Board of Directors Meeting
Date:
25 June 2008
Agenda item:
7.3, Part 1
Title:
IM&T Strategy
Prepared by:
Wendy Ware, Deputy Director, IM&T and
Mike Stevens, Director of Finance & Business
Development
Presented by:
Mike Stevens, Director of Finance & Business
Development
Action required:
Board to consider and approve the IM&T
strategy for inclusion within the overall Trust
Strategic Directions
Monitoring Information
Please specify HC standard numbers andtick
9
other boxes as appropriateHealthcare Standards – CORE Standard numbers Healthcare Standards – DEVELOPMENTAL Standard numbers
Monitor Finance
Service Development Strategy
9
Performance ManagementLocal Delivery Plan Business Planning
9
Assurance Framework Complaints
Equality, diversity, human rights implications assessed Other (please specify)
1. PURPOSE
1.1 This paper forms the final section of the Trust Strategic Directions focussing on the strategy for the use of IM&T in the delivery of key service objectives
2. BACKGROUND
2.1 The Trust approved a Trust Strategic Directions document in the autumn of 2007 2.2 The delivery of many of the key objectives contained within that document are
supported by the implementation of technological advances not least in the form of IM&T.
3. KEY ISSUES
3.1
3.2
The NHS is in the process of implementing a new national IM&T strategy through the National Programme for IT (NPFiT). At the current time, the Southern Cluster is without a Local Service Provider following the termination of the contract with Fujitsu. The Trust needs to set out its future strategy for the deliver of information and
information systems to support the delivery of its service strategies over the next 5 years.
4. PROPOSALS
4.1 It is proposed that the Trust adopts the enclosed IM&T Strategy at which time the remaining sections i.e. Executive Summary, Key Milestones and Investment Plan can be populated prior to final publication.
5. FINANCIAL/OTHER IMPLICATIONS
5.1 Financial implications are summarised in the investment plan contained within section 7.
6. RECOMMENDATIONS
6.1 The Board is requested to consider and approve the enclosed IM&T strategy for inclusion within the overall Trust Strategic Directions
DRAFT
IM&T STRATEGY
2007 - 2012
Version 1.0 June 2008
CONTENTS
Page Number
PART 1
1.
2.
Introduction
Executive Summary
3. Strategic
Context
4. Current
Status
5. Future
Direction
6. Key
Milestones
7. Investment
Plan
1. INTRODUCTION
1.1 This section forms part of the overall Strategic Directions 2007 – 2012 and sets out the future direction in terms of exploiting IM&T to both further and enable the delivery of the Trust’s service strategies and objectives .
2.
EXECUTIVE SUMMARY
3. STRATEGIC
CONTEXT
3.1
The strategic context for this section lays within the overall strategic objectives and
key milestones highlighted in the main body of the document. In essence the IM&T
strategy will specifically support and enable the delivery of a range of key service
objectives as set out below.
3.2 The overall vision of the Trust is set out in the following statement:
The RD&E aspires to be at the leading edge of healthcare provision; an organisation which is modern and competitive, smart, flexible and distinctive, in all aspects of its service to patients and relationships with commissioners.
3.3
In order to achieve this vision we must focus our attention and build our service
around the three key themes - RESPOND DELIVER ENABLE - which will be
central to everything we do.
3.4 RESPOND
R1 To be the service provider of choice for local people, delivering care in a seamless manner, in the most convenient and appropriate location, without delay;
R2 To eliminate avoidable hospital-acquired infections, minimise the incidence of infections being brought into hospital, and ensure safe and effective care management to prevent cross infection;
R3 To deliver services in an environment which is comfortable, acceptable and friendly for patients, improves health and wellbeing and enables staff to care for patients effectively;
R4 To recognise our wider responsibility to the environment and local community through the most effective utilisation of resources and assets.
3.5 DELIVER
D1 Consistently high standards of care, designed in partnership with patients, delivered by experts, which is safe and effective and meets the needs and aspirations of patients, staff, carers and the public;
D2 A comprehensive range of cost-effective accessible local services to provide the best possible care, meeting the needs and expectations of local people in a variety of settings within the communities we serve;
D3 A broad range of specialist services in areas where the Trust can excel on a scale which ensures high quality and cost-effective care appropriate to the needs of the wider health care community.
3.6 ENABLE
E1 To be the employer of choice, valuing staff and ensuring the right staff with the right skills are available at the right time working together in effective teams focussed on meeting the needs of patients;
E2 To foster the welfare of staff to ensure a positive work/life balance and create opportunities for all staff to achieve their full potential;
E3 To encourage and invest in education, research and innovation to achieve excellence and on-going quality improvement;
E4 To achieve future and sustained success through financially-responsive and responsible action, making the most cost-effective use of facilities and resources to ensure the on-going financial well-being of the Trust.
3.7
In delivering this vision we will maintain its core values in everything we do:
The RD&E’s values are to foster a culture of:
i. inspiration, research, innovation, learning and development; ii. openness, honesty, transparency and integrity;
iii. fairness, equity and trustworthiness;
iv. inclusion, collaboration and openness to scrutiny; v. caring, patient-focussed professionalism; vi. equality, respect and dignity;
vii. safety and quality;
viii. striving for excellence in everything we do.
3.8 The key strategic milestones are set out in the document ‘Strategic Directions 2007 – 2012’ and are replicated in the table below:
Key Milestone Delivery Date 1 Waiting
1.1 At least 85% of patients of patients admitted wait no longer than 18 weeks from initial referral until they have received treatment.
1.2 At least 90% of patients who do not require admission wait no longer than 18 weeks from initial referral until they have received treatment.
1.3 At least 90% of patients of patients admitted wait no longer than 18 weeks from initial referral until they have received treatment.
1.4 At least 95% of patients who do not require admission wait no longer than 18 weeks from initial referral until they have received treatment.
1.5 At least 85% of patients of patients admitted wait no longer than 15 weeks from initial referral until they have received treatment
1.6 At least 90% of patients who do not require admission wait no longer than 15 weeks from initial referral until they have received treatment.
1.7 At least 90% of patients of patients admitted wait no longer than 8 weeks from initial referral until they have received treatment
1.8 At least 95% of patients who do not require admission wait no longer than 8 weeks from initial referral until they have received treatment.
1.9 Patient waiting is eradicated - measured by patients being able to be given a date of their choice for either an outpatient appointment or admission within a month
1.10 Ensure at least 98% of accident and emergency patients are either admitted or treated and discharged within 2 hours
March 2008 March 2008 June 2008 June 2008 Dec 2008 Dec 2008 March 2011 March 2011 March 2011 March 2011
2 Privacy and Dignity
2.1 Patients are accommodated in single sex wards (apart from agreed emergency areas)
2.2 Patients are accommodated in single rooms (if they wish)
March 2010 March 2012
3 Efficiency and Effectiveness
3.1 Ensure all elective patients are pre-assessed prior to their date of admission and at least 90% of such patients are admitted on the same day as their operation where clinically appropriate.
3.2 Where operational requirements dictate, all facilities operate routinely on evenings and weekends where demanded
3.3 Ensure that the follow up outpatient ratio is better that the national average in all specialties
3.4 Ensure that the follow up outpatient ratio is in the upper quartile nationally in all specialties
3.5 Deliver an operational ‘Emergency Hub’ for the care of emergency patient admissions
3.6 Fully implement Service Line Management across all specialties 3.7 Length of stay in all specialties to be within the upper quartile of
performance nationally with no major outliers at HRG level 3.8 Increase overall day case rate to over 70% (including work
undertaken in community hospitals)
March 2009 March 2010 March 2009 March 2012 Sept 2010 March 2009 March 2012 March 2009
4 Delivery of Care Close to Home
4.1 Increase the proportion of daycases undertaken in a community setting from 13% to 25%
4.2 Hold at least 25% of outpatient clinic appointment in a community setting
4.3 Ensure all daycases and outpatients that are deemed clinically appropriate and can be effectively delivered in a community setting are done so if that is the wish of patients
March 2010 March 2010 March 2012
5 Communications
5.1 All discharge summaries are completed and dispatched to GP within 24 hours of discharge (where clinically appropriate)
5.2 All clinical communications are completed and dispatched within 7 days
March 2009 March 2009
6 Infection Control
6.1 Eliminate avoidable hospital acquired infections March 2010
7 Risk Management
7.1 Achieve significant reduction in risk in accordance with targets as set out below under Risk Management
Various
3.9 Key IM&T Objectives
With regard to IM&T the following key objectives will be achieved in the delivery of change into the future:
• Information should be fit for the purpose that it is intended for, should be accurate, available to the right people at the right time , in the right place and in the right form.
• Patients should whenever possible only be asked for information once, and that data should only be entered into information systems once and thereafter be made available to all who have a legitimate right of access subject to appropriate data confidentiality requirements.
• There should be one authoritative source for patient demographics currently the Patient Administration system.
• Information systems should support clinical activities, should be directed to ensure that data is collected efficiently and as an integral part of operational processes and patient flow and never as a process in its own right
• Data security and confidentiality shall be maintained at all times
• Information and information systems must at all times support and encourage the delivery of first class clinical care to the benefit of patients and staff.
• Information systems must conform to national standards both from an information perspective and technical and functional compliance with the National Programme for IT
• To encourage collaboration with other local health and social care organisations to support the care of patients and clients.
IM&T Strategy 2007-2012 Page 11 of 28
• To ensure patients are correctly identified and matched with their associated records by displaying data items consistently; to reduce/eliminate errors in the matching of patients with their care
• To innovate technology solutions which can support and deliver clinical and key service change
• To enhance resilience of IT infrastructure to improve access to information 3.10 National Context – National programme for IT
3.10.1 The NHS established the National Programme for IT (NPfIT) in October 2002. At the heart of the NHS modernisation agenda is the NHS Care Record Service which is to be delivered consistently via national contracts. It is widely acknowledged that the eventual introduction of electronic patient records, provided through the deployment of NCRS, will deliver significant benefits in patient care and information management
3.10.2 Five geographical clusters covering the whole of England were identified and a national contract for local service provision has been award to each of these clusters. The main local NHS relationship will be with the Local Service Provider (LSP). The ten-year contract for LSP provision to the Southern Cluster was signed between the NHS and the Fujitsu Alliance (now known as Fujitsu) in January 2004, the main contractual variance from current practice is that the RDE has no contractual relationship with the contractor. However, since the national contracts were signed with 5 original LSPs there are now only two in existence, namely, BT and CSC who are offering as their main CRS software Cerner Millenium and Lorenzo respectively. Currently the Southern Cluster which the RDE falls into do not have a nominated LSP due to recent termination of contract with Fujitsu.
3.10.3 The Southern Cluster consists of NHS organisations within the former Strategic Health Authority areas of South West Peninsula, Dorset and Somerset, Avon Gloucestershire and Wiltshire, Thames Valley, Kent and Medway, Surrey and Sussex and Hampshire & Isle of Wight. These organisations have now been merged into the three Southern SHAs of South West, South Central, and South East Coast.
3.10.4 The implementation of NCRS lays the foundation towards the achievement of the national vision by enabling information to be shared across NHS organisations.
3.11 Integrating with the National Programme for IT
3.11.1 The “Guidance for NHS Foundation Trusts on co-operation with the National Programme for Information Technology” must be adhered to by the Trust in accordance with Condition 20 of the terms of authorisation for all NHS foundation trusts. The Trust must achieve technical and functional compliance with the hardware and software provided under National Programme for Information Technology. This has already been achieved with spine compliance to support the Choose and Book (CAB) application through our Patient Administration
3.11.2 Equally the Trust must comply with the requirement of Condition 2 to exercise their functions “economically, efficiently and effectively” in the procurement of particular systems and hardware. This must be applied especially for systems that are outside of the core1 National Programme for Information Technology provision.
1 Core in this context refers to those system elements defined as “core” in the contract between the Secretary of State and the Local Service Provider
4. CURRENT
STATUS
4.1 Information and information Systems
4.1.1 The Trust has for some years endeavoured to implement information systems that primarily support the clinical and business objectives in the Trust. In the last IMT strategy, it stated that for clinical systems, the Trust would use one single patient index, namely, the Patient Administration System master patient index to ensure integrity of patient data and reducing duplication of data entry. It would also aspire to transfer or share patient episodal information whenever possible to again reduce duplication of effort and to maintain the core PAS data which is used as the primary source to feed PBR.
4.1.2 This vision has been largely maintained in the last 10 years with core clinical systems using the common PAS master patient index achieved through a unidirectional interface with PAS. It has also been achieved with some departmental clinical systems. However, given there is quite an overhead in supporting these interfaces and the inability to have realtime admission, discharge and transfer information at the point of care, it is time for this to be reappraised and with the aim to reviewing the feasibility of introducing a Trustwide interface engine.
4.1.3 The following table shows the current core clinical, business and administrative systems together with fit for purpose status and any plans of replacement in the next 3 years. Note that a number of the EDS systems are on a replacement programme partly due to fitness for purpose reasons but also due to EDS notice on contract and the dwindling userbase resulting in increased support charges.
Name of System
Supplier Main Function Status for Replacement
Clinicals
PAS Internal Support
and
development
All modules within PAS are fully integrated giving the Trust one primary system to support
administrative functions of patient care and include an Outpatient, In patient (including elective and emergency admissions) and waiting list modules, clinical coding module, casenote tracking system and the master patient index. Records all patient episodal information eg admitted and non admitted episodes and all RTT events Booking system for
This system was implemented in 1986 as the SW Regional Computer Centre system and adopted across the SW Region from Gloucester to Cornwall. When EDS succeeded the SW RCC, the RDE continued to internally support and develop PASv6. Whilst this is eighties technology, this system is still fit for purpose, however, as part of the Trust’s overall electronic patient record vision it is suggested that this is reviewed within the next 12 months.
all outpatient and elective admission appointments. All clinical coding is undertaken within PAS. Choose and Book ATOS Origin NHS national contract Facilitates patient choice and the electronic GP booking of new outpatient
appointments
Current functionality and ability for the Trust to influence is under review.
Pharmacy Stock Control
EDS Stock Control
system
Not able to support patient level costing and clinical e-prescribing. Business case underway, along with e-prescribing
and medicines management with plans
to replace 08/09
Maternity EDS Obstetric electronic
casenotes
Not able to support some information requirements for CNST. Proposed 09/10 business case development and replacement
Pathology EDS Integrated
pathology system for all pathology disciplines, result electronic enquiry, pathology
messaging to all GP systems
Not able to support order communications and patient level costing.
Business case approved May 08, implementation planned go live Q4 08
Theatre PLATO Theatre scheduling, theatre
and patient management
recording along with operation note production Planned implementation of theatre list production in 2008 Integrated with PLATO document viewer/clinical information system
Fit for purpose although information extraction cumbersome.
Review as part of EPR Trust requirements over next 12 months. Clinical Information System PLATO Trustwide production of discharge summaries, outpatient letters and other clinical
Fit for current purpose. Need to review as part of EPR Trust requirements over next 12 months
documents stored in Document Viewer available enabling electronic viewing of all hospital patient correspondence. Enabled e-discharge summaries to GPs ED system MSS Patient First Records all ED attendances, full patient tracking, and electronic documentation
facilitating real time data entry
Fit for purpose. Needs further development on admission, discharge and transfer integration with PAS.
Ward Whiteboard
Internal Electronic whiteboard view of real time ward patient
movements,
clinical alerts, discharge planning tool
Fit for purpose. Further development to support business requirements, planned in Q2 and Q3, potential extension to community hospitals and/ GPs.
Reviewing technology to examine potential to replace the ward physical whiteboards PACS and CRIS Fujitsu, NHS national contract Digitised diagnostic imaging Trust and community wide. Inetgrated radiology information system providing electronic booking, scheduling and statistical analysis also linked with PAS MPI
Fit for purpose
Extending viewing of images to GP practices with Exeter, East and Mid Devon areas. Sharing of images across relevant other Trust sites within the South West.
Business
Agresso Agresso UK Finance system Fit for purpose, examining potential to extend functionality into other areas of activity. Planned to retain medium term
ESR McKesson National electronic
staff record and payroll system
Implementation
commenced in 2006 roll-out of functionality in progress
Rosterpro HMT Electronic rostering
system linked to ESR
Implementation re-commenced 2008 roll-out in progress
IM&T Strategy 2007-2012 Page 15 of 28
EROS Bellmin Procurement Under review to consider replacement with a module from agresso and integration with financial systems
Datix Datix Risk management Fit for purpose, latest
version being implemented.
Comex Internal Trust intranet and content management system Procured replacement system EBIS, implementation planned Q3 2008 Contract management system
Internal Produces invoices
to commissioners from the Contract Dataset
Being reviewed as part of business intelligence system project and nationally provided Secondary User Service (SUS)
Email Internal, MS
Exchange 2003
Email system Review of NHS Mail in progress
4.1.4 Some of these core systems are being offered through the National Programme for IT (NPfIT) contract free of charge, both being supplied and hosted by the Local Service Provider (LSP). However, to date the functionality of the systems on offer fall short on our existing systems to the extent of losing significant functionality to gain a fully integrated electronic patient care record.2 The departmental systems such as Pathology and Pharmacy are being offered as additonals and can be procured through the LSP or through the Connecting for Health (CfH) ACSS process thus negating the requirement for going out to EU procurement.
4.1.5 There are a number of other smaller clinical systems supporting both the above systems and departmental processes not specifically referred to in this strategy and their fitness for purpose will be kept under review and over time will be encompassed within the electronic patient record.
4.2 Technical Infrastructure
4.2.1 The Trust has a modern resilient IT infrastructure on the main hospital campus. For the purpose of this document it is useful to baseline current and future plans on technical infrastructure. Timeframes for future plans are detailed in the 3 year IMT Proposed Investment Programme attached in section 7. Infrastructure can be defined into the following core areas:
4.2.2 Network
The network at the main Wonford site uses a fibre optic backbone, running at 1 gigabit/second, with copper cabling to desktops, running at 100 megabits/second, based on paired Cisco core switches, and smaller switches in each template of the main hospital, and in outlying buildings.
2
Given limited lifetime of the Heavitree site, the network both data and voice will be upgraded to reflect services requirements.
The Trust has wide area network links to local hospitals and to the national NHS network.
The Trust secures the network with Checkpoint firewall software running on Nokia hardware.
There is a pilot wireless network in operation on one ward on the Wonford site which will be fully evaluated before further implementation across the Trust.
4.2.3 System Software
The supporting system software is based on Microsoft software, taking advantage of national contracts where applicable. The software used includes: the Windows operating system, mainly Server 2000 and XP; Exchange mail server; SQL Server database; Active Directory identity authentication; and Office desktop applications. Anti-virus software is supplied by Trend Micro.
4.2.4 Servers
The Trust has recently consolidated supported systems into the server room at Wonford, prior to the completion of a server room build at Heavitree to hold Devon PCT and DPT servers.
Unless particular applications have alternative requirements, the Trust uses Dell servers running the Windows server operating system.
4.2.5 Desktop and laptop PCs
The Trust has approximately 4000 desktop and laptop PCs, almost entirely Dell, and an annual technology refresh programme replacing all devices after the 3 year warranty expires. This is implemented on a central basis via the IMT Projects Office. Additional devices are purchased by directorates as required. There are Trust standard devices in routine use. The annual replacement programme is to ensure both fitness for purpose locally along with ongoing conformance with NPfIT standards.
4.3 Health Records
4.3.1 It is widely acknowledged that the eventual introduction of electronic patient
records, provided through the deployment of CRS, will deliver significant benefits in
patient care and information management.
4.3.2 However, the NHS currently holds around 13.6 billion pieces of paper within 163
million health records, with the management of this information estimated to cost
£324 million each year. There is no national solution, or commonly defined policy,
for a transition from these paper-based health records to an electronic format.
Furthermore, there is no strategy for the integration of such records with the locally
deployed CRS functionality.
4.3.3 Over recent years, although the number of Health Records at the RD&E has stayed largely static, the Trust is faced considerably growing pressures as the average size of the records has continued to increase year on year
4.4 Clinical Coding
4.4.1 The NHS Operating Framework for 2008/09 identifies the need for sustained focus on information management and technology (IM&T) in the NHS to deliver better, safer care. There is wide recognition within the NHS of the importance of good quality coded clinical data and the fundamental role it plays in the management of hospitals and commissioning of services for the population.
4.4.2 Clinical coding has an increasing role in finance management. Payment by Results (PBR) is changing the way funds flow between commissioners and providers of healthcare in England Providers are paid on the volume and complexity of care they actually deliver, and precise clinical coding is an essential first step of this reimbursement process. The Audit Commission are commissioned to undertake annual clinical coding audits to ensure Trusts conform to national standards and are fit for purpose from a PBR perspective. The Audit Commission’s report on the Trust for Q4 07/08 was very good.
4.4.3 Reimbursement
is being standardised across the country. For the first time, tariffs
are based on the clinical care that is given, and not where it is given. The system
relies on accurate, quality and timely clinical coding and without this it is impossible
to collect the required level of information to reimburse providers fairly, so it’s vital
to trusts that they can provide accurate, up-to-date and timely data. Any coding
errors may impact on a trust’s annual income.
4.4.4 Clinical coding is a highly specialised process requiring a minimum of 2 years detailed training and development. It is largely a manual and laborious process which is required to be undertaken to very exacting standards and to a high degree of accuracy.
4.4.5 All trusts are subjected to a regular external audit of the accuracy of coding through the Audit Commission. The latest audit carried out on the Trust’s records demonstrated an accuracy rate in excess of 98% for both primary diagnosis and primary procedure coding.
4.5 Training
4.5.1 IMT Training is a key service in developing the capability and competency of the Trust’s workforce in the use of the Trust’s clinical and business systems. The team primarily train on all Trust clinical systems and ensure minimum competency levels prior to application training. The training team are an integral component to system implementation and cultural and business awareness in the use of the systems to ensure integrity of the data input and engaging with the wide business issues. Examples for 07/08 has been the Referral to Treatment application and awareness training.
4.5.2 Training is undertaken not just related to specific applications but also in terms of basic IT techniques, keyboard skills etc.
4.6 IM&T Governance
4.6.1 Governance of IMT Planning and Procurement
4.6.2 Historically there has been limited mechanisms to engage managers and clinicians from across the Trust in the delivery of an effective IMT strategy. This has now been remedied. 4.6.3 The IMT department maintains a professionally trained group of project managers (formally
trained in the PRINCE2 project management methodology) to ensure the effective planning and execution of IMT projects
4.6.4 A 3 year IMT capital programme plan will be submitted annually along with supporting business cases and CAP1 forms.
4.6.5 The Information Governance Strategy sets out the framework for the Trust to deal with the information handling requirements as set out by the DH, compliance with legislation and year on year improvement plans. It covers the following six components:
Confidentiality and Data Protection Information Quality Assurance Information Security
Records Management Clinical Assurance Freedom of Information
4.7 Management of change
4.7.1 The implementation and change team are a resource to support key service redesign and cultural change to improve and modernise services normally as a result of a DH mandate such as RTT or as part of a technology implementation such as PACS. They drive the service benefits realisation identified in business cases or as part of a department or directorate who are seeking to make efficiencies through technology.
5.1 Information
5. FUTURE
DIRECTION
5.1 Information and Information Systems5.1.1 The Trust has procured the Ardentia data warehouse with its aim to replace the Trust’s locally developed “Pivot Table executive information system over the next 12 months. It also has a patient level costing module and Referral to Treatment tracking tool together with intertated performance management and action planning tools.
5.1.2 The data warehouse will enable data feeds from a number of clinical and business systems to be held in one repository enabling the end user to have access to a range of information through one system. This will improve usability, particularly look and feel, access to information from a number of disparate systems in one place and support patient level costing. The Information team will build on its existing expertise to develop and customise this application to underpin the Trust’s information requirements.
5.1.3 This technology will future proof the Trust in terms of information delivery and will build and develop on the information culture established over the last 10 years. It will also continue to provide the Trust with the capability of extracting data to support real time information systems for clinical activity such as the Ward Whiteboard development.
5.1.4 Data quality is key to underpinning good quality and timely information to clinical, business and financial users. Dedicated leads on information systems and within the Information team have been appointed to pick up this element of work both from the input and output perspective. Development work will be identified in 08/09 to ensure ongoing compliance with national standards and progress to improve data quality by both the user and customer of the information. The data quality improvement programme will identify requirements and reflect these in changes either in work practices or technology enhancements.
5.1.5 National Programme for IT (NPFiT)
5.1.6 The Trust has developed a strategy for responding to the delivery of the national programme based on an option appraisal of available alternatives.
5.1.7 An optional appraisal has been undertaken to review the Local Service Provider (LSP at that time being Fujitsu offering Cerner Millenium) National Care Record System solution its aim being to review and recommend the future direction for IT development and investment for the Trust.
5.1.8 The option appraisal based its recommendations on the Trust’s strategic direction which had identified a number of IT developments to support service requirements over the next 5 years, namely,
Order Communications (OC)
Pathology replacement to support OC
Pharmacy replacement to support electronic prescribing, medicines management and stock control
Patient pathways (including decision support) to support clinical pathway management and Referral to Treatment
Patient level costing system (PLC)
Data warehouse to support PLC and other information requirements
Electronic document management (EDM) to support clinical care, improve accessibility of information, reduce paper and ultimately casenote storage.
Sustain and enhance current functionality of PAS and clinical systems Enterprise wide scheduling
Improving patient flow - automated arrival system; continuing development of inhouse ward whiteboard functionality and real time bed management).
5.1.9 The options considered were:
i. Continue with LSP with limited implementation of core modules, retain legacy or purchase new systems
ii. Procure from national programme supplier directly not through LSP
iii. Continue with LSP but delay until process and functionality proven; in meantime retain legacy and purchase new systems as required
iv. Procure own solution outside of the national programme
5.1.10 The recommendation is to continue with the LSP but the implementation timing to be dependent upon a change in contractual management arrangements and functionality of solution proven to be fit for purpose; in meantime retain existing legacy systems or purchase new systems as required. Since the option appraisal there have been two significant developments within the National Programme for IT, namely, the LSP for the Southern Cluster and therefore potentially the RDE, the contract with Fujitsu has been cancelled and as yet there is no replacement strategy in place and secondly Connecting for Health have tendered additional IT suppliers to provider additional capacity on both core and department clinical systems known as the ASCC list. Clearly there is some uncertainty around the future for the Southern Cluster and choice that individual Trusts may have. However, the recommendation within the optional appraisal is still appropriate at this point in time.
5.1.11 In addition to the national programme a number of specific developments have been identified which are aimed at ensuring the use of technology with support and enable the trust to achieve its strategic objectives based on responding to the needs of a range of stakeholders.
Stakeholder Development Objectives
Patient Auto-arrival To enable patients to self-register their arrival at hospital without the need to ‘queue’ at reception desks
PACS in GP surgeries
Extending the current PACS service to enable GPs to view digital X-Rays from within their surgeries Internet/Extranet Extend functionality of Trust internet/extranet to be
more supporting to patients to enable more informed choices and to be better informed about their condition, treatment and services/facilities on offer by the Trust.
Text messaging Automated reminder of appointments and admission via SMS
Telephone access Improved access and timeliness through introduction of voice activation and/or DTMF dialing to reach required destination.
Patient surveys Use of technology to help facilitate more effective collection of patient views surrounding their experience and services provided by the Trust
Referrers e-discharge Electronic summaries of care provided by the Trust to patients delivered to them electronically within 24 hours of discharge
e-letters Written communications to referrers on all matters delivered electronically within 7 days
PACS Extending the current PACS service to enable GPs to view digital X-Rays from within their surgeries Choose and Book Direct booking of appointments for diagnostic
testing
Directory of
services
Improved access to information to facilitate rapid and accurate referral of patients to the most appropriate services
Diagnostics Direct access to referrals for testing and reporting of results.
GP whiteboard Access to information concerning the clinical care, condition and discharge arrangements for patients both before, during and after their stay in hospital. Clinicians Electronic patient
records
Continual access to all clinical and non clinical events regarding the care given to patients in real time throughout their treatment integrating all aspects including clinical data, electronic documents, images , notes etc.
Pathology Replacement of existing ageing pathology laboratory Information Management System.
Order communications
Introduction of an electronic means to order goods, supplies and clinical services.
Pharmacy stock
control and e-prescribing
Replacement of existing ageing pharmacy stock control systems and introduction of new electronic prescribing system including oncology.
Voice recognition Introduction of voce recognition and dictation systems to improve efficiency in the production of clinical information and correspondence.
Patient pathways Electronic patient pathway analysis integrated with electronic patient record highlighted above.
Clinical coding Technical solution to assist in the delivery of same day clinical coding of patient episodes.
Enterprise scheduling
Systems to support the scheduling of multiple services within a single appointing system to support multi-professional .
Departmental systems
Development of specialist departmental systems where appropriate to support the delivery of specialist clinical care.
Business Business intelligence system
An integrated solution to deliver improved information related to patient activity, finance, workforce, waiting times, performance, planning and action planning.
Voice recognition Introduction of voice recognition and dictation systems to improve efficiency in the production of information and correspondence.
Workforce Extension of technology to allow data collection related to attendance, pay and expenses directly by employees.
General Technology Regular technology refresh to keep pace with technological advances.
Wireless Introduction of wireless network technology to assist with delivery of technology at the point it is required.
Mobile Introduction of internal mobile communications and replacement of traditional ‘bleep’ system.
Extension and development of mobile working to allow home and remote working connecting to Trust information resources.
Intranet Replacement of current Intranet system (Comex) with new technology to support required levels of functionality including content management.
Electronic document
management
Development of a ‘paperlight’ environment
Workflow Introduction of workflow control systems as an aide to greater efficiency.
Email Review of the timing and desirability of migration to NHS mail
Data Security Enhanced security measures including the encryption of all identifiable and other sensitive data for any data that is vulnerable to attack or inappropriate access.
Single sign-on Ability to sign in once only in a secure manner to access information across all systems.
Resilience/security Delivery of an infrastructure that guarantee the delivery of a robust technological platform and delivery of key information/data and operations supported by robust disaster recovery plans.
5.2 Technical infrastructure 5.2.1 Network
There are proposals to upgrade or replace some of the network hardware in financial year 08/09.
Measuring existing, and setting target for improving, system availability.
The power requirements of the network will be reviewed, with an intention of reducing these over the replacement lifecycle.
The Trust is running a project to support ‘Productive Wards’, which is using alternative PC devices, including tablet and wall-mounted PCs, and a wireless network; this will be reviewed, with the strong expectation of rolling out these technologies further.
The convergence of IT and telephony, using of ‘voice over IP’ technology, is being studied, in conjunction with a review of the replacement of the telephony switch.
5.2.2 System software
The Trust is reviewing its email provision, with an intention of moving to the national NHSmail as soon as practical.
Together with South Devon Healthcare and NHS Connecting for Health, the Trust is working to create a local standard PC installation for Windows Vista, which may become the basis for a national standard.
Review and maximise utilisation of NHS Enterprise Infrastructure licensing agreements eg antivirus, Microsoft, reducing costs, power and support requirements.SQL, Encryption etc
5.2.3 Servers
The overall energy consumption of the server rooms and the servers are being reviewed, with an intention to reduce the requirements.
The Trust is investigating the use of server virtualisation software to reduce the overall number of servers required and to support the reduction of energy consumption and improve overall resilience.
5.2.4 Desktop and laptop PCs
The Trust is in the final stages of a change of PC supplier from Dell to HP, as a result of a national procurement exercise; this is expected to be completed by July.
The Trust will investigate the options for measuring and reducing the energy consumption of all PCs.
As stated above, the Trust is piloting the use of alternative PCs types, such as mobile tablet and wall-mounted PCs.
There is a rolling programme for mobile devices, in particular, laptops to be encrypted and a current review is being made of the national encryption software
Secure access easier for all users - reviewing the use of ‘single sign on’ to reduce the number of user access passwords and increased use of smartcards.
Extension in remote working
Review use of thin clients and desktop virtualisation 5.2.5 IT Development
Developing systems when there are good business reasons, such as innovation or unmet demand. Work with commercial and NHS partners where possible, to support development and maintenance costs.
To review technologies to support remote management of long term conditions Modern paging and response system, eg Vocera
5.3 Health Records
5.3.1 Importing Paper Records to an Electronic Repository
5.3.2 A number of NHS organisations are examining the options for converting current
(paper-based) health records into an electronic format and providing tools to
manipulate the subsequent images through an electronic document management
(EDM) system.Clinicians and medical administrators will be able to view an
individual patient record on a computer screen, navigate the material in the
electronic record, manage the content and append new material to the record. It is
believed that implementation of an EDM solution would provide a number of
cash-releasing benefits alongside significant strategic benefits that include:
Improved record organisation and security;
Improved access to records at point of care;
Improved access to records for research and clinical audit;
Support for improved processes for patient management and therefore
improvements in patient care.
5.3.3 Investigating EDM for RD&E Health Records
5.3.4 The RD&E is investigating options for the storage and management of health
records. As part of this process, a feasibility study has been commissioned to
consider the impact of implementing an EDM solution for the health records held by
the Trust.
The principle drivers for this study are:
Clinical notes size at the RD&E has become untenable:
This results in clinicians being unable to find the information they require quickly,
It
presents
manual
handling issues,
It can also mean information is not filed correctly,
Lack of storage space:
Records storage at the RD&E is already at capacity with no room for further
growth,
IMT has been given a directive that there will be no space for records storage on
the Wonford site by 2018);
Efficiencies:
It is anticipated that any EDM solution should enable operational/process efficiencies as information will be retrieved quicker,
An EDM solution should also facilitate financial savings as the resources required to manage and process records will be reduced.
5.3.5 In the meantime and for some considerable time into the future, paper records will need to be retained as a primary source of record keeping. To support the continued use of paper into the future the following strategy is being maintained:
Regular review of requirements to retain records
Routine ’weeding’ of notes to only retain information long term as required
‘Culling’ of notes at regular intervals to destroy notes no longer required in accordance with national guidance
Regular review of the required content of paper notes and replacement with electronic versions wherever possible
Updating and review of storage options to ensure notes are available whenever required in a prompt and secure way.
Review of long term storage requirements
Opportunities for ‘digitalisation’ where appropriate.
5.4 Clinical Coding
5.4.1 A Clinical Coding Strategy (CCS) is being developed which will ensure that clinical coding can continue to support PBR, healthcare planning, clinical research studies and audits and statistical analysis. The CCS will provide the direction and framework of ensuring that clinical coding can continue to support the business, adhere to National clinical coding standards whilst engaging clinicians in the process to improve the awareness, timeliness and quality of clinical coding. The CCS will review opportunities through technology, service improvement, revised coding structure, training and audit to ensure clinical coding delivers to meet Trust strategic objectives.
5.4.2 This strategy will include the development of processes to allow more timely coding to be undertaken to ensure all patient episodes are coded within 24 hours of discharge but without any diminution in accuracy through the use of technological aids, delivery of less complex coding through appropriately trained assistants and through improvements in the quality of clinical information collected as part of the patient journey to assist with rapid and accurate coding taking place. A programme of continuous improvement will form part of the strategy to improve the quality and depth of coding.
5.5 Training 5.5.1 E- Learning
5.5.2 The Trust has adopted a ‘blended learning’ approach. e-learning is available to staff on site and to some at home on a wide range of subjects and several thousand staff have sampled the technique. This will be expanded further particularly with the adoption of the imminent release of the Connecting for Health products on Information Governance and Essential IT skills and competency testing.
5.5.3 Staff competencies will be evaluated at regular intervals to ensure they are able to perform effectively in an ever technology driven environment.
5.5.4 Training plans will be developed, geared to meeting the requirements of all staff compiled through a training needs analysis ensuring that the maximum benefit can be obtained through the exploitation of the potential benefits of IM&T not just by means of formal training but through the sharing of experiences and knowledge.
5.6 IM&T Governance
5.6.1 An IMT Steering Group has recently been set up to oversee the delivery of the programme of IMT identified within the IMT Strategy in support of the Trust’s strategic objectives and to support service redesign and modernisation within the Trust. This will include the Trust’s component of the NPfIT implementation, other non-NPfIT initiatives and all other IMT initiatives to support and maintain service provision. The group will actively seek out and drive forward innovation in all areas supported by technology aimed at delivering key service and clinical objectives. The group will advise on the ongoing development and implementation of the Trust’s IMT strategy ensuring it supports the Trust strategic goals. The group will provide a forum for senior managerial and clinical staff to agree proposed IT procurement prior to formal ratification by the Trust Executive Group. This will ensure that proposed projects are aligned to Trust Overall strategic direction.
5.6.2 The Trust will continue to roll out the delivery of its Information Governance Strategy in compliance with national guidelines and standards.
5.6.3 The IMT Programme office will continue to support both IMT projects which are not restricted to technology but also service modernisation and building programmes. The projects and programmes will be run using Prince 2 and or Managing Successful Programmes methodology to ensure rigor and due process is followed at all times of the project lifecycle.
.
6. KEY MILESTONES
To be included in final version
7.1
