Minutes of the meeting Held at 9:30am on Friday 14 th February 2014 At Castell Caernarfon NWIS, Bocam Park Pencoed Bridgend CF35 5LJ

Transcription

1 Minutes of the meeting Held at 9:30am on Friday 14 th February 2014 At Castell Caernarfon NWIS, Bocam Park Pencoed Bridgend CF35 5LJ In Attendance Ian Kelsall Patrick Coyle Vivienne Harpwood David Smith Jocelyn Parkes David Staniforth Tina Donnelly Catherine O Sullivan Chair of Wales Information Governance Board Chair of the Privacy Advisory Committee Specialist in medical law, Vice Chair Cwm Taf Health Board Corporate Information and Customer Services Manager, Conwy County Borough Council Director for Wales, Royal Pharmaceutical Society Expert Public/Patient Member Director RCN Chief Officer, Community Health Council Advisors Dr Martin Murphy Clinical Director (NWIS) Darren Lloyd Claire John Head of Information Governance (NWIS) Information Governance Manager (NWIS) Observers Anne Jones Stephen Hinde Secretariat Andrew Fletcher Assistant Information Commissioner (Wales) Member of the UK Council of Caldicott Guardians, and Retired Head of Information Governance and Group Caldicott Guardian, Bupa Secretariat, Information Governance (NWIS) Author: Andrew Fletcher, Secretariat P a g e 1 Version: APPROVED

2 Also In Attendance Darren Reynolds Ken Leake Phil Ransome Karla Scott Gareth Bulpin Nick Elcock Project Manager, NWIS; Integration & Reference Applications Manager Project Manager, NWIS Principal Project Manager, NWIS Technical Development Manager, Cardiff and Vale UHB Programme Manager, NWIS Apologies Angela Thomas Fraser Campbell Alison Machon Head of Business Strategy, Neath Port Talbot County Council (Social Care Member) Assistant Medical Director, Primary Care (West) (BCU HB) Social Services Leadership & Improvement Division, Welsh Government Tony Calland Sue Youngman Nicola Ryley Eleri Thomas representing Keith Towler Mike Ogonovsky Member BMA Welsh Council Patient / Public Representative Assistant Director of Nursing, Aneurin Bevan Health Board Children s Commissioner Head of Health & Social Care Informatics (NWIS) Author: Andrew Fletcher, Secretariat P a g e 2 Version: APPROVED

3 1. Welcome and Apologies The Chair welcomed all in attendance and noted apologies. The Chair congratulated Jocelyn Parkes on her appointment as Royal Pharmaceutical Society Director for Wales Members were reminded that David Middleton of the Social Services Leadership and Improvement Division of the Welsh Assembly Government retired in December; and were informed that Alison Machon who has deputised at meetings of the Board for him in the past has taken over the position. 2. Declarations of Interest Members of the Board were asked to declare any interests that they may have in terms of any items on the Agenda. There were no declarations of interest. 3. Minutes of last meeting Approved: The minutes were approved as a true and accurate record of the meeting. 3.1 Matters Arising Updates to the actions from the previous meeting were as follows: Item 3.1 Matters arising: It was confirmed that the progress report and forward plan were in the process of being finalised. Item 3.4 NIIAS update: The Chair had been kept abreast of development and an update was to be provided on the Agenda. Item 3.5 Sensitive Codes: The Board were to be provided with an update paper on the Agenda. Item 4 Individual Health Record in the Welsh Clinical Portal: The agreement has been amended. An update in relation to this item was on the Agenda. Item 7 Position of sending PII within the NHS Wales system: A statement from the Board had been drafted to reflect the position that ing within the NHS Wales system was a secure method of transfer but had not been published as yet. Item 8 Public Services leadership commitment to improve practice in sharing personal information: Identified parties had been in contact. Item 9 Wales Audit Office: The Wales Audit Office representatives are to attend the next meeting to update the Board with the progress being made with the 2014 Disaster Recovery and Business Continuity review. Item 11 WHIGNet Future Role: Action completed. An update in relation to this item was on the agenda. Author: Andrew Fletcher, Secretariat P a g e 3 Version: APPROVED

4 3.2 Privacy Advisory Committee (PAC) and Welsh Health and Social Care Information Governance Group (WHSCIGG) Members were informed that work had been undertaken to examine the future role of the Privacy Advisory Committee (PAC) of WIGB and the non affiliated Welsh Health Information Governance Network to enable a better interaction with Health and Social Care. Members were informed that both PC and DL had also been in discussions with the Confidentiality Advisory Group (CAG) of the Health Research Authority surrounding how PAC could work more closely with them and to ensure a greater visibility on approvals relevant to Wales. Members were reminded that the proposal is to create a group called the Health and Social Care Information Governance Group (WHSCIGG) which was based on the existing Welsh Health Information Governance Network (WHIGNet) model, only covering a wider base. It was noted that NWIS were in the process of speaking to local authority colleagues in the hope that this can be set up, which will then support the community and integration work. Action: Further defining work on the groups terms of reference are required It was queried as to whether the new group would be in place when the Protection of Freedoms Act 2012 comes into force. Members were informed that it was hoped that the group would be in place by then and the terms of reference would reflect the obligations under the Act. It was observed that the amendments to the Freedom of Information Act 2000 as introduced by the Protection of Freedoms Act 2012 would be relevant to certain research applications as it introduced dataset provisions. It was confirmed that in terms of the NWIS datasets, the approval to use the information was still subject to approval by CAG under section 251 of the NHS Act The Board were informed that WIGB and CAG had established a strong relationship and that there was a good dialogue between leads. It was mentioned that there is a possibility that a member of NWIS will be invited to be a member of CAG. It was noted that there are currently difficulties in processing invoices for NHS Wales patients treated by some NHS England providers because they will not supply any information on the invoice in order for the patients to be identified. It emerged that some providers were of the view that there should be an alternative means of identifying the patient, however given that there had been no notice of this position, no resolution existed and therefore invoices would not be paid unless they could be ratified. DL noted that he is in discussion with various bodies in attempt to resolve the situation. It was observed that a temporary approval for use of data for invoice ratification had been made under section 251 of the NHS Act 2006 by the Confidentiality Advisory Committee and that it was on the Agenda at their next meeting. Some members of the Board expressed their surprise at the position and disagreed that this use in any way compromised the legislation as it was needed for health service administration. The importance of having one process and resolving these issues was discussed by the Board and the view was formed that discussions were needed with the relevant organisations. Action: Explore the possibility of speaking to the relevant NHS England Finance leads to seek resolution. Author: Andrew Fletcher, Secretariat P a g e 4 Version: APPROVED

5 3.3 Wales Accord for the Sharing of Personal Information ( WASPI ) Service The Board acknowledged the receipt of a written update in relation to the WASPI project. The Chair noted that good progress had been made. It was recognised that WASPI was significant to the sharing of information in all sectors and was not restricted to Health and Social Care. It was agreed that it was important to engage with the Local Service Boards given the range of public authorities represented there. It was queried as to who would have responsibility for information sharing if something went wrong under WASPI when the Welsh Government funding comes to an end. It was clarified that it will be the statutory organisations responsibility for the sharing and that this has always been and will remain the position. Members queried how the service would operate after the Welsh Government funding had ceased. The Board were informed that the intention was to embed WASPI as a process within each public authority to ensure that the process was used by default. It was noted that WASPI facilitators had been identified in each organisation and that most of the relevant Facilitator training had been done. Key to the project was the Sharing Personal Information Board which remains after the end of the funding of the WASPI team as hosted in NWIS and decisions on the future direction of the project will come out of that Board. Members emphasised the importance that organisations remain aware that Information Sharing under WASPI was their responsibility. The role of the Chief Executive was stressed as important to the success of WASPI within organisations. Members were made aware that the Public Sector Leaders Group was engaged in the project and would give Chief Executives exposure to the wider concept of information sharing between public bodies. 3.4 Sensitive codes The Board acknowledged the receipt of a written update in relation to the work being undertaken in terms the identification of sensitive codes. Members were pleased with the progress being made. It was noted that a work package would also be undertaken separately to identify the data flows between England and Wales and to make a comparison between the statistical information produced within NHS Wales and that produced by NHS England. It was suggested that undertaking such a comparison would illustrate the different approaches being undertaken by NHS Wales and NHS England particularly in relation to Care.data in England. 3.5 Secure Communications: The Board acknowledged the receipt of a written update in relation to the Secure Communications project. It was noted that dialogue continued to take place with NHS Wales Heath Boards and Trusts in promotion of the project. It was also noted that some English Primary Care Trusts had been in discussion with NWIS with a view to adopting the solution. Members observed that one Health Board had asserted that they would not go into Enforce Mode citing concerns surrounding clinical risk. The Health Board had expressed concern that any delay in informing the clinician that the was being held for review would be a risk. Members noted that Author: Andrew Fletcher, Secretariat P a g e 5 Version: APPROVED

6 the system was working well in those Health Boards in Enforce Mode with no known incidents and this should reassure other organisation in this respect. The consequence of a breach of the Data Protection Act by misdirection was discussed. It was noted that the consequences of such a breach where the organisation was not in Enforce Mode could carry a significant financial penalty, especially considering the technology is in place and the organisation has chosen not to use it. It was noted that ultimately the Minister will be informed of those Heath Boards and Trusts who did not switch to Enforce Mode within an acceptable timescale. The Board discussed the timescales by which it was expected that all organisations should be in Enforce Mode. A period of six months was considered reasonable by members. Agreed: That Board expected all Heath Boards and Trusts should to be in Enforce Mode within six months. It was noted that NWIS and WIGB were only in a position to encourage Heath Boards and Trusts to implement the rule sets. The Board observed that it was important that each organisation was reminded as to the importance of the project to ensure that this remained on their Agenda. Agreed: That WIGB write to Heath Boards and Trusts reminding them of the importance of achieving Enforce Mode of the secure communications project and encouraging them to do so within six months. Action: Secretariat to draft a letter to all NHS Wales Heath Boards and Trusts to remind them of the importance of implementing Enforce Mode. It was observed that Velindre NHS Trust did not appear on the implementation status list. Action: WIGB to be provided with an update as to the position with Velindre NHS Trust at the next meeting. 3.6 Demographic Cleansing Information from the Office of National Statistics The Board were informed that as a result of a change introduced under the NHS and Social Care Act 2012 the Office of National Statistics (ONS) would no longer allow NWIS to use the feed of all death registrations that they receive from them for the purposes of cleansing the demographic lists. It was clarified that initially the General Register Office, the originator of the data had refused, however now ONS had also refused. Members were informed that the ONS feed continued to be supplied to NHS England for the purpose of data cleansing the Patient Demographic Service (PDS) and ONS had suggested that NWIS should get the death data from PDS instead. Members were told that this was not practical. As a consequence data cleansing had not occurred for a period of nine months which was of great concern in respect of data quality. Members of the Board were informed that a working group had been set up to look at all data flows to do with mortality. The Board noted that Wales have not been invited to be involved. It was understood that there were plans to record the patient NHS number as part of death registration process. This was not likely to happen soon, however when this is in place it would remove the reliance on postcode to decipher if a patient is from Wales. Author: Andrew Fletcher, Secretariat P a g e 6 Version: APPROVED

7 Members noted that Public Health Wales were in communication with ONS on the same issue as this information was critical for their purposes. Comment was made that in terms of the issue of presumed consent in organ donation this was critical. It was clarified that the ONS data continues to be received for statistical purposes, but there was no explicit permission to use it for the purpose of data cleansing. The Board was of the view that if the data was received that in the interests of accurate data that NWIS uses the data for cleansing on a temporary basis whilst further discussions with ONS and the General Registrar Office continue. Agreed: It was agreed that NWIS continue to use the ONS mortality data for the purpose of datacleansing demographic information whilst negotiations continue. In coming to this conclusion the Board recognised the importance of accurate data and the issues that inaccurate data could cause, particularly where the death of a patient was not reflected in the dataset. The Board further recognised the compliance issues that may exist if information was not kept up to date. It was noted that a series of meetings had been facilitated to discuss issues surrounding the availability of mortality data. It was further noted that a new technological solution will eventually be available which will resolve the issues encountered. 3.7 IG Summit Taking forward Caldicott 2 Members were very supportive of the proposal to hold an Information Governance Summit. The objective of the summit was to facilitate closer working between Health and Social Care. It was proposed that the summit would take place before the schools summer holidays and include speakers and workshops, to include Caldicott2. Members suggested that Dame Fiona Caldicott and the Minister himself would be ideal speakers at such an event, especially in light of their support for the increased sharing of information for the benefit of the patient across the boundaries of Health and Social Care. Comment was made that health professionals should be included in the summit as they can sometimes introduce barriers to sharing. It was suggested that there could be benefits to holding an annual conference to keep professionals up to date; and Ministerial support of this would be a valuable asset. Members noted that a preliminary costing exercise of the proposed summit had taken place. Agreed: The Board noted the intention and supported the concept of an IG summit taking place. 4. National Intelligent Integrated Audit Solution ( NIIAS ) update Members were informed that the project had encountered further delays. It was noted that NWIS directors had been prepared to ensure that the tool was implemented within the financial year, however there had been setbacks in terms of informatics colleagues based in Health Boards and Trusts who had concerns about the resources required to implement the solution. Members expressed their disappointment at the news and it was stressed that the implementation of NIIAS was key to enabling the opening up of electronic health records. Author: Andrew Fletcher, Secretariat P a g e 7 Version: APPROVED

8 Members were informed that the most recent setback had occurred when NIIAS was taken to an all Wales Prioritisation Board. Although the Prioritisation Board recognised the need for such a solution, it was not considered a priority. It was confirmed the system would not now be procured before the new financial year. Members were informed that it had been suggested that NWIS should develop an in house solution; however it had been acknowledged that this was not the best approach as NWIS did not have the expertise in house and there were solutions available which were already developed. In order to ensure that NIIAS was in place, it had been suggested by the Directors of NWIS that the approach to the NIIAS be changed so that NWIS would provide a centralised audit service where initial analysis would be undertaken centrally and thereafter forwarded to the Health Boards for action. In doing this, there was also the potential of monitoring cross-border information flows. It was noted that in operating this as a centralised service, NWIS would not be taking on the obligations of the statutory bodies; it would remain the responsibility of the statutory bodies to act on any potential breaches flagged to them. NWIS Directors were aware that the implementation of a solution was now a priority as it was not possible to roll out any more systems, or extend the use of existing implementations any wider, without the NIIAS in place. Members of the Board stressed that approvals for developments had been given on the basis that the solution would be in place before any further roll out and the view was taken that if NIIAS was not implemented WIGB should withdraw their support for the systems previously agreed to. Members were agreed that WIGB should send a letter to NWIS restating the position. It was commented that the role of WIGB was to ensure that public trust was maintained and therefore in order to demonstrate that WIGB must act. It was agreed that a resolution of the Board was required that should note the Board s full support for the rollout of national systems but that this was dependent on the NIIAS. The Board resolved that without the NIIAS they could not assure the public that the control measures in place were sufficient to maintain the confidentiality of their records and on this basis they would not be able to support any further roll out of national systems. It was further agreed that funding for NIIAS must be agreed, and the procurement instigated within the next three months. Agreed: It was agreed that WIGB write to the Chief Information Officer for Health at NWIS restating their position. Agreed: It was agreed that in order to demonstrate a commitment for NIIAS being in place, NWIS Directors must agree to commit to allocating the budget for; and agree the procurement process within the next three months. Action: A resolution of the Board to be drafted and circulated to members via the secretariat to iterate their position that without NIIAS, WIGB will withdraw support for all NWIS products that were assured on the basis that NIIAS would be in place. 5. Demonstration of the IHR in WCP Members of the Board were reminded that the purpose of the project was to make the IHR available via the Welsh Clinical Portal for Emergency Admissions. In doing this the IHR would be available to view by Doctors and Pharmacists providing direct care to any Welsh patient admitted to a Welsh Hospital. It was noted that there was no change to the originally agreed content of the IHR. Author: Andrew Fletcher, Secretariat P a g e 8 Version: APPROVED

9 Members of the Board noted that the pilot was authorised to proceed on the basis that there was assurance that there was a full commitment at a senior level in each health board to meeting the audit requirements; and the receipt of written confirmation from each health board to evidence that audit is taking place. It was noted that both pilot Health Boards have provided written assurance that they are fully committed to the project including the full auditing requirements. Members were informed that a three month pilot is planned on six wards in Cardiff and Vale Health Board and on four wards in the Medical Admissions Unit at Aneurin Bevan Health Board. Members of the Board were assured that the project had received approvals from GPC Wales, the BMA Wales IM&T subcommittee, the Board of Community Health Councils including all Chairs of each individual CHC and the Medical Directors of all Health Boards and NHS Trusts across Wales. It was noted that the consent principles were the same as those required for the IHR when used in the Out of Hours setting. A patient has to give explicit consent to access the record unless they are in a position that they cannot give consent; in which case emergency consent can be used. Members noted that controls were in place to restrict access to the clinical staff looking after the patient and that such access was audited. Patients can continue to use the already established process to opt out of having an IHR. Members were provided with a demonstration of the IHR in the Welsh Clinical Portal. Members attention was brought to the consent screen. It was explained that each healthcare professional needing to access the IHR would be required to seek consent and this would last for 72 hours. Comment was made that there was a high likelihood that patients would not be happy with being repeatedly asked for their consent. It was ascertained that this assurance was required in order to gain the support of the professional bodies and the impact would be evaluated during the pilot. Assistance of the Community Health Council was volunteered for the patient evaluation. Members noted that the adoption of individual consent for the pilot should not set the precedent for full roll out until evaluation findings have been assessed and communicated to the respective professional groups. Action: Contact Community Health Council via Cathy O Sullivan to assist with the patient evaluation in the pilot sites Agreed: The Board accepted that while individual consent was a condition for the pilot of the IHR for emergency admissions, they were concerned about the potential impact on patients in being repeatedly asked for their consent. The Board agreed they did not want this to set the precedent for full roll out. The Board were provided with a demonstration as to how the IHR could be seen in an emergency where consent could not be given. Members questioned the correctness of the pre-configured reasons that can be selected when using emergency consent. It was confirmed this would be looked at by the project team. Action: Project team to review the pre-configured text associated with the emergency consent option. It was queried as to whether the IHR would display highly sensitive information such as sexually transmitted infections such as HIV. It was confirmed there is an excluded list which includes HIV and items on the list do not appear on the IHR. The view was expressed that legitimate users may need to see some of the sensitive information in order to treat patients. It was clarified that it had been Author: Andrew Fletcher, Secretariat P a g e 9 Version: APPROVED

10 necessary to restrict this in order to gain the approval of professional bodies. It was noted that in time it would be necessary to revisit the model where highly sensitive information is excluded from the IHR to one where it is available behind break glass. A discussion took place surrounding whether the opt-out from the presumption of consent for organ donation was visible on the IHR. It was confirmed that while the code relating to the opting out of organ donation existed on the GP system, this had not been implemented on the IHR. Members noted that this was always something that could be considered at another time. The view was expressed that this should be implemented into the system to reduce potential delays in ascertaining whether someone had or had not opted out of organ donation. Members were shown a sample of the audit log that appears to the user and it was commented that this would remind the user that their access was logged. The attention of members was drawn to the fact that the system offers a number of reminders to ensure that the user is aware of their responsibilities which aims to act as a deterrence to misuse. A discussion took place surrounding the potential need to correct any incorrect entries in access logs. It was noted that while access logs should not be wrong, that if any system displayed any inaccuracies that these would need to be rectified by going through the correct secure process. The Board discussed the issues surrounding inappropriate access and the need for patients to have easy access to information about who has been accessing their record. It was noted that an audit report would show who has had access to any given record and when they had access to it. Where a patient requested a copy of the audit log or an investigation is underway concerning inappropriate access this report can be provided. Comment was passed that there should be a process in place for patients to access this information if they so wished. It was stated that on roll out, it would be necessary to go back to patients with comprehensive information which would include information as to how the audit logs could be accessed. The Board were reassured that they would be consulted on every step of the process in order that they can provide continued advice and assurance. Some of the IHR screens were demonstrated to members, including the allergy screen. A member of the Board noted that neither blood nor serum could be extracted from an unconscious patient for purpose of establishing HIV/Hep B status and provision for this should be considered in the Welsh Clinical Portal. Action: Tina Donnelly to provide further information on the legal restrictions of extracting blood from an unconscious patient for purpose of establishing HIV/Hep B. Members were provided with a copy of a joint letter from NWIS and the BMA General Practitioner Committee which had been sent out to all GPs in Wales. It was noted that adequate time had been given to ensure that any queries could be addressed ahead of go live. 6. Digital Communications Policy (Formally Internet Services Policy) Members were informed that the proposed all Wales Internet Services Policy had been renamed the Digital Communications Policy following feedback from the group. It was noted that work to develop an all Wales Policy was ongoing and that the Minister was to receive an update at the next meeting with WIGB representatives. It was submitted that an all Wales Policy was an enabler for future progression. Author: Andrew Fletcher, Secretariat P a g e 10 Version: APPROVED

11 7. Community Care Information Solution (CCIS) The Board were given a presentation on the Community Care Information Solution. The Board noted that there were a number of policies and strategies that aim to achieve better integration of services; and were informed that the Community Informatics Programme Board had been working together with the relevant authorities in order to procure a Community Care Information Solution. The importance of engaging and working with patients themselves to ensure that patient views on information sharing are understood and respected was stressed. Members were informed that patient engagement had not yet occurred, however this was part of the communications plan as the project progressed. The importance of engaging with the Community Health Councils was stressed. It was noted that a core requirement was to be able to treat the patient holistically and that traditionally the GP and nurse communication via GP systems works well in parts of Wales. It was clarified that the Community Care Information Solution was intended to be the system helping people in the community. It was noted that one of the next steps was to decide the core data items that needed to be shared. A discussion took place surrounding the use of the system. It was recognised that while information sharing between Health Boards and Local Authorities was being looked at, that the information flows between GPs and community teams was a fundamental aspect to integrated care. Some members expressed the view that such a system should be available at hospital level. Members were reassured that there was a significant amount of work underway which was looking at all the technical requirements to ensure that this was achieved. Tina Donnelly congratulated Karla Scott on an informative presentation and invited her to do the same presentation at the RCN leadership summit. Members expressed their gratitude at the presentation and noted that they were appreciative of the amount of effort that has gone into getting the project so far. Members recognised the importance of the work package. The efforts of Bev Thomas in this programme of work were noted. Members noted that the IG Assurance Process was underway and that this would consist of multiple layers in terms of the parties involved. Members again expressed the importance of the audit tool in terms of taking the project forward. Members discussed the issue of sharing information with third sector organisations. It was recognised that a high percentage of patients were cared for by organisations which were not part of either Health or Social Care organisations. It was noted that the NWIS strategy would take this into consideration. The Chair queried as to whether the forthcoming reconfiguration of Local Authorities would have an impact on the roll out of the system. Members were informed that the system would be configured in such a way that it would be flexible in dealing with a future restructure; however the reorganisation may impact on progress. The Chair thanked Karla Scott for her presentation and thanked members for their contribution in the discussions. Author: Andrew Fletcher, Secretariat P a g e 11 Version: APPROVED

12 7.1 The Board are asked to support the proposal to allow Carmarthen Local Authority access to the Electronic Master Patient Index Members noted that it was the intention that the NHS number was used as an identifier in both Health and Social care and that to do this it was essential that Social Care colleagues should be able to look up the NHS number relating to any patient they were providing care for. Members were informed that the demographics of all patients in Wales registered with GPs appeared on the Master Patient Index. It was noted that a pilot had taken place to establish whether the demographics held by Social Care systems was sufficient to look up patients on the MPI. The outcome of the pilot was that in ninety eighty percent of cases the Master Patient Index had been successful in matching the NHS number with the patient. It was established that the intention of the first phase of the project in hand was to attach the NHS number to all Social Care records; and that in the second phase of the project Social Care staff would be given the facility to look up the NHS number for unmatched records and new clients. The Board were informed that one way of achieving this in the interim was to allow access to the Master Patient Index to look up the patients; and it was therefore proposed to pilot this in Carmarthenshire County Council. It was identified that the proposal would involve a small number of Social Care staff having read only access to the Master Patient Index in order to carry out the task. It was noted that it was possible to restrict access to those patients in the Hywel Dda area, however while this was not ideal it would give a start. Members were reassured that access to the Master Patient Index was logged and is audited. The view was taken by members that looking up the NHS number was in itself reasonable for this purpose given the need to use a common identifier across Health and Social Care and it was established that fair processing had been legitimised in terms of the Schedule 2 conditions of the Data Protection Act Members were assured that Sensitive Personal Data which was sometimes held by the Master Patient Index would be removed and only demographic information would be visible. It was queried as to whether it was proposed that the user would look up the patient via the clinical system or the Master Patient Index. It was clarified that the proposal was to look up the patient on the Master Patient Index as there was a cost involved, and as some of these systems were soon to be replaced it was hoped that this could be achieved without investing in this at this stage. It was noted that browsing the Master Patient Index was not possible as a minimal set of demographics was required before patient details would be located. Members of the Board observed that in previous instances there had been an insistence that access to look up a patient should be done via the relevant system in order to ensure that the process was appropriately recorded by the system. Members were assured that risks are considered through the Information Governance Assurance Process. It was suggested that further work should be done to establish if it is possible to look up the MPI via the Health and Social Care system as opposed to accessing the MPI directly. Action: Further work should be done to establish if it is possible to look up the MPI via the Health and Social Care system as opposed to accessing the MPI directly. Experience with the Welsh Demographic Service lookup provisions should be utilised. Author: Andrew Fletcher, Secretariat P a g e 12 Version: APPROVED

13 Action: The Board requested to be updated on the project on a regular basis. It was suggested that this process could be used as an example of the integration between Health and Social Care at the IG summit. 8. Cardiff & Vale Health Board Virtual Clinics Cystic Fibrosis and Open Access Wi-Fi Gareth Bulpin gave a presentation entitled Healthcare without Boundaries: A dream of reality to the Board. It was submitted to the Board that the expectations of the patient and the clinician was that the internet should be supported at a hospital and that the current WLAN structure was under-utilised. In addition it was submitted that there was increased pressure on the IT department to deliver in this regard. The Board were informed that Cardiff and Vale Health Board set a 58 day challenge deadline to give patients access to the internet in time for Christmas and to give clinicians access to the Cardiff Clinical Portal by mid January. The Board were informed that feedback from the patients and clinicians had been positive and that both the The Director of Innovation and Improvement and the the Anesthetic Consultant and Associate Dean had recognised the significance of its contribution to Healthcare. Members of the Board noted that to date there had been developments in linking universities and councils to the network to enhance services. Virtual clinics and group sessions had been enabled, free Patient Wi-Fi Internet Service was now available, and Bring Your Own Device was being implemented in parts of the Health Board. The Board were informed the all-wales Adult Cystic Fibrosis centre at the University Hospital Llandough had a significant patient base spread across Wales, Herefordshire and Cheltenham and Tewkesbury and offered free patient access for one month following registration. In terms of support it was noted that only three calls for support had been received in the three months since go-live. Members were made aware that most patients wanted to use Skype and Facebook, however some sites such as gambling sites had been disallowed to help minimise the use of bandwidth. It was clarified that while Skype was allowed for personal use, virtual clinics must take place via the client software as designated for the purpose. Members were informed that use of virtual clinics took place within a set of rules that had been established. In the first instance the patient would be asked whether they would like to participate. If the patient did, their written consent would be obtained. It was suggested by members of the Board that logging into the system would be sufficient to demonstrate consent. In terms of the consultation, this would take the same process as if it had been undertaken on a face to face basis. There was an assurance that the patient was asked at the start of the consultation to confirm that they were happy to continue. It was noted that the outcomes of a virtual clinic were exactly the same as a face to face clinic with the outcome being entered in the patient s medical record. Members were informed that there was a rule that patients were not to record virtual sessions; and also clinicians should not give bad news to a patient via a virtual clinic. Author: Andrew Fletcher, Secretariat P a g e 13 Version: APPROVED

14 It was confirmed that it could be monitored whether any recording was taking place and this was being monitored as part of the pilot. Members were informed that the no recording rule concerned assuring that a record was not created that may form part of the patient record, which the user may not think of as a record. It was clarified that only the host could record and this was forbidden. It was confirmed that this too could be monitored as the recording would be saved to the client software. The Board were informed of the next steps for Virtual Clinics. It was noted that a Microsoft pilot for 100 users was due to take place and that work was being undertaken with the nurses dealing with stomas and radiologists to establish new pilots. It was also noted that x-rays and scans may be virtually available via the client in order for remote experts to make an online diagnosis. A discussion took place surrounding virtual sessions in general and some members expressed that they would be concerned if the whole process became dehumanised with no face to face contact. Direct contact was stated to be an important aspect of care and the danger of losing direct contact was considered a risk. A discussion took place surrounding the use of Skype as a communications tool in some environments. It was noted that virtual sessions using Skype were taking place in some Health Boards and this was viewed as positive. The Chair thanked Gareth Bulpin for his presentation. 9. AOB Members were informed that the Confidentiality Advisory Committee in England was seeking to recruit new members. It was noted that details of the advertisement could be found in the Guardian newspaper. 10. Date and Times of Next Meeting The Chair thanked everyone for attending and noted that the next meeting was scheduled to take place at 9:30am on Wednesday the 16 th of April 2014 at the Board Room, Brunel House, Cardiff. Author: Andrew Fletcher, Secretariat P a g e 14 Version: APPROVED

15 Summary of Approved and Agreed Items Item Item Description Approved / Agreed Item 3.1 Minutes, matters arising Approved: The minutes were approved as a true and accurate record of the meeting. 3.5 Secure Communications: Agreed: That Board expected all Heath Boards and Trusts should to be in Enforce Mode within six months Secure Communications: Demographic Cleansing Information from the Office of National Statistics IG Summit Taking forward Caldicott 2 National Intelligent Integrated Audit Solution ( NIIAS ) update National Intelligent Integrated Audit Solution ( NIIAS ) update Demonstration of the IHR in WCP Agreed: That WIGB write to Heath Boards and Trusts reminding them of the importance of achieving Enforce Mode of the secure communications project and encouraging them to do so within six months. Agreed: It was agreed that NWIS continue to use the ONS mortality data for the purpose of data-cleansing demographic information whilst negotiations continue. Agreed: The Board noted the intention and supported the concept of an IG summit taking place. Agreed: It was agreed that WIGB write to the Chief Information Officer for Health at NWIS restating their position. Agreed: It was agreed that in order to demonstrate a commitment for NIIAS being in place, NWIS Directors must agree to commit to allocating the budget for; and agree the procurement process within the next three months. Agreed: The Board accepted that while individual consent was a condition for the pilot of the IHR for emergency admissions, they were concerned about the potential impact on patients in being repeatedly asked for their consent. The Board agreed they did not want this to set the precedent for full roll out. Author: Andrew Fletcher, Secretariat P a g e 15 Version: APPROVED

16 Summary of Actions Item Item Description Action 3.2 Privacy Advisory Committee (PAC) and Welsh Health and Social Care Information Governance Group (WHSCIGG) Action: Further defining work on the groups terms of reference are required 3.2 Invoice remuneration for cross boarder patients discussed under item 3.2 Action: Explore the possibility of speaking to the relevant NHS England Finance leads to seek resolution. 3.5 Secure Communications: Action: Secretariat to draft a letter to all NHS Wales Heath Boards and Trusts to remind them of the importance of implementing Enforce Mode. 3.5 Secure Communications: Action: WIGB to be provided with an update as to the position with Velindre NHS Trust at the next meeting. 4. National Intelligent Integrated Audit Solution ( NIIAS ) update Action: A resolution of the Board to be drafted and circulated to members via the secretariat to iterate their position that without NIIAS, WIGB will withdraw support for all NWIS products that were assured on the basis that NIIAS would be in place. 5. Demonstration of the IHR in WCP Action: Contact Community Health Council via Cathy O Sullivan to assist with the patient evaluation in the pilot sites 5. Demonstration of the IHR in WCP Action: Project team to review the pre-configured text associated with the emergency consent option. 5. Demonstration of the IHR in WCP Action: Tina Donnelly to provide further information on the issue of extracting blood from an unconscious patient for purpose of establishing HIV/Hep B. 7.1 The Board are asked to support the proposal to allow Carmarthen Local Authority access to the Electronic Master Patient Index 7.1 The Board are asked to support the proposal to allow Carmarthen Local Authority access to the Electronic Master Patient Index Action: Further work should be done to establish if it is possible to look up the MPI via the Health and Social Care system as opposed to accessing the MPI directly. Experience with the Welsh Demographic Service lookup provisions should be utilised. Action: The Board requested to be updated on the project on a regular basis. Author: Andrew Fletcher, Secretariat P a g e 16 Version: APPROVED