scheduled to be fully implemented until 2020. Similarly, NHS staff reported that the implementation of GP test requesting was being discussed over 10 years ago. Nonetheless, these two systems are rated as ‘green’ in NWIS’ progress report,” says the WAO report.

“A system might largely be in place, but is not necessarily being used properly (or at all). For example, NWIS considers the Welsh Clinical Portal to be ‘live’, including the functionality that allows GPs to make electronic referrals. However, health boards reported that doctors find the referral process difficult and time consuming to use, so many are instead continuing with paper referrals. “

Launching the report, the WAO said: “Many of the building blocks – such as GP systems, a national radiology system and laboratory systems – of an electronic patient record are now in place or at an advanced stage. However, significant delays to the delivery of new systems have caused widespread frustration and there is still a way to go until it the electronic patient record is fully in place.”

Commenting on the report, Vanessa Young, Director of the Welsh NHS Confederation, called for high-quality informatics systems to support the delivery of NHS health and care services in Wales. “The right technology will improve efficiency, enable the significant change required to services, and help people better manage their own health and wellbeing,” she said. “Creating an electronic record for every patient, that can be accessed by all services across the NHS in Wales must be an absolute priority for the service.”

Links:
WAO announcement      
WAO ‘Informatics systems in NHS Wales’                 
Welsh NHS Confederation statement         

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