Information Management and Technology Strategy

Transcription

1 Information Management and Technology Strategy This document supersedes CORP/ICT 5 v.1 Information Communication and Technology Strategy Name and title of author: Date revised: June 2011 Approved by (Committee/Group): Date of approval: 05/07/2011 Date issued: August 2011 Next review date: Target audience: Mark Norwood Head of Information Technology Tracy Crookes Head of Applied Information Trust Board, Medical Committee and Management Board 01/07/2012 extended to July 2015 as new strategy is developed to include ihospital and wider government policy Trust-wide WARNING: Always ensure that you are using the most up to date approved procedural document. If you are unsure, you can check that it is the most up to date version by looking on the Trust Website: under the headings Freedom of Information Information Classes Policies and Procedures 1 of 32

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3 Executive Summary This document outlines the Information Management and Technology (IM&T) Strategy for Doncaster and Bassetlaw Hospitals NHS Foundation Trust. It supersedes the strategy published in 2001, providing an update on the Trust s IM&T arrangements and the national and local IM&T agendas. The purpose of the strategy is to create a framework around which the organisation s IM&T work programme can be set and, more importantly, how IM&T will support the Trust in achieving its objectives to deliver local sustainable excellent services. This strategy demonstrates the range and complexity of the Trust s IM&T work programme for the next five years and beyond. The Trust has invested sensibly in developing its IM&T infrastructure and services in the last few years working from a low base, but is playing catch-up with many other NHS Trusts in terms of deploying some key clinical systems, despite recent acceleration in activity. It has been held back to a large extent by waiting for the National Programme for IT (NPfIT) to deliver systems that have been promised. There continues to be uncertainty around scope and schedule of strategic IT products / functionality to be delivered by the NPfIT which continues to create planning blight within many NHS organisations. There have been a number of delays and changes in scope within in the programme to deliver systems to acute Trusts over the last five years and there is still no definitive timescale for the Trust to receive Lorenzo - the Patient Administration/ Electronic Patient Record system for the north of the country. To manage the risk of non-delivery or non-suitability of Lorenzo, the Trust is embarking on the procurement of a replacement PAS system with planned deployment in mid The Trust will continue to closely monitor developments with Lorenzo and will consider its adoption should it meet the Trust s requirements and delivery timescale. The Trust wishes to move to an electronic patient record (EPR) but not in the big bang way that some other Trusts have adopted, due to the costs, risks and manageability of change in an increasingly challenging environment within the NHS. It will take an incremental and managed approach, exploiting technology based on the benefits it can deliver at the time whilst being mindful of the end-goal. A complete EPR with a paperless hospital will not be reached during the lifetime of this strategy but considerable progress will be made. As well as PAS, we are already committed to a number of key system replacements and new developments in the next few years. These include PACS, Radiology Information System, Cancer System, Maternity, Electronic Order Communications and a Therapy system. In addition we will continue to roll-out e-prescribing across the remaining inpatient areas, e-rostering into non-ward areas and other staff groups, itracker in conjunction with local GPs, social services and community staff, Medisec digital dictation and document workflow for clinical correspondence and continue to enhance and extend the Data Warehouse. This strategy proposes a number of other key systems that will be required to move towards an EPR and to improve efficiency. These include a clinical portal, a system to support patient level costing and a patient flow system. 3 of 32

4 There will still be need for paper notes, although over time this will diminish as more data is entered electronically. This strategy suggests that the notes should be digitised and available to view via the clinical portal, which will improve availability to 100% and radically reduce the costs of managing notes. Due to the size and scope and likely costs of this project and its need to be closely linked with PAS, it is recommended that it happens after PAS has been replaced. The strategy talks briefly about telephony, as a separate strategy which is being developed to cover this area and overlaps and dependencies with IT infrastructure will be explored in detail. Improvements and upgrades to infrastructure are planned including upgrades to video conferencing facilities, telemedicine, remote access, core networks and server infrastructures to support agile working, improve accessibility of systems and information in clinical area, minimise single points of failure and provide robust failover and recovery for critical systems. In order to ensure that systems can be used effectively it s important that IT and Information services are effective in supporting staff in their use, ensure that they are supported 24/7 and that training is delivered in the most effective and flexible means. Finally the Trust will ensure that these developments are set within an Information Governance Framework that ensures that data is of high quality, kept safe and is shared within or outside the Organisation only where allowed and required. 4 of 32

5 Table of Contents Executive Summary Introduction Context Principles and Objectives of the Strategy Review of the Current Position Strategic Development of Information Technology Systems Development of IM&T infrastructure and Services Information Governance Key Risks Conclusion Appendix A Glossary of Terms Appendix B Outline IM&T Programme Timeline Appendix C DBH Healthcare IT Maturity Model Appendix D The Digital Hospital of 32

6 1. Introduction The purpose of an Information Management and Technology Strategy is to support the Trust s business strategy and operations by: ensuring that information and information technology is used to support Trust staff in giving patients the highest quality care and experience both within the Trust and across organisational boundaries; providing business intelligence to support effective management, clinical practice and the strategic aims of the Trust and its ambitions for service development and improvement. This paper defines the strategic direction for Information Management and Technology to support the strategic aims and ambitions of the Trust and to improve its position both as a service provider and as a business. Many service improvements and changes depend on a modern and robust IT infrastructure and good quality and relevant information provision. The IM&T strategy should not be a technically driven agenda; but technology does enable the use of information when and where needed for best clinical and operational effect. There are two key elements to IM&T investment therefore: Infrastructure (the glue that holds everything together and delivers services to where they are needed, when they are needed) and Systems (the corporate and clinical applications that provide staff, managers and clinicians with the tools and information to perform their tasks safely and efficiently, to enable effective, timely decision making, improved utilisation of resources and support new delivery models). The plans that sit within this strategy cannot be exhaustive as a number of requirements will emerge in a changing national and local NHS environment, but the approach should remain consistent to ensure the key objectives are delivered. 2. Context 2.1 The Organisation Doncaster and Bassetlaw Hospitals NHS Foundation Trust serves the populations of Doncaster and Bassetlaw across five hospital sites and in the community. The Trust serves a population of 410,000 in Bassetlaw and Doncaster and employs over 6,000 staff. Three hospitals are owned by the Trust: Bassetlaw District General Hospital (BDGH), Doncaster Royal Infirmary (DRI) and Montagu Hospital at Mexborough (MMH). Outpatient services are provided at Retford Hospital (owned by Bassetlaw Primary Care Trust), and rehabilitation services at Tickhill Road Hospital (owned by Rotherham, Doncaster and South Humber Healthcare NHS Trust). Outpatient and Community Services are also provided in other premises. The Trust, along with the rest of the NHS, is having to respond to a significantly more difficult financial environment and has recently reorganised into a much more clinically led organisation consisting of a 16 Clinical Service Units (CSUs) each led by a clinical director. 6 of 32

7 2.2 National Drivers Equity & Excellence: Liberating the NHS (June 2010) sets out reforms that will free NHS organisations from direct Government control, coupled with an increased responsibility to be locally accountable for the quality of services provided and the efficient use of public money. Liberating the NHS: An Information Revolution (November 2010) supports this and describes an environment in which people have the information they need to stay healthy, to take decisions about and exercise more control of their care; and to make the right choices for themselves and their families. There will be greater openness, transparency and comparability of information and a focus on data collected real time, with the patient, as a bi-product of patient care, not as an administrative add-on. New technologies will need to be developed to make data collection easier for clinicians, and which enable access to richer and more easily understood information for patients or service users. The government expects to make an accurate record of their care available to all patients electronically and is moving away from an approach where every organisation is expected to use the same system, to one where we connect and join up systems; QIPP: IM&T is a key enabler for transformational change and provides a significant opportunity, through the exploitation of technologies, to drive innovative new ways of working and enable new organisational models; Quality & Safety: Improved access to information, using modern systems and tools to support clinicians and managers, will help drive better care, improving outcomes, innovation and the better use of resources; Lorenzo: has still not been successfully deployed into a large acute Trust. Morecambe Bay (Spring 2010) was the litmus test of scalability, robustness and clinical fit. Problems persist, its fitness for purpose is not therefore yet proven and it is extremely unlikely that this will be the case until at least the end of This, together with emerging national policy, provides a mandate for Trusts to consider local alternatives; Compliance: all NHS organisations should comply with the NHS Infrastructure Maturity Model (NIMM) which ensures that our technical environment (networks, servers, desktops and server rooms) can provide an appropriate level of security and can support new business tools and service models 2.3 Aligning IM&T to the business Deployment of technology must support Trust Business Strategy and plans. It is not clear, that in the past, some of the developments took place were driven by business need, so it is imperative that current and future deployments support organisational objectives. Many elements of Liberating the NHS (remote working, out-reach clinical services, community working and integration with local partners, e.g. social care, local authority, GPs, etc) will bring significant benefits and outcomes (to the patients and to ourselves as a care delivery organisation). These cannot be achieved without investment in technology, infrastructure and applications. 7 of 32

8 2.4 NPfIT Although there has been considerable slippage from the original NPfIT plans the programme still plans to deliver the key administration and clinical system to Trusts in the English NHS. The most important system to be delivered by Connecting for Health (CfH) is the Care Records Service (CRS) that will not only replace local Patient Administration Systems (PAS) but, through later releases, provide support for the majority of key administrative and clinical processes within trusts including a full Electronic Patient Record (EPR). The original date for the software to be available that would be suitable to replace the aging PAS system the Trust uses was 2005/06. This PAS replacement software is called Lorenzo and is the system that was originally intended to provide PAS and core EPR functionality to the North, Midlands and East of England. The agreed date for DBH to implement Lorenzo P2 has slipped several times and no firm timetable currently exists. McKesson, the current PAS supplier, have agreed to extend support to Later releases of Lorenzo were intended to build on this and provide comprehensive electronic patient records across the whole Trust replacing numerous individual clinical systems over the next 7 years. Following recent events there is highly likely to be significant reduction in functionality available in future releases. 3. Principles and Objectives of the Strategy The aim of any investment in IM&T systems and services should be to create a modern, value for money, IT and Information infrastructure that supports modern clinical practice, administrative operations and provides useful business intelligence. For the successful delivery of the strategy, a number of key principles for the implementation and use of systems and information need to be followed: 8 of 32

9 The Trust will work in stages to develop a complete Electronic Patient Record The Trust will work with partner organisations, in particular with GP practices, to ensure IT supports seamless care across organisational boundaries Information should be input once only into operational and clinical systems in as near to real-time as possible Systems should support high data quality and reduce room for errors where possible and training should reinforce the responsibility of all users for getting it right first time All IT projects must be managed by experienced project managers and use the PRINCE 2 methodology All IT systems purchased should adhere to the Electronic Governmental Interoperability Framework standards (e-gif), be capable of integration with applicable key systems using standard messaging formats, must have audit capability and security controls must adhere to current good practice IT systems should support clinical and operational processes not hinder them Ability to access IT systems should be driven by service requirements leading to a greater user of flexible mobile and remote solutions IT investment should reduce corporate risk not add to it Information to managers and clinicians should be more accessible, more meaningful, more timely and of a consistent high quality The Trust will adopt NPfIT strategic solutions when available and where the functionality meets the Trust operational and clinical needs All data should be kept secure and backed-up and any person identifiable information should be managed in line with data protection law and the Caldicott Principles All IT projects should be supported by robust business cases that explicitly support corporate objects with clear, and wherever possible, quantifiable, benefits with a clear plan for ensuring benefits identified are delivered When purchasing systems, consideration of data flows with other Trust systems and systems of healthcare partners should be given to ensure that interoperability is achievable able to support safe and secure flow of information to where it is needed 4. Review of the Current Position This section discusses the current position of the IM&T systems, infrastructure and services 4.1 IM&T Structures and Services The Information Management and Technology services are split across two departmental structures namely: Applied Information and Information Technology. Both departments report into the Executive Director for Finance, Information and Procurement. 9 of 32

10 4.1.2 Applied Information The Applied Information Services cover the following 2 areas:- Information Services provides a management information service to the Trust. The Corporate team are responsible for the submission of returns and datasets to meet national requirements, including those laid down in the NHS Standard Contract with Commissioners. The CSU team are directly aligned to CSUs providing direct analytical support and business intelligent information to each CSU. The Development team are primarily responsible for the roll out and development of the Trust s new data warehouse, which is key in providing the Department with modern tools, desk top reporting capabilities and opportunities for data processing efficiencies. This is key for ensuring Information Services can provide a responsive, high quality service, which meets the ever increasing requirements being placed upon it. The Information teams are currently undergoing skills development programmes including improving analytical and technical capabilities. Currently the data warehouse development project is not progressing quickly enough for the organisation resulting in the need for short term additional developer resource. Clinical Coding - reviews clinical information in case notes and other documents to translate the clinical notes into nationally defined clinical codes for all patients admitted into the Trust each year. High quality and timely clinically coded data is essential for a whole host of agendas including Trust income. The quality of clinical coding at the Trust is very high but the challenge remains around maintaining coding quality whilst working to very strict and challenging coding deadlines Information Technology The information Technology Department covers the following IT functions: IT Services - provides support for end users, IT infrastructure and key information systems. It consists of a server support team, networks team, IT Service desk, desktop support staff and PAS support. This area, despite having willing and quite knowledgeable staff has had a lack of structure and suitable tools to manage an effective and responsive service with a rising workload due to the increasing use of 24/7 systems in clinical areas. This is being addressed by a departmental restructure, improved access to training and better service desk software and telephony systems. IT Development - consists of a small development team who work on smaller scale systems, develop and support the Trust integration engine (links key systems together) and also provide 3 rd line support for the key software and hardware that is used by the PAS, Radiology (RIS) and Maternity (Stork) applications. In the past this team have been mainly focussed around supporting the core applications that run on legacy database software i.e. PAS, Radiology, Pharmacy, Pathology and Maternity and the hardware and software they run on. With the plan to move to more modern systems and platforms this workload will reduce but will be replaced by an increasing need to integrate systems and develop and support tactical and niche systems, meeting needs that cannot be met by NPfIT or other suppliers. IT Training - consists of a team skilled and experienced in delivering training for staff to confidently use general IT, Corporate and clinical IT systems. The team offer continual 10 of 32

11 support following all training. The team has been split into three sections covering Core IT Skills, PAS and Clinical Systems. These roles are being merged and a generic IT trainer post created to provide a more flexible team that is able to react quickly to changing demands. IT Projects a small team that plan and manage the IT programme that consists of all the ongoing and future IT projects. Some projects are managed by the team whilst other large projects have a dedicated project manager who works both to a Project Board and the Programme Manager. The team ensure that the IT programme overall are delivered, individual projects are managed and scheduled, resource bottlenecks are managed, better use of scarce resources made and the funds are managed as per the original agreement of the Strategic Capital Group. They are also responsible for supporting benefits management within projects and helping ensure that planned benefits are realised. 4.2 IM&T Programme IT Programme Board s role is to govern and monitor IT programmes at the strategic level. This includes formulating and setting strategic priorities, taking decisions on the deployment of IT resources in support of corporate business requirements, agreeing both programmes and individual projects. The IT Programme Board will review project submissions and make decision to proceed or not, taking account of both the Trust s Business Strategy and IM&T Strategy. The Board s monitoring role encompasses ongoing progression of projects, taking decisions as necessary to adjust strategic direction and reflect changing circumstances. Taking account of technology, business and individual issues to ensure that: clinical needs are addressed efficiency and quality of service are delivered infrastructure is in place and maintained to meet both current and future service needs processesfor procurement and project management are adhered to The Board is comprised of Directors from the Trust s managerial and clinical functions under the chair of the Director of Finance, Information and Procurement together with representatives from the PCT, Strategic Health Authority and other bodies, when required, to give a broad view of the Trust s strategic and operational requirements, national and local health communities. 4.3 Infrastructure Baseline For the purposes of this section the definitions of IT infrastructure and services are as follows: the Data Network; the computer server systems hardware and software; The trust computer rooms; desktop facilities (PCs, printers etc) IT Services (support and infrastructure development) In order for modern information systems to be implemented it is important that the core infrastructure is robust and scalable. There has been a considerable increase in the number of PCs across the trust which is putting increasing demand on the network. There has also been a 11 of 32

12 corresponding increase in computer servers to provide storage and application services to users. Connecting for Health has published an IT infrastructure assessment tool called the NHS Infrastructure Maturity Model (NIMM) with levels 0 5 that provides the ability to benchmark against good practice and other NHS organisations. Internal assessment indicates the Trust is at level Computer Network The Trust has high capacity and resilient network infrastructures at its key sites utilising CISCO equipment. It also has a resilient WAN (wide area network) across the three main sites. The core WAN and the core computer networks at each site are reasonably resilient to single device failure. There are high-speed (1Gb) network links between DRI, BDGH and MMH. This provides for resilience against failure of any one core link. A secure wireless network is now rolled out to most wards and some additional areas and is being specified in most new builds. However, some of the major benefits of the wireless network will not be deliverable until it is available in a critical mass of areas Core Servers and Storage There has been a considerable growth in the number of computer services placing increasing demands on staff in deploying, managing and monitoring equipment especially as 24/7 usage is a requirement. There is a need to deploy server management software so proactive monitoring can be delivered across all key systems whilst reducing management costs. In addition the Trust is starting to use a technique called virtualisation, which allows software to be attached to a virtual rather than physical hardware. This not only allows a reduction in hardware costs, storage space and cooling/ electricity costs in server rooms it also give the potential for a system to be failed over to other hardware at another site if required. The majority of the data storage used within the Trust is held on a storage area network (SAN). It is a well proven solution and has been expanded to meet Trust needs, but is getting to an age 12 of 32

13 where upgrading of key equipment is required. Due to its nature it does not provide the facility to move systems and data to another site easily in event of a complete site failure. It is also a relatively expensive and complex solution that, although highly resistant to single-point of failure, is difficult and time-consuming to recover from if there is a major disaster causing loss of the SAN Server Rooms The Trust has a number of server rooms across its sites although the majority of core services are at DRI. The server room at DRI has significant issues that need addressing quickly. The main server room at BDGH requires some investment to take it to the required standards. In order to provide maximum resilience to failures and improve disaster recovery the reliance on the DRI server room needs to be reduced and the ability to move services between BDGH and DRI needs to be developed. This would require investment in a more flexible data storage solution than the current SAN as well as increased used of virtualisation. This work has commenced and a number of clinical systems including pathology are mirrored between the two sites Desktop Hardware and Software The Trust has around 3400 PCs and has standardised on using Microsoft Windows XP across all PCs utilising the latest version of Microsoft Active Directory for managing security and upgrades. This allows automation of many upgrades to software on all PCs which use Microsoft Office, making maximum use of national contracts. The Trust is about to have transferred to it around 1.5m of Microsoft software licences (previously held nationally) and it will be responsible for purchase of these licences in the future. The Trust has no fixed replacement period for equipment, although it has investment plans to replace the oldest PCs where they no longer support key current and planned applications over the current year. Over the last year, the Trust has replaced the remaining 300 Windows Terminals and expects to replace all PCs over six years old during The Trust has largely standardised on HP printers with a mixture of personal and workgroup printers deployed. It has not so far explored the use of digital photocopiers for printing which have been shown to improve manageability and reduce running and support costs for printing in many environments. This option will be explored jointly with colleagues in the Supplies and Procurement Department Video Conferencing and Telemedicine The Trust has video conferencing facilities in the three main sites for general business and in the MDT rooms for clinical meetings. The MDT rooms have been updated to move to flat screen technology and the number of screens has been increased. The rooms have been moved off ISDN links to network links using N3 for connection to other Trusts. Work is going on with North Trent Cancer Network to improve and standardise equipment across the Trusts in the Network. The non-clinical video conferencing facilities have recently been upgraded and have also been moved off ISDN to use the Trust s network. The Trust uses some teleconferencing between DRI A&E Department and the Stroke Department to support remote assessment of patients. The Trust is also working with the Stroke 13 of 32

14 Network to implement network-wide telemedicine facilities with access from home for stroke consultants Telephony The Trust is facing a series of challenges over the medium to long term future regarding the development of its voice communications infrastructure. Following on from the replacement of the Bassetlaw hospital system with Adastra technology, the Trust has also made a limited deployment of this equipment at DRI. The main system at DRI and Montagu is still the Siemens ISDX, which has end of equipment sales dates commencing in 2011 and end of life dates in 5-7 years time. Alongside this the Trust has emerging requirements for increasingly sophisticated features such as Interactive Voice Response (IVR) and contact centre functionality which cannot be met by the legacy ISDX systems. Whilst the intention when the Adastra system was chosen for Bassetlaw was to adopt this as the preferred technology for the Trust as a whole, it is now appropriate to revisit this decision before embarking on further strategic projects and investment. This is being incorporated into a voice/ telecommunications strategy that is under development. Overall the Trust has invested sensibly in IT infrastructure in the last few years which gives it a solid foundation to build upon but continued investment is required to meet ever increasing needs and increasing requirement to support fully available 24/7 clinical applications. 4.4 Current Information Systems Whilst waiting for progress on Lorenzo, the Trust has maintained the integrity of its core systems, and deployed a number of clinical systems. This approach has protected the Trust from the potential vagaries of Lorenzo and provided legroom to develop an alternative strategy should Lorenzo fail to materialise, but it is now reaching the stage that the Trust must start the process of replacing a number of its core systems, most notably its ageing PAS system. Where possible, we have continued to enhance clinical and operational capability by upgrading the functionality of key systems and deploying others. These include: Upgrading Pas to fully support 18week wait management and starting roll-out of the BedWeb extension to provide full bed management Continued roll-out of e-prescribing across inpatient areas Deployment of Medisec including digital dictation and delivery of clinical correspondence to GPs Development and deployment of itracker to support inpatient discharge processes and reduce length of stay Development of a Trust data warehouse Deployment of e-rostering for ward nursing The new maternity system (Evolution) is to go live in summer 2011 The first phase of the Electronic Order Communications and Results Reporting Systems (ICE) goes live for phase one in July of 32

15 In addition we have been upgrading and moving interfaces between systems over to using HL7 via Ensemble (Trust Integration Engine) as systems are replaced or upgraded. This considerably reduces the cost, work required and risk when replacing systems, most notably PAS where only one interface will need rewriting instead of the 15 or so if Ensemble had not been utilised. The diagrams below illustrate the approaches to integration:- Previous (Point-to-Point) Integration Topology Pharmacy ProMIS EDIS A&E CIS Clinical Therapies Radiology CAMHS PACS Patient Administration System Hearing Rehabilitation Renal SQL Database Pathology Blood Tracking Cassie C & B Clinisys Chemotherapy MS Access Databases External Systems Integration via Ensemble PACS Data Store Trust Systems PACS EDIS A&E Patient Administration System Specialist Clinical Systems Radiology CAMHS Ensemble Integration Engine Pharmacy Hearing Rehabilitation Renal Business Intelligence Solution Pathology` Blood Tracking Cassie C & B Clinisys Chemotherapy SQLServer Databases Integration using HL7 International Standards 15 of 32

16 5. Strategic Development of Information Technology Systems 5.1 The Vision There are so many advances in technology in healthcare it is easy to attempt to do everything at once or take a piecemeal approach and not take advantages that can be gained with the interaction between systems and technologies. It s therefore helpful to use a framework to assess the current and plan the future against to provide a coherent whole. One such framework is the The Western European Maturity Model which uses five stages to describe the evolution of healthcare IT in hospitals as follows: Stage 5: Digital virtual enterprise. The most advanced hospitals have not only fully automated their business and clinical functions but also have a robust clinical data repository (CDR) complemented by business and clinical intelligence reporting tools and are looking to extend the clinical reach beyond the institution using telemedicine and remote patient monitoring and participation in regional information-sharing initiatives Stage 4: Digital hospital. Once the core clinical information systems are fully implemented, Stage 4 hospitals will begin to implement the requisite infrastructure to support more advanced clinical applications such as computerized provider order entry (CPOE), wireless point-of-care clinical documentation, use of Web portal technology by patients and employees, and a fully functional electronic medical record Stage 3: Advanced HIS/CIS. Stage 3 hospitals are beginning to lay the groundwork for electronic medical records (EMRs) by implementing the foundational clinical information systems (CIS), including laboratory information systems (LISs), radiology information systems (RISs)/radiology results reporting, picture archiving and communication systems (PACS), and pharmacy Stage 2: Advanced HIS. In addition to the basic HIS applications, Stage 2 offers more sophisticated administrative capabilities such as electronic claims submission and payment processing Stage 1: Basic HIS. The core financial and administrative systems are implemented to support patient registration, patient billing and accounts receivable, human resources and general finance, and other back-office business functions Appendix C contains an assessment of DBHFT against this model used to help inform the plans within this document. Appendix D contains a graphical representation of how this vision may look. 5.1 Delivering the vision This section lays out the developments required to be delivered based on vision, requirements and principles set out previously. It, albeit slightly arbitrarily, divides developments into two parts, namely developing an EPR and improving operational efficiency. Developing an Electronic Patient Record This strategy proposes an incremental route to an EPR, namely that we have a number of best of breed systems that conform to established standards that meet operational and clinical needs of their areas. The clinical information can be brought together using established interfacing standards through what is known within the NHS as a clinical portal creating a virtual, patient centric, EPR. This will have all key clinical information for a patient being available to clinicians 16 of 32

17 wherever they need it. This incremental approach has the key advantages of being more flexible, the amount of change required by staff groups is phased into manageable chunks and costs can be incurred according to resources available.. To deliver this will require that systems are interlinked to avoid clinicians having to hop from one system to another and the development of a clinical portal that brings all key information about the patient into one viewer. Clinicians will then have a choice of method of access to information electronically depending on the role and circumstances. an A&E doctor may use the A&E system as they manage the patient through the department but will be able to access results and xrays from buttons within the system which retrieves information for the current patient from others such as pathology or PACS without having to leave the A&E system. An acute physician on MAU may use the portal as it will give them the key information from a number of systems for a given patient within one screen. When purchasing systems there are some key requirements that need to be met to ensure that they not only meet current needs and provide value for money, but will allow integration into a full EPR in the future. These include: conforming with current standards on messaging and, where possible, emerging standards, to ensure interoperability with each other and to primary care and other healthcare providers where required; there is full clinical participation to ensure that products meet current and future clinical needs; that a replacement system is needed and that the current system will not be able to be developed or used differently to meet current and future requirements collect all information required for both clinical care, clinical audit and reporting/ analytical/ quality requirements. In addition, in order to ensure that systems are able to be used effectively it is important that the supporting elements are put in place: clinical PCs provide a common desktop, using single sign-on to improve ease of use and reduce training needs; access to systems is highly flexible in terms of location (including non-trust premises) and devices they can be used on whilst, meeting the Trust requirements for security; access to training and materials to ensure staff are fully equipped to make the best use of IT systems they access; the necessary external infrastructure is available to allow linking to systems within other healthcare organisations (e.g. GP practices) and access to Trust systems by staff from other healthcare orgnanisations where required. PAS, as it forms the foundation for the patient demographics and manages patient flow and associated data to other systems, must be replaced with a modern, flexible system with full integration capabilities. 17 of 32

18 5.4 Supporting Operational Efficiency and Quality It will be important in supporting the Trust to deliver the efficiencies required to operate successfully in the more difficult funding environment of the future. This includes significant income linked to quality which will create extra challenges for data collection and reporting. To meet this challenge the Trust will: continue to improve the flow of documentation across the Trust and into primary care by moving to a single repository of all forms of clinical correspondence and enable secure and robust electronic delivery to primary care, introduce real-time bed management and patient tracking to ensure access to accurate bed states and provision of information to diagnose and remove bottlenecks, support infection control and reduce length of stay; introduce patient level costing to help the organisation and individual clinicians understand what it costs to carry out patient activities, understand and investigate unexplained variations and act as a catalyst for constructive discussion between managers and clinicians around delivering high quality care at a manageable cost; have the systems and high quality data to support proactive management of patient pathways, assess and manage capacity, monitor and improve quality of services; improve access to information for patients about their own care and trust services, as well as the ability to electronically request changes to appointments and ability to deliver appointment reminders, where the patient gives approval; enable online access to key operational information and reports as well as benchmarking data, to assist in driving efficiencies and quality of care; support e-learning and video conferencing to make best use of staff time; link to GP and community systems to ensure that systems support complete patient pathways, not just episodic care; digitise notes to reduce staffing, storage and transportation costs as well as increase note availability in all setting to 100%. The expectation is that improvements in operational efficiency and patient experience will have a positive effect on clinical productivity by ensuring reduction of lost time, wasted appointment slots, cancelled operations and/or admissions and maximising the time clinicians are able to spend with patients. 5.5 Key System Deployments/ Developments The major systems that will be deployed to support these aims are detailed in the table below. This list is not exhaustive but covers the major projects planned or proposed at time of writing. Clearly additional projects will emerge to meet new demands and changes in the environment in what is likely to be an uncertain and challenging period for the NHS. An outline timeline is included in appendix B. 18 of 32

19 System Status Timescale PAS Clinical Portal A&E System Therapy System Replacement needed as old system near end of life, procurement started Proposed to commence in 2012, with possible pilot in Will be a phased development with systems added incrementally Will be replaced in the same procurement as PAS Deployment project due to start in next few months Deploy mid Mid 2013 Early 2012 Maternity System Due to go-live shortly Mid 2011 Cancer System Business case being developed Late 2011 E-prescribing Order Communications Patient Flow Data Warehouse/ Business Intelligence E-Rostering Patient Level Costing Roll-out to remaining inpatient areas including critical care and paediatrics Pilot to commence shortly followed by roll-out to Trust and GPs. Includes Radiology and Pathology, but other systems such as Cardiology may be added later Will be procured with the replacement PAS Will continue to be expanded to include other data sets and business intelligence tools will be integrated. Rolling out to ward areas to be followed by other nursing areas and other staff groups Will require key data sets within data warehouse to be available Telephony system Business case prepared itracker Continued development and roll-out to GPs, community staff and social services. Will be integrated with PEAKS key worker alert system 2011 Portering management system Currently being procured 2011/12 6. Development of IM&T infrastructure and Services In order to support exploitation of new information systems as well as allowing efficient use of Trust resource, modern, flexible and fit for purpose IM&T infrastructure and services are required. 19 of 32

20 6.1 Video Conferencing and Telemedicine The Trust has embarked on an upgrade on its video conferencing facilities and has moved all endpoints over to IP networks from ISDN lines. Some upgrades have been carried out on the video conferencing equipment in the MDT rooms but further work will be carried out in conjunction with the North Trent Cancer Network to ensure equipment and processes are harmonised across the network. In addition the video conferencing facilities in the site boardrooms have been upgraded As part of the work on the integrated laparoscopic theatre, high quality video feeds will be available in post graduate education (PGE) facilities during Work will also take place to allow interoperability between MDT facilities, post graduation education facilities and boardrooms to allow flexible use of all these resources to maximise use and benefits of these systems. Although the Trust has some limited telemedicine equipment, it is working with the South Yorkshire Stroke Network to pilot use of such facilities across the area to improve access to clinical stroke expertise across Trusts 24/7. The work with stroke is expected to act as a prototype for other acute conditions. 6.2 IT Infrastructure and Services The network infrastructure will be developed to improve capacity and resilience and support future services such as high quality intersite video conferencing and voice services. This will involve upgrade to core equipment to higher speed technology as more devices and traffic are added to the network. All interfaces will move over to Ensemble using standardised HL7 messaging, which will improve resilience and support whilst reducing the technical effort and complexity to change systems, link in new systems and make the migration of interfaces to a new PAS considerably easier. There will be increasing emphasis for agile working by continuing to improve remote access and access from non-trust premises such as schools, as well as community staff utilising mobile phone networks. In addition we will expand the use of wireless/mobile technology in clinical areas including additional deployments of computers on wheels (COWS) in wards and A&E areas, and use of other portable equipment such as clinical tablets, digital pens and laptops as appropriate to the area and the work being carried out. Expensive software licences will be exploited to achieve the maximum benefit, in particular the ones transferred from national ownership, and consideration will be given to alternatives to replace Microsoft Office and other expensive software, when required with open source or similar software, such as NHS Office. Server rooms at DRI and BDGH will be upgraded to data centre standards with appropriate and resilient air conditioning and power supply. We will continue to reduce reliance on DRI server room and improve disaster recovery capabilities by deploying more services from BDGH, making intelligent use of virtualisation and deploying data storage technology that allows replication across sites and failover facilities for critical systems and data between DRI and BDGH. 20 of 32

21 The Trust will develop a plan for voice and data convergence to move to a single infrastructure, reducing costs and improving flexibility, whilst allowing exploitation of the technological benefits convergence can bring. IT Services will move to an ITIL approach to IT service delivery starting with the customer facing parts of the service and will reach at least NIMM level 3 across key areas by 2012, which is the minimum to provide the infrastructure and service required to deploy and support the clinical systems to be deployed over the next 5 years. 6.3 Telephony The Trust s intention is to move to a predominantly VOIP solution over a period of four five years allowing voice and data convergence and both the internal process benefits that will bring to key areas of the Trust, as well as the ability to provide more flexible and friendly means to communicate with patients. A detailed telephony strategy is being developed which will incorporate the plans and costs to replace aging ISDX technology and move to a largely VOIP solution. This is expected to be completed mid 2011 but will broadly cover the following areas: Review the current Adastra deployment and comment on Adastra s position in the UK marketplace compared with other vendors including Cisco Undertake a high level review of the Trust s data network deployment and planned strategy to assess its readiness to support IP Telephony. Identify a 5 year plan to achieve replacement of the ISDX system at DRI and Montagu prior to the systems being declared end of life. Identify key milestones and decision points. Identify a high level capital budget to achieve replacement of the ISDX systems. Review the current management of telecommunications service and identify the likely tasks, roles and responsibilities that will be required to support a converged network and IP telephony deployment. Identify potential areas where unified communications applications could benefit the Trust. Identify potential benefits of proceeding with the replacement project including any cost saving opportunities such as a consolidated switchboard service. 6.4 IT Procurement IT Procurement should take advantage of national contracts wherever possible and standardise on both PC hardware and software to reduce support and training overheads. At present the preferred supplier of PC hardware is Dell, but this is currently under review. Contracts will be reviewed annually or whenever a significant order is placed to assess on price, quality and reliability of equipment and quality of after sales support. 21 of 32

22 All IT hardware that will be attached to the Trust network must be approved by the IT Department before being purchased. The department will normally have standard desktop computer, printer and software that will be approved for users. Non standard purchases of hardware or software must be approved by the IT Services Manager and be installed by Trust IT staff. Any software or hardware installed without the knowledge of the IT Department will not be supported and may be removed if it poses a risk to security of data or system operations. 6.5 Project Management All significant IT procurements and hardware and software implementations will be managed according to Prince 2 project management methodology. Any large system implementation (a total cost of over 50,000) should have a Prince 2 qualified Project Manager appointed and a properly constituted Project Board and Project Team in place according to the Prince 2 standards. A supplier Project Manager and/or representative will be expected on the Project Board. Any IT system, no matter how well implemented, will not deliver significant benefits unless the organisation makes the necessary changes to processes as well as any cultural/ behavioural changes necessary to deliver these benefits. All significant IT deployments (including CfH products) will take a systematic approach to benefits management. This means that the project sponsor must outline the benefits, tangible and intangible, up front. As a minimum, the following should be stated: What is the benefit to the Trust Who is responsible for making the changes and hence delivering the benefit How the benefit is to be measured and baseline values Expected timescale and milestones for the benefits to accrue. These benefits must be held in a Benefits Register and the Project Board should ensure that the expected benefits are being realised. It is often the case that many benefits will continue to be delivered long after the project is complete, so the IM&T Programme Group may monitor delivery of benefits on the Trust s behalf. 6.6 Internal IT System Development The Trust has limited capacity for internal systems development. Any significant system requirement should be met by purchase of a commercial solution whether that be bespoke or off the shelf. In general bespoke developments should be avoided whenever possible due to their higher costs and risks around future support. The IT Development team will support existing in-house systems, develop small scale tactical systems where commercial purchase would not be cost effective and the project is deemed essential. They will also be responsible for supporting and developing the Trust Interface engine which all new IT systems that require integration with other systems will use. They will also support development of the Trust Data Warehouse, other databases used by the Information Department and Integration Engine. All internally developed applications will have the knowledge within the team and documentation to ensure that they can be supported and further developed throughout the useful lifespan of the system. All internal development work will be carried out using web technologies to minimise support and deployment costs and maximise accessibility in all care settings except where the number of users or functionality required is very limited. 22 of 32

23 6.7 IT Training To succeed in the successful exploitation of IT systems considerable training will be required for all staff. Training requirements will be integral to each major system deployment project plan and intended users will not be given access to any significant Trust systems without appropriate prior training. As well as scheduled courses there will be targeted training where a significant need is identified for a particular group of staff or to use a specific part of a system. As part of the continual drive to ensure data quality is achieved and maintained, mandatory annual data quality and PAS workshops will be delivered to key users of PAS. This training will be delivered in partnership with information services and patient admin departments. With the increasing demands on the team with more clinical systems being rolled out, it is important that alternatives are developed to the traditional classroom approach. This will also reduce the requirement for staff to free up time for training. General IT training will be delivered using a blended approach offering staff a number of training delivery methods which best suit the individuals, department and the Trust. This will include increasing use of e-learning materials and courses utilising tele-training delivery technologies Training materials will be developed for access from the Trust Intranet that support self-learning to both replace (in some cases) or supplement classroom based learning. Evaluation of all training delivery methods will be conducted to ensure that current trends and methods which are available, both internally and externally, are fully explored and utilised effectively. 6.8 Information Services The Information Services Department is currently implementing an approach to develop an information service which is resilient, flexible and responsive to the organisation s current and future needs. It aims to provide a sustainable and excellent information service to the Trust. Key priorities are outlined below:- Continued development of a single, cleansed, authoritative source of information data warehouse and business intelligence tool, which replaces PROMIS (the old PAS data Warehouse), providing further opportunities for efficiencies in processing and timeliness of reporting of PAS related data. Continuing to extend the data sources to other systems to provide integrated reporting and to start rolling this out through an intuitive reporting tool set to key managers and clinicians. Support business planning and service development including more detailed integrated data sets to support monitoring and compliance of quality standards. Improved capability to fulfil the information requirements to a high quality standard laid down in the NHS Standard Contract and nationally mandated requirements through Information Standard Notices (ISNs), minimising any risks associated with contract penalties around information provision. Automating as many standard processes, requests and submissions as is practicable to provide efficiencies and a more responsive service to customers Giving as much autonomy as practical to users for amending and publishing their own reports promoting ownership for the quality of the data and performance of their areas. 23 of 32

24 Spending time with key information users both in understanding their businesses/ clinical processes and information needs as well as developing information literacy in users where required. CSU Analysts continually developed to ensure the provision of tailored, value added information to truly support the business and clinical quality agenda. Information input into IT system procurement process and Information Services being responsible for delivering integrated reporting functionality for newly implemented systems. Full evaluation of the Dr Foster project to ensure benefits have been realised and this will feed into Trust decisions around extending the contract beyond 2011/2012. To continually look for other opportunities for other sources and system solutions of benchmarking data which can add value to analyses. Developing standardisation in presentation across the Trust and access to relevant key performance information. For example use of Performance Accelerator for monitoring of key targets and standards. Beyond this the longer term strategy will be to evaluate all available options, including assessing whether to go out to the market place to procure a data warehouse or continue with in house development assessing the full advantages and risks of each option against the full business requirements. Throughout all of the development stages links will be made to Trust projects which have reporting elements to ensure this is a core element of any Trust project. Consideration will always be given to developing as flexible a solution as possible to ensure system replacements such as the PAS result in the minimum amount of re-work in relation to the data warehouse and reporting solutions. 6.9 Clinical Coding Key priorities are outlined below:- Securing Trust income and financial viability through the PbR regime. Just over half the Trust income, direct from Commissioners, is reliant on clinical coding. Sustaining challenging deadlines whilst maintaining quality for completion of clinically coded data to allow conformance of the NHS Operating Framework and NHS Standard Contract. Closer clinical engagement including increased levels of coding within ward areas. Know your coder. Succession planning to ensure at all times sufficient qualified Clinical Coders are in post to ensure there is no threat to the delivery of the service Data Quality The Trust recognises the importance of high quality information as a fundamental requirement for the prompt and effective treatment of patients. High quality information, which needs to be underpinned by high quality data, is crucial in the delivery of high quality care to patients and in meeting the needs of clinical governance, management information, accountability, financial control, health planning and service agreements. 24 of 32

25 Currently the Trust is carrying some risk areas around data quality. The Operating Framework for 2011/2012 strongly encourages Commissioners to use the financial penalties available to them through the NHS Standard contract to improve performance. Consequently, to minimise future risks, the Trust has identified some key data quality work packages for 2011/2012 along with some additional temporary data quality resource. These work packages include historic clean up of 18 Weeks pathway data, large-scale cleaning up of the Patient Master Index (PMI) on PAS and improved NHS Number coverage. These work packages will also assist in some of the basic work required in the future for data migration to a new PAS. The Trust is committed to continuing to develop a culture of excellence and get it right first time around data quality. Targeted training programmes to include all staff involved in data collection and management of patient care will continue to be delivered. This is key in ensuring that data quality standards do not start to slip, once the central data clean up has been completed and that CSUs and Corporate Directorates take responsibility for the data they generate and enter into systems. The Trust undertakes a number of IM&T projects each year which have an information element. The Information representative and the IM&T Training representative must ensure data quality is fully incorporated into the project Developing IM&T Staff With the continuing march of technology and the large programme of activity it is important that IT staff have the skills to not only provide a high quality service to users but also to improve the productivity that can be gained with a better more standardised infrastructure. This productivity improvement is essential due to the rapidly increasing number of computers in the Trust, the increasing dependency of staff on their IT systems and the increasing complexity of the networks and software systems. Staff not only require the technical skills such as technical certification, but also service management knowledge and skills to produce an effective and high-quality user experience. There has been investment in training in IT staff but it is important that skills are continually kept up to date. Therefore all IM&T staff will be required to work towards certification and/or demonstrate competencies in relevant areas: IT support staff (including staff on the Service Desk) will need: Microsoft Certified Professional, Dell Certified Engineer and ITIL Foundation as well basic network skills. Infrastructure Systems Engineers will need to have Microsoft Server Qualifications, CISCO Network Qualifications, ITIL Foundation. IT Programme Team will need to be Prince II Qualified as MSP (Managing Successful Programmes) at least foundation level. Project Managers should be PRINCE II Qualified IT Trainers will require TAP (Training Accreditation Programme) qualifications Clinical Coders will require Accredited Clinical Coder Status (ACC) Information staff will require SQL 2008 skills ranging from basic querying to reporting and analysis services as well as development of their general analytical skills in applied information. 25 of 32

26 7. Information Governance The Trust Information Governance Strategy is consistent with the legal requirements and guidance from the NHS and the Office of the Information Commissioner, including the NHS Confidentiality Code of Conduct, NHS Records Management Code of Practice and the Information Governance Toolkit. The Information Governance Policies and Procedures are available to all staff and the public on our website. These documents are regularly reviewed in light of changes to legalisation or policy. There is a small Information Governance Team within the Trust dealing with Freedom of Information requests, Data Protection, patient access to medical records, IT security and work closely with the Trust s Caldicott Guardian who is also the Trust s Medical Director. The Trust has various high level sharing protocols in place including an Information Sharing Protocol across health communities, which include Acute, Primary Care and Ambulance services. A sharing protocol exists with the Police, Social Services and the Prison Service. Other protocols with other agencies will be developed as required. Patients are responded to on an individual basis and their wishes taken into account. Requests for copies of their information are handled under our Access to Health Records Policy. Patients requiring their information not to be shared are responded to in line with Trust policies. The Trust has disaster recovery plans for key systems and infrastructure that will be updated in line with system and technological changes. There is also an IT security policy in place that details the measures in place to maintain data confidentiality. All systems with confidential or other important information are secured with password entry and access levels appropriate to the individual user s job requirements. Software is employed to protect against virus or other software attacks and secure firewalls are in place to secure the network at all entry points. The Trust also employs web logging software to ensure all Internet access by staff complies with Trust policies. All portable computer equipment taken off site has securely encrypted storage. 8. Key Risks Many risks are both explicit and implicit from the strategies that set the direction for IM&T and each impact on the associated work programme, in terms of creating additional work and affecting the ability to complete tasks. Risks to continuity of current services and wider programme delivery risks are held in the IM&T Risk Register and managed according trust policy. Risks to delivery of individual projects will be held in the risk registers of the projects concerned and managed by the project and manager and board. This section lists the headline risks to delivering the strategy. Failure of NPfIT to deliver Lorenzo in a useful timeframe with adequate functionality to meet the Trust s requirements- there have already been considerable slippage in timescales and changes to the contracts and it is almost certain that there will be further slips. Even though the Trust has embarked on an alternative strategy of procuring a PAS, the knock-on effect of a major failure of NPfIT could increase demands on a relatively small pool of alternative suppliers. 26 of 32

27 Lack of resources/ investment it is likely, with the reduction relative to growth of funding within the NHS, that IM&T investment could be impacted unless the required return on investment is very clearly demonstrated - staff require a level of basic IT competency and specific system skills to progress to allow them to use modern IT systems successfully. This is particularly the case where staff have only used character based systems like PAS and are not used to Windows based systems. The two biggest hurdles in getting clinical staff adequately trained is the cost and difficulty in obtaining backfill in busy areas and the lack of opportunities to practice skills in the working environment. Change Management the biggest risk to successfully exploiting any new IT system is resistance to change and the temptation to use the system like the old one rather than utilise the newer features to support process change. This can lead to loss of efficiency rather than productivity gains. Uncertainty and change within the wider NHS environment could make it difficult to engage and work effectively with local partners to deliver joined up systems. 9. Conclusion The problems surrounding NPfIT have caused a level of uncertainty and planning difficulties around the delivery of clinical and operational IT systems over the last few years. Recently, at DBH, there has been significant investment in IT infrastructure, clinical systems and information services. The current plans see a further acceleration in planned and proposed deployments with a raft of replacements and new systems supplemented by sensible investment in underlying infrastructure. During the lifetime of this strategy the Trust will have moved incrementally towards an Electronic Patient Record. We will have a modern PAS as well as other key clinical systems, digitised notes, seamless linking of systems and ongoing development of a clinical portal meaning that the vast majority of clinical information will be available electronically to clinicians and the Trust can become paper light. As well as an EPR, the Trust will utilise technology to support efficiency and quality as well as improve communications and working relationships with primary care and community staff to the benefit of all parties including patients. The delivery of these key systems and the improvements they will enable, are important factors in ensuring that the Trust is able to continuingly improve the efficiency and quality of the services it delivers to patients and enhance the working environment for staff. 27 of 32

28 Appendix A Glossary of Terms Term Description Definition CfH Connecting for Health The NHS agency (now a directorate of the Department of Health) responsible for running core IT infrastructure in the NHS, setting standards and delivering the NPfIT. CAB/ C&B Choose and Book CAB is a national service that, allows electronic booking and a choice of place, date and time for first outpatient Data Warehouse Data Warehouse appointment within a hospital or clinic. A data warehouse is a repository of an organisation's electronically stored data designed to facilitate reporting and analysis. Dr Foster Dr Foster Health A provider of comparative information on health and social care services and provides business intelligence data and tools to NHS organisations. HL7 Health Level 7 A set of internationally agreed flexible data standards for exchange of clinical information between computer ISDX ITIL IVR Integrated Services Digital Exchange Information Technology Infrastructure Library Interactive voice response. systems. Technology that the Trust s existing telephony switches are based on Set of best practice guidance for IT Service management. Systems that are accessed via the telephone network and which allow users to enter data or retrieve information. User data is captured using telephone key input or speech recognition. LAN Local Area Network Cables and devices that allows connections between computers and other associated devices. LSP Local Service Provider The provider of local applications and services to support NPfIT which has been appointed for the area. For the North, East and Midlands the LSP is Computer Sciences Corporation. Lorenzo Lorenzo Regional Care The core patient administration and clinical system being developed for trusts in the north, east and midland areas of England. MDT Multi Disciplinary Team Clinical teams working together on cancer cases MSP Managing Successful Programmes OGC best practice framework for managing programmes links in closely to Prince II Project Management. NPfIT National Programme for IT The programme responsible for delivery a number of projects supposedly to improve, develop and link IT systems within the NHS. This includes Trust products such as Lorenzo and national systems such as N3 or Choose and Book. N3 New NHS Network Computer network that connects all NHS premises managed by BT. NHS Elite NHS Elite NHS E-learning IT Essentials and introductory IT skills qualification that covers the key skills and NHS member of staff would need to use clinical systems. NHS Office NHS Office Suite of software mimicking the functions of Microsoft Office based on open source software developed by NHS Scotland. 28 of 32

29 PACS PAS Picture Archiving and Communications Patient Administration System System for recording storing and distributing radiological images. The core hospital system that records all patient activity such as clinics, waiting lists, inpatient stays, outpatient appointments and location and requesting of medical notes. Also provides the data sets to support billing for activity carried out and links with Choose and Book. POE Power over Ethernet A technology that provides power over the network cable to low power usage network devices such as IP Phones and wireless data access points to avoid the need for putting additional mains power supplies in. PbR Payment by Results System of payment to NHS providers based on type and Prince II PROMIS Prince II Project Management PAS Data Warehouse level of activity carried out. OGC best practice guide for management of projects widely in use and often mandated with the public sector. Old data warehouse attached to PAS and written using the same technology. SAN Storage Area Network A storage area network is a high-performance and resilient network whose purpose is to enable data storage devices to communicate with computer systems. SQL Server Microsoft SQL Server Microsoft s business strength database which is used with many clinical and data warehouse systems. WAN Wide Area Network A geographically dispersed communications network, used to link computer and telephony systems. 29 of 32

30 Appendix B Outline IM&T Programme Timeline. 30 of 32

31 Appendix C Healthcare IT Maturity Model Roadmap Status Stage 1 Basic HIS Doncaster and Bassetlaw Hospitals NHS FT - Healthcare IT Maturity Model Stage 2 Advanced HIS Stage 3 Advanced HIS/ CIS Stage 4 Digital Hospital Stage 5 Digital Virtual Enterprise Required Systems Systems that require investment and there is no OBS or Business Case Planned Systems Systems where at least outline approval has been given and have a planned timescale Current Systems (major) Systems that are at least partially deployed Replacement PAS Current PAS Data Warehouse Integrated Demographics Clinical Document Management Advanced A&E System integrated with PAS Patient Flow / Advanced Bed Management Order Communications Replacement RIS Replacement PACS Cancer System PACS / Medical Photography Database Radiology Information System Clinical Portal Digitised Notes/ Document Mgt Increased use of mobile technology Self-Service Kiosks Theatre Stock Management Portal for patients to access information and interact with Trust Expansion of Data Warehouse Orders and results to GPs Pharmacy Robotic Dispensing e-prescribing (JAC) ESR Patient Reminders IIS Pathology System Single Sign-on Finance Systems Choose and Book Trust HL7 Integration Engine e-rostering Pharmacy Renal System Theatres Endoscopy Medisec Cardiology Electronic sending of clinical correspondence to GPs (Medisec) Portering Mgt System Chemotherapy e-prescribing Clinical tablet PCs Digital Pens Increased use of Telemedicine/ Using tele monitoring Fully integrated portal /EPR with Primary and Community Care Access to and integration with Summary Care Record Patient Level Costing Business Intelligence Toolset Paperless procurement Patients access to care records electronically TeleMedicine for Stroke 31 of 32

32 Appendix D 32 of 32