NHS 24 KNOWLEDGE MANAGEMENT SYSTEM INITIAL AGREEMENT

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NHS 24 KNOWLEDGE MANAGEMENT SYSTEM

INITIAL AGREEMENT

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1 Title

The project, as it appears in the NHS 24 Five Year Plan, is titled the Knowledge

Management System (KMS). At the time of preparation of the Capital Expenditure Plan for 2004/05 and on, the KMS was considered as revenue expenditure. However, with more information now available, capital expenditure has been identified and that can be covered within the Capital Resource Limit agreed for the year, as the capital expenditure is not considered substantial.

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2 Introduction/Background

2.1 Strategic Objectives

The Health Plan ‘Our National Health: A plan for action, a plan for change’1 _{identifies that}

“time and time again people say they want more information. They want to know how and where to access services. They want to know more about their illness or about their health more generally. They want to be involved in decisions about their treatment and care and to be able to exercise informed choices.” Successive Scottish Executive Health Department (SEHD) policy documents such as ‘Partnership for Care’ and ‘Patient Focus, Public Involvement’ have also highlighted the priority of information provision in the healthcare setting.

NHS 24 was established in 2002 and the health information services it delivers contribute to supporting these policy commitments. In order to deliver the service, frontline staff require access to a broad range of quality assured information, including accurate details of Locations of Care, through a robust, efficient and user-friendly Knowledge Management System.

Although information is being provided at present, there are numerous issues with the current system, and the ability to provide a safe and quality service is becoming increasingly compromised as we integrate with additional partners; take on an increased role as the front-door to all out-of-hours emergency care in response to the new General Medical Services (GMS) contract; and more fully understand the extent of our information needs.

The NHS 24 Board has therefore agreed, as part of approving the Five Year Plan, that NHS 24 develops a Knowledge Management System, which is also capable of growth and development to meet strategic needs, in the current financial year as a business necessity. This is also fully aligned with the NHS 24 IT Strategy.

The Initial Agreement (IA) and Outline Business Case (OBC) have been considered informally by the NHS 24 Board who support the submission of the Initial Agreement at this

stage. The IA and OBC will be presented for formal approval at the Board Meeting on 30th

June 2004.

There are no implications on property through this development.

2.2 Clinical Needs

Delivering a safe and effective NHS 24 service requires access to quality assured accurate information. At present, the ability to do this is compromised through the existence of a health information system that is not fit for purpose. Therefore a Knowledge Management System is considered a high priority within the NHS 24 organisational risk register.

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2.3 Proposed Outcomes – Benefits

A new Knowledge Management System will deliver many benefits including:

• increased patient safety through the reduction in the risk of providing inaccurate or out-of-date information, in particular, in relation to Locations of Care;

• a Knowledge Management System which is fit for purpose, with a flexible data structure

that meets the business needs;

• improved information management and ease of upload and maintenance where

information providers can maintain their own data, eliminating the need for duplicate data entry;

• a single point of access for staff to their service delivery information needs;

• improved confidence of frontline staff in the quality and usability of an information system;

• an inter-operable system which supports information sharing with NHSScotland (NHSS)

organisations;

• alignment with the NHS 24 knowledge management strategic direction;

• knowledge management capability, not simply data management;

• support for NHS 24 in enabling compliance with the Freedom of Information Act;

• a system which can grow and develop to address changing business needs and strategic

intent. This includes the ability for the KMS to form the foundation of the eHealth Information for Patients Gateway2_.

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3 Description of Service

3.1 Current Service

NHS 24 operates from three Contact Centres across Scotland, and functions as a ‘virtual’ service which requires access to a shared national database. Frontline staff require a broad range of quality assured information resources in a timely manner. These resources include details of Locations of Care, voluntary organisations, clinical processes and information on diseases and conditions.

Although the necessary information is being provided at present to callers of the NHS 24 service, there are numerous issues with the current NHS 24 Health Information System (HIS), including the inability to display accurate information which is relevant to a caller, the inflexibility around searching for and locating information, and the inability to support efficient electronic information upload and update and maintenance.

This lack of a flexible and robust Knowledge Management System has led to a high clinical risk of providing inaccurate information, lengthy call times, manual input of information, inefficient information management whereby data may be held in three different systems, and inability to efficiently grow and develop the system to address changing business and strategic needs.

The need for a new Knowledge Management System has existed since the service became operational in 2002 and a project to address this was commenced in early 2003. However, this project was halted in order to align with the SEHD eHealth Information for Patients Programme as it was recognised that there are many synergies between the two projects and that to proceed would result in the introduction of duplicate technologies and therefore increased costs.

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3.2 Proposed Service

The Knowledge Management System establishes a tool which provides efficient access by frontline staff to high quality health information required in service delivery. It will:

• support the efficient delivery of the NHS 24 Nurse Assessment and Health Information

service, through the provision of timely and reliable access to quality health information resources required in service delivery;

• reduce the risk of providing inaccurate information to patients/callers which could

increase clinical risk;

• be integrated with NHS 24’s core applications;

• make the job of NHS 24’s frontline staff easier and more efficient by working with

leading-edge technology3_;

• assist in embedding a knowledge management culture in NHS 24 through the support of

technology;

• provide content management services to NHS 24 and its information providers such as

NHS Health Scotland and NHS Boards, to support distributed update and maintenance, and enable data sharing as required;

• create a scalable and flexible platform for future growth, including the ability to form the

foundation of the eHealth Information for Patients Gateway.

3_{Improving the use of information and communication technology in the health service was a key issue identified in the Wanless}

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4 List of Options

There are two options for consideration:

• option 1: do nothing;

• option 2: procure a Knowledge Management System.

4.1 Option 1 - Do Nothing

By doing nothing/continuing with the use of existing systems, the resolution of NHS 24’s fundamental knowledge management needs will not be addressed. The ability to deliver current services and develop quality services into the future becomes compromised, and the clinical risk of providing inaccurate information remains high. This option is not recommended.

4.2 Option 2 – Procure a Knowledge Management System

This is the only effective option to reduce the risks, provide a clinically safe virtual service and deliver the benefits outlined in Section 2.3.

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5 Capital Costs

5.1 Broad Indication of Capital Costs

The financial investment required across five project years is estimated at £1.1m. The division of costs is shown in Table 1 below.

Cost Grouping Yr 1 - £k Yr 2 - £k Yr 3 - £k Yr 4 - £k Yr 5 - £k Total - £k

Programme - Revenue 31 0 0 0 0 31 Technology - Revenue 642 0 0 0 0 642 Technology - Capital 112 0 0 0 0 112 Content – Revenue 21 0 0 0 0 21 Running – Revenue 15 59 62 65 68 269 Contingency @ 5% 41 3 3 3 3 53 Totals 862 62 65 68 71 1128

Table 1 - Five Year Building and Operating costs

Capital costs for the Knowledge Management System are estimated at £112k. Revenue Costs are estimated at £1016k.

Note that the Knowledge Management System costs are also included in the eHealth Information for Patients Initial Agreement and Business Case as the KMS is a foundation part of that Project. Proceeding with the KMS, will decrease the overall cost of the eHealth Single Gateway Business Case.

5.2 Sources of Capital Funding

Costs in Year 1 are included in the current, agreed Revenue Resource Limit and the Capital Resource Limit for 2004/05. Subsequent operating costs will be included in the internal allocation of each year’s Revenue Resource Limit.

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5.3 Timescales

At the end of 2004, NHS 24 will have fully rolled-out across Scotland. Therefore there is a business imperative to address these issues as soon as possible, not only to ensure clinically safe national delivery of the service, but also to support the key NHSS role NHS 24 is taking on with regards to the GMS contract.

The implementation of the NHS 24 Knowledge Management System will take a phased approach and address the following aspects. This is a draft plan and will be validated with the Systems Integrator, to enable the delivery of quick wins where possible.

Phase 1 Phase 2 Phase 3

KMS Framework Build – underlying information and technical infrastructure to support the KMS

Processes Leaflets and ordering

Locations of Care Searching on external

websites, including health improvement, diseases and conditions, benefits and rights and responsibilities

Communications material

Voluntary Organisations Enquiry Support Resources Training resources

Health Alerts Healthy Living material Bulletin Boards/Forums

Integration with PRM, including distance calculation and tagging

Migration of remaining NHS Helpline and Knowledge Web content

Forms and feedback channels

Reporting Phase 1 Reporting Phase 2 Reporting Phase 3

Future phases will likely include exploiting the functionality portal and content management products can offer. These phases will be treated as new projects and channelled through the existing NHS 24 programme of work. Approval of the Business Case for the eHealth Information for Patients Programme, will also allow the KMS to be further developed to form the eHealth Gateway.

Figure 1 below outlines the proposed, high-level implementation schedule for the NHS 24 KMS.

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Project Yr, Months 4-6 Project Yr, Months 7-9 Project Yr, Months 10-12 Project Yr, Months 1-3

NHS 24 KMS Implementation Overview KMS Framework KMS Framework Phase 1 Phase 1 Phase 2 Phase 2 Phase 3 Phase 3

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6 Impact on Revenue Costs

See statement in Section 5.

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BILL TEMPLETON

NHS 24 KNOWLEDGE MANAGEMENT SYSTEM INITIAL AGREEMENT