The Safer Hospitals, Safer Wards Technology Fund Expression of Interest Applicant name

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1 FOI Ref 398 Tech Fund 1 Technology Bid to NHS England Appendix 1 The Safer Hospitals, Safer Wards Technology Fund Expression of Interest Applicant name State the organisation name for the project application. In order to be awarded funding, the applicant must be an eligible organisation as defined in the prospectus and must have lead responsibility for the project Royal Cornwall Hospitals NHS Trust Applicant Address State the contact address for the organisation Royal Cornwall Hospitals NHS Trust, Penventinnie Lane, Truro, Is this a joint application? Project title Project Aim & Description Cornwall, TR1 3LJ No Provide the title by which the project is known eprescribing and Medicines Administration Provide a description of your project. Explain what you are seeking to achieve and the expected benefits for patients, clinicians and efficiency The aim of the project is to advance and complete the implementation of the eprescribing system in the Trust and partner organisations. The bid will enable all clinicians to use one safe, electronic prescribing system by September 2014 rather than a mixture of electronic and paper based prescribing. eprescribing has already been successfully piloted. Many benefits have been identified for patient safety, clinical decision making and operational efficiency. The pilot identified the need for a clinical implementation team and investment in additional mobile technology on wards and other clinical areas. This bid will put in place the technology and implementation team required to complete this project by September eprescribing and the integrated decision support will provide improved patient safety and help the Trust achieve its objective to focus relentlessly on quality of care and patient safety. The Trust and the Cornwall health community is implementing clinical electronic patient record systems that will enable the care and treatment of patients to be provided using electronic systems. eprescribing will allow us to move towards a paperless system, as part of the Integrated Digital Care Record. The Trust s Care Quality Commission report and provider compliance assessment in 2011 for outcome 9 highlights the importance of antibiotic prescribing and allergy. eprescribing can restrict prescribing for allergic patients and guide the clinician to prescribe appropriate alternatives. Such functionality is not only limited to antibiotics but also other formulary decisions. The wealth of electronic data captured by eprescribing will allow

2 for improved audit and review of practice, helping to support our staff in education, training and research and drive improvements in prescribing practice. Digital/Paperless Roadmap Highlighted Benefits: Improved patient safety through legibility and monitoring of compliance with prescription Reduced prescribing and dispensing errors Clear and consistent prescription information for patients Cost reduction and control through compliance with formulary Provides improved patient information at the point of care. Ensures secure access to confidential patient information- drug charts removed from the bed-end Is standards based. Information recorded once and shared Improving people s experience of health, care and support Reduced nursing drug administration time Reduced cost of paper/dugs charts Reduced cost of FP10's Avoid cost of drug errors/litigation Improved Information into service line reporting Improved patient flow Speed up patient discharge Reduced writing and rewriting drug charts Provide organisation s roadmap to move from paper to paper light to paperless. This should include an indication of the progression that an award of funding would make in terms of scope, scale or speed. The Trust has a coherent and Board approved strategy for building an Integrated Digital Care Record using the NHS Number as the key patient identifier. The building blocks of the strategy are Underpinning technology platform including high mobility, follow me desktops/devices and single sign on. Strategic Hospital wide PAS/EPR/Pathway/Workflow/Patient Tracking System Implementation of a scan and deliver health records service to digitise all health records Best of Breed specialist EPRs (e.g. cardiology) and Departmental Support systems integrated with the PAS/EPR including eprescribing the basis of this bid. Clinical or care Portal across Trust and wide care community EPRs Supporting Corporate and Business Support and MIS development. The pace of programme implementation is restricted by capital availability. The programme has been profiled over the next 5 years within capital programme constraints. The Technology

3 Fund will enable the Trust to make more rapid progress in delivery of the strategy and the move to paperless working. It is worth noting that Royal Cornwall Hospitals Trust has not received any national funding following the issues with Fujitsu in the national programme. The Trust Board has agreed a programme to be delivered with an identified Capital budget to put the Trust on the path to Integrated Digital Care: To date the Trust has fully implemented the following integrated modules: Real time bed management Real time Emergency Department System Electronic Correspondence edischarge Order Comms Imaging Order results Imaging and Pathology PACS and RIS replacement In progress 2013/14 Order Comms Pathology pilot live eprescribing Pilot live Health records scan and deliver - mid procurement Strategic PAS procurement In progress and planned for 2013/14/15 PAS/Pathway/Patient tracking & Theatre strategic procurement Complete order comms and eprescribing increased EPR functionality Vital signs and infection surveillance Planned for 2015/16/17 Clinical decision support Clinical portal within Trust and health and social care community Best of breed departmental and specialist service EPRs integrated through the interface engine and clinical portal. Project Delivery Approach A slide set outlining the Trust strategy is available including diagrammatic representation not able to be included as part of the on-line bidding process. Provide an outline of the intended approach for delivering the project, confirming if the project is currently in flight The project is established (in flight), chaired by the Medical Director and led by a clinical team supported by Informatics. The project uses formal Prince 2 methodology and has an aggressive rollout plan based on the success of the model used in the early pilot wards.

4 Part of the reason for the bid is to help to speed up the rollout. The pilots identified that to roll out eprescribing requires a dedicated implementation team, mainly consisting of nursing staff along with a considerable investment in mobile technology. The bid will allow the Trust to complete the project by September 2014, achieving full eprescribing. Sourcing Strategy The system has been piloted in two of the Trusts hospitals for Inpatients. The next stage for implementation is within Inpatients in the Trust s largest hospital: Royal Cornwall Hospital, Truro, followed by Outpatients throughout the Trust. Provide an outline of the sourcing strategy and suppliers involved (if known) and the likely procurement approach and timescales The Trust has selected JAC as the system supplier. The project is in flight and the phase timescales are shown below assuming the bid is successful. Phase 1 Pilot Inpatients at West Cornwall and St Michaels Hospital - delivered on schedule. Phase 2 full roll out in West Cornwall and St Michaels Hospital in progress Phase 3 Inpatients, RCH, Medicine being scheduled for Autumn/winter 2013/2014 subject to this bid Phase 4 Inpatient, RCH, Surgery scheduled for April 2014 Supplier Partner Capability Assessment Phase 4 Outpatients scheduled for June 2014 Provide details on any delivery capability and capacity assessment that has been made regarding the envisaged supplier partner(s) involved The supplier, JAC, has been selected in through an OJEU procurement using a scoring framework of overall best fit including capability, system functionality and cost. The supplier s role in the implementation is to provide the application support, train the trainers, updates and system support including drug file updates. NHS VistA Solution Strategic Alignment Supplier performance and engagement is monitored and assured through the eprescribing Project Board, chaired by the Medical Director. Confirm your interest in being involved in the development and adoption within your organisation of an NHS Open Source IDCR, NHS VistA, that would provide a core platform for digital care records. The Trust would be interested in exploring VistA and other open source approaches, although this project is already established and underway. Describe the fit of the project with the organisation s information and IT strategy and the current level of infrastructure and capability The Trust has a Board approved Health Informatics Strategy that will put in place an Integrated Digital Care Record using the NHS Number as the key patient identifier. The building blocks of the strategy are:

5 Underpinning technology platform including high mobility, follow me desktops/devices and single sign on. Strategic Hospital wide PAS/EPR/Pathway/Workflow/Patient Tracking System Implementation of a scan and deliver health records service to digitise all health records integrated with the PAS, EPR and Portal Best of Breed specialist EPRs (e.g. cardiology) and Departmental Support systems integrated with the PAS/EPR including eprescribing the basis of this bid. Clinical or care Portal across Trust and wider care community EPRs Supporting Corporate and Business Support and MIS development. The path to paperless working is in line with the patient safety and quality improvement strategy in the Trust. It is strongly supported by the Trust Board and the Trust s aim: safer, better, good value care. There is formal programme governance structure in place. The Health Informatics Delivery Board, chaired by the clinical lead for health informatics, is well established and has a good track record in managing the safe implementation of patient centric systems. Each significant project within the health informatics programme is managed by a project board that reports into the Health Informatics Delivery Board. This project is at the heart of the health informatics strategy with the development of an electronic patient record with increased access to information across wards, departments and the wider health and social care community. The intention of the Health Informatics Strategy is to implement clinical electronic patient record systems that will enable the care and treatment of new patients to be provided using electronic systems. The Trust has a good level of capability and capacity that would be enhanced if successful with this bid. The projects are supported technically by a shared service and formally managed by experienced and capable Project Managers. All projects are staffed by integrated teams to achieve success including clinical, operational and technical staff with change management operationally owned. The Trust strategy is clear in its ambitions and the route to deliver these ambitions. It is capital availability that is determining both our approach and pace of the health

6 Total Project Cost Total Amount of Funding Requested Financial Breakdown Delivery in FY13/14 Is this a multiple application? informatics strategy delivery. If the Trust is successful with this and the other bids, it will enable a significant increase in pace for the Trust journey towards integrated digital care records. Please state the total cost of the project ( k) 2013/14 788k 2014/15 681k Please state the total amount of capital funding requested in this application ( k) 2013/4 394k 2014/5 290k Provide a breakdown of total project costs by year, the profile of the costs split by capital/revenue. See attached spreadsheet Please state if your project will begin to deliver and incur capital spend from the fund by March 2014 (YES/NO) Yes. The project is incurring capital spend during the financial year 2013/14. Please indicate if your organisation has made multiple applications to the fund and please rank your applications in priority order, (1st, 2nd, 3rd etc). This priority ranking may be considered if the fund is oversubscribed Yes. The application is priority 1. Date 24/07/13

7 Financial Planning Template Organisation name ODS code Please Indicate if this is the First or Second Priority Project Project title Project Type (Select from List) Project SRO name Project SRO contact details Date of making this return PLEASE ENSURE THIS FILE IS SAVED USING THE NAME BELOW WHEN RETURNING SHSW Financial Planning Template_REF_First Royal Cornwall Hospitals Trust REF First eprescribing and Medicines Administration Electronic Prescribing and Medicines Optimisation Paul Upton XXX 27th September 2013 PLEASE COMPLETE THE INFORMATION REQUESTED IN TABLES ONE AND TWO BELOW: Table One: ( 000's) Onwards ROW INITIAL PROJECT COSTS A1 Capital Expenditure - Centrally Funded Element Per VFM Total Cost x 50% A2 Capital Expenditure - Trust Funded (i.e matched funding) Per VFM Total Cost x 50% Less category 4 A3 Revenue Expenditure - Trust Funded (i.e. matched funding) Per VFM Template cost category 4 FOLLOW-ON COSTS B1 Capital Expenditure - Trust Funded B2 Revenue Expenditure - Trust Funded Other Per VFM Template cost category 4 B3 Revenue Expenditure - Trust Funded Cost of Capital Charge Trust funded capital ONLY - assumed central funding classified as donated asset. If funding classified as PDC these figures need doubling B4 Revenue Expenditure - Trust Funded Depreciation Trust funded capital ONLY - assumed central funding classified as donated asset. If funding classified as PDC these figures need doubling Notes: A1 This is the funding the project is requesting from The Department of Health. Funding is available for the years and Funds must be drawn down and spent in the year of allocation. A2 Use this line to record the capital expenditure the applicant organisation will be investing into the project. A3 Use this line to record the revenue expenditure the applicant organisation will be required to provide to the project. B1&B2 These rows are to be used to show the capital (B1) and revenue (B2) costs annually to the applicant organisation of maintaining the project upon completion. B2 should EXCLUDE the costs shown in rows B3 and B4. B3 The Department of Health imposes a 'cost of capital' charge on the asset base of Hospital Trusts. Please use this row to record the future expected annual cost of capital charge for the assets created as part of the project. B4 Please record the annual depreciation cost in the trust accounts for the assets created in this project. Table Two: ( 000's) Oct-13 Nov-13 Dec-13 Jan-14 Feb-14 Mar-14 Apr-14 May-14 Jun-14 Jul-14 Aug-14 Sep-14 Oct-14 Nov-14 Dec-14 Jan-15 Feb-15 Mar-15 ROW INITIAL PROJECT COSTS C1 Capital Expenditure - Centrally Funded Element 271,332 30,667 30,667 30,667 30, ,167 30,667 15,833 15,833 C2 Run rate of transition team - step down when IT completed 30,665 30,667 30,667 30,667 30,667 30,667 30,667 30,667 15,833 15,833 C2 Purchase of IT Equipment/Infrastructure 210, ,500 Notes: C1 C2 Please indicated the current forecast draw down profile for the central funding the applicant is requesting. Please note that this funding is usually tied to the completion of certain milestones within the project. This row is to be used to give a view brief description of the milestone applicable. If appropriate please point to a relevant table in your application if this is more appropriate.

8 Financial Planning Template Organisation name ODS code Please Indicate if this is the First or Second Priority Project Project title Project Type (Select from List) Project SRO name Project SRO contact details Date of making this return Royal Cornwall Hospitals Trust REF First PLEASE ENSURE THIS FILE IS SAVED USING THE NAME BELOW WHEN RETURNING SHSW Value for Money Template_REF_First eprescribing and Medicines Administration Electronic Prescribing and Medicines Optimisation Paul Upton XXX 27th September 2013 Value for Money template Please insert Project Name and Trust here Financial Year 2013/ / / / / / / / / /23 TOTAL Discount rate Cost category 1. Initial Capital expenditure 420, , , Ongoing capital costs - 3. Transition costs 368, , , Additional revenue costs associated with investment 101, , , , , , , , ,000 1,605,000 TOTAL COSTS 788, , , , , , , , , ,000 2,973,000 Benefit category 5. cost savings 62, , , , , , , , , ,000 4,791, increased productivity of staff - 7. Other quantifiable benefits - TOTAL BENEFITS 62, , , , , , , , , ,000 4,791,000 UNDISCOUNTED TOTAL OF COSTS AND BENEFITS - 726, , , , , , , , , ,000 1,818,000 DISCOUNTED TOTAL OF COSTS AND BENEFITS - 726, , , , , , , , , ,741 1,346,831 Undiscounted costs 788, , , , , , , , , ,000 2,973,000 Undiscounted benefits 62, , , , , , , , , ,000 4,791,000 Discounted costs 788, , , , , , , , , ,941 2,694,574 Discounted benefits 62, , , , , , , , , ,682 4,041,405 Discounted benefit to cost ratio 1.50 Please list and describe qualitative benefits here: 2013/ / / / /18 Reduced cost of paper/drugs charts 4,000 18,000 18,000 18,000 18,000 Reduced drugs spend through compliance with formulary and feed into PLICS 56, , , , ,000 Remove cost of FP10s 2,000 12,000 14,000 14,000 14,000 Avoid cost drug related litigation Information into service line reporting for overall resource management Improved patient flow Speed up of discharge through ETTA Time spend writing and rewriting drug charts Support for more efficient hospital at night through remkote precribing/medication management Improved medicine reconsiliation Improved audit data Improved infection control through integrated Infection Control System and EPMA Please describe the assumptions and state the calculations for each benefit: Actual cost of current paper/drug charts Detailed estimate of cost of formulary non compliance/branded drugs savings Actual costs of FP10s

9 # Risk Likelihood of risk before Impact of risk before Rating before Risk Mitigation Strategy Likelihood of risk post Impact of risk post Rating post 1 2 Clinical staff will be resistant to a major change in the prescribing change and will not change practice Medium High Red Insufficient equipment on wards and other clinical locations to ensure ease of and convenient use by clinical staff High High Red 3 Changes to other systems can have an impact on EPMA & JAC Medium High Amber Med Admissions unit under pressure. There is a risk that EPMA will have 4 significant negative impact Medium High Red Approval of business case by clinical cabinet. Ensure that pilot identifies and removes all barriers to successful introduction. Ensure clinically led project and implementation/transition team Low High Green Ensure that pilot identifies optimal mix of devices for use on wards and other clinical areas. Earmark funding from either the Technology fund or strategic infrastructure capital budget. Low Low Green Impact assessment. Alterations only allowed after IA and Testing Low Medium Green High performance IT. Sufficient equipment. High level onsite support during transition. Medium Medium Amber 5 Space constraints in clinical areas will limit EPMA ease of use High Medium Red Influence design of new unit. Use poc IT equipment with less impact making use of Trust WIFI Low Low Green Lesson from pilot is that mixed manual paper and electronic prescribing 6 causes problems with patient moving live/non live service areas. High Medium Red Increase speed of rollout either through technical fund bid or reprioritisation of existing capital or additional capital available through loan. Low Low Green 7 Insufficient funds for refresh after initial investment Medium Medium Amber Ensure requirement built into refresh programme. Medium Low Green Switching from paper to EPMA will reduce compliance with VTE 8 assessment Medium High Red Implement electronic VTE integrated with EPMA Low Low Green 9 System will not be embraced by clinical body in the Trust High Medium Red 10 Reliance on system solely to produce gains in patient safety Medium Medium Amber Support structure for the implemented service will not match the demands placed on it by a 24 hour service Medium Medium Amber Savings associated with formulary compliance will not be achieved through clinical staff forcing past system blocks to non formulary drugs. High High Red Implementation clinically led, direct sponsorship by Med Director. Must be sole protocol for prescribing Low Low Green Monitoring of errors, capturing system issues, business change and development Low Low Green Increase in technical cover and put in place out of hours support or workarounds to deal with all 24 by 365 working scenarios. Low Low Green Medical Director to provide ongoing leadership of benefits realisation phase of project to ensure compliance on both cost and safety ground Low Low Green

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