The need for a digital record for eye care is well recognised in the UK as a requirement for modern ophthalmic care. Eye care digitisation supports NHS Wales’ strategic direction of providing appropriate care closer to home, supporting people to maintain their independence by reducing sight loss as well as meeting the quadruple aim.
The Welsh Government’s Together for Health: Eye Health Care Delivery Plan for Wales 2013-2020 has as one its ten priorities, the digitisation of eye care. This nomination is for the Procurement of a EPR system which is the first of its kind.
The lack of an EPR is impeding achievement of capacity and demand balance for eye care and missing opportunities to deliver cost savings by skill mix. Without EPR functionality, the Health Board Eye Care Plans will not be deliverable and patients will not receive timely, prudent care. A vital part of the Eye Health Care Plan is the digitisation of Eye Services. This is an essential enabler to improving integration, and accessing and sharing information. An EPR is required to allow the hospital clinicians and community optometrists to electronically record and access information relating to patients in order to speed up and improve treatment. A key element of this will be to enable the transfer of treatment from hospital settings (currently unable to meet demand) to community settings where clinically appropriate. This can only be achieved effectively through an electronic system. Paper-based systems impede the service redesign needed to manage the patient safely and efficiently.
Referral from Optometry practices to hospital eye services is essential to connect the whole system and provide the ability for safe, timely referrals between Optometrists in the community and hospital eye services, reducing the need for some patients to be referred at all. The introduction of the EPR will enable the expansion of “shared care”, where the NHS and community optometry practices will share a patient record system, to avoid delay and duplication. Information on the treatment of the patient will be available to all appropriate staff, wrapping care around the patient and avoiding duplication of diagnostic tests. It will provide secure access for Optometry practices into the NHS Wales network, utilising commercial access software. The model developed will allow Optometrists to enter patient data for those receiving “shared care” directly into the EPR as the prime source of data collection, which can then also be viewed by the hospital eye service and vice versa. This digital model also supports the national guidance on Ophthalmic Diagnosis and Treatment Centre (ODTC), providing comprehensive diagnosis and management based on multidisciplinary working. It will also support the development and rollout of regional working to make the whole system more resilient.
In February 2018, the Health Minister committed to introduce a ophthalmic digital system to refer people quickly for treatment and where appropriate to enable more people to be treated and cared for locally.
New guidelines from April 2019 require hospital eye services to have procedures in place to ensure people receive their assessment or treatment by the most suitable person within a clinically appropriate time. This means those people at highest risk of eye disease who need be seen quickly due to their condition, should experience fewer delays. The new measure is based on priority and urgency of care required by each individual patient. Priority is the risk of harm associated with the patient’s eye condition if the target appointment date is missed. Urgency is how soon that patient should be seen, given the current state and/or risk of progression of the condition. Wales is the first UK nation to introduce a measure of this kind for eye care patients alongside the existing referral to treatment target.
In order to achieve this aim, Cardiff and Vale Frontline Procurement Services commenced a competitive OJEU tender on behalf of NHS Wales for a fully integrated digital system. The SRO was an Executive Lead from Cardiff and Vale UHB and the evaluation team included All Wales representation from a significant number of stakeholders comprising of Opthamology clinicians both from primary and secondary care along with management colleagues, IT and Finance. To fully support this evaluation team and implement the awarded bidder’s solution, Regional Groups were created comprising of both Clinical and Operational Management staff who met on a monthly basis.
The Procurement had a robust evaluation process incorporated a qualitative assessment on various areas such as design specification, information governance, security principles, information and audit and theatre imaging and integration along with site visits and presentation demonstrations.
Following successful completion of the Procurement, the EPR is now commencing the implementation stage of this project which will allow a view of the patient within hospital pathways, in accredited community optometry practices and in ODTCs that sit at the interface between Primary and Secondary Care. This is the first of its kind to be implemented especially for a single Nation. The investment is sponsored fully by the Welsh Government.
The benefits to awarding this contract will be;
- ensure patient safety is managed effectively by reducing the demand in secondary care which are currently unable to meet demand and transferring treatment to community settings where clinically appropriate
- deliver timely, prudent care by avoiding delay and duplication of both appointments and diagnostic tests through the introduction of a live EPR system
- improve integration, accessing and sharing information across multi disciplinary teams both locally, regionally and nationally, ensuring that the All Wales Ophthalmology system is more resilient than current practice.
- potential reduction in referrals between Optometrists in the community and hospital eye services due to the connection between primary and secondary care
- support the national guidance on Ophthalmic Diagnosis and Treatment Centre (ODTC), providing comprehensive diagnosis and management based on multidisciplinary working.
- increase efficiency and workflows through;
- Low Risk Eye Pathology being “moved” from the Acute Sector into Primary Care.
- Enabling performance and enhancing quality and timeliness of care
- Consultants in the Acute Sector to under “virtual clinics” to support the “shared care” of the “low risk” Eye Pathology patients “moved” into Primary Care
- Integrated remote professional oversight, governance, care and delivery
- Data reporting (e.g. eye outcome focused measures, local and national targets/reports)
- collection of PROMS and PREMS questionnaires to form part of the contract enabling a value based system crossing secondary and primary care, to help capture and support the data.
- There will also be efficiency savings which will again lead to patient benefits such as;
- access to real time information at all stages of the patient pathway
- removal of paper records leading to less cancelled appointments
- ensures clinical information is recorded in a consistent manner
- access to clinical audit and business intelligence information to support service planning
All these benefits will lead to real improvements in experiences and outcomes for patients in Wales.
Finalist: 2020 HCSA Procurement Technology Award and Highly Commended: 2020 HCSA Procurement Technology Award
Name: Claire Salisbury
Job Title: Head of Procurement (Cardiff & Vale Frontline Procurement)
Organisation: NHS Wales Shared Services Procurement
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