Wales seeks ‘urgent approval’ for IHR rollout

Tags: consent diabetes Wales

18 Mar 2008

The leaders of the Welsh NHS IT programme are calling for urgent approval of the business case for rollout of the Individual Health Record.

Informing Healthcare’s programme board want the Welsh Assembly Government to give the go-ahead to the nationwide expansion of the IHR which is currently being piloted in Gwent and due to be rolled out to four more areas by June this year.

The IHR is extracted from GP records every day using an implied consent model but only available to view by out-of-hours services with explicit consent. It contains patients’ demographic details plus a wide-range of information including medication history, current and past diagnoses, allergies and contraindications, test results and information on referrals and information.

Some information is blocked from the uploads from GP practices including codes covering sexually transmitted diseases, abortion and gender reassignment. Further information is currently withheld from the IHR when it reaches the NHS Wales computer system, including family history, obstetric procedures, diabetes diagnoses and smoking status.

A spokesperson for Informing Healthcare told EHI Primary Care that the IHR would be rolled out to Gwynedd, Anglesey, Pembrokeshire and Ceredigion by June 2008.

She added: “It will then cover about a million people which is one in three of the population.”

However, an all-Wales rollout is reliant on approval of the business case by the WAG. The Informing Healthcare programme board is arguing that approval is essential if the Assembly is to successfully implement its Delivering Emergency Care strategy, which aims to ease the pressure on A&E through a network of urgent care centres.

The IHR is currently only available for viewing out-of-hours, but there are plans to look at expanding the coverage to others such as urgent care centres, A&E departments, NHS Direct, NHS Wales Ambulance Services and mental health services.

Approximately 400,000 patients currently have their information uploaded in Gwent. A survey of clinicians working in out-of-hours found that more than 70% felt the IHR helped sometimes or frequently to inform their clinical decisions. When dealing with older patients, or those with chronic conditions, this rose to 80%.

Reader's Comments

Has there been mission creep?

24 Mar 08 08:03

"The IHR is extracted from GP records every day using an implied consent model but only available to view by out-of-hours services with explicit consent." I assume the original pilot had adequate consultation and was approved by the population - but has there been mission creep since? In November 2007 "The individual health record in out-of-hours care holds details of the individual's medication, allergies, current problems and diagnoses." But in March 2008 "It contains patients’ demographic details plus a wide-range of information including medication history, current and past diagnoses, allergies and contraindications, test results and information on referrals and information. Some information is blocked from the uploads from GP practices including codes covering sexually transmitted diseases, abortion and gender reassignment. Further information is currently withheld from the IHR when it reaches the NHS Wales computer system, including family history, obstetric procedures, diabetes diagnoses and smoking status."

In addition, some of the exclusions seem a bit odd: I would have thought that "diabetes diagnoses" were not particularly sensitive - and would be important in managing patients outside general practice.

The links, which lead eventually to a patient leaflet, don't really explain the situation.

Points to be made: were patients consulted about this and given the opportunity for informed dissent, and if so, were they aware that the scheme was intended to gather additional information in the future and be made available to an increasing number of organisations?

Bit like SCR I suppose - but done differently and more successful in fulfilling objectives. People in Wales and Scotland certainly seem to trust their health services more than those in England!