Development, implementation and evaluation of the digital transformation of renal services in Wales: the journey from local to national

Abstract

Background: Treatment for people with kidney disease is often associated with complicated combinations of medicines. Logistical challenges with traditiona paper-based prescribing means that these patients are particularly susceptible to medication-relation errors and harm.

Aim: To improve the quality of care that people with kidney disease receive across Wales through a Value-Based digital transformation programme.

Setting: Renal units within the National Welsh Renal Clinical Network (WRCN).

Development: A novel Electronic Prescribing & Medicines Administration (EPMA) system, integrated into a patient care record and linked to a patient portal was developed in South West Wales (SWW) region of the WRCN, enabled by the Welsh Government (WG) Efficiency Through Technology Fund. National upscale was enabled through the WG Transformation Fund.

Implementation: EPMA was designed and rolled out initially in SWW region of the WRCN (2018). A dedicated delivery team used the blueprint to finalise and implement a strategy for successful national roll-out eventually across all Wales (completed 2021).

Evaluation: A multi-factorial approach was employed, as both the technology itself and the healthcare system within which it would be introduced, were complex. Continuous cycles of action research involving informal and formal qualitative interviews with service-users ensured that EPMA was accessible and optimally engaging to all target stakeholders (patients and staff). Results confirmed that EPMA was successful in improving the quality of care that people with kidney disease receive across Wales, contributed to Value-Based outcomes, and put people who deliver and access care at the heart of transformation.

Conclusion: Key findings of this study align directly with the national design principles to drive change and transformation, put forward by the WG in their plan for Health and Social Care: prevention and early intervention; safety; independence; voice; seamless care.

Keywords: Electronic prescribing patient care; Kidney disease; Patient portal; Quality of care.

Fig. 1

Number of medication digitally recorded as administered each month in Welsh dialysis units since start of development of EPMA, noting the start and end of each respective development and/or roll-out period (left) and the location of the 18 dialysis units across the three regions in Wales (right). The height of each rectangle represents the size of the respective unit, in terms of patient population numbers

Fig. 2

Key quotes from framework analysis of interviews with patients, mapped against the three dimensions of health [27] and the six domains of healthcare quality [28]. Figure created using Canva Education edition