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Digital Strategy. April 2015 to March 2017 THE RIGHT INFORMATION, TO THE RIGHT PERSON, AT THE RIGHT TIME, FOR THE RIGHT DECISIONS.

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April 2015 to March 2017

THE RIGHT INFORMATION,

TO THE RIGHT

PERSON,

AT THE RIGHT TIME,

FOR THE

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2

Status Date Names

Draft March 6th 2015 Justin Griffiths Head of IM&T Draft v2 March 10th 2015 Justin Griffiths Head of IM&T

Steve Kennedy Director of Finance Draft v2 April 10th 2015 Justin Griffiths Head of IM&T

Final April 21st 2015 Justin Griffiths Head of IM&T Steve Kennedy Director of Finance Stuart Moore Director of Strategy and Planning

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Executive

Summary

This document has been created to underpin the IM&T strategy 2012-2017, this strategy is to layout the final 24 months of work required to achieve a digital solution for the Walton Centre. The document is focused on pervasive digital connections that looks at how we can bring together all parts of the workflow into a single digital presence which will enable patient care. Whilst the rich data might be coming from several back end systems to the carer, this will give the impression of a single digital record of their patient

The pace of technology development has never been as fast as it is in the current time. With the major companies bringing digital innovations to the marketplace within small timescales due to the extreme market pressure.

These innovations are not limited to just hardware as software is constantly evolving and the customer of “Apps” now expects nothing less than a high standard of software within their personal activities and therefore an expectation is that this should be reflected within the working environment as well.

This strategy is therefore designed around bringing together all digital connections to enable a fluid way of working within the Walton Centre and to ensure that there are no blockers in the information flow; thus enabling the clinical team to deliver care to patients with all the required information about that patient and this information should be available no matter where they are.

We must ensure that the use of information and information technology to improve patient care, access to care, the patient experience, delivery of clinical outcomes, health record keeping and value for money should be, and will be, a fundamental part of the Walton Centre. The goals of the previous strategy haven’t changed and continues to strive for

:

improve effectiveness and clinical outcomes.

Improve effectiveness in planning, deployment and evaluation.

Improve access to relevant information by both NHS professionals / managers and patients/the general public.

Improve diagnostic services and access to the results of those services.

Improved communication between stakeholders across the whole patient pathway give patients more control over their health and wellbeing

empower carers

reduce the administrative burden for care professionals

Digital records must support the delivery of care in the community as much as in the

hospital – their mobility, extensibility and interoperability is fundamental.

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4

It is important to state that IT is an enabler to the organisation and therefore this strategy must always underpin the Trust objectives and be able to fulfil each objective. The Trust has six strategic aims, with supporting strategic objectives. This strategy is intended to deliver the specific strategic objective:

Develop a full electronic patient record and the wider information management and technology in-frastructure to support the delivery of excellent clinical care and the effective management of the Trust’s operations

It will also contribute though to all six strategic aims, as shown below:

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Where

do we

need to be

?

This strategy, sets out the Trust’s vision for completing the journey to the electronic medical record for its patients. By the completion of this strategy the Trust should be aiming to have and implemented :-

Clinical information

Rich Data Information Management in the shape of Digital Dashboards.

Better and quicker access to Clinical information and focus on outcome measurement, including elec-tronic patient reported outcome measures (ePROMS).

Electronic Clinical decision support

Full Order results reporting

Nursing/clinical documentation

E-charting

Service delivery

 Mobile working adoption, beyond boundaries

 Tele-Medicine ,Telehealth and Telecare; allowing clinical data collection via the creation of a Health Hub.

 As close to paperless as possible

IT infrastructure and management

 A high reliability in our IT Infrastructure – staffing and equipment.

 Improved Information Governance and Data Quality

 Carbon Reduction and cost improvement.

Real time clinical information—To ensure that our patients’ clinical information, decision-support tools and their care plans are available in real time at the point of care and easily shared between not only local care teams but also the wider health community.

Deployment of technology—To improve and innovate on how the use of technology being deployed to the organisation to help shape the way delivery of information is delivered to the point of care and revolu-tionise the way care that is delivered

Flexible digital information infrastructure—To ensure by moving away from paper based static infor-mation with its associated issues to a digital hospital that is able to cope not only with the rate of develop-ment within health care, but also to embrace the

changes within technology in innovative ways

Patient input—To also allow the patients to input their own data into these records to help and contribute to the care plan and healthcare of themselves

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are:-The Trust has made major inroads into the development of an electronic patient record over the last 12 months and there have been considerable infrastructure developments since leaving the shared IT service in 2014.

Examples of clinical systems progress over the last 12 months:-

Electronic Document Management System (EDMS) MS (Multiple Sclerosis) Nurse Advice Line

Hand Hygiene/Saving Lives Audits Oak House Kiosk PAIN Questionnaire

CRPS (Complex Regional Pain Syndrome) Nurse Advice Line Theatre Information Management System (TIMS)

Decision To Discharge Neurophysiology Reporting e-Observations (pilot)

Examples Infrastructure Updates over last 12 months:-

Printing centralisation at the new Sid Watkins Building Increased WiFi coverage to allow RFID implementation VOIP at SWB

Windows 7 upgrade New data centre in SWB

Increase mobile devices within ward areas Virtualisation of servers

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Digital

Strategy

The Trust’s digital strategy has three strands:

 EPR systems development and implementation

 IT infrastructure

 Effective IM&T management

The journey to an EPR for the Walton Centre increased in pace during 2014 with the view to get new processes in place that allowed the capture of patient data. This was facilitated by the help of funding from the Safer Hospital Fund.

It is noted that there is a mix of new systems being created to replace existing ones that whilst they don't replace any current paper forms they give us the ability to have much richer patient data than was previously accessible. An example of this is TIMS that will bring a joined up approach to operations from all areas eg Theatres, outpatients, wards and portering.

The other part of the mix is to rid the organisation of paper forms that are no longer fit for purpose in a digital era where information needs to be able to be delivered to the care giver instantly. An example of this is the EWS (early warning system) which offers so much benefit from being digital compared to paper, including automated alerts and visual graphical displays for instant reading

These two approaches are being undertaken over the next 18-24 months, with a strong project management function now in place since the exit from Informatics Merseyside and a team of developers this would be a reasonable task to undertake within the strategies timescales.

The fill delivery plan on the next page shows the component parts of the remaining items to bring together a electronic record, this incorporated into work already completed will allow the Trust to be prepared for a paperless service.

What is

required to deliver

this

strategy

?

Our development team is a key cornerstone in this strategy and the organisation has 3 perma-nent roles within plan . However during the next 18 months it will be a mixture of expert contractors and 2 permanent roles to offer the expertise mix to implement the programme as quickly as anticipated. Software Developers roles are in a niche market and there is huge competition for experienced developers and market rates are dictated accordingly especially with the private sector; it is anticipated that this will create a cost pressure

Our newly formed project management office will also be key for delivery to ensure both Project Management as well as Business change. The team only has 2 members currently and whilst this has been acceptable in 2014 it may suffer during the next 18 months due to business change pressures

as more digital projects go live.

The IT Technical function is now fully staffed since leaving Informatics Merseyside and will be able to help carry out any technical roll out as and when required.

The IT Training department has 1 full time member of staff and 2 contractors; a 2 year fixed term position will be advertised to ensure we have the correct number within the team and give it some more stability during the transition period after this the function will be reviewed.

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How

EPR

will

support

the Trust’s

Ensuring that the IM&T function is an enabler for the services required by the organisation it is important to ensure like previous strategies the Digital Strategy supports the Trusts objectives.

Improving Quality by focusing on patient safety, patient experience and clinical effectiveness—The whole digital strategy is supporting this goal, by ensuring information is available to the care giver at the right time improves effectiveness of that care giver, by ensuring all the information is present including previous local medical history that can highlight any safety concerns around the patient that paper wouldn't allow e.g. the comparison of historical data and current (e.g. previous weight when doing a MUST form)

Innovation for patient care — This digital strategy outlines the development in systems that are patient centric, allowing care to be provided to the patient from the beginning of the journey with the patient portal to the end where with pain management they can review documents and have engagement in a social media setting with others.

Developing our Hospital — it is not enough to implement systems without ensuring that processes which are being overlayed by IT are structurally sound. The investment into business change and supporting the F2E program ensures that when IT delivers a solution, the process includes helping to ensure business processes are examined before implementation and tasks like training, floorwalkers and service are in place to support users after implementations.

Investing not only into the systems and patients but into the workforce highlighting that EPR is an enabler of change. In doing so we have the ability to reduce medication errors with data from JAC EPMA, show patient risk assessments monitoring through data from ePatient and increase triage information by adopting the ereferral system in 2015/16 Q1.

The key result areas for the Trust’s EPR solution are outlined in the following sections.

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Supporting

Clinicians

and Care

Professionals

Clinicians and care professionals are the heart of the Trust. It is they and their patients, around whom the systems should be designed, built, delivered and supported.

Information should be as near to real time as possible to allow and support clinical decisions, by eliminating the need to chase information and enabling a robust system to deliver information. The current ePortal will be expanded to give clinicians instant access to a clinical overview of their patients. It does not matter where the information originally resides as long as an overview of the patient information is displayed direct to those who require it.

Data should not and will not be collected in isolation (i.e. in Microsoft access databases, spreadsheets etc.) The technical architecture will be put into place to allow corporate information department to query real time data as much as possible to create digital dashboards

Supporting

Patients

Patients and the public are increasingly being encouraged to take an active interest and involvement in their own healthcare and in using their care records, health “benchmarks” and outcomes.

It is intended that the strategy will, through the availability and accessibility of care information, provide patients, their carers and the public an awareness of their conditions and the care that will be provided by the Trust and its partners.

This information will be specific to the individual patient, with appropriate controls to ensure the confidentiality of such information, and more general information relating to specific medical conditions and other issues that may impact on patients of the Trust.

The development of the Trusts ePatient Web Portal both for data input and feedback is another cornerstone to the success of this element of the Strategy. Patient access via websites/cloud access will be expanded to include a more holistic patient view of the Walton Centre. The intention during 2015/16 is to gather more patients email address and start enquiring if they would like access to the portal for their correspondence.

Remote monitoring of patients health issues and patient reported outcomes via digital devices (such as headache diary, pain diary etc.) to help support the vision of the Trust to “Develop a new model of neurology provision in GP services” and “piloting telemedicine and assessing suitability to further development“

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Supporting

Staff

The best systems in the world will fail, or under deliver if the staff using them are not able to understand their use or appreciate their benefits and are not appropriately trained to use them.

Staff must be adequately trained and supported in the use of the technology and, more importantly, the information that it delivers. Systems need to offer clear and tangible benefits to the users in completing their day to day tasks.

The Trust will, therefore, seek to further develop its programme of staff training and help with business change

Supporting

Managers

It is imperative that the Trust is able to ensure that its core objectives are being met and this can only be assured on the basis that accurate and appropriate information exists to support informed decision making.

Development of analysis and reporting tools and processes to support managers at all levels in the delivery of their individual and corporate objectives. By defining what information is required for a manager/executive to do their daily job, irrespective of technology. This will drive the development of dashboards and delivery of information which has a value to the individual user, based on roles rather than predefined reports across multiple users that creates confusion finding specific information.

We must ensure the ability to access systems from as many devices as possible whilst maintaining security

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Predictive

Business

Intelligence

The Trust follows the traditional approach to trend analysis by providing a historic perspective on data that has been taken from Trust systems and is therefore predominately not based on real-time events although more of its systems will allow this to happen.

A development of a new Trust data warehouse and the creation of a live queriable MPI/live clone data sources will move the organisation away from historic data to a system of reporting based more on the predicted future.

Data from the deployed systems will be incorporated into a new data warehouse, which will be designed to offer data in real time; this is an opportunity to provide a real time digital dashboard delivered to both clinical and managerial staff. This will help support day to day operational decisions, and make real time data available to a wider audience within the Trust.

Longer term planning models can be developed to allow the assessment of the impact of changes to bed availability, theatre or outpatient capacity etc. Future modeling will now include financial predictions in re-lation to the costs and income generated by forecast changes or predicted bed management utilizing time series predictions.

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Beyond

Boundaries

To ensure that Quality of Life and good patient experience is held as a priority for our patients, we should gather as much information from all providers who are involved in the care of our patients beyond the boundaries of the Walton Centre. This will help in several aspects of care;

Promotes continuity of care and helps prevent hand-over problems that may occur at the interface of each element of care (e.g. discharge to secondary or community care).

Reduce readmissions and ensure quality of life is maintained after the care received at the Walton Centre has finished.

Helps the Walton Centre, other providers and commissioners identify and measure the cost and the benefits of each element of care across the whole care pathway.

This critical information would also help in research and development and give the Walton Centre a glimpse into the patient’s holistic health record.

This is a methodology to adopt a “whole systems” approach and, therefore, to improve the quality and experience of care for patients across the complete journey from primary care through to secondary care sector and back into the community.

The objective being improve care and quality of life for each patient that comes through the Walton centre as part of the pathway, not in isolation but as a complete and joined up journey; by understanding these pathways further learning and improvement to the pathway as a whole can be developed.

“In order for patients to be treated in the most appropriate setting and closer to home, we will educate GPs, pain nurses and other health care practitioners to enable them to develop skills to treat patients in a primary care/ district general hospital setting.”

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Mobile

Working

Whilst we look at the right information at the right time internally to the Walton Centre we must also be able to allow staff to access a variety of services from external with the appropriate levels of security. All staff (where appropriate) should have at least access to the organisations email services from home. A granular approach will then be applied allowing access to files via a web portal and even further into the ability to access clinical systems.

We have the ability for clinical eportal to be used outside the organisation and will populate this service over the coming months to offer a complete range of products

Security controls will be based on user access and end-point access e.g. if a PC doesn't have antivirus it might be limited to email only to ensure the security of the network.

Patient

Access

The Health Secretary spelt out that organisations need to have plans in place to enable secure linking of electronic health and care records wherever they are held, so there is as complete a record as possible of the care someone receives. This system should be able to allow for those records to be able to follow individuals, with their consent, to any part of the NHS or social care system.

The Walton Centre is commissioning a Patient portal just for the Walton part of the patients pathway which will allow the patient to access correspondence to start with and later a more transparent view of care. We will continue to offer an API to allow other organisations with a legitimate need the ability to query parts of our patient record.

Legitimate

Access

Access to patients clinical information and correspondence from locations beyond the Walton Centre i.e. GP practices, community outreach etc… will be available via an API into the patient record at the Walton Centre.

This will either allow Walton to offer information portal direct to the community/GP or will broker the information in a correct format that can be shared by the wider community.

The Walton Centre will work closely with stakeholders including the iLinks programme to achieve this goal.

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IT Infrastructure

The Trust acknowledges that it is important to maintain investment in the technical architecture and new devices in order to ensure that strategy is delivered. The Trust intends to continue its investment with the aim of being an example of excellence and innovation. Particular issues which will be investigated and implemented will be:-

VOIP

VOIP (Voice over I.P) is the modern way for businesses to manage their phone systems. It is easier to configure and more resilient than the old analogue systems and it also provides greater functionality and ease of user for staff members.

VOIP also allows phone lines and numbers to be accessed from a PC or laptop this makes it invaluable for enabling staff to work agile and effectively

A new VOIP system has been installed at the Sid Watkins building with a great deal of success. The system has been well received . Over the coming year the impetus we be on installing this system at the Main Walton Building and expanding on the functionality offered by it. The system will also increase our resiliency and make us less dependent on 3rd parties for our phone services.

SSO

SSO (Single Sign On) allows users to access all their applications that require a username/password to be accessed via a single initial login. This saves time and increases the usability of systems. The solution that we are implementing for single sign on will require users to create a PIN number that will be associated with their card used to access the door security. Both will need to be presented to the machine in order for the user to access the systems but once in they can access all their systems without having to log in again.

We are in the process of testing this technology with a view to trial it with a select user group first to assess its applicability before rolling out to the appropriate users in the trust.

Printing

Printing has been modernised at the Sid Watkins Building, with the introduction of push/pull printing. This means that instead of having a large fleet of printers each requiring toners and drums to be replace designated printer pods exist with high output multifunction devices where staff can retrieve their printing.

As well as cost benefit this also provides a benefit in security as the user must be at the printer and swipe their security card to retrieve their print outs. This means that prints sent in error never get printed therefore saving money and any potential IG issues caused by printing in error.

The multi function devices also allow Faxing, scan to email and photocopying.

Expansion to the main build is due during 15/16 as well as print reduction software to further reduce printing costs.

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Resilient Server Architecture

During 14/15 we have improved our server infrastructure, with the SWB we now have an additional Server Room, meaning we have server rooms on two separate sites. This will allow us to be able to put heartbeat servers at both sites and more resilient backups in place to ensure that the staff will have more access to the systems they use every day.

Mobile Devices

As technology moves on, tablets and mobile devices are becoming more and more powerful. This is technology that the trust is committed to which will enable staff to use more portable pieces of technology.

Having already made great progress with the use of iPads and iPods both in clinical and corporate setting and the aim of the coming years will be to push further with this and ensure that The Walton Centre stays at the cutting edge of mobile device usage.

The introduction of the VOIP system may provide further areas we can expand this usage into the corporate setting in addition to the progress made in the clinical setting.

Self Password Reset

One of the most common types of call in any I.T helpdesk settings is the “forgot password” call. SSO will negate a lot of these calls but as SSO is not appropriate for everyone we will be looking at new ways of making this easier for staff and ensuring faster resolution to this common problem. We will do this by Introducing technology in which staff are able to reset their own passwords without the need for I.T, by answering a series of personal questions that they will have previously set up.

VDI

VDI (Virtual Desktop Infrastructure) or variant will be invested in to allow clinicians the ability to move between computers with fast login times and the desktop protected to be exactly how they left it on the computer they have moved from. This way clinicians can move from office to outpatients/wards/theatres with quick and seamless technology

UC

UC (Unified Comms) allows staff using desktop computers, tablets, desk phones, mobile phones and smart-phones the ability to coordinate conversations, collaborate with colleagues with voice and shared screens, check location and presence of colleagues and offer full conference and webex facilities.

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Effective

IM&T Management

Information

Governance

The holding and use of patient information within the Trust and beyond its boundaries brings with it a duty of care, not only to patients but to all of those accessing and using the information to deliver care. Patients have a right to expect that their information will be treated confidentially. Clinicians will expect that such information is available when and where it is needed while both parties will, undoubtedly, expect the information to be accurate. These concepts are the foundations of the national information governance initiative.

The Trust is fully committed to continuous improvement in information governance and acknowledges that this is a major factor in delivering effective health informatics. The Trust has invested in the Information Governance team that takes responsibility for overseeing activities designed to not only meet, but exceed the requirements of the Information Governance standard. A typical example of this being the Trust’s commitment to the robust security requirements contained within ISO27001 (the International Standard for Information Security Management) The Walton Centre is the only specialist Trust in the UK to have achieved and maintained this standard for Information security.

Expansion of services to outside organisations is planned during 15/16; to offer training packages i.e. Information Asset Management, Corporate Records Management

The Trust has an Information Governance and Security forum that meets every month to discuss maintenance and development within the organisation, both in terms of IT Security (ISO 27001) and

IT

Training

The Training and Development strategy for the Walton Centre Foundation NHS Trust is founded upon the principles of the NHS Plan and lifelong learning.

The strategy has been carefully designed to enable the Trust to respond in a consistent way to the widespread changes that are required to deliver the high quality modern NHS care and services. In the delivery of the strategy, staff will begin to acquire and build upon existing knowledge, skills and attitudes and approaches towards education, training, learning and development activities.

Thus the strategy sets out to encourage and challenge staff at every level of the Trust to contribute towards a learning culture. Based upon a training and development infrastructure, colleagues will be supported to reach their full potential and be enabled to respond more effectively to the needs of the patient.

IT Training will be offering in 15/16 Microsoft Office courses (Word,Excel,Outlook) to ensure staff get to use all functions of the current office package.; as well as designing and leading courses for EPR so-lutions.

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Implementing the Digital Strategy

Governance

The effective use of information technology means that IT has to be fully aligned to the Trusts strategy and objectives, key risks have to be identified and controlled, and legislative and regulatory compliance demonstrated. To ensure that this is maintained and has the correct governance arrangements the following structure has been put in place

EPR Programme Board Business Performance

Committee

Information Governance

Project Boards

The EPR Programme board meets bimonthly and has a full multi-stakeholder membership Director of Finance — Finance lead

Director of Operations — Operational lead Medical Director — Trust Clinical lead

Clinical Director (Neurosurgery) - Neurosurgery lead Clinical Director (Neurology) - Neurology lead Clinical Director (Radiology) - Radiology lead Director of Nursing — Nursing lead

Head of IM&T — IT lead

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Open Source

The organisation is a keen supporter of the open source agenda by NHS England and has been engaged with them throughout 2014/15.

A case study on the outpatient system was released by NHS England in January 2015 (www.england.nhs.uk/wp-content/uploads/2015/02/success-story-walton0115.pdf)

The Trust is in discussions with several organisations around the release of the outpatient system into their organisations.

Whilst the commercialisation of the above mentioned product could be optimal both in recognition and financial benefit for other systems being developed, there is also a realisation that resources are not infinite and currently it may not be the best time to approach commercialisation to heavily if it came at the expense of the EPR programme

This will be a standing item on the EPR Programme boards agenda moving forwards and as the programme starts to reduce in resources this could be seen as an option in the future. The trust will continue to link with the likes NHS England and North West Coast Academic Health Science Network (NWC AHSN) around partnerships and support of such routes

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Managing

Risks

The IM&T function is certified in ISO27001 (information security) and has a robust risk framework in place in line with the Trusts policy. Software development is included within the ISO standard to ensure a comprehensive risk management platform through the function.

The main risks identified are

Loss of key staff members.

There is always a risk of losing key personnel during a major piece of work, from the developers function we have adopted several methods to ensure continuation of services if any one individual leaves. Including full documentation of all system functions and the underlying architecture ongoing throughout the development. There is also a buddy system that means no one individual knows a single system, at least 2 must be aware of system development coding at all times

With the Project Management aspect there is a full Project library that has been built to ensure that any person qualified in Prince2 can pick up project packages. This process has been audited by MIAA. To ensure everything was correct before embarking on this programme of work

Failure to deliver

The strategy will be reviewed every 6 months and will be taken to the EPR Programme Board for acceptance each time. If there is a major exception highlighted then this will be escalated to the Executive Team via the EPR Programme Board Chair (Director of Finance). The plan of work doesn't allow major scope creep and this needs to be discussed at each Programme Board to ensure that with changes there will always be consequences in the programme of work against current resources.

Lack of resources

The 2 constraints to any programme of work is budget and time. The function of this strategy by keeping it short in life cycle and the agile 6 monthly review of the strategy means the two constraints can be highlighted early and the strategy can either be reviewed and extended or have additional resource allocated to it to maintain its milestones.

System Resilience

There was inherently always an issue with the Walton Centre only having the one data centre. With the advent of the Sid Watkins Build, an additional data centre has been created. Utilising VM architecture the splitting of servers between buildings and having a resilient backup server are being implemented during Q4 2014/15 and Q1 2015/16. This will ensure that system reliability and recovery are significantly improved.

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