Health Informatics Strategy 2016/17 to 2019/20

Transcription

1 Health Informatics Strategy 2016/17 to 2019/20 Prepared for: Author: Date / Version: Status: Rob Presland/Thomas Manning Neil Stevens 15 th April 2016 Final Draft Final Draft 22 nd March Sirius Partners Page BNSSG Informatics Strategy 17 th March Page

2 Document Control Distribution Name/Group Rob Presland, Head of PMO Thomas Manning, Head of Information and Performance Management Phil Trickey, Director Neil Stevens, Director Organisation Bristol CCG South Gloucestershire CCG Sirius Partners Ltd Sirius Partners Ltd Amendment History Date Version Changes Author 20/2/ First draft and format NS 3/3/ Second draft including RP comments NS 7/3/ More detailed version NS 8/3/ Further refinements NS 11/3/ Changes following conference call NS 13/3/ More enhancements and addition of plan information NS 14/3/ Inclusion of 3 phases and more refinements NS 15/3/ Refinements with GP input NS 17/3/ Edits following RP and TM review NS 21/3/ Add constraints, dependencies and risks NS 22/3/ Final draft for Partnership Group NS 15/4/ Final draft for Governing Body RP Sirius Partners Ltd contact details: Neil Stevens neil.stevens@siriuspartners.co.uk nd March P age

3 Contents 1. Preface... Error! Bookmark not defined. 2. Acknowledgments Executive Summary Why have an Informatics strategy? The Individual and the Patient The Health and Social Care Professional The Commissioner Introduction Local strategic context Current IT Support and BI arrangements Progress since the 2012 Informatics strategy CCG Strategic drivers Vision and key objectives Digital Maturity Assessment CCG Challenges Objectives and Principles of the Informatics Strategy Informatics Definition Required outcomes Strategic principles Strategic Informatics Aims Outcomes and Benefits High-level objectives More specific objectives Delivering the Strategy recommendations Governance and leadership Digital maturity IT Service Delivery partner Data, Information, Knowledge and Wisdom Primary Care Development and Support Other recommendations Financial impact Current expenditure Initial indicative costs Potential funding sources nd March P age

4 10. Constraints Dependencies Risks Appendix A Progress since the 2012 Informatics Strategy Appendix B Bristol and South Gloucestershire CCG Priorities Appendix C External Business Drivers Appendix D - Personalised Health and Care Appendix E Summary of Digital Maturity Index Appendix F - Strategic Methodology nd March P age

5 1. Preface - Foreword from the Bristol and South Gloucestershire CCG Governing Body Chairs and Chief Operating Officers The development of technology to improve the way in which we communicate and use information to deliver care to patients is fundamental to the functioning of CCG s, our member Practices and the wider NHS. By 2020 the NHS in England has ambitions to be paperless at the point of care. Our jointly refreshed informatics strategy identifies the areas of work that we will be undertaking to deliver this ambition. There are some exciting developments planned within the strategy which we believe will provide the technology to support a shift in the quality of care for patients, in addition to safeguarding the future sustainability of the services the CCG commissions and provides. As three CCGs in Bristol, South Gloucestershire and North Somerset, we are absolutely committed to the informatics developments required to enable the delivery of the five year forward view for the NHS. This strategy and the contribution it makes towards our local digital roadmap will be critical to delivering future sustainability and transformation plans with our partners across health and social care. Martin Jones, Chair, NHS Bristol Clinical Commissioning Group John Hayes, Chair, NHS South Gloucestershire Clinical Commissioning Group Jill Shepherd, Chief Operating Officer, NHS Bristol Clinical Commissioning Group Jane Gibbs, Chief Operating Officer, NHS South Gloucestershire Clinical Commissioning Group 22 nd March P age

6 2. Acknowledgments This strategy has been prepared following a significant amount of engagement with management, operational and clinical staff in Bristol and South Gloucestershire CCGs and with input from respective GP IT leads. Sirius Partners would like to thank all stakeholders who have contributed, as well as representatives from South, Central and West Commissioning Support Unit. Particular thanks are due to Rob Presland, Thom Manning, Luke Koupparis and Andrew Appleton for their sustained input to the strategy development, and their commitment to provide comments and feedback, often at short notice. 22 nd March P age

7 3. Executive Summary This document sets out the Informatics Strategy for Bristol and South Gloucestershire CCGs for the period 2016 to Bristol, North Somerset and South Gloucestershire (BNSSG) CCGs are currently developing a Digital Roadmap together. Due to timing differences North Somerset CCG have already commissioned a strategy refresh prior to this strategy being developed. However, dialogue is taking place to ensure consistency between the Bristol and South Gloucestershire informatics strategy, the North Somerset informatics strategy and the BNSSG Digital Roadmap development. The objective of the strategy is to consider a number of key internal and external drivers for the CCGs and Primary Care providers, and to identify strategic corporate objectives in response to these drivers and the CCGs strategic vision. The Informatics Strategy is designed to support the delivery of the CCGs objectives, support delivery of Primary Care by GPs/GP Practices and to enable significant improvements in the way that healthcare services are commissioned for the population of Bristol and South Gloucestershire. It includes Primary Care requirements as well as the role that the CCGs have in relation to strategic interoperability between health and social care organisations within their respective footprints. Emerging themes and requirements from the wider health and social care agenda have been considered in formulating the strategy, as have the findings from significant engagement activity with CCG management and operational staff, as well as lead GPs for IT and CCG IT leads. BNSSG has made good progress in achieving the recommendations in the 2012 Informatics Strategy, and this is summarised in Appendix A. There has been particular success in relation to the Connecting Care inter-operability programme, which has made significant progress in the sharing of information between different organisations something which is a key strategic enabler in delivering some of the recommendations outlined in the Five-year Forward View and now being considered in the development of Sustainability and Transformation plans. However, there are also a number of areas where progress has been more limited. These include Business Intelligence to support commissioning and efficiency and workflow improvements supported by technical solutions. Four strands are considered in this strategy: CCG business requirements as a commissioner of health and care services; Primary Care computing; Strategic interoperability across the community; Business Intelligence and Performance information; A number of the recommendations made in the Informatics strategy remain valid, and this strategy emphasises the need to make tangible progress in these areas. In addition the strategy identifies opportunities to redesign the way that care is delivered, and to make best use of the technology to deliver efficiency and productivity gains across health and social care organisations. The use and understanding of available information to focus on the measurement of outcomes will also be an important area of focus. 22 nd March P age

8 Having considered the key drivers, objectives and outcomes that need to be delivered, the strategy sets out a number of recommendations (each of which is an enabler to achieving one or more of the strategic objectives) in section 8 Delivering the Strategy. These are grouped into the following themes: Governance and Leadership; Digital Maturity; IT Service Delivery partner; Data, Information, Knowledge and Wisdom; Primary Care Development and Support; and Other recommendations. Each of the individual recommendations is supported by a more detailed action plan with identified timescales, indicative costs, and accountable owners. A summary of the recommended timescales is provided in section 6.4 Strategic Informatics Aims. This section shows the phased roll-out plan of the high-level activities. The Lead Provider Framework presents an opportunity to find the right IT Service partners to support delivery of the strategy as well as to make improvements to the delivery of BI solutions. This should have as a core objective the improvement of the availability of information to support planning, performance and commissioning activities, and to ensure delivery of Sustainability and Transformation plans which are currently in the process of being developed. 22 nd March P age

9 4. Why have an Informatics strategy? This section briefly considers What s in it for me? from the perspective of a number of stakeholders including Individuals/Patients, Health and Social Care Professionals and Commissioners The Individual and the Patient Once approved and implemented the Informatics Strategy will have a significant impact on individual citizens and patients from their own perspective. The Informatics Strategy will: Support my care and experience by providing information to support the ethos of no decision about me without me ; Use technology to support delivery of care to me and to better prevent, predict, detect and treat illness; and Enable me to securely communicate online with clinicians looking after me. Benefits to me: I will only need to tell my story once; I will be able to access some services online from a location convenient to me; Everybody looking after me will know what is going on with my care; I will be able to see all my appointments and arrange for them to be at times convenient to me; I will be able to use technology and information to look after myself when appropriate and reduce unnecessary reliance on healthcare professionals; and I will be able to access my own healthcare record, or allow relatives or carers to access it on my behalf. I will participate by: Advising healthcare professionals how I prefer to be contacted; Ensuring accuracy of my records; Advising if I am unable to keep my appointment for any reason; and Allowing my health and care records to be shared with those who are helping to care for me The Health and Social Care Professional Similarly, Health and Social Care Professionals would be expected to see a significant impact from implementation of the strategy. The Informatics Strategy will: Ensure electronic systems are integrated and automated so everything is virtually paperless ; 22 nd March P age

10 Help to ensure that referrals, requests, results, prescriptions no longer get lost, mis-transcribed or duplicated; Help me to ensure fewer unnecessary consultations, test results, requests of prescriptions so we can spend more time on treating and caring for patients that need us; Support primary care in meeting extended hours obligations by allowing neighbouring practices to handle some of our appointments; and Clinical staff will spend less time finding out about the patient and more time caring for them. Benefits to me: I will have access to the right information in the right place at the right time to support my clinical decision making; My operational effectiveness and efficiency will be helped by access to modern technology; I will spend less time finding out about a patient and more time caring for them; My patients will be able to better care for themselves through the use of technology in their own homes; and I will waste less time as a result of patients failing to attend appointments. I will participate by: Ensuring I have the necessary IT skills to use available systems effectively; Make every effort to record data on systems in a timely and accurate manner; Support colleagues in the effective use of IT systems when necessary; and Taking responsibility for ensuring that best use and best value is achieved by the systems I have available to me The Commissioner A key driver for the Informatics Strategy is to ensure that CCGs are well placed to plan and commission services which maximize benefits to the population. Commissioners should therefore see a difference once the strategy is in the process of being implemented. The Informatics Strategy will: Help in the provision of robust information so that there is one version of the truth about what has happened, what is happening and what could happen; and Support the monitoring of contracts based on outcomes across whole care pathways and therefore support commissioning of care that is more effective for our population. Benefits to me: 22 nd March P age

11 We will make efficiency savings by reducing inappropriate appointments, unnecessary duplication of care and eliminating treatments known to be ineffective; We will be better able to assess which patients are at risk of falling ill and this will support early intervention to prevent deterioration in health and reduce cost to the health economy; We will be able to commission the most appropriate and cost-effective clinical services which make the greatest difference to the population of Bristol and South Gloucestershire; and We will be able to share information between health and social care professionals to ensure that the most informed health and care decisions are made. I will participate by: Supporting providers in ensuring that their systems are able to share information within and between organisations; Through the commissioning process, ensure appropriate standards are adopted by providers, suppliers and primary care organisations; and Support the development and implementation of the Digital roadmap for the community. 22 nd March P age

12 5. Introduction Informatics infrastructure and services play a key role in supporting safe and effective delivery of healthcare services to the population of Bristol and South Gloucestershire and in the way that they are delivered. Without effective informatics solutions, the capturing, processing and reporting of information to support the planning, commissioning and management of personcentred care would not be possible. The CCGs are ambitious about integration with partners and between services, and good progress has been made with the Connecting Care Programme. Most staff in the CCGs and GP practices rely on IT systems and solutions in some way to support them in doing their jobs on a day to day basis. It is therefore essential that the systems and technologies used are intuitive, reliable and robust and help to make it easier for staff to carry out their duties. Whilst this is a corporate strategy for Bristol and South Gloucestershire CCGs, it also includes provision to support clinical services delivered by Primary Care organisations. The last Informatics Strategy was published in August 2012 when the main focus for CCGs was to gain authorisation to operate as CCGs within the new arrangements as set out in the Health and Social Care Act (2012). Since this time a number of new national and local drivers have emerged which are set out in section 5.4 below. CCGs are currently in the midst of finalizing Operating Plans for 2016/17 as well as 5-year Sustainability and Transformation Plans. Alongside this is the requirement to deliver Digital roadmaps for local communities having recently completed Digital Maturity Assessments for each provider organisation. Additionally, there have been changes to the GP IT Operating Framework (due to be refreshed in 2016) which need to be reflected in the strategic direction for Informatics. There has also been significant commitment from NHS England and the Treasury to invest in Informatics solutions as key enablers of the transformation required in Health and Social Care over the next five years. All of these factors mean that it is now appropriate to refresh the CCG Informatics Strategy, and ensure alignment of the Informatics investment plans with the delivery of Sustainability and Transformation plans to improve the health and care services provided to the population of Bristol and South Gloucestershire Local strategic context CCGs are responsible for the planning and commissioning of hospital and community health services to ensure that the health needs of a given population are met. Responsibilities include: Commissioning a range of healthcare services; Ensuring public involvement in planning of commissioning; Working with local authorities and other NHS and Social Care organisations to promote integrated care provision; 22 nd March P age

13 Ensuring continuous improvement in quality of services; Promoting individual patient involvement in their healthcare to support achievement of no decision about me without me. NHS Bristol Clinical Commissioning Group (CCG) is responsible the population of Bristol (over 432,500 people). It is a clinically-led organisation of 54 GP practices which are grouped into localities, each of which reflects distinct local needs and ambitions. NHS South Gloucestershire Clinical Commissioning Group (CCG) is responsible for a population of over 260,000 residents. The CCG is also clinically-led and operates as a single membership organisation, made up of all 25 GP surgeries in South Gloucestershire. As part of collaborative work within the Bristol, North Somerset and South Gloucestershire (BNSSG) area a number of joint strategic priorities have been agreed: Sustainable and efficient acute configuration; The transformation of community and primary care services, shifting care out of acute hospital settings; A step-change in the coordination of health and social care, supported by the roll out of the Connecting Care (interoperable patient records) programme; A shift in working practices and organisational culture to make prevention and selfcare a priority in service delivery; Transformation in identified key disease areas to deliver value and improved outcomes such as long term conditions, cancer, frailty, musculoskeletal (MSK) services and mental health pathways; and Workforce and Informatics to support required transformational change. These priorities have been considered in developing the Informatics Strategy, as the innovative use of technical solutions is critical in ensuring they are able to be delivered. Clinical priorities for Bristol and South Gloucestershire are shown in Appendix B Current IT Support and BI arrangements The main SLAs for provision of IT services and Business Intelligence (BI) are with the Central, South and West CSU. They provide services to the CCGs as well as to Primary Care organisations for both business as usual services and developments and projects. The indicative current spend is shown overleaf, both for GP IT and for CCG IT. In addition, the CCGs currently support Connecting Care which is the Bristol, North Somerset and South Gloucestershire (BNSSG) interoperability programme, dedicated to using technology to support: Better information sharing between local health and social care organisations; Joining up information to ensure care is focused on the individual and their needs; 22 nd March P age

14 Improving better, safer and more joined-up care; Supporting increased efficiency in the delivery of health and social care Services; Ensuring that the people who are providing care have the information they need, when they need it. 22 nd March P age

15 The focus of work during the pilot stage of Connecting Care was the delivery of a shared care record i.e. a view only electronic patient record. All three of the BNSSG CCGs support ongoing development and increased functionality of the Connecting Care programme in support of improved access to information and strategic interoperability between health and care organisations across the geographic area Progress since the 2012 Informatics strategy The last strategy set out a number of objectives and an assessment of progress against these is shown in Appendix A. The tables have been completed by Bristol and South Gloucestershire CCGs using a desktop assessment of progress made against delivery. This was done to inform decisions about which activities need to be carried over into the plan. The tables were completed with input from the GP clinical leads and managerial leads at Bristol and South Gloucestershire CCGs. Whilst good progress was made against many of the strategic objectives set out in 2012, there are a number of areas where more limited progress has been made. As a number of strategic drivers have changed since then it is appropriate to consider whether they remain valid objectives, or are no longer appropriate. 22 nd March P age

16 5.4. CCG Strategic drivers As Informatics systems and solutions only exist to support the business needs of the organisation, it is important to understand what the current external and internal business drivers are. These are listed briefly below, with more detail provided in Appendix C External National drivers There are a number of external national drivers which inform the development of the Informatics Strategy and priorities for funding and development from now to Five Year Forward View (October 2014) and The Delivering the Forward View: NHS Planning Guidance 2016/17 to 2020/21; Personalised Health and Care 2020 (Appendix D) - Using Data and Technology to Transform Outcomes for Patients and Citizens - A Framework for Action (November 2014); The Care Act 2014; Building the NHS of the Five Year Forward View: NHS England Business Plan ; Requirements to develop Operating Plans for 2016/17 (incorporating the 9 must-do objectives required of each health system) and 5-year Sustainability and Transformation plans; Patient access to own records; Requirement to be paper-free at the point of care by 2020; National Financial and productivity challenges; National Information Board Interoperability Strategy; NHS England Interoperability Handbook; GP IT Operating Framework; Rightcare and Outcomes Based Commissioning; Lead Provider Framework; NHS England Digital Roadmap Requirements Local drivers More locally to Bristol and South Gloucestershire, a number of specific drivers have a direct impact on the Informatics strategy. The main ones are: The use of Information Technology as a key enabler for self-care in a number of specific areas such as: On-line self-assessment; Telemedicine monitoring and the use of prompts and feedback to patients in their own homes to promote self-care; Social prescribing; 22 nd March P age

17 A personalised patient-held record; Better patient access to information; Improved communications between patients and their GP; Greater involvement of patients in decision making about their care; Early identification about exacerbation of symptoms to ensure early intervention and reduced admissions to acute hospital settings. The informatics strategy presents an opportunity for doing things differently through the effective use of IT systems and solutions, helping Bristol and South Gloucestershire to achieve strategic objectives in improving health and care across the geographical area; Interoperability between health and care organisations in Bristol, North Somerset and South Gloucestershire (supported by Connecting Care); Activities and plans of other Health and Care partners within the footprint for production of the Digital Roadmap. These are: Partner CCGs o NHS North Somerset o NHS South Gloucestershire Providers o Avon and Wiltshire Mental Health Partnership NHS Trust o Bristol Community Partnership o North Bristol NHS Trust o North Somerset Community Partnership o One Care Consortium o Sirona Care & Health CIC o South Western Ambulance Service NHS Foundation Trust o University Hospitals Bristol NHS Foundation Trust o Weston Area Health NHS Trust o 104 General Practices Local Authorities o Bristol City Council o North Somerset Council o South Gloucestershire Council Local financial challenges including a significant savings challenge for Bristol and South Gloucestershire CCGs ( 25-30m) in addition to managing increasing demand for health care services; Internal drivers Stakeholder engagement carried out as part of the strategy development identified a number of internal drivers which help to inform the development of the Informatics Strategy and priorities for funding and development over the period to These are listed below: One Care and future plans, including the need to ensure sustainable support once the Prime Minister s Challenge Fund ceases; 22 nd March P age

18 Frustration with lack of consistent approach to mobile device allocation and management across the organisation; Lack of strategic approach to procurement of IT infrastructure and devices; Consideration of 3-tier approach to Business intelligence (core, shared and CCGspecific) as part of the Lead Provider Framework; Focus on improving electronic referrals from GPs to secondary care; Plans to work more flexibly including hot-desking at South Plaza; Desire to reduce/remove interdependency between estates and IT infrastructure; A requirement to strengthen the GP IT role and provision of additional support Vision and key objectives The informatics vision for Bristol and South Gloucestershire CCGs is to provide responsive, cutting edge IM&T support for excellent commissioning. In order to realise this vision, along with responding to other drivers and requirements set out by NHS England and the National Information Board, a focus on the delivery of a number of strategic informatics initiatives is now required. Key strategic objectives arising from this vision include: Improving the quality of health and social care services; Ensuring timely provision of information; Enabling a channel shift to the individual to promote self-care through greater access to clinical information; Maximising value for money and minimising costs through improving the efficiency of healthcare services; Recognition that healthcare services are provided across different care settings; Integrating information from disparate systems; Collaborating with partners to enable the sharing of clinical information and care plans appropriately and securely across care settings; Supporting patients right to appropriate and secure access to their clinical information; Providing appropriate clinical access (within information governance and data protection requirements) to patient information at the point of care, wherever that may be Digital Maturity Assessment Providers have recently undertaken a Digital Maturity Assessment as part of the work on Digital Roadmaps which is being progressed by NHS England. This has provided a useful baseline which describes the current position as well as a starting point for planning the future Digital Roadmap. 22 nd March P age

19 The current high-level assessment for organisations within the Digital Roadmap footprint (which includes Bristol and South Gloucestershire CCGs and all associated providers) is provided at Appendix E. It shows a range of maturity between and within provider organisations and is currently being used to inform development of the Digital Roadmaps which will be aligned with 5-year Sustainability and Transformation Plans due for publication in June The areas where the consolidated scores for the Digital Maturity footprint were marginally higher than the national average were: Resourcing; Governance; Decision Support; Asset and Resource Optimisation. The areas where the consolidated scores for the Digital Maturity footprint were marginally lower (within a 10% variation) than the national average were: Strategic Alignment; Information Governance; Records, Assessments and Plans; Medicines Management and Optimisation. The areas where the consolidated scores for the Digital Maturity footprint were significantly lower (greater than 10% variation) than the national average were: Leadership; Transfers of Care; Orders and Results Management; Remote and Assistive Care; Standards; Enabling Infrastructure. Whilst it is recognised that the local context and future plans need to be taken into account in making a meaningful evaluation of the data, it is perhaps an indication that these 6 areas are ones where future investment and focus may be required. In order to transform the way that healthcare organisations use technology to improve patient care and ensure more productive working, it is critical that these areas of lower digital maturity are addressed. There are also opportunities to share local best practice where one or more organisations is assessed as ahead of the national average position. The Digital Maturity Assessment will be used by NHS England, along with the Digital Roadmap, to assess candidates for investment in technology to help improve overall digital maturity across health and social care, though timescales are yet to be advised by NHSE. 22 nd March P age

20 5.7. CCG Challenges The CCGs have a number of specific challenges which the Informatics Strategy must help to address. These include: Supporting the health and well-being, financial, efficiency and care and quality objectives of the 5-year Sustainability and Transformation plan; Supporting the CCGs in delivering the NHS England 9 must dos in the 2016/17 NHS Planning Guidance; Achieving healthcare priorities, for example: o Premature mortality: Reduce premature deaths from cancer, heart disease stroke, lung disease and liver disease; o Inequalities: Reduce inequalities in healthy life expectancy and quality of life; o Prevention: Tackle harm caused by smoking, rising rates of obesity, diabetes, preventable sight loss and alcohol-related harm. Ensure a focus on prevention and early identification of ill health, in order to manage increasing demand; o Mental health: Reduce the suicide rate, halt the rising rates for self-harm and mental health conditions in children and young people; o Ageing population: Develop services that support the rising prevalence of frailty, dementia, multiple long term conditions and reduce excess winter deaths; o Health protection: Monitor and review systems to manage anti-microbial resistance, healthcare acquired infections; reduce HIV incidence rates and improve screening coverage; monitor and work to address TB rates. 22 nd March P age

21 6. Objectives and Principles of the Informatics Strategy The Informatics Strategy is focused on delivery of those activities which enable achievement of operational and strategic business objectives. Each objective has one or more outcomes/measures which can be monitored to identify successful delivery. In the context of the Informatics Strategy the activities planned over the next 5 years are essentially enablers for one or more business targets to be achieved. The methodology used in developing the strategy is briefly described in Appendix F Informatics Definition The knowledge, skills and tools which enable information to be collected, managed, used and shared safely to support the delivery of healthcare and promote health. This is illustrated below. Source: UK Council for Health Informatics Professionals. 22 nd March P age

22 6.2. Required outcomes Following engagement and ongoing dialogue with a number of stakeholders and stakeholder groups, a number of high-level priorities were identified. These reflect the areas in which, for a variety of reasons, the CCGs have not yet managed to implement optimal solutions and which therefore may threaten achievement of strategic operational, primary care and commissioning objectives Overall: The following outcomes are required within the CCG organisation, for GP computing, as well as across the wider community. There is a natural tension between business as usual service and developments due to resource levels being finite. Clarity is required about the level of resource required to run the day to day services, and the capacity/capability to deliver projects and developments; The need to ensure IT purchases are strategic rather than spot purchases or buying the latest gadget ; Productivity simple business processes need dramatic improvement through the use of efficient IT to maximise productivity and minimise duplication of effort; There is a need for greater synergy but reduced dependency between estates and IT; A requirement for reliable and resilient IT infrastructure and systems; Staff across health and care organisations need appropriate skills to use the tools provided; Clinical and administrative staff need access to the right information at the right time in the right place; Ideally organisations will have IT Infrastructure which is agnostic to the organisation s form and function; CSU SLA management and CCG Intelligent customer function needs some attention to ensure delivery of best value in IT services GP Computing: A number of specific needs can be identified in respect of GP computing: Supporting the move to 7 day access to Primary Care services; Maximising benefits from OneCare Artemis project, and putting in place sustainable support arrangements; Some possible risk to future GP Systems of Choice (GPSOC) funding has been identified. This needs to be clarified at the earliest opportunity; 22 nd March P age

23 Mobile devices for clinicians visiting patients in the community with access to Summary Care Records (SCR) and Electronic Prescription Service (EPS); Cross-organisation tasking (eg GP/Community); Consistent e-comms to all GPs; Patient access to GP healthcare records; Patient online access to appointment booking; Improved infrastructure such as wifi and cloud-based hosting CCG Business requirements: To enable to CCGs to function optimally, the following need to be addressed: Business Continuity and resilience for all IT infrastructure and solutions; The requirement for a more proactive IT Service; 24/7 on-call cover required for clinical services, and an on-call service in the event of a major incident being declared; Core IT service delivery/reliability systems and technology should just work ; Mobile devices access to systems and information from anywhere; Supporting the sustainability and green agenda; Staff training and organisational development; LPF for IT services and BI it is important to get this right and address some of the current challenges Strategic Interoperability: The CCGs should consider as part of the Digital Roadmap plans, how each stakeholder organisation across the area contributes to interoperability between clinical systems to support more integrated delivery of health and social care. This should include: Shared pathways and clinical documentation between health and care organisations and professionals; Collaborative support for any major systems implementation choice (eg Lorenzo, Medway, EMIS, IAPTUS); Seamless integration and connectivity; Strategic support across the community for patient self-care solutions; Strategic support across the community for agile working access to information from anywhere and any device to support clinical care, data input and decision making; Need to consider holistic view of the patient requires integrated information; 22 nd March P age

24 Connecting Care has made good progress but focus now needs to be on using it to enable stepped change in the way care is delivered across health and social care. This will require a commitment from all partners to make this happen; Refresh the strategy once Digital Roadmap is signed off as part of the STP Business Intelligence: Both South Gloucestershire and Bristol CGs use Avon Business Intelligence (ABI) to provide information to support planning and commissioning of services. However, ABI is not considered intuitive to use nor does it fully support commissioner requirements. To resolve this: Plans to migrate to a single version of the truth and one source of BI data should be developed; Big data and population-level studies linking NHS, Public Health and Social Care data should be explored; There should be a focus on data modelling and forecasting to support healthcare planning and commissioning; A BI solution should provide real-time access to information 24/7; A collective Data Quality improvement programme should be developed and implemented; Better risk stratification tools should be evaluated and procured; There is an emerging view that some CSU-based BI services need bringing into the CCG. These priorities have been presented back to a number of fora and they have been confirmed as accurately describing requirements for the IT systems and solutions to support the organisation s operational and strategic objectives Strategic principles In order to provide assurance about the benefit of investing in Informatics solutions, the following 6 underlying principles are recommended for adoption: Use of new technology (supported by appropriate training) should: Make it easier for staff to fulfil their duties and for patients to access their own record, and become active partners in their health and care; enable improvements in the delivery of high-quality care and maximising availability of clinical time to be spent with patients; enhance the ability to share information within and between health and social care organisations; make it easier for staff to do their jobs; 22 nd March P age

25 result in the consolidation of systems to minimise duplicate data entry; support near real-time reporting to support planning, management and delivery of high-quality services. Any business case for investment in Informatics solutions should be able to clearly evidence achievement of at least one of the above outcomes Strategic Informatics Aims The Strategic Informatics Aims can be summarised under one of the following headings: Clinical systems ensuring real-time capture and access to clinical records, regardless of location; BI and Performance to provide data, information, knowledge and wisdom in support of the planning, commissioning and management of care; Informatics Infrastructure which is reliable and securely accessible from any location; Strategic Interoperability to provide appropriate sharing of clinical information between multiple organisations involved in the health and social care of our patients; Capability and capacity so that there is internal and external expertise to support the ongoing running of systems and solutions, as well as research and development in opportunities for new solutions; Agile working to drive the most efficient and productive working arrangements across the whole workforce as part of improved health and wellbeing at work. Each of these areas relate to delivery of a range of activities which add strategic benefit and link with high-level corporate strategic objectives. It is important that investment in Informatics solutions is driven both by operational plans (to ensure that short-term, in year, requirements are satisfied) and by strategic plans (providing a roadmap to achieve longer term Objectives). The delivery of the Strategy is therefore considered across a number of phases: Phase 1 (2016/17) For the CCGs this phase incorporates a number of foundation activities, many of which are enablers for future strategic priorities: New BI solution via the Lead Provider Framework; BI/Analytics capability to be brought back into the CCGs; New risk stratification solution; IT Services partner specification via LPF; Digital Roadmap planning and approval; Technology refresh programme including a number of must-do upgrades; Planning for South Plaza move; 22 nd March P age

26 Planning for Virtual Desktop Infrastructure/Cloud solution; NHS Mail 2 planning and implementation; Productivity improvement planning and first wave implementation; Mobilisation of GP/CCG intranet (Artemis); Technical response to self-care strategy; Connecting Care roll-out (Stage 2 Platform enhancements, document sharing and new system interfaces); Connecting Care roll-out (Stage 3 Children's project). For Primary Care the majority of planned activities sit within Phase 1: Document sharing using Connecting Care; Clinical decision support solution; Providing patient access to own primary care records; Baseline assessment and strategy development for e-consultation; Establish EMIS reference group and optimisation programme, and start to implement it; Mandatory projects such as GP2GP, Electronic Care Record, EPS2, 7-day access to primary care, as well as any impact arising from the new GP IT Operating Framework due for publication in 2016; Windows server upgrades; Wifi in all GP practices; NHS Mail 2 planning and implementation Phase 2 (2017/ /19) Phase 2 for the CCGs has a small number of initiatives, though they are significant in impact: Implementation of South Plaza move; Implementation of Virtual Desktop Infrastructure/Cloud solution; Single sign-on solution; Second and third wave of implementation of productivity improvement; Connecting Care roll-out (Stage 4 optimisation and roll out to 10,000 active users). For GP practices, schemes identified so far for Phase 2 are: Implementation of e-consultation; Ongoing implementation of the EMIS optimisation Programme. Many of the Phase 1 activities are pre-requisites for the above schemes so any slippage on Phase 1 will impact delivery timescales for Phase nd March P age

27 Phase 3 (2019/ /21) Phase 3 for the CCGs has as its primary focus ongoing implementation of the Connecting Care Programme. For Primary Care the main priorities for Phase 3 are ongoing EMIS development and optimisation and completion of other schemes such as providing 7-day access. This should be reviewed in light of the new GP IT Operating Framework when it is published. The Strategy sets out the Objectives, Outcomes, Recommendations (which are key Enablers of delivery of objectives) and timescales across these three phases in sections 7 and nd March P age

28 7. Outcomes and Benefits Strategic Objectives define, at an organisational level, the scope of what the Strategy is designed to accomplish. For each Objective there are one or more Outcomes/Benefits associated with them. Outcomes are those things that we are expecting to change or be delivered in order to achieve the Objective High-level objectives The Strategy focuses on a number of specific Objectives that require systems and services to increase in maturity and interoperability in order to support taking the Individual and the Patient from being isolated to being informed, educated and empowered so as to maximise their role as a partner in their own healthcare. A number of high-level objectives have been identified as important for the CCGs: Objective 1 Providers deliver safe and effective care through an optimised, patient centric healthcare delivery system. By using technology to share relevant patient information, health and social care services are shifted from being centred on individual organisations to being centred on the patient. This enables the patient journey to be joined up across multiple health and social care settings and that journey to be more efficient, effective and economic driven by the needs of the patient rather than the needs of the health and social care organisations. Outcome Healthcare outcomes improved Objective 2 Patients are empowered and in control of their healthcare journey. If the patient can access, understand and add to their healthcare information (both care records and care plans), and that information is integrated across the healthcare journey(s) that they make, then they become more in control of their own healthcare. If context sensitive information is then related to their records and plans they are better informed in order to make meaningful and relevant decisions about their healthcare and treatment rather than simply satisfying the needs of the health and social care providers. Outcome Patient satisfaction increased Objective 3 Commissioners transform healthcare services as set out in the 5-year sustainability plan (which is in the process of being developed). Development of annual Operating Plan for 2016/2017 and the five-year sustainability plans should include future Informatics requirements. These should be closely aligned with the development of the Digital Roadmap due to be completed by June nd March P age

29 Outcome Year Strategic Plan on track Outcome 1.4 Achievement of paperless at the point of care by Year Strategic Plan on track Objective 4 Individuals are empowered and in control of their health and wellbeing. Individuals are empowered to make decisions and act on their health and wellbeing through the provision of appropriate information that is relevant to their personal circumstances. It is important that individuals are able to add to their health and wellbeing records and plans, including the addition of personal data (such as weight, blood pressure, diet, exercise etc.) which they are able to record themselves. Access to mobile apps that integrate with their health and wellbeing records further automate and add to the richness of their records. Individuals are increasingly empowered to take control of their own health and wellbeing. Outcome Individual satisfaction increased 7.2. More specific objectives A number of more detailed objectives are considered, with associated oucomes: Objective 5 - Safe & Effective Care Ability for providers to update and share their patients care records and care plans with each other. In order to increase health and social care providers ability to provide safe and effective care, it is important that they are able to share patient care records and plans with each other. This will also support the provision of efficient healthcare services. In order to achieve this, there is a requirement to increase the maturity of IM&T systems is to move them from silos of data to interoperable systems of information. For BSG this journey has already started with the Connecting Care Programme. Outcome Health outcomes improved Outcome Patient satisfaction increased Objective 6 - Patient in Control Patients have access to view & update their care records & plans with the ability to book their own appointments across care pathways. Patients become more in control of their healthcare journey when they have access to, and are able to update, their own care records and care plans and that these records and plans are based around their patient journey rather than the services provided by the organisations that hold the data. Outcome Health outcomes improved 22 nd March P age

30 Outcome Patient satisfaction increased Outcome Patient choice increased Objective 7 - Supported Self-care Patients have access to contextualised intelligence and decision support information with the ability to design & own their care plans. In order to increase the patient s ability to manage their own care, and in a way that is appropriate for them (rather than the health and social care service providers) patients need to have access to decision support information that is relevant to their condition and personal circumstances. They are then better informed to be able to design and take ownership of their own care plans. Outcome Health outcomes improved Outcome Patient satisfaction increased Outcome Patient choice Objective 8- Personalised Care Patients are able to select relevant services offered by a range of providers with the ability to share their care plans & records with them. Ultimately patients should be able to take control of their care records and plans and make them available to the providers of their healthcare services that they choose. Patients should have a choice of relevant online health and social care services and the ability to choose appropriate services that are relevant to their condition and personal circumstances. Outcome Health outcomes improved Outcome Patient satisfaction increased Outcome Patient choice Objective 9 - Sweating our IM&T Assets Maximise return on historic investment in Informatics systems and soltions. The NHS has invested significantly in local and national informatics solutions and services over the last decade. This objective is about maximising the return on that investment through a collaborative approach to sweating these assets. The more effective use of the informatics systems and solutions that is already available will also inform the requirements of a longer-term strategic informatics solution. Outcome Reduced cost Outcome Increased Return on Investment Objective 10 Research, Develop and Innovate 22 nd March P age

31 Research, develop and innovate to continually improve solutions and services based on leading-edge technology and experience. IM&T continues to evolve and develop at a significant pace. The NHS lags behind other industries in its effective use of technology. Investment in R&D, innovation and continual improvement is paramount if increasing demand on health and social care services is to be satisfied in the future. Outcome Improved efficiency Outcome Improved effectiveness Objective 11 - Benefits Driven Approach Maximise Return on Investment and value through a benefits driven approach. It is important that investment in IM&T solutions is driven by their contribution to the Objectives in the Strategy with a quantifiable benefit and return on investment. Benefits must be identified, quantified, managed and communicated. Being clear on the answer to the question What s in it for me? from every stakeholder s perspective will be the foundation of a benefits realisation plan that will ensure the Objectives are met and the value realised. Outcome Benefits achieved Outcome Greater stakeholder engagement Objective 12 - Awareness, Education and Training Ability for healthcare professionals, patients and individuals to make efficient and effective use of systems Education and training for health and social care professionals, patients and individuals is paramount if the IM&T systems procured and implemented are able to be used and put to good effect. While intuitive and user friendly systems are a design principle of the Strategy, a strategic approach to training and education in the use of IM&T solutions is required. A joined up approach to IM&T training for the individual and patient should be developed working with other government departments and industry sectors. Outcome Improved uptake and effective usage of IM&T systems Objective 13 - Health and Care Information Service Maximise the health and wellbeing of the local population through shared access to holistic patient and population level health and care information. An holistic information service that provides appropriate access to patient and population level information in order to support: Improving the health of the local population; 22 nd March P age