Informatics and Technology Supporting the Delivery of High Quality Clinical Care

Transcription

1 Informatics and Technology Supporting the Delivery of High Quality Clinical Care [Type the document subtitle] Associate Director of Technology, Helen Reading Head of Information, Simon Beaumont

2 Contents 1 Executive Summary National Context Local Environment and Challenges Organisational Risks Corporate Risks Clinical Risks The Vision The Strategy Programme Risks Capital Funding Introduction and Background Context Strengths and Weaknesses The Risks Corporate Risks Clinical Risks Supporting the Estates Strategy Business Drivers and Organisational Objectives Technology Objectives The Role of Informatics The Vision Technology Supporting the Patient Technology Supporting the Clinician Technology Supporting the Organisation Current Technology Profile Technical Infrastructure Clinical and Corporate Information Systems The Strategy Technology Information IT Technical Support The Delivery Plan Year 1 Achievements Technical Infrastructure Page 1 of 31

3 7.1.2 Systems Year 2-4 Plan Technical Infrastructure Systems and Information Roadmap EPR Review 2012/ Smart Working and Mobility Capital Programme Page 2 of 31

4 1 Executive Summary 1.1 National Context The strategy below is designed to reflect the national context and policy environment in the NHS for technology and information. There is an increasing emphasis on patients owning their own information, the ability to access information at the point of care, interoperability to share information across multiple stakeholders, and the organisational ability to demonstrate good performance in terms of real impact upon outcomes for patients. In addition, in light of increasing competition to the NHS, (Any Qualified Provider) it is essential to capture innovation to support the changing needs of the organisation as it grows. 1.2 Local Environment and Challenges The complex history of multiple predecessor organisations to Southern Health and long-term underinvestment in technology has led to unresolved technology problems in design and operability: Poor quality expensive technical support from multiple suppliers; inconsistent access to networks for users; staff using a multiplicity of legacy systems that are poorly supported and not aligned to new models of clinical delivery; and an inability to input or access clinical information at the point of care. In addition the organisation, as a provider of community and hospital-based care, faces a number of complexities that smaller or single campus acute organisations do not have to consider, including: Large geography with a multitude of services, large numbers of staff and roles working in a wide variety of non- Southern Health settings; and multiple stakeholders with whom to share information across integrated pathways. 1.3 Organisational Risks This environment translates to a number of organisational risks Corporate Risks The inability to derive information to meet our financial and contractual obligations The inability to measure effective and ineffective performance in our services The inability to demonstrate delivery of clinical outcomes both internally and to our external stakeholders Inefficient and inflexible use of staff resource across the organisation due to lack of the ability to work or share corporate information across multiple or remote locations The inability to support business development through accurate corporate intelligence and innovative solutions built around patient pathways Clinical Risks Staff are unable to input and access information required at the point of care affecting delivery of care Systems are not aligned to clinical strategy leading to inefficient use of clinical time and reduced time spent face to face with patients Page 3 of 31

5 1.4 The Vision Southern Health s vision is to increase use of IT systems and electronic media supporting the modernisation of clinical services which in turn will lead to supporting the improvement of the quality of care delivered to patients. IT systems should be used extensively to support corporate and business functions to reduce cost, improve efficiency, and effectively manage a large workforce. The vision is that technology and information will not be constrained by organisational boundaries, the patient will be at the centre, in control of their own data and data flows so that information can seamlessly and effectively be available to the clinicians delivering the care. The vision for patients is that they will feel more confident in the care they are given as they will be able to see that the clinician has all the relevant information to hand, will be supported by technology to receive a more efficient and timely service, and avoid unnecessary repeated tests. The vision for clinical staff is that they will be able to quickly and efficiently access relevant information at the point of care, whether this is within the patient s home, health centre, or community hospital and increasingly use virtual consultations to provide expert advice quickly, thus improving clinical outcomes. This accessibility will provide them with the ability to view, share, and enter clinical information within a real time setting using systems that can be locally customised to support clinical pathways of care. The vision for the organisation is that technology solutions will provide benefits to reduce costs and improved efficiency through efficient communication infrastructure, reduced mileage, reduction in storage costs for paper records, reduction in the numbers of repeated tests and automation of administrative functions. 1.5 The Strategy The strategy to support the vision is based on the technology triangle shown below. The initial focus will be on ensuring the foundations are sound. Without sound foundations any investments will not deliver expectations or value for money. It is essential that this is recognised in the implementation and delivery of the strategy. Network infrastructure - will be re-designed to meet the needs of the organisation and able to support the introduction of new technologies to support a growing, modern organisation. Migration to Single domain - All Southern Health staff will be on a single modern domain designed to be robust and resilient with a virtualised environment giving flexibility and control to the organisation. Data (EPR records) implementation of a fully functional Electronic Patient Record (EPR) across the organisation with specialist packages delivered where required to meet specific service needs. Innovative solutions - support the organisation s move to working smarter by harnessing technology through; use of mobile devices, expanding the use of the data warehouse exploiting the potential it provides; introducing portal technology; extending the use of alerting and targeted information delivery; developing e-learning packages and introducing communication tools such as video conferencing. Page 4 of 31

6 Mobile working hardware and equipment provision of mobile devices to support SMART working in the SHFT clinical and corporate workforce. Running throughout these elements is the critical business process and change approach, within both clinical and non-clinical settings technology alone will not deliver the organisations vision for modernisation and transformation. The organisation at all levels will need to embrace technology and lead the change to fully realise the potential benefits that this strategy will enable. 1.6 Programme Risks The scale and complexity of the programme brings inherent risks. Successful delivery will require skilled resource both internal and external; engagement of staff at all levels; awareness of the inevitable disruption and challenges; awareness of the potential impact upon external relationships and partner organisations. This will require sustained and visible commitment for the programme from the Trust Board and proactive leadership from senior managers. 1.7 Capital Funding Delivery of the programme requires commitment to significant funding. Programmes of Work 2012/ / /15 Infrastructure 1.3m 0.5m 0.3m SMART Working and Mobility 1.6m 0.9m 0 EPR (RiO deployment /future analysis) 0.8m 0.2m 0.2m Business Initiatives 0.3m 2.2m 1.5m Archiving and Maintenance 0.8m 0.6m 0.6m Total Programme 4.8m 4.4m 2.6m *It should be noted that this funding does not cover potential costs associated with the replacement of RiO and E_CAMIS Electronic Patient Record systems or significant clinical innovations identified. The capital funding will be requested via a full business case for each element (15 business cases) as part of a full options appraisal with external validation and procurement input. Page 5 of 31

7 2 Introduction and Background The five year technology strategy was written in April 2011 to ensure that technology investment was focused and relevant, to avoid planning blight and to safeguard development of the required technology while the organisation developed its overall strategy and objectives. It was possible to develop the strategy prior to the completion of the clinical service strategies because a number of intrinsic technology issues requiring urgent and significant attention existed. Change was required to achieve significant savings and reduction in total cost of ownership and to take advantage of the economies of scale now possible because of the organisation s increased critical mass. 2.1 Context The history of the predecessor organisations was one of complexity which brought with it unresolved technology problems in design and operability including: Provision of technical support by multiple suppliers Fragmented and disjointed technical infrastructure Multiple legacy systems poorly supported with varying and unclear supplier support contracts No in-house technical capability and capacity The technology strategy had to address a number of complexities that smaller or single campus organisations do not have to consider. These include: Extensive geography A multitude of services, with large numbers of staff and roles working in a wide variety of settings Multiple stakeholders with whom to share information In addition it had to address local long term underinvestment in technology, particularly infrastructure and the constraining impact of the National Programme for IT. This combination has resulted in outdated unreliable technology infrastructure, systems not tightly aligned to clinical service delivery models, and technical support issues Strengths and Weaknesses As part of developing the strategy a SWOT analysis was carried out to ensure that there was focus and understanding of the internal and external environment. Page 6 of 31

8 Table 1 - SWOT Analysis OPPORTUNITIES (EXTERNAL) End of national programme/contract leading to new suppliers offering customer focussed solutions Potential to collaborate across regions Introduction of private sector experience and standards to the NHS Active recruitment environment due to recession Foundation Trust ability to obtain capital funding Green agenda driving potential for technology solutions THREATS (EXTERNAL) Increased competition for business from 3 rd sector/aqp and other Trusts with strong technology Increased activity by 3 rd sector/aqp potentially draining skilled IT resource within NHS Trusts National programme collapse leading to multiple providers and lack of collaboration across NHS and stakeholders e.g. GPs, Local Authorities Destabilisation across health community leading to lack of collaboration required to deliver technology improvements e.g. networks STRENGTHS (INTERNAL) Robust new organisational structure to meet the needs of corporate and clinical teams Diversity of skills currently within team Executive level representation on Board Contribution to support services in delivery of CIP savings, value for money, economies of scale Recognised areas of excellence based on industry standards of technologies and methodologies WEAKNESSES (INTERNAL) Inability to influence national programmes (RiO) to meet needs of our organisation Insufficient funding to provide technology that is up to date and sufficiently competitive to gain new business and retain current services Large geography and dispersed estate leading to challenges with infrastructure implementation and management Complexity in business development leading to unplanned costs and unstable workforce, potentially large funding losses with loss of current business Inconsistent delivery of external information to support the organisation (Business Intelligence) The Risks The strategy takes into account the following risks in order to investigate options of technology and informatics provision. To do nothing was not an option as the business cannot transform and achieve quality and cost improvements without technology reprovision. Current technology services at all levels are failing and the risks of this failure outweigh the risks of not implementing change Corporate Risks The inability to derive information to meet our financial and contractual obligations The inability to measure effective and ineffective performance in our services The inability to demonstrate delivery of clinical outcomes both internally and to our external stakeholders Inefficient and inflexible use of staff resource across the organisation due to lack of the ability to work or share corporate information across multiple or remote locations The inability to support business development through accurate corporate intelligence and innovative solutions built around patient pathways Page 7 of 31

9 2.1.4 Clinical Risks Staff are unable to input and access information required at the point of care affecting delivery of care Systems are not aligned to clinical strategy leading to inefficient use of clinical time and reduced time spent face to face with patients The organisation has recognised and agreed that the strategic risks for technology within the assurance framework are: Limited availability of or poor quality data impacts on delivery of care, service line management, and limits the Trust s ability to prove effectiveness, delivery of strategic objectives, and contractual requirements The Trust is unable to accurately measure clinical outcomes and activity due to ineffective or inadequate IT systems and infrastructure The Trust does not have sufficient long term financial plans and capacity to enable sufficient investment Failure to achieve required standards in information governance impacts on quality of care, ability of Trust to pursue business acquisitions, and reputation Sharing the Estates Strategy It was recognised that Technology is a core enabler to support the Estates Strategy to achieve its aims of: Full utilisation of the estate, avoiding technology investment in sites not planned for long term use Maximum flexibility by supporting the hot desk model and ability to use space in diverse ways Value for money Southern Health provides services from in excess of 156 locations this makes the delivery and support of an effective technology service complex. SHFT owned premises Shared sites Staff working in GP s surgeries and health centres supported by health care computing Staff working within the community in church halls to the patient s own homes This complex picture means that IT solutions to support clinical staff deliver care and get to the technology they require has to be varied and flexible. This picture adds expense and challenges; this was taken into account when designing the technology architecture required to support Southern Health. Page 8 of 31

10 3 Business Drivers and Organisational Objectives Alongside the Organisations work to develop its strategic objectives the technology strategy was reviewed to ensure that it remained aligned and relevant to support the emerging clinical strategy. With the following business drivers being identified: Integrated clinical care System interoperability and integration with stakeholders to allow information to follow the patient or service user Contemporaneous Information available at the point of care Required ability for technology innovation to support emerging models of care To provide technology solutions to support the Organisation compete for services Each of the four organisational objectives was used to identify the contribution required of technology to support their delivery. These deliverables are detailed in table 2. Table 2 - Technology Contribution to the Organisational Strategic Objectives Strategic Objective 1 - Quality, operational performance and financial obligations Right systems Data available at the right time and the right place Uses of information in supporting the outcomes framework Enabling CIP s to be delivered Reducing the total cost of ownership and ensuring value for money whilst providing robust IM&T services Strategic Objective 2 - Transforming our clinical services Supporting the delivery of high quality care to patients and service users Information at point of care Risk stratification of caseload for integrated care Integrated working: there will be a strong focus on integrated care with other providers, particularly primary and social care across the care pathway. This will require wider access and sharing of patient information Strategic Objective 3 - Developing our people and their leadership capability and capacity Strategic Objective 4 - Developing our organisation Providing information in order to assess performance and supporting PDR and capacity planning Access to systems eg ESR, Lead, SBS, e- rostering Use of outcome measures to aid the identification of best practice IT training Developing the capacity, skills and leadership within the Information and Technology Directorate Mobile solutions to support SMART working Robust business cases to support the capital programme Supporting Business Development and enabling competitiveness Agile technology team able to adapt to organisational requirements Capability and capacity to provide high quality professional advice and solutions in response to opportunities and threats, for example the consequences of new GP commissioning arrangements. Page 9 of 31

11 3.1 Technology Objectives Using the SWOT analysis the business drivers and the organisational objectives, showed three key technology objectives which are required: Making working lives easier to improve the delivery of care to patients Supporting the SHFT clinical model of quality care as partners Harnessing technological innovation to drive business development and value for money in SHFT Delivery of the three objectives will enable technology to support Southern Health clinical teams to achieve the strategic objectives of the organisation; of improved patient experience, quality clinical outcomes, services at reduced cost, and or increased efficiency. 3.2 The Role of Informatics In a climate of increasing financial challenge and a desire for System Wide reform, accurate, timely and appropriate Information is critical in enabling the Organisation to make informed decisions and effectively monitoring service transformation. Information will support: Modelling and options appraisals within service transformation Business expansion through tendering processes that utilise Information to highlight the achievements of the Trust Promotion of the Trust s services to internal and external stakeholders Transition to Outcome led performance frameworks which engage Clinicians and Patients through meaningful metrics The early identification of poor practice within Clinical Teams through triangulation of data across multiple corporate services, whilst also enabling best practice to be highlighted, and shared across teams Identification and monitoring of integrated pathways, internally (i.e. ICS Community Care Teams and OPMH) and externally (i.e. Older Persons Partnerships) Increased business intelligence through costing models developed by the Finance Directorate that utilise accurate data The benefits of increasing quality and quantity of information will not be realised within the Organisation until increases in the Information Culture is embedded within all Services. It is the responsibility of all employees to understand the value of information and ensure it is utilised at all times to continuously challenge processes and support service transformation. The role of Business Information Analysts, in partnership with other Corporate partners (Finance, Contracting, Performance, Governance etc.) will ensure that information is understood and informs all aspects of decision making within the Organisation. Page 10 of 31

12 4 The Vision Southern Health s vision is that information technology will enable the Organisation to be paper-light through less reliance on hard copy medical records and documents, with a welldeveloped information culture. With the increased use of IT systems and electronic media supporting the modernisation of clinical services which in turn will lead to supporting the improvement of the quality of care delivered to end service users. The use of IT systems in place to support corporate and business functions the programme will: Reduce cost Improve efficiency Support effectively management and engagement of a large workforce The vision is that technology will not be constrained by organisational boundaries, the patient or service user will be at the centre of their information, in control of their own data and data flows so that information can seamlessly and effectively be available to the clinicians delivering the care Figure 1 - Patient pathway data flow Page 11 of 31

13 4.1 Technology Supporting the Patient The organisation s vision for the future and its investment in technology will support the patient and service users to be able to: Access their own information via electronic means the ability to review and check details of their consultations and visits Ability to check appointments and special instructions A facility to link with pharmacy information so they can view their up to date medication and prescription instructions Interactive capability will be provided giving the patient the opportunity to: Send messages and ask the clinical team providing their care questions Quick and easy links to sites and support groups relevant to their conditions that they may wish to interact with. Patients will have control over their information and who can access it helping to overcome IG issues so if the patient decides to give access to family or carers this is within their control plus ability to share information with social care as they wish. The vision is that patients and service users will feel more confident in the care they are given as they will be able to see that the clinician has all the relevant information to hand, removing the sense that the clinicians do not seem to know their medical history. The vision will be that the patient will be supported by technology to receive a more efficient and timely service with no need to wait to get more information from elsewhere. Technology will help avoid the discomfort and inconvenience of unnecessary repeated tests as the clinician can see what has already been instigated and the results will be to hand. This will mean the patient does not have to wait so long to get a diagnosis and treatment. 4.2 Technology Supporting the Clinician The vision of the organisation s clinical staff is that they will be able to quickly and efficiently access relevant Information at the point of care, be this within the patients home, health centre, or community hospital. This access will provide them with the ability to view, share, and enter clinical information within a real time setting using systems that can be locally customised to support clinical pathways of care. Clinical staff will have on-line access to: View and order tests Carry out prescribing View radiological images Decision support packages Clinical noting Time will not be wasted in multiple login to many systems together allowing clinicians to view information in the best way to allow them to deliver care. Decision support packages will be Page 12 of 31

14 available supporting high quality and best practice. The vision will be the support of a truly multidisciplinary approach to care as all records will be accessible and available to the clinician. The vision is more effective and efficient consultations including the ability to have virtual consultations, accessing expert advice quickly and efficiently improving outcomes. Having information available on line will mean less time is spent searching for records enabling more clinical time to be spent directly providing patient facing care. This will also reduce the amount of time that staff spend travelling through not having to return to base to view and store records, time taken to place orders for tests, make phone calls chasing results and avoidance of duplicative data entry. Automatic alerting packages that will provide monitoring for patients within the community and early detection of changes to vital signs, allowing prompt and relevant interventions that will help avoid acute admissions to secondary care. 4.3 Technology Supporting the Organisation The vision is that technology solutions will provide benefits for the organisation due to reduced costs and improved efficiency through: Communication infrastructure to support effective and efficient working Reduced mileage Reduction in storage costs for paper records Reduction numbers of repeated tests Comprehensive information for reporting supporting service line management, collection, and data Information to support service management in the form of trending analysis and comparisons Proving the opportunity to standardise and buy support services more cheaply Technology will provide automation of administrative functions such as: production of patient letters discharge information digital dictation electronic booking into outpatient clinics ordering of patient meals and transport Provision of modern communication facilities will reduce travel time making the organisation s large geography less prohibitive to efficient working. Managers will have available to them high quality aggregate information to enable them to target and deploy resources effectively. Information will be available that supports their accountability to the organisation and the public for ensuring that key performance targets continue to be met. There will be an increasing need for integrated performance information so that the interplay between finance, activity, and manpower can be assessed. The data Page 13 of 31

15 warehouse holds the corporate knowledge from all trust systems and will increasingly provide: Data and information to meet the business reporting requirements Trust statutory submissions SUS, MHMDS, Psychiatric Census, etc. Performance monitoring and reporting Interactive alerts e.g. text and alerts to community teams where vulnerable SHFT patients have been admitted or discharged in Portsmouth There will be e-learning packages for all staff, delivering essential training skills and testing competency. This will enable staff to access training at times and places convenient to themselves and by supplementing classroom and workshop training sessions. Page 14 of 31

16 5 Current Technology Profile This section is included as it is important to recognise the current profile so as to understand why significant investment is required to deliver the strategy Technical Infrastructure The Network The current network infrastructure is based on historic contract arrangements and old technology, resulting in staff experiencing problems using and accessing systems across Hampshire. Problems include: Poor bandwidth or data throughput causing access to current systems to be slow or unavailable, and prevents the use of the most basic interactive materials such as e-learning packages Access to wireless networks and speed of access at acceptable levels is not available to all clinical staff Inability to work from any SHFT site due to fire wall configurations controlled by HIS organisations and lack of willingness to put trusted arrangements in place Shared infrastructure with other stakeholders, gives SHFT no clarity of ownership or control Lack of transparency of network costs, as charges are within the baselines paid to the HIS organisations Poor and slow response to requests for change to support service and estate changes Increasing high number of reported outages and network problems forcing staff using current electronic systems to revert to paper contingency plans causing much frustration and additional workload The network map below illustrates the current complex network that exists across Hampshire. Page 15 of 31

17 Figure 2 - Current Network Map The Domain Infrastructure calendars, files, and clinical applications are held in user accounts within a domain. Southern Health staff can be on any one of four domains that exist across Hampshire. This legacy design results in staff being unable to effectively share calendars and access key information that is contained within another domain. This design prevents the organisations ability to work in a unified and cohesive manner, causing frustration to staff that need access to be easy and ubiquitous. The four different domains are geographically based and managed by three different HISs. There has been no comprehensive investment in this technology for many years so these domains are old and not based on modern and reliable technology. Numerous outages and failures occur. The domains are also expensive and problematic to support. The domain infrastructure amplifies the information governance issues as information is held in a disparate manner. The diagram below illustrates the current domain infrastructure currently used by Southern Health staff. Page 16 of 31

18 Figure 3 - Southern Health Domain Infrastructure Clinical and Corporate Information Systems The Trust uses a number of clinical and corporate systems which provides its own challenges. The table below provides an illustration of the IT systems that the organisation currently uses to support its services. (The table is not comprehensive) this picture results in numerous challenges and complexities. The problems faced are: Complex support arrangements Considerable dependency on other trusts Legacy systems with varying contract arrangements in place National solutions and contracts limit SHFT s ability to innovate and meet clinical service needs Table 3 High Level Summary of IT Systems Used Across Southern Health System What it does Who it supports Clinical RiO Electronic Patient Record Mental Health Learning disabilities Children s services and Adults services Ascribe Solutions Electronic Patient Record Lymington Hospital / Diabetes service PACS and RIS Digital imaging archive Lymington Radiology service Poppie Specialist system, Substance Misuse IAPTus Clinical Record The italk service psychological therapies for people in Eastleigh, Fareham, Gosport, Havant, New Forest, Test Valley and Winchester. R4 Dental Clinical Record and digital Xrays Dental service Telehealth Tunstall Patients record their own vital signs. Adult Services (COPD) Page 17 of 31

19 System What it does Who it supports units The telehealth monitoring units use uses the patients personal phone lines to transfer the information to the Tunstall data centre that initiates text or alerts to the relevant clinician who take who can take quick and responsive action and to respond to potential complications avoiding unnecessary hospital admissions Access to partner systems e.g. PHT PAS, HHFT Cerner, Frimley PAS Bespoke database Quit smoking Corporate Systems Data Warehouse The trust also has an established a powerful and effective data warehouse which incorporates data from both clinical and corporate systems across the trust and provides interactive reporting for all areas of the business ESR Is the electronic Staff Record HR MAPS erostering Staff Management system(links to HR ESR and Payroll) LEAD Database to hold training records Education and Training and ability to book training PLICS Patient Level Patient level costing system Finance Costing (warehouse) NHS Mail for Secure patient identifiable National Programme information transfer Share Point Collaborative Working Areas Used by corporate and clinical groups to share documents, news, contact details etc. regardless of network restrictions. E.g. Two virtual wards use collaborative sites to share caseloads, erostering, patient messages etc. Safeguard Risk system Governance The management of data is complex because of the number of systems the Trust uses. Data is recorded, coded, and held differently in each system requiring significant expertise and experience to ensure that the data is consolidated and is useable as high quality and timely information that can be used to support service provision. Page 18 of 31

20 6 The Strategy 6.1 Technology The strategy to support the vision is based on the technology triangle shown below. The initial focus will be on ensuring the foundations are sound. Without sound foundations any investments will not deliver expectations or value for money. It is essential that this is recognised. Figure 4 - Strategic Model for Information Technology The network infrastructure will be re-designed to meet the needs of the organisation, and reprocured to ensure that it is fit for purpose with bandwidth being appropriately provided to allow quick access to systems. The network will be able to support the introduction of technologies that will support a modern and expanding organisation such as the ability to run a modern telephony service, access to interactive packages, and conferencing packages. The new network will give the organisation flexibility to expand and reduce network lines to reflect the changing estate. Arrangements will ensure that the bandwidth of the lines can be increased if required. Contracts will be owned and managed by the organisation, with accountability for provision of service and support of the network being delivered by the expert telecom providers. All Southern Health staff will be on a single modern domain designed to be robust and resilient with a virtualised environment giving flexibility and control to the organisation. This Page 19 of 31

21 will allow the organisation to introduce innovation and flexibility through the introduction of modern systems and technology. The organisation will invest in systems that are able to interoperate and use standard messaging formats to ensure that information can be aggregated and shared as required. The technology strategy will be to implement a fully functional Electronic Patient Record across the organisation with specialist packages delivered where required to meet specific service needs. The strategy will be to support the organisations move to working in smarter ways by delivering a mobile solution that is robust and reliable with staff being given the technology equipment they need to support them to deliver care. The organisation will continue to develop and expand its use of the data warehouse and exploit the potential it provides. To achieve the vision of patients and clinicians having access to systems and information that is pertinent, portal technology will be developed which will support the introduction of alerting packages. Technology will support the development of e-learning packages and introduce communication tools such a video conferencing. Technology will provide robust business plans to support the investment required to deliver the strategy. 6.2 Information The Organisation will be supported by an Information function which translates the wider Trust strategic objectives and more specific Directorate business objectives into meaningful and informed analysis. There will be an increasing need for integrated performance information so that the interplay between finance, activity, and manpower can be assessed. Through Business Information Analysts that are an integral part of a Directorates corporate support network, transformation and service development will be effectively monitored, providing mangers with high quality aggregate information that is available down to individual clinicians. Clinical Coding will be seen as an integral part of enabling the Organisation to understand its Inpatient and Consultant led patient cohorts, supporting the transition to Payment by Results and enabling effective costing models to be developed. Information will be available that supports a Directorates accountability to the organisation, acting as a key enabler for effective Service Line Management and providing internal and external stakeholders with the assurance that key performance targets continue to be met. The transformation of performance to be based upon meaningful Outcome Measures that are supported through a framework of predicting factors and supporting information will see information provide all levels of the Organisation with informed analysis that meets the needs of target audiences, from individual Clinicians, through Directorate Management Structures, the Trust Board, and ultimately our patients. Page 20 of 31

22 At all times the concept of real time reporting that provides the Organisation with the ability to make informed decision making will be central to the Information function. Through effective partnership and collaborative working with the Systems Development and Systems Analysis function, utilisation of appropriate technology will be a fundamental element of ensuring the required information is available at all times, in an appropriate format. Data warehouse to enables reporting against all systems to facilitate rich analysis of patient data alongside public health, personnel, and financial data. The data warehouse includes sophisticated dashboard and data mining tools in addition to being the tool for managing performance, service redesign, contractual, and management information. Managers will be supported in using the tools by the information services team to provide comprehensive information analysis. Managers will have available to them high quality aggregate information to enable them to target and deploy resources effectively. Information will be available that supports their accountability to the organisation and the public for ensuring that key performance targets continue to be met. There will be an increasing need for integrated performance information so that the interplay between finance, activity, and manpower can be assessed. 6.3 IT Technical Support In order to deliver the strategy the organisation is moving forward with its plans to ensure that the Trust receives improved technical support. Currently the Trust receives its technical support from a multiplicity of providers: Hampshire IT Services (HITS) Island and Portsmouth Health Informatics Service (IPHIS) Hampshire Hospital Foundation Trust The problems caused by this model include:- High cost, payments to the HIS s are primarily historical and appear higher than is required Confusing for staff -have to contact the correct HIS supporting the area in which they work Inconsistencies between the different service level agreements Services are shared with other stakeholders and SHFT is not always the priority Services are not designed to be agile to support the changing health and social care landscape Constrains the Trust s ability to develop services and solutions at the required pace Prevents SHFT from being able to take full advantage of its investments to achieve a competitive edge Additional internal overhead to manage the three HIS s Unclear / historic and difficult governance arrangements with an expectation that SHFT have to compromise for the benefit of other organisations Page 21 of 31

23 Significant redesign of IT support is therefore required and a restructure of these arrangements is currently underway. Southern Health gave notice to the two main providers of these services in December Strategic support of complex services will become an in-house function with non-strategic commoditised services (Service Desk and PC Support) being delivered by a single provider from April The options being reviewed are: Single HIS provider (IPHIS) 3 rd party private supplier In-house provision The Trust will obtain direct control of IT hardware, software and other resources to ensure that: All IT assets are aligned with its business requirements Responsive service to changing requirements Ease of innovation It receives the necessary returns on investment Provision of a single Hampshire wide working IT solution for its entire staff This strategic approach was validated by an independently commissioned report provided to the organisation early in 2011 by BT Consulting. Page 22 of 31

24 7 The Delivery Plan The delivery of the strategy is supported by a 5 year delivery plan The table below shows the high level components of the Technology Delivery Plan Table 4 - Programmes within the plan inconsistent sections with triangle above; no mention of the Refresh programme ( 600k of our bid) Programmes Infrastructure Network (1) Migration to Single domain (2) Smart Working Electronic Patient Record Business Initiatives Archiving and Maintenance Components Improved technical support & standards, improved Hampshire network, (data voice & video) Core single infrastructure, to enable standard solutions for all staff irrespective of their base Mobile working, Unified Communications, support for flexible working, teleconferencing, digitised processes, digital dictation, e-learning, single sign on EPR, (RiO, E CAMIS) ordercoms, prescribing, telehealth/medicine. PACs replacement, information sharing, Interoperability, Future EPR Requirements Enabling the potential benefits of new technology. IT will support the Trust as it aims to secure new business. Continued Warehouse development, single warehouse Figure Infrastructure 5 illustrates the schedule for the delivery of core components within the plan. Upside down from the triangle we are now delivery top to bottom, not bottom to top Domain Built Domain Migration Network Reprovision Smart Working Business EPR Initiatives Archiving Maintenance and ecamis Windows 7 Migration RiO to R1.1 MH & ICS RiO to HHR Feeds Data Warehouse Technology Refresh Capital Replacement Programme Mobile Working Digital Dictation Review of EPR SE Older Persons Wireless Provision Single Sign On Integration Engine Electronic Document Management Figure 5 - Programme Delivery Plan Page 23 of 31

25 There are a number of detailed specific delivery risks: Table 5 - Delivery Risks Delivery Risks Potential disruption to service delivery associated with the domain migration and therefore short term impact on productivity Availability of staff to support the necessary transition Loss of skilled technical and health informatics staff to local competitor organisations to support similar initiatives Lack of service and clinical support Challenges to organisational relationships as Southern Health pursues the changes to achieve autonomy. Mitigating Actions Careful management of transition arrangements Retaining staff and recruiting temporary resources as necessary Offer competitive remuneration, development and support. Early engagement with clinical services. Proactive relationship management and openness to collaboration where it is in the best interests of SHFT and its patients. A report will be made to the Trust Board at 6 monthly intervals on the programme delivery, all risks will be escalated where appropriate as part of the Board Assurance Framework. 7.1 Year 1 Achievements Significant progress has been made during 2011/12, to deliver the technology strategy with a number of significant developments occurring Technical Infrastructure Network re -design The Design of the Network infrastructure has been completed and the Business Case to support the funding requirement developed Southern Health Domain has been built In 2011/12 Southern Health funded a Server Virtualisation Project required to replace a large number of servers that had reached their end of life. The design and delivery of this project allowed Southern Health to build its own Domain all within the allocated capital of 250,000, thus beginning the delivery of Southern Health s ability to enable staff to use a single flexible and modern domain, as well as replacing old servers and data storage Mobile Working Capital was invested in designing and developing a mobile working solution that would allow Southern Health staff to work in the mobile way. The investment in the build was made as the old build designed by HIS organisations only worked on old technology and Southern Health were keen to move ahead with a more modern approach. The new build allows staff to work seamlessly across hard wired network, wireless network, and if available over the national 3G network. Alongside the RiO roll out the mobile project has now moved from being a technical solutions project to a delivery of mobile technology to clinical staff. To date over 200 staff have been provided with mobile devices, this will increase to 1,500 staff by March 2013.Of 140 sites identified as requiring wireless technology, 19 have been enabled with a plan rollout to all identified sites by March Page 24 of 31

26 7.1.2 Systems Both HPFT and HCHC had numerous systems in use, during 2011/12 there has been an ongoing programme of: System rationalisation and consolidation where possible remove any system duplication Review of systems specifically around the areas of security, support training, and current contracts arrangements Development of the trust data warehouse to capture and monitor data in terms of completeness and quality to make use of the data for clinical and business decision making Rationalised warehouse services to provide a single trust warehouse solution Completed the mental health RiO roll out Completed the Children s services roll out of RiO Planning and rollout to community adults services underway Completion of ecamis project to deliver an electronic Patient record in Lymington hospital Established feeds from RiO to the HHR to allow information sharing with GP s and other staff with a relationship to patients and service users not using RiO Creation of a SUS submissions process which was previously provided by various other applications 7.2 Year 2-4 Plan Significant work has been undertaken to develop the plan and funding required to continue the delivery of the strategy Technical Infrastructure Network infrastructure Over the next 24 months Southern Health will begin the re-provisioning of network links to provide a network that is fit for purpose providing seamless connectivity across all the Southern Health Geography and allowing staff to log in wherever they are and to get the bandwidth they require to enable the flexibility the organisation requires Domain Infrastructure The plan is to begin the migration all Southern Health staff onto the new domain over the next 18 months. Migrating Southern Health staff into a single domain meets strategic objectives and critical success factors. Such a large migration of staff and their data will be a significant and complex undertaking and will not be achieved without senior level commitment and resolve. Page 25 of 31

27 Domain Development Strategic Storage & Back Up Ongoing Domain Migration & Access Process Implementation Service Desk & Desktop Support Reprovision Ongoing Network Reprovision Utilisation of Southern Health s Virtual Environment & Business as Usual Ongoing Figure 6 - Infrastructure Roadmap Systems and Information Roadmap Systems Reshaping and Next Steps The programme of work to rationalise and consolidate systems is nearing completion. The final stages of this is to complete the migration of Adult Services to ICS RiO by Autumn 2012, migrate the ECT service and decommission the HECS/HONOS system. The diagram below illustrates the consolidation of systems and how the system map will look at the end of 2012/13 Page 26 of 31

28 Figure 7 - Systems Rationalisation and Consolidation Once the consolidation is complete the systems used by Southern Health will be rationalised to: Use of core strategic systems e.g. RiO Specialist systems where appropriate for the business e.g. IAPTus, Poppie, BEST Use of external provider systems for community hospital care where it is necessary to maintain the patient pathways Connectivity to national systems e.g. Patient Demographics Service and Secondary Users Service Single warehouse with feeds from clinical and corporate systems to provide a trust wide view of workforce, finance, activity, and outcomes Page 27 of 31

29 Following rationalisation the system focus will be to maximise use of the systems and develop the functionality to enable sharing of data across the patient pathway with the introduction of messaging, alerting and targeted information delivery EPR Review 2012/13 The RiO contracts expire in April During 2012/13 the Trust will begin to consider and develop a full requirements profile and strategic outline case to support the delivery of the replacement solution. The piece of work will include significant engagement both internally and with external stakeholders to ensure that the Southern Health solution takes into account the need to share information across the patient pathway Smart Working and Mobility To continue the roll out of mobile capability to clinical staff using RiO to inform the prioritisation plan. This will incorporate the implementation of wireless networks and utilising Southern Health and stakeholder estate more effectively to maximise the ability of staff to connect to the network, with utilisation of 3G connectivity where available. To introduce a strategic digital dictation capability that can be extended as required to meet the urgent needs and to avoid increased costs of disparate local solutions being developed at the local level. Page 28 of 31