DORSET HEALTHCARE UNIVERSITY
NHS FOUNDATION TRUST
Information Management & Technology Strategy
2013 - 2016
“Providing care all of us would recommend to family and
friends”
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1. Introduction1.1 The Trust has, since July 2011, undergone a significant expansion in its scale and scope of activities and now has disparate infrastructure platforms and systems, with some areas requiring upgraded 21st century systems to support the delivery of care it undertakes. The purpose of the Information Management & Technology (IM&T) Strategy is to set out the principles as to which areas, and in what manner, Dorset HealthCare University NHS Foundation Trust will meet the challenges both of its own needs and the national NHS and social care IM&T agenda as set out within the 21 May 2012 issued DoH publication1 ‘The power of information: Putting all of us in control of the health and care information we need’.
1.2 Change will be undertaken against a backdrop of significant financial pressures, but it is expected that IM&T will be an enabler of service transformation and efficiencies, as well as it contributing to other associated agenda issues having their own strategic plans including supporting the need to evidence quality services and outcomes. It is recognised that technology has wider scope, away from core service facing information systems, to contribute to the areas of innovation, sustainability, safer working, estates, back-office services and transport.
1.3 This Strategy provides a framework that outlines how the Trust will utilise technology and a changing culture towards information management, its governance and the technology that underpins it, to support the Trust in meeting its responsibilities to patients and their carers. Not just in how their care is delivered and managed, but also in how that information is to be shared with service users and their carers, and how their feedback may be obtained.
1.4 Information is not always valued as a key tool to support decision-making – and this has a knock-on effect in terms of cultures and behaviour. IM&T is often seen as the preserve of IT specialists, rather than as an enabler to providing better, more efficient and more convenient care. Too often the way care is delivered is constrained by the capabilities of information systems, rather than those systems being designed to support the way the Trust would want to deliver care, or to receive care as service user.
1.5 The current use of information and IT, though much improved in parts of the Trust and nationally, is all too often too variable and disjointed to enable the integrated, high quality care we would all want to see. There have been significant improvements in recent years with the introduction within the Trust of an electronic patient record system (RiO) for our mental health services, and it will be a priority to ensure that this is continuously upgraded through the deployment of newer releases. We have already extended the deployment of RiO to encompass those mental health services in the west of Dorset, replacing the older Sepia and Maracis systems giving a holistic, county wide mental health platform. Similarly, the digitisation of X-Ray services within our community hospitals has seen improvements in that area of care. We have also introduced real time feedback surveys. However, it is recognised that staff can struggle with the information systems they need to use, perhaps because of lack of training and support, because these systems are not the
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most intuitive and user-friendly, because they are not always available in care settings away from hospital premises, because they seem bureaucratic and are not seen as an integral part of delivering excellent care, or because professional staff do not see the links between the data they record and the uses that data can be put to, to improve their work and the care that they provide.
1.6 All too often the introduction of new information initiatives are seen only as an IT issue, and not the opportunities as the catalysts for service transformation & innovation they can present, with their lead being left within IT rather than within the services (clinicians and service users) they contribute to. Technical implementation will sit with IM&T professionals, who can be expected to lead upon the infrastructure building blocks upon which ‘front end’ clinical systems and communication reside. For this Strategy to be successful though cultural engagement with, and by, clinicians and patients will be key to the Trust delivering innovative, safe and high quality care in the holistic manner it sets out to achieve.
1.7 Consequently, key to the successful delivery of this Strategy will be the engagement with, and support to, clinical staff and service users, and also engagement with other agencies, particularly those delivering social care. Without engagement with other agencies it will not be possible to maximise the potential benefit IM&T can deliver to the users of our services and their carers.
1.8 This strategy sets out four strategic themes to act as both catalysts and instruments of change. These themes are summary grouped as:
A. To promote interoperability and information sharing; B. To enable mobile working;
C. To enable patient access to information;
D. To provide an IM&T capability that engenders better patient care and enhanced trust services.
1.9 This IM&T Strategy aims to ensure that the Trust moves forward with its Clinical Strategies retaining a model of being a good ‘corporate citizen’ and continuing statutory compliance, whilst delivering care in line with our Trust’s vision:
“Providing care all of us would recommend to family and friends”
1.10 The Trust’s overarching 2013-2016 strategy is centred around eight clinical service strategies. This IM&T strategy corroborates the previous findings by aligning in certain areas, such as that of e-Clinics and bookings now being trialled with IAPT services and supports them in general.
1.11 How each of the above theme’s commitments is to be achieved are detailed in the underpinning work programme at Appendix 1, and these are summarised later in this document.
2. Governance
2.1 The realm of IM&T within the Trust is delivered from two distinctly separate, yet closely aligned departments operating within and reporting through the Finance Directorate. Each of the departments has separate agendas, which
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can be précised as follows:
2.1.1 Information (Management) Department – encompasses a number of further sub teams
Informatics (Development) – it is here that innovation and change will be developed, piloted and deployed. This can range from bespoke application developments, website management, technical training and technical project management. Data Warehousing resides in this function. Performance Management - turning the raw data collated at
operational source into meaningful information and organisational knowledge and intelligence. This ensures the Trust can evidence the Governance Risk ratings for Monitor, adherence to local contractual targets with the CCG and Specialist commissioners, DH and other nationally mandated data sets along with day to day knowledge for proactive Trust service management and exception monitoring.
Information Governance – to provide advice and best practice guidance on our obligations to safeguard corporate and patient information, mitigating risk where possible to ensure our responsibilities under data protection legislation.
Clinical Coding – an embryonic function, but one which feeds into patient safety, governance and will become ever more important around future activity evidenced funding.
Electronic Patient Record Helpdesk – supporting nearly 2000 users of RiO and will grow to support up to 3000 users of the Community System.
2.1.2 Information Technology Department
The function of the IT department within the Trust is to support the complex and diverse infrastructure upon which the various clinical systems such as RiO are deployed across a challenging topography.
System security and maintenance is a cornerstone of the work undertaken here, with one aspect of ITs role being to advise upon initiatives in terms of the infrastructure required to support it.
2.2 Currently, both Information and IT Departments also support the CCG and primary care Dorset GP Practices with infrastructure, system deployments and various technical projects as part of existing contractual arrangements. The Trust will need to consider the impact upon its net capacity should any economies of scale be lost in the event there is any changes to these arrangements.
2.3 The distinction of having separate IM and IT departments recognises the very different skill sets, which are needed within each. The structure allows expertise in both areas without someone less expert in one having to oversee and manage in another. Overseeing each of the departments is an Associate Director of Finance who is available to assist in any non-technical issues regarding the teams and act in a customer facing role. Overall strategy for
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these functions is guided and set by the Finance Director, who retains an oversight level of knowledge across both disciplines.
3. Four Strategic Themes
3.1 How each of the four theme’s commitments is to be achieved are detailed in the underpinning work programme at Appendix 1.
3.2 A. To Promote Interoperability and Information Sharing
3.2.1 The interoperability and integration of systems within the Trust is critical to successful communication between Trust teams and also into the wider health and social care economy including across GP’s, acute hospitals and social services. Information should be recorded once, at first contact and shared securely with those providing care.
3.2.2 The Francis report published in February 2013 singled out efficient and effective record keeping as a major issue. The report highlighted the potential of IM&T systems as an enabler for quality control of information and data, communications and the management of care pathways in order to address the issues it identifies.
3.2.3 Our commitment:
To see information used to drive integrated care – within and between organisations, and across the health, care and support sector as a whole. Information recorded once, at first contact, and shared securely between those providing care to our service users – supported by consistent use of information standards that enable data to flow whilst keeping our confidential information safe and secure. As a part of this aim the Trust will need to consider the implications of the recently published Caldicott 2 review “Information: To Share or Not to Share?”2 on current information governance rules and their application to ensure appropriate balance between the protection of confidential and identifiable information within health & social care records, and the use and sharing of this information to improve the quality & safety of care.
To prioritise where possible interoperability and appropriate information sharing involving children between agencies to improve outcomes, including MIU activity with acute hospital A&E departments, and at the transition point between children’s and adult services.
All health and social data, wherever held, to use the NHS Number as the default identifier, to be recorded as the care is delivered (not retrospectively). It is accepted that there will be some cases where a local temporary identifier will still be needed e.g. in sexual health or drug treatment services where patients may wish to remain anonymous.
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Adopt the general principle of ‘digital first’, and as a part of this introduce eFax in place of paper fax machines as an early win. Engage with national and local partnership working to transfer all correspondence electronically rather than on paper, including the sharing of discharge notifications, medication, and assessment arrangements for continuing health care by secure email or other electronic means.
Adoption of consistent coding and terminology practices across the Trust to ensure data of a high and useful quality. For example, the January 2013 RiO upgrade introduced Systematized Nomenclature of Medicine Clinical Terms (SNOMED), supplementing the existing ICD 10 coding.
To support the NHS as it undertakes to make data collections, and increasing use of minimum data sets such as MH, CAMHS and IAPT, more relevant to clinical need and, increasingly, aligned to collecting data focused on outcomes rather than processes.
The replacement, to occur from 2015 onwards, of our major information systems to be planned in conjunction with social care partners, and other similar NHS organisations where a consortia approach may be beneficial.
Reviewing and implementing the DoH route map for the 2013-2018 setting and implementation of information standards across the health and social care system in England.
Whilst promoting interoperability, to repatriate data concerning our own service delivery, and its associated clinical coding, from other NHS organisations back into the Trust’s own systems and oversight. Future income payment mechanisms, and publicly published clinical performance information, make it essential for the Trust to take full control of its own services’ data.
To develop systems that ‘talk’ to one another, reducing the need for the handling of data.
3.3 B. To Enable Mobile Working
3.3.1 One of the four Trust priorities for 2013/14 is to work with our partners in the delivery of integrated care closer to people’s homes. A key enabler in the delivery of this priority is to have a functional mobile workforce, using the most effective technology. There are huge benefits to mobile working and the ability to deliver a reliable, real time method of accessing and updating a patients record at the point of contact is paramount.
3.3.2 Our commitment:
To provide appropriate mobile devices to staff. These may be utilised to enable professional viewing and recording of data, including digital dictation and also, where a business case
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demonstrates improved quality, improved staff working and cost savings, mobile devices as other working aids which may include the provision of sat-nav GPS car devices to appropriate community staff. Appropriate mobile solutions for community services staff are integral to the 2013/14 deployment of the Trust’s new Community Information System.
Offline functionality for RiO (notionally called Store and Forward) is set for Release2, scheduled during July 2014 with project initiation in October 2013; this allows for offline viewing of caseloads and for the updating of patient notes which will synchronise to the central record once a connection is established at a later time. Similar or better functionality for mobile working with the Community Information System are also being investigated, but an initial offering of a compact, high performance wireless enabled laptop will be the first foray into community mobile working. The January 2013 release of RiO Release2 was a functional upgrade to enable the later implementation of RiO2RiO reporting, allowing records to be shared across other RiO2RiO enabled Trusts, along with results reporting for the automated feed of pathology results into patient records and electronic prescribing. Each of these additional functions require a 6 to 12 week deployment window.
A key enabler to successful mobile working is the availability and quality of the telecom data networks mobile phone reception (e.g. 3G) and internal localised Wi-Fi facilities. The Trust has only recently renewed its mobile telecommunication provision with Vodafone, but will undertake to make improved rural coverage a key procurement decision factor ahead of the next contract renewal in 2015. As part of the Community Information System project, mobile signal carriers' coverage and strengths are being collated at key locations across Dorset to help give the Trust an informed view as to which providers offer the better pan-Dorset reception.
To utilise the service mapping already undertaken to survey the main telecom service providers 3G signal at each location of care to provide informed local network allocation choices to staff. To significantly simplify the network’s remote log-on process
The provision of Trust network Wi-Fi access to all sites
Mobile hardware improvements including built in optimised 3G and wireless connectivity with video camera facilities.
The provision of web based tools to enable real time quality data and collection reporting.
3.4 C. To Enable Patient Access to Information
3.4.1 The May 2012 Department of Health strategy ‘The Power of Information’ sets out a framework for transforming information within
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health and social care. Harnessing new technologies, one of its ambitions it to recognise that information about patients within their records is about the patient and that it will become normal for them to be allowed self-service access to their own data.
3.4.2 Our commitment:
To provide to service users secure electronic online access to their patient records should they request it. This will be progressively centrally mandated across health & social care, commencing with GP compliance, by 2015, when they will be expected to make available via online means electronic booking, cancelling of appointments, ordering of repeat prescriptions, communication with the practice and access to records. The Trust will, as a minimum, be expected over time to deliver similar levels of functionality.
To make publicly available information about our care at clinical or professional team level and other information that enables service users to ‘benchmark’ our services. It is nationally expected that data by clinical teams relating to activity since April 2013 will be available by April 2014, and that all clinical outcomes data will be put into the public domain by 2015. The April 2014 date has been set to allow opportunities for professionals to check their own data and for any local action necessary regarding data/coding quality.
To extend and improve on our technology to collect patient experience and feedback information.
To make publicly available online our Patient Reported Outcome Measures.
92% of the population are believed to have mobile phones and 45% of UK adults now have a smartphone, a proportion that is only expected to grow. Similarly 75% of all homes now have access to broadband. Not forgetting that still leaves significant parts of the population without such access and acknowledging ‘digital first’ will still require traditional mediums be continued or patients otherwise signposted, the Trust will seek to develop electronic signposting and self-help/care decision making applications, in tandem with national portal initiatives, regarding its services and care. These may stand-alone, via our website or other means e.g. Facebook.
The Trust will promote the culture that patient records are seen as the patient’s, not the professional’s, and ideally service users see what we are writing about them as we write it.
We will provide our service users with the facility of personal Wi-Fi connectivity when they are in-patients. This may require upgraded, smartphone or Android based tablet type, Trust replacement devices (with camera facility disabled).
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Identification with service directors of priority areas for patient apps.
3.5 D. To Provide an IM&T Capability That Engenders Better Patient Care and Enhanced Trust Services
3.5.1 Having the right IM&T within the Trust will help support those clinical initiatives that lead to ever improving patient care, quality and effectiveness.
3.5.2 Our commitment:
To continue with our plans to introduce a comprehensive community information system (CIS), to replace the SADIE system and other localised solutions, by Quarter 4 2013/14 and to ensure full CIS dataset compliance by April 2014 along with Monitor’s community indicator compliance mid-deployment.
To continue to upgrade our RiO patient records system and to seek to bring forward additional functionality to be future offered wherever possible to improve patient care.
To ensure a focus upon the aims of this strategy, the Trust will run the down the volume of ad-hoc locally requested, often short life, system enhancements it has historically been engaged in and in respect of systems development instead focus on the introduction of, and enhancement to, the trust-wide CIS and RiO, and such similar systems, across the Trust.
To rationalise our number of acute patient administration systems and data warehouses.
To extend and improve real-time daily exception reporting and clinical dashboards, with the ability to locally drill down data. This will encompass both Community and Mental Health services.
To enhance and improve our clinical coding and medical records management.
To prioritise the consolidation of email server/Windows server/Active directory to a single domain across user accounts, printers, servers, shared drives, mail boxes, Blackberry migration & VPN remote access log-ins. This is critical to the subsequent development of IM&T initiatives across the Trust.
Move to a single help-desk system; rationalise Wide Area Network data lines; rationalise disaster recovery arrangements and to adopt comprehensive asset management & remote software deployment systems.
With the scheduled demise of Microsoft support to Windows XP by April 2014, to progressively move the Trust to Windows 7 and MS Office 2010 as the standard local desktop platforms.
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To enable an internal business based focus, to continue to IM&T support our existing cluster CCG and local GP community arrangements but to not seek to further extend external IM&T activities.
Whilst acknowledging the costs of the future repatriation of data to newer systems in the future, to consider the potential benefits of a document management system promoting paperless scanning of historic files. As a part of this look to implement a corporate document management system, scoping requirements against the digital first principle and with considerations to the 2015 national system contract expiry timelines.
To appoint a senior clinician or care professional responsible for taking the lead in ensuring that information is organised & utilised effectively in support of better patient care as highlighted in the DoH publication1 ‘The power of information: Putting all of us in control of the health and care information we need’
To enhance and promote teleconferencing and video conferencing facilities, and to enhance our intranet and website as communication tools to staff and service users respectively.
To utilise technology and information systems to extend on-line training opportunities and back-office efficiencies, e.g. electronic staff record ‘self-service’ and electronic travel claims.
To develop and implement electronic referral routes into Trust services via website developments. Look to social media channels for new routes into patient advice and to extend accessibility to Trust services.
To deploy solutions, initially for IAPT, of e-Clinic access. Due to associated confidentiality and security considerations, this will be progressed via a 3rd party NHS Provider with an already operational solution.
To utilise IM&T to promote the take-up and use of tele-medicine and tele-health, and to more generally support the Trust’s wider innovation programme.
To enable staff to safely access social networks and external sites for the benefits of patient care and in support of the innovations and communications strategy.
For IM&T to be the change enabler in supporting medicines management led initiatives with ePrescribing to improve patient safety and quality
Through delivery of this Strategy, and the wider service transformation and innovation agenda, to foster a reputation of being a leading healthcare organisation in its use of technology.
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4.1 The four themes represent the initial areas identified that require development by the Trust, either through the necessity of the current position of IM&T within the Trust and/or the emerging agenda being centrally NHS determined.
4.2 The Trust has in its financial planning been anticipating (and recent central publication has confirmed) that central funding for our both our main mental health and impending community patient management systems will be removed from 2015/16, for the Trust to have to locally fund these going forward. Also, central funding for the Trust’s wide area data network (COIN - Community of Interest Network) will be similarly withdrawn as the current contract expires.
4.3 Many of the initiatives set out in this strategy will require significant man-hours (including back-filling costs of operational staff time) and/or non-pay costs to develop and deliver, be these initial non-recurring enabling costs (revenue or capital) or on-going revenue commitments. Whilst the major system change costs have been scoped, other costs this Strategy will entail have yet to be considered. These can be expected to become both calls upon the capital cash reserves of the Trust and, in the final event, add to future years’ CIP savings targets.
4.4 There are still centrally set timetables that we have yet to be advised of that will steer the prioritisation and delivery of some of the aims of this Strategy. Some of these dates may not be known until much later in 2013. A period range of 2012-2018 has been outlined by the DoH for the delivery of some of the Strategy’s aims, and a ten-year period for the development of interoperability systems has been nationally mooted in respect of that particular aim.
4.5 Underpinning the strategy will be an IM&T Work Programme. Following service user feedback and Director level prioritisation on the Strategy’s aims, this Work Programme will establish individual lead responsibilities and delivery timescales.
4.6 That the Trust has historically opted to take forward its major IM&T systems within, rather than outside of, national procurements means that we have to align major change to the renewal of these arrangements due to the punitive financial costs of abandoning existing contractual commitments ahead of their scheduled expiry. This presents challenges in being a ‘cutting edge’ proponent of IT when similar organisations operating outside of national arrangements have greater flexibility to introduce change.
4.7 That the Trust operates from so large a number of settings will present logistical challenges to the timely roll-out of change across the Trust as a whole.
4.8 Directors will look to identify and deliver early wins, aligning IM&T Strategic aims wherever possible with other Strategy imperatives during 2013, but the thrust of work during 2013 will necessarily being on delivering the supporting infrastructure changes needed following the coming together of Dorset and Bournemouth & Poole Community Health Services with the Trust and the major community information system deployment and RiO upgrades within the Trust.
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5. Strategy Review5.1 Whilst a three year strategic period is envisaged as being encompassed, rapid advancements in the technology arena and nationally mandated changes, not least from the demise of the National Programme for IT and the downstream impact on trusts, would suggest it prudent that this document should be Board assessed and reviewed again in 12 months’ time.
6. References
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Department of Health (2012)
The Power of Information: Putting all of us in control of the health and care information we need
http://bit.ly/JN2kFu
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UK Government (2013)
Caldicott Review: Information Governance in the Health and Care System
Appendix 1
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IM&T Work Programme 2013-2016Trust Priorities (Key below)
IM&T Strategic Themes Work Project Lead 2013/14 2014/15 2015/16
Priorities 1 and 2
To promote interoperability and information sharing
Ensuring continual adoption of the NHS Number as the de facto standard patient identifier within the Trust
All Directors
Engaging with local partnership working to transfer correspondence & share information electronically e.g. discharge notifications
Finance Director
Deploying RiO2RiO functionality, in conjunction with partner Trusts. MH / Finance Directors
Development of Clinical Coding function applying consistent standards Head of Information Development of new data sets as mandated by national timelines Head of Information To work in a consortium approach with other NHS Trusts to procure and
migrate major clinical systems by 2015
MH / Finance Directors Implementing all relevant nationally mandated ISN’s / DSCN’s against
major clinical systems
Head of Information
Repatriation of Trust data from other organisations systems. CIS will be a major driver of this
Finance Director / Community Service Director
Priorities 2 and 3
To enable mobile working Horizon scanning those mobile offerings in the pipeline for our major clinical systems. Actively engaging with suppliers at an early stage e.g. Store and Forward, Android, iPad versions
Finance Director / Head of Information
Actively review mobile signal coverage across Dorset and use as a key driver to inform the procurement decision when Vodafone expires in 2015
Finance Director
Further deploy appropriate mobile devices to staff, including optimised connectivity features
Head of IT
Testing of new remote log-on technologies to simplify current process Head of IT
To enable Wi-Fi access with the Trust Head of IT
Priority 1 To enable patient access to information
Provide secure patient electronic access to their records along with facilities to better engage with services via alternative mediums
Service Directors / Head of Information
Appendix 1
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Publication of clinical team level data to allow service user benchmarking of the Trusts performance
Service Directors / Head of Information Extend devices and developments to improve patient experience and
feedback for analysis and learning’s Service Directors / Head of Information Publish Patient Reported Outcome Measure summary findings on the
Trust website
Head of Information
Development of self-help and signposting applications. Prioritise potential app development opportunities with service directors
Service Directors / Head of Information Provide In Patient personal Wi-Fi connectivity and devices Head of IT All Priorities To provide an IM&T
capability that engenders better patient care and enhanced trust services
Fully deploy a Community Information System, replacing localised bespoke solutions and reliance on external organisations systems
Community Services Director / Head of Information / Head of IT
Continue national path RiO upgrade programme, introducing new functionality across mental health services
MH Services Director / Head of Information
Extend and Improve reporting functionality, with Business Objects further deployment (or similar) to cover all Community Services for near time, exception and BI reporting
Head of Information
Review and recommend options for Trust Wide Clinical Coding Head of Information Single domain consolidation of Windows, email, AD across all user
accounts, printers, servers etc
Head of IT
Migrate to MS Windows 7 and MS Office 2010 Head of IT
Review options and business case for implementation of corporate and service user Electronic Document Management System, not least in line with 2015 requirements
All Directors
Promote the use of tele and video conferencing facilities alongside intranet and internet enhancements to better communications with staff and service users alike
Finance Director
Extend online internal training and staff self-service opportunities. HR Director Develop electronic referral avenues into services All Directors
Deployment of eClinic solution to IAPT services in first instance, working with 3rd party suppliers
CAMHS / IAPT Director
Appendix 1
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Review the telemedicine / telehealth opportunities within the Trust, working with Innovations.
All Directors
IM&T supporting medicines management led ePrescribing initiatives Director of Nursing / Finance Director
Priority 1 To deliver high quality, safe, patient outcome focused services that demonstrate our vision of providing care all of us would recommend to family and friends.
Priority 2 To invest in and develop our staff to innovate and deliver continuous quality improvement, as one Trust.
Priority 3 To work with our partners in the delivery of integrated care closer to people’s home.
Priority 4 To remain a highly performing organisation through the delivery of our key performance and financial targets.
