Digital Health and Care Wales

We conducted a six-month randomised controlled trial of home telemonitoring for patients with chronic obstructive pulmonary disease (COPD). A total of 40 stable patients with moderate to severe COPD who had completed pulmonary rehabilitation took part. They were randomised to receive standard care (controls) or standard care plus home telemonitoring (intervention). During the monitoring period, patients in the telemonitoring group recorded their symptoms and physical observations twice daily. The data were transmitted automatically at night via the home telephone line. Nurses could access the data through a website and receive alerting email messages if certain conditions were detected. The patients completed the St George's Respiratory Questionnaire, Hospital Anxiety and Depression and the EuroQoL EQ-5D quality of life scores before and after pulmonary rehabilitation, and then periodically during the trial. There were significant and clinically important improvements in the scores immediately following pulmonary rehabilitation, but thereafter there were no differences in quality of life scores between the groups at any time, or consistently within either group over time. The study showed that telemonitoring was safe but, despite being well used, it was not associated with changes in quality of life in patients who had stable COPD.

Abstract The use of computers in the National Health Service (UK) as a workplace is fundamental to its future. However, there is evidence of a paucity of information technology skills within the workforce and therefore, information technology skill training is essential. The National Health Service in Wales has been using the European Computer Driving Licence qualification to educate its staff in order to cover this skill gap. This paper reports on an evaluation of the perceived benefits to staff, both clinical and non‐clinical, working for the National Health Service in Wales of information technology training through the European Computer Driving Licence qualification. Results show that there is an increase in confidence in terms of tasks undertaken but also towards other general life skills. Additionally, for those respondents with clinical contact, there is a perceived increase both in the time available with and the quality of care, given to patients. As the continued move towards a computer orientated healthcare system occurs, the information technology skills obtained through but not limited to training schemes such as European Computer Driving Licence will become of paramount importance, particularly as the single most important failure for technology‐related projects in healthcare is a lack of readiness.

A system was developed to allow general practitioners in Swansea to send urgent cancer referrals electronically to consultants at the South West Wales Cancer Centre. Five practices from the Swansea area took part in a pilot trial. Information was extracted from the system to evaluate the e-referral activity of the first six months, during which a total of 99 referrals were submitted electronically; most (81%) were processed within one hour. Evaluation interviews were conducted with staff at the general practices, who were asked to rate the system on a 10-point Likert scale (1 = completely dissatisfied to 10 = completely satisfied); the lowest satisfaction rating given by the practices was 8. The staff agreed that the use of a standard form was beneficial and improved the quality of the referral information submitted to consultants.

This article describes the establishment of an all-Wales nursing and midwifery steering group to support the activities of the Welsh information, communication and technology programme, known as Informing Healthcare. Early indications are that Informing Healthcare is communicating well with the steering group which, in turn, acts as an intermediary communicating with frontline nurses in Wales. Other organisations in the UK might be interested in the approach taken, particularly in involving nurses and other clinicians in information technology projects.

Parallel processing and memory bottlenecks dominate current platform architecture conversations. After many years on the sidelines, parallel architectures are rapidly becoming mainstream, with more parallelism the obvious way to gain yet more performance. Feeding data to and from all these parallel cycles is also becoming more challenging. What does this have to do with XML? Surely all this is under the hood, something for compiler designers, software architects and other non-content people to worry about? The answer is that these issues can't be totally hidden under the hood. Balisageurs as content-folks and interoperability-folks need to pay attention now to the high level information design heuristics that will prevent our data structures being the ones that happen to run like treacle (or molasses) on the coming generations of faster, larger and neater systems.

The concept of a flexible and yet also breakable interface is central to successful configuration and version management for a messaging specification. Changes which are made to a message or message definition should not affect systems or design teams that are not concerned with the subject of the change. However, changes causing unexpected behaviour or misinterpretation of a message should ‘break the interface’ thus making it impossible for systems to unknowingly use a changed message in a way which may hold clinical safety or other risks. Achieving these features in a complex specification with a diverse implementation community is not a simple matter. However, there are several measures that could be beneficial. Applying the kind of configuration management discipline that is well known for complex software artefacts to the development of a complex specification is likely to be cost-effective, even though the tools available are less mature. A combined strategy of representing key aspects of design configuration not only within the specification artefacts published to the implementation community, but also as a matrix documenting expected impacts, and within message instances in live operation, is also promising as a way to enable gracious handling of change.

The Map of Medicine provides access to around 400 care pathways for clinicians. Its primary function is to support clinical decision-making and increase clinical effectiveness. It also has the potential to act as an educational tool. This paper seeks to explore that function and to evaluate how student nurses take advantage of this facility. Two student nursing cohorts at a single college in Wales were asked to complete two questionnaires; one at the point where the Map of Medicine was first introduced to them, and subsequently six months later. The results show that the expressed initial enthusiasm for the Map waned over the six months, but that most students recognized the benefits of the online resource compared with paper-based alternatives. Traditional resources remain important and there were indications that access to other resources or forgetting about using it alongside the lack of IT access in a clinical setting may have presented a barrier.