In developing the Informatics Strategy, a number of specific recommendations have been identified which are each enablers of the delivery of one or more outcomes and contribute directly to achievement of strategic objectives. They can be summarised under the following themes:
8.1. Governance and leadership
These recommendations are about providing appropriate leadership and assurance for Informatics ‘Business as Usual’ as well as for developments.
• Effective relationships with partners and suppliers – Define and resource an appropriate ‘Intelligent Customer’ and supplier management functions to ensure best value and delivery from external IT Service Level Agreements.
• Following agreement of the Digital Roadmap there should be a review of Governance arrangements so that Bristol and South Gloucestershire CCGs are leading the Informatics strategic agenda for GP IT and ensuring that the CCG IT requirements are met. This should ensure appropriate accountability, ownership, challenge and ongoing senior level engagement to deliver the strategy.
• Programme management and benefits realisation – Ensure alignment between the Informatics Programme and corporate PMO, and a robust approach to benefit planning and realisation for all projects and programmes.
• IG and cyber security – Continue to develop IG policies and procedures, and develop a risk mitigation approach to emerging cyber security threats.
8.2. Digital maturity
8.2.1. Infrastructure
In order to maximize opportunities to work in the most productive way, certain underpinning technical infrastructure is required.
o Align with Digital Maturity assessment – Use the recent Digital Maturity Assessment as a baseline to determine future investment requirements.
o Support for Digital Roadmap – Work with other organisations in the same ‘footprint’ to develop future Digital Roadmap and maximize opportunities for securing additional funding from NHS England.
o Migrate to cloud-based solution – use the LPF process to ensure the chosen IT Services partner commits to put in place plans to migrate to cloud-based services to maximize flexibility and minimise local infrastructure costs.
o Virtual desktop infrastructure/roaming profiles – Make best use of modern technology to support the ability for staff to access information from any device and location.
Bristol CCG and South Gloucestershire CCG – Health Informatics Strategy 2016/17 to 2019/20 – Final
o Single sign-on – Implement single sign-on solution to minimize time spent logging on to multiple systems and to maximize opportunities for interoperability between systems.
o Wifi – Implement secure WiFi access for all NHS sites to maximize convenience for staff and patients.
o Networks including 3G/4G – Ensure appropriate network design to maximize access to information from any location.
o Mobile solutions – Review options for providing mobile access to clinical and administrative information so that staff can optimize their working arrangements and provide the best possible care supported by real-time access to information.
o Telephony – consolidate current telephony solutions to provide better functionality and reduced cost.
8.2.2. Interoperability
In order to support integrated care within and between organisations it is critical that each clinician involved in the care of patients has access to the relevant information at the point of planning and making clinical decisions. The focus should be on:
o Systems which use open Application Programming Interfaces (API’s) so that information can be readily accessed and shared with other systems;
o Access to clinical systems from any location the healthcare professional requires it;
o Meaningful use of clinical systems to capture and report information in real- time;
o Data sharing agreements between different healthcare organisations, and between health and social care;
o Patient consent model to enable clinical and social care professionals to access the information to enable the best possible care to be provided.
8.2.3. Capability and Capacity
In order to support current and future requirements some improvements to expert capability and capacity are required.
o Impact of projects on ongoing BAU – Assess all business cases for new developments to ensure that any impact on ‘BAU’ resources are identified and resolved as part of the business case approval process. It is recommended that this would be delivered through a PMO or similar function.
o Office software and productivity – Support users in making the best use of available systems to maximize productivity and minimize the number of paper- based processes.
o Focus on training and education – Develop and implement a structured training programme to ensure appropriate education, training and development for
Bristol CCG and South Gloucestershire CCG – Health Informatics Strategy 2016/17 to 2019/20 – Final
users of IT systems and information. This links with the requirement to develop a culture of making effective use of IT systems and solutions mentioned above. o Supplier management – Through the ‘Intelligent Customer’ function, ensure
best value from all external Technology Service Level Agreements.
o Maximise the opportunities presented by the Lead Provider Framework in selecting the most appropriate external partners for delivery of IT services and Business Intelligence, making sure the CCG requirements are clearly specified and delivered.
8.3. IT Service Delivery partner
Through the LPF specification, the CCGs should ensure that its preferred IT Service Delivery partner puts in place industry best-practice. This will help to ensure a more resilient and robust service to end users, and minimize the number of incidents that adversely impact users and clinical service delivery.
• Best practice Service Management (ITIL) – The use of the “IT Infrastructure Library” framework will ensure a controlled approach to all aspects of the IT support lifecycle.
• Proactive approach to availability and capacity management – Standard processes should be adopted to ensure a more proactive approach to managing and supporting the IT infrastructure.
• Remote support and extended hours – Technical support should be provided remotely wherever possible and the service hours should be extended so that services delivered ‘out of hours’ can always access IT support as required.
• User self-serve – Systems and processes should be implemented to ensure greater self-reliance of end users of IT solutions to minimise impact on the technical support functions.
• Service Level Agreements – Transparency of services provided and appropriate levers and incentives for delivery of high-quality services should be developed. • KPIs – To ensure all parties are clear about the success criteria of future IT service
provision and appropriate incentives and levers to ensure consistent delivery against agreed KPIs.
• Procurement – Clear procurement processes to support the strategic purchasing of new IT equipment, and ensure the most effective use of agreed catalogue items.
• Asset management – So that the end-to-end IT asset management cycle supports the delivery of high-quality service provision and ongoing software licensing. • Lead Provider Framework – Documents have been developed to help to inform a
market-testing process for future IT and BI Service delivery.
8.4. Data, Information, Knowledge and Wisdom
In order to fully understand the impact of activities commissioned in support of patient care, it is key that there is a movement from simply counting activities, to capturing
Bristol CCG and South Gloucestershire CCG – Health Informatics Strategy 2016/17 to 2019/20 – Final
and reporting outcomes. This will enable better support for outcome-based commissioning.
• BI capability – The CCGs are already considering making changes to the delivery model for BI. The proposal is to have 3 levels:
o Tier 1 – core service (including Data Management and Integration Centre (DMIC), and appropriate front-end, provision of a ‘single version of the truth’ to support commissioning);
o Tier 2 – Joint BI team across BNSSG (with the appropriate capability and capacity);
o Tier 3 – Local analytics services based in each CCG.
This should continue to be progressed through the LPF process.
• Capacity – Once demands are well understood, the available resource to meet those demands should be considered and adjustments made (to productivity, demand and/or capacity).
• Data quality focus – An ongoing data quality programme should be supported to address a number of known data quality issues. There is a clear link between system configuration and optimisation, standard operating procedures, training, and service desk ‘intelligence’ about which users may require additional support and training. It is recognised that many data quality issues are due to processes and use of systems within provider organisations so a collaborative approach will deliver the greatest benefit.
• Focus on measuring outcomes and risk stratification – Once the data quality issues and new data flows have been addressed, the development of ‘outcome dashboards’ should be a priority to support the planning of future activity and commissioner negotiations.
• Use of ‘big data’ and predictive analytics – To identify those members of the population who are most at risk and may need interventions to prevent more acute episodes.
• Data => Information => Knowledge => Wisdom – Support needs to be provided to help information users to become more discerning users of the information available to maximize informed decision making.
8.5. Primary Care Development and Support
In order to support the best possible delivery of Primary Care, and guided by the latest version of the GP IT Operating Model, the following recommendations are made:
• IT infrastructure – continue with plans to move practices to off-site data storage and hosting and implement wifi to all sites.
• Artemis intranet – capitalize on opportunity for establishing CCG and GP member internet portal.
• Document management solution – continue with plan to enable documents to be shared between primary and secondary care using the MiG or Docman.
Bristol CCG and South Gloucestershire CCG – Health Informatics Strategy 2016/17 to 2019/20 – Final
• Clinical decision support solution for GPs – prioritise procurement of solution within 2016/17 and associate costs.
• NHS Mail2 – migrate from current email solution to NHS Mail 2 within 2016/17. • Providing online access to primary care services (appointment booking, e-
consultations, access to patient records) –develop e-consultation strategy for implementation in 2017/18 onwards incorporating self-care strategy recommendations from commissioners.
8.6. Other recommendations
A number of further recommendations are shown below.
• Spend resources strategically – To ensure that investment in IM&T solutions and systems is carried out strategically and to maximize the positive benefit from the investment.
• Strategic partnerships – To address the requirement for time-limited Subject Matter Expertise, which may be for specific projects or to support cyclical requirements.
• Adoption of the following Design Principles which should be considered for any planned investments/developments in the use of IT and Information systems and could be written into provider contracts:
1. Adopt appropriate national standards as set out in the National Standards Policy in particular with respect to interoperability standards;
2. Adoption of national systems as set out in the National Systems Policy;
3. Procure IM&T solutions that provide open generic APIs or are prepared to develop specific APIs and make them widely available with use of open-source code where appropriate;
4. Ensure that this open platform architecture allows a multiplicity of patient- facing apps to be developed and link to back end clinical and transactional systems;
5. Procure IM&T solutions that enable and integrate with appropriate single sign-on solutions;
6. Procure IM&T solutions that are easy to use and adopt;
7. Involve end-users and patients in the procurement process to ensure that their requirements are satisfied;
8. Collaborative procurement wherever possible in order to reduce costs; 9. Compliance with the agreed Information Governance Policy;
10. Adherence to nationally published data dictionaries, or locally agreed data dictionaries, where appropriate.
Bristol CCG and South Gloucestershire CCG – Health Informatics Strategy 2016/17 to 2019/20 – Final