15 February 2022
In the first of a series of spotlight features, Mr Rhidian Hurle, Consultant Urological Surgeon in Cwm Taf Morgannwg Health Board and Medical Director for Digital Health and Care Wales, shares his personal experience of digital health care over 25 years.
When I qualified as a doctor in the previous century, my late father, who was a GP in Pembrokeshire, gave me a Bic biro as a present with words of advice that have always stuck with me: “press hard enough on the carbon copy paperwork so that the person who gets the bottom copy can read it!”
Safer patient care relies on communication between health care professionals and a record that is visible and legible to all involved in the care environment. Keyboards and connectivity have dramatically improved visibility of care records. We are not yet completely free from carbon copies and paper records, but the vision of a single digital health and care record has become closer on our horizon in Wales.
Like most in the NHS, my clinical day as a consultant urological surgeon starts by logging in. Depending on the setting, finding a computer that is switched on and working, connected to a printer that is switched on and working, with trays that contain paper correctly inserted, is a challenge.
I find the Welsh Clinical Portal icon. Using a single ID and unique password I open an application that has changed the way I deliver care. Access to over 211m results and reports, more than 35m care documents and 3.1m GP summary records. I can request blood tests electronically, view any radiology imaging from anywhere in Wales, write directly into the digital record and share instantly with over 30,000 NHS users.
I sit in the outpatients and choose to view the schedule ahead. A timetable of patient appointments that require face-to-face consultations appears, with a click to access the individual patient’s health record. This coordinated care event is administered though the Welsh Patient Administration System in the background. If no appointments are sent, no patients would arrive - I would just drink tea. But this has never happened, and the patients come and go, with follow ups scheduled if needed.
I electronically vet referrals through the day that come from GP colleagues. Legible, content-rich referrals, linked to the patient’s digital record that enable me to choose how the patient needs to be managed, the urgency of their requirements, and who best to see them. No lost referrals means safer care.
I see my results counter increase and the nudge makes me electronically sign some off. No longer does an army of staff cart tonnes of paper notes with results pinned to the front of each to weigh down my office desk. I can do this anywhere, any time I have connectivity. The work of Digital Health and Care is responsible for this.
At the end of the day, I electronically sign off my letters sent for typing from my digital Dictaphone and the hospital WiFi. I telephone some patients with their results and use clinical notes to record what I’ve said and done, and share it within the NHS Wales ether.
When on call and receiving a phone call for advice, I ask for the NHS number and using the quick search box in the Welsh Clinical Portal. I soon find the patient’s record. Often I have more information than the referring colleague. I type a clinical note. I hit save and the document is instantly visible within the electronic health record.
Information governance and our approach to it in Wales has delivered benefits rarely seen elsewhere. We scope, design, build and assure software with our users that changes people’s lives. Through sharing the record content across and along the patient journey, we facilitate safer care.
Frontline patient health care is difficult, sometimes exhausting, often frustrating, but hugely rewarding. Informatics in healthcare is difficult, sometimes exhausting, often frustrating, but the prize is equally large and rewarding. What we can do as a team together makes healthcare safer, more economically efficient, and facilitates better outcomes for individuals and populations.
To colleagues at DHCW, pause at your workstation, breathe deeply and smile. You make a positive difference within the NHS every day. Keep going and I hope that one day soon I will only use that Bic biro to write a thank you card.