St Helens and Knowsley Health Informatics Service Strategy

Transcription

1 St Helens and Knowsley Health Informatics Service Strategy Informatics Strategy- Final July 2013 Version 2.0

2 Table of Contents 1. Executive Summary Introduction Strategy mapping Funding Informatics Strategy support for the Director of Informatics Approval and Actions Basis of Strategy Key Strategic Initiatives Informatics Strategy Key Outcomes Environment Strategy Results Strategic Objectives for Informatics Strategy Stages within horizon Strategic Futures and beyond... 9 Section Informatics Strategy Strategy Format Structure of document Section Informatics Strategy - Demand Demand The need for a dynamic service Development of Strategy via iterative discussion Halton, St Helens and Knowsley Local Health Community Context Foundational systems implemented in the period Prevailing situation Management of data and information Evolution of the Strategy Key Areas of Strategy Clinical Engagement Development of Core Support Systems Systems Integration System Resilience Systems Accessibility Section Informatics Strategy - Supply Supply Strategy for Supply Side Describing the Electronic Health Record (EHR) Components Marketplace dynamics applied to EHR Solution Suites Marketplace EHR vendor considerations Client Confidential - for internal use of St Helens & Knowsley Health Informatics Page 2

3 4.1.4 Single country solutions Extending reach for UK based solutions Single system to multiple countries Strategic choices for EHR adoption Potential Future Scenario Summary Systems Initiatives Clinical Engagement Core Support Systems System Integration System Resilience System Accessibility Enterprise Architecture System Topology Support for technical client diversity COIN services (Virtual private Cloud computing) Proactive monitored Infrastructure Remote technology and security Emerging Technology Impacts Mobile systems and BYOD related Data centre virtualisation and private cloud People Organisational structure IT Training Training objectives Benefits of effective IT Training Approach to Training Trainer Capabilities Timing of training IT Skilling levels Sourcing Broader Strategic Considerations Healthcare Provider Hype Cycle EHR system deployment is still maturing Related Analytics is predicted to be the next big thing Assistive technologies Typical Strategic timing considerations Informatics Strategy Major Systems Notes on Major Systems Section Informatics Strategy - Control Control Principles Key Aims, Principles, Decisions and Processes Client Confidential - for internal use of St Helens & Knowsley Health Informatics Page 3

4 5.1.2 Evolutionary nature of the Informatics Principles Service Delivery Principles within a broad ITIL Framework Areas of Proposed Principles Governance Executive Director HIS Board Organisational Implementation groups Services Provided by HIS HIS Staffing Risk and Issue Management Training Financial Management Investment Strategy Information Governance Information Governance Manager Information Governance process and escalation Performance Management Balanced Scorecard Benefits realisation Benefit Classifications Benchmarking and Best Practice Programme and Project Management Section Risks Risks Managing Strategic Risk Top Risk Areas identified Section Acute Care Acute Care Acute Care Clinical Engagement Development of Core Support Systems Systems Integration System Resilience Systems Accessibility Benefits of Strategy for Acute Care Acute Care Strategy Key Outcomes Mapping Acute Care Objectives to the Strategy Acute Care Objectives interaction with Primary, Community and Mental Healthcare 69 Section Primary Care Primary Care Client Confidential - for internal use of St Helens & Knowsley Health Informatics Page 4

5 8.1 Primary Care Benefits of Strategy for Primary Care Drivers for Primary Care Primary Care Strategy Key Outcomes Mapping Primary Care Objectives to the Strategy Primary Care Areas of functional scope Primary Care Information (non-clinical) Statutory Reporting: Provider of Services Information Provision to address evolving needs Support to GP practices and CCGs Information Governance The Scope of the Information Governance Strategy Section Community and Mental Healthcare Community and Mental Health Benefits of Strategy for Community and Mental Health Drivers for Community and Mental Health Mapping Community and Mental Health Care Objectives to the Strategy Community and Mental Health Strategy Key Outcomes Section Supplementary Information Supplementary Information Guiding Principles for operation of the HIS Data Quality Primary Data Quality Drivers Additional Data Quality Drivers Systems Access and Identity Flexible working methods Remote working Fitness for purpose of systems Systems Integration Big Data Delivery via web-based reporting Flexibility for changing organisational needs Data sharing Library and Knowledge Service support Knowledge and Training Service Communication to Patients Client Confidential - for internal use of St Helens & Knowsley Health Informatics Page 5

6 1. Executive Summary 1.1 Introduction The purpose of this strategy is to secure agreement between the organisations within the Halton, St Helens and Knowsley Local Health Community to the Informatics strategy for the period The business drivers leading to this strategy have been developed by local clinicians, health professionals and IM&T professionals. This strategy is one of a number of developments which will support the transition to new commissioning arrangements in the NHS. The capabilities provided in the strategy support Acute, Primary, Community and mental Health goals. This includes continued improvements to interoperability as well as specific initiatives targeting each of the constituent communities. In delivering this strategy, IM&T aims to support the delivery of strategic goals through: Provider Systems Provisioning: Provision of systems in line with the evolving needs of the Clinical 5 comprising Patient Administration Systems, Order Communications and Diagnostic Reporting, Discharge summaries with coding, Scheduling beds, tests and theatres medical early warning scores and eprescriptions. Patient centric care: Enablement of economy wide joined up patient care through systems integration, interoperability and information sharing across all providers and General Practices encompassing Primary, Community, Secondary, Mental Health, Out of Hours and Social Care services. Consistent links with CQUIN initiatives: A consistent approach within commissioning in the management of IM&T initiatives with providers in relation to Commissioning for Quality and Innovation Schemes (CQUIN). enotes - Modern system navigation supporting clinical pathways: Delivery of modern and innovative technology to support Interoperable electronic clinical recording, and clinical pathways. Improvements in Primary Care: Primary Care Informatics development and transformation in General Practice. Strong infrastructure: Delivery of a high performing, world-class standard technical infrastructure. Patient access: Enablement of patient access to health records, health advice and assistive living facilities and technology. GP Computing: GP IT operating model in improvement in primary care. Information provision: The provision of high quality information for primary and secondary use. Safe, secure systems: The delivery of safe, secure systems in compliance with all relevant Information Governance and Security standards This vision contributes to the direction of travel of the Local Health Economy (LHE) IM&T Strategy. It is essential that as IM&T Strategies are developed and delivered, they are in harmony with this vision and strategy to ensure connectedness and consistency between future Commissioning and Provider organisations. The strategy provides plans for direction and investment in IM&T over the next 3 years as well as preparing the way for the following strategic planning period. Client Confidential - for internal use of St Helens & Knowsley Health Informatics Page 1

7 1.2 Strategy mapping Using initiatives identified for the Acute area and Programmes from the Clinical Commissioning Groups (CCGs), all linked with the predicted benefits, it is possible to map benefits from the Informatics Strategy for The five principal Strategy initiative areas are illustrated on the diagram below: The above mapping illustrates support for the National Policy from the Government s White Paper, Equity and Excellence: liberating the NHS and subsequent local organisational change to respond to the future NHS structures. This informatics planning is aligned with primary, secondary, community and mental Health initiatives and the commissioning needs and intentions of CCGs. It is clear that information system provisioning will play a crucial enabling role in the future clinical, service and business planning throughout the St Helens and Knowsley Health Informatics environment We will need to continually exploit and develop relevant and sufficiently mature new technologies to ensure that systems are fit for purpose and meet the needs of clinicians and patients. This will include examination and introduction of new and emerging technologies supporting patient empowerment in areas such remote diagnostics and Telehealth. Client Confidential - for internal use of St Helens & Knowsley Health Informatics Page 2

8 1.3 Funding Overall, the Informatics programme and the Health Informatics Service will cost 9.5m per year. This money has already been committed by the local organisations through the HIS Board. The HIS will engage to contribute to efficiency savings for the stakeholder organisations and will consistently review staff and structure to accommodate future changes to funding and service provision. 1.4 Informatics Strategy support for the Director of Informatics This Strategy will support the Director of Informatics function in its management duty to understand, monitor and control all St Helens and Knowsley Health Informatics expenditure in a way that seeks optimum business support for minimum cost. The investment profile will continue to be one focused upon synergies and relevant consolidation of solutions, augmented by new logistical systems to support the workflow and Clinical Wrap for solutions. Before the start of the next strategy period, we will have reviewed our direction in light of business driver, which could include merger and acquisition based activities. 1.5 Approval and Actions Approval of the Strategy will be via the Halton, St Helens and Knowsley Local Health Community (LHC) HIS Board. The HIS Board is asked to approve this strategy and to support its dissemination throughout the local organisations. A summary slide presentation will be created and this paper includes additional supplements suitable for distribution to relevant communities of interest within the respective organisations. In approving the strategy the local organisations are asked to confirm to the HIS Board that they have the necessary internal mechanisms in place to ensure they can fulfil their obligations with regard to delivering the various initiatives. Client Confidential - for internal use of St Helens & Knowsley Health Informatics Page 3

9 1.6 Basis of Strategy The St Helens and Knowsley (STHK) Health Informatics Strategy has been developed to meet Business Objectives. It covers the period from 2013 to 2016, with a view forward into the next planning period. There have been distinct stages to the evolving IS Strategy, over the period from 2005 onwards. This can be summarised as follows: The St Helens and Knowsley Health Informatics track record in terms of both following the Strategy and keeping to implementation targets has been good and this next iteration should follow the same path. The preceding strategy has created a Foundational basis for the further work within this Strategic Planning horizon of The preceding period has created parts of the foundational solutions which are to be augmented in the period, and can be illustrated by the diagram below: The strategy continues to support improvements to integration, resilience and accessibility as well as providing vital capabilities around core support systems (passive systems). Together this provides underpinnings for additional systems supporting clinical engagement as well as providing greater interoperability for Primary and Community to Acute data and information. Client Confidential - for internal use of St Helens & Knowsley Health Informatics Page 4

10 1.6.1 Key Strategic Initiatives The Clinical Wrap and Logistical stages represent a major step in the evolution of St Helens and Knowsley Health Informatics: Firstly, it exploits the resilient and interoperable infrastructure platform created as a consequence of the previous strategy phase. We have good control of our systems estate and are consolidating onto a preferred sub-set of vendor solutions. Secondly, it supports a convergence agenda such that the relevant aspects of the separate clinical operational silos can become better integrated. This includes convergence for EDMS, PAS, Clinical Speciality Systems, Community, primary care and Knowledge systems. Thirdly, it provides a basis for solutions which can be reviewed at a future point, when certain key marketplace application solutions have been in use long enough to become viable options for selection. This can include the necessary reviews of Electronic Patient Record solutions based upon the maturing of marketplace solutions available. 1.7 Informatics Strategy Key Outcomes There are a range of stated Key Issues to be supported by the IS Strategy. For each of these areas, there is a preferred IS approach to ensure a good alignment of the Strategy with business needs, across all business areas supported. The areas are summarised in the following table: Each of the areas listed has been matched to the major initiatives planned within the strategy period. From this, the resultant initiatives have been grouped according to their area of greatest support for the strategy. Client Confidential - for internal use of St Helens & Knowsley Health Informatics Page 5

11 It should be noted that there will be other initiatives beyond the primary ones listed, but that the core direction is set by the core areas and their resultant demands. 1.8 Environment Strategy Results The strategy included the elements to create foundational systems and introduce consistent business solutions Core initiatives from the Strategy have created an environment as follows: This has foundations for the next stage of the strategy to be implemented. In particular: There has been good progress in secondary care to introduce the Clinical Five processes comprising Patient Administration, Order Communications and Diagnostic Reporting, Discharge Summaries with coding, Scheduling beds tests and theatres and eprescriptions. The basis of a GP Order Communications system and related Acute Ward order communications system has been introduced. This is in preparation for the extensions to Outpatients and GP and Community enhancements in the next stage of the strategy. The Acute and Community Maternity system has required some rescheduling from the original targets of the 2009 strategy, but by publication of this strategy will be implemented. The current interoperable solutions form a basis for next steps within the strategy Client Confidential - for internal use of St Helens & Knowsley Health Informatics Page 6

12 1.8.2 Strategic Objectives for The strategy further exploits the foundations created by the preceding strategy and additionally provides the basis for the logistical back-bone (enotes) and clinical wrap of solutions. It will position for a potentially broad range of future business directions by the end of the strategy period The strategy supporting this systems evolution will include the following key Components The approach will develop a series of Key Strategic Outcomes in support of business imperatives. Client Confidential - for internal use of St Helens & Knowsley Health Informatics Page 7

13 1.9 Informatics Strategy Stages within horizon Key NEW STRATEGY Area Approach Initiatives Realisation Strategy Outcome 2012/ / / /2016 Clinical Engagement - Clinically led Strategy Group Continuation of support for the Initial Clinical 5 Support Continuing Clinical 5 Implementations Clinical 5 - Raise the profile and Champion IT Order Communications/Ward Order Comms IP Order Comms OP Communications - Encourage involvement at all levels inc Clinician leadership at workstream level eprescribing started eprescribing continuation - Provide logistical continuity Creation of logistical systems Maternity System Maternity System to support clinical workflows Theatre System Bed Management / Whiteboards edischarge edischarge/ice Enhanced alerts Bar coding/event logging/timeline Core Supporting (Passive) Systems - Collaborative development of an EPR Development of EDMS and strategy review of practical options - Improvement of active, searchable systems - Further develop components of EDMS into Include EPR components, even EPR strategy ahead of a full system System Integration - Develop a strategy to integrate systems Development of Portal and Clinical Wrap - Retain and Develop systems that work well now - Aim to use consistent language across the health economy Include existing good systems and relevant extensions using approved infrastructure EDMS and Interactive EDMS developemnt Initial web portal care record ICU/Draeger Cancer Clinical Computer New A&E Extending EDMS Clinical Wrap/Portal ICU/Draeger Cancer Clinical Computer RFID equipment tagging EMEWS - early warning score Internal referrals: Sunquest ICE + incumbent GP OrderComm & edischarge enotes New A&E - Develop relevant cross system linkages Identify Priority areas for cross system links Links to Primary and Community Systems System Resilience - Understand and minimise the risk of developing new and existing systems - Develop a methodology to measure resilience against resources System Accessibility - Collaborative development of a mobile device strategy - Shared understanding of the different approaches required in inpatient and outpatient environments Patient Monitoring and Telehealth Create single signon processes to aid secure access Mobile device and Bring Your Own Device (BYOD) Support Patient Monitoring and Telehealth Community and Child Health systems Single signon Laboratory L2L Patient Monitoring and Telehealth Community and Child Health Systems Single signon Mobile devices and BYOD Client Confidential - for use of St Helens and Knowsley Health Informatics Page 8

14 1.10 Strategic Futures and beyond As with the preceding strategies, it is informative to examine the period towards the end of the Strategy. A range of possible scenarios could be envisaged and are summarised here: The purpose of the post 2016 Scenarios is to ensure that the Strategy is able to handle the most likely outcomes. The initial set provided here should be regarded as part of a planning framework for review by the Strategy Steering Group. Client Confidential - for use of St Helens and Knowsley Health Informatics Page 9

15 Section Informatics Strategy Client Confidential - for use of St Helens and Knowsley Health Informatics Page 10

16 2. Strategy Format This Informatics Strategy is a St Helens and Knowsley Health Informatics document developed for general communication and to provide a framework for IT developments. It is updated annually to support IT budgetary planning and periodically to reflect significant business and IT strategic changes. The Informatics Strategy covers the period from 2013 to It also covers indicative work beyond the 2016 time horizon in outline. 2.1 Structure of document The format of the main Strategy uses the sectional headings described in the table below. This is based upon the Gartner Strategy template, which has been created and is used as an example of best practice for communication of strategy. In addition to the executive summary section, there are separate sections for Demand side (what the business wants), Supply Side (how it will be provided) and Control (how the balance is created and managed). Supplements to the document contain further information, including a section for Risks and Issues and additional sections containing relevant information to clarify aspects of the strategy. Client Confidential - for use of St Helens and Knowsley Health Informatics Page 11

17 Section Informatics Strategy - Demand Client Confidential - for use of St Helens and Knowsley Health Informatics Page 12

18 3. Demand 3.1 The need for a dynamic service Informatics within the NHS is a dynamic service enabling excellent patient focused care along the various clinical pathways. A key direction for this strategy is to build on the investment and achievements of the previous strategy that delivered a robust infrastructure, consistent processes and a staffing structure to support the delivery of reliable and capable informatics services. St Helens & Knowsley Health Informatics has a good track record to create a strategy and then develop a suitable implementation path and this third wave of the modern strategies will build upon the foundational work achieved in the last iteration. In particular, this strategy will develop a range of logistical capabilities that can work alongside the clinical systems. A Clinical Wrap will be achieved by the end of the planning period, along with a range of options for further developments in light of emerging business needs. This strategy moves forward information delivery for the patient and the health professional in a dynamic way, reflecting both local and national drivers. It builds on the progress made over the previous four years and introduces new themes to maximise the delivery of excellent patient care. 3.2 Development of Strategy via iterative discussion The strategy has been developed through an iterative process of discussion, review of the current situation and assessment of the business drivers yields key areas, as follows: Client Confidential - for use of St Helens and Knowsley Health Informatics Page 13

19 3.3 Halton, St Helens and Knowsley Local Health Community Context For the purposes of this strategy Halton, St Helens and Knowsley LHC includes three metropolitan boroughs Halton CCG, St Helens CCG, Knowsley CCG, St Helens & Knowsley Teaching Hospitals NHS Trust, Bridgewater community Halton & St Helens Division and 5 Boroughs Partnership NHS Foundation Trust. The health community has 88 GP Practices. 55 Practices within Halton & St. Helens, 33 in Knowsley, including 8 Equitable Access Practices. Shared health informatics service was established in 2000 and restructured in 2004 to enable a new strategic direction for the health community informatics. The service has grown to accommodate the merger of the Halton and St Helens Primary care trust in 2007 and began providing ICT services to Five Boroughs partnership in The service has now matured, delivering to every type of NHS organisation, from Commissioners to Provider services, Primary, to Secondary care and mental health. Size of organisation Total population served St Helens & Knowsley Teaching Hospitals NHS Trust 420,000 Halton CCG 128,000 Knowsley CCG 161,000 St Helens CCG 192,000 Bridgewater Community Halton & St Helens. 315,000 5 Boroughs Partnership NHS Foundation Trust 978,700 Number of staff pan-health community 12,500 The fundamental components of the service have relied on a quality in house staff, industry standard ICT infrastructure, robust information systems, business processes and an overarching culture of delivery. Over the period of the last two issues of the strategy, the NHS organisations within the LHC have taken the strategic decision to work together on the development of informatics services which support the delivery of care. This has enabled development of a robust infrastructure, implement and operate effective IT solutions and to establish a strong Health Informatics Service (HIS), with the potential for structured and scalable expansion. Client Confidential - for use of St Helens and Knowsley Health Informatics Page 14

20 3.4 Foundational systems implemented in the period The preceding Foundational Strategy stage has seen the implementation of a range of solutions which form the basis of building blocks for the next stage. The local organisations have successfully implemented a range of information technology solutions including: a Community of Interest Network (COIN); VOIP telephony (Voice over Internet protocol telephony); an Executive Information System (EIS); an Electronic Document Management System (EDMS) solution; a Community and child health system; GP system hosting; Improved primary and secondary care interoperability; and a range of what were NPfIT (National Programme for IT) solutions including PACS (Picture Archiving and Communications System) and Choose & Book. 3.5 Prevailing situation The NHS organisations within the LHC have made significant progress in recent years with substantial reductions in access times for both primary and secondary care, improvements in patient services and the transition towards broader commissioning objectives. There has also been major reforms of the organisational structures with the creation and reorganisation of the Clinical Commissioning Groups (CCGs), the creation of arm s length provider services and significant service and estate rationalisation. It is anticipated that within this Strategy period there will be an increased emphasis on the ability to demonstrate value for money from the services offered and to prioritise investments. St Helens and Knowsley Health Informatics continues to concentrate upon quality and efficiency initiatives, through a focus on quality, innovation, productivity and prevention (QIPP). 3.6 Management of data and information The NHS recognizes the vital importance of access to accurate, reliable and timely information both on the front line of service delivery and throughout the management structures of the organisation. We must fulfill these obligations with regards to patient safety and clinical and corporate governance. Ongoing initiatives in the new strategic planning horizon incorporate extensions to the support already provided from the installed building blocks of EDMS. In addition, the revisions to strategy will need to identify any truly interim solutions provided related to access to data. This may be particularly the case when examining data related to performance targets, which may have been created rapidly to meet demand, but may now require a more consistent basis for ongoing use as a management and analytic tool. Client Confidential - for use of St Helens and Knowsley Health Informatics Page 15

21 3.7 Evolution of the Strategy The underpinning approach supported by the Strategy, across its iterations, is to develop a range of comprehensive capabilities in support of core themes, progressively raising their level. The themes in turn, support the evolving development of increasingly comprehensive and integrated capabilities for St Helens and Knowsley Health Informatics. The themes used in the Foundational stage were: Clinical Engagement: including positioning for the Clinical Wrap strategy Information Capture: the effective capture and retention of information) Information Delivery: distribution of information to the point where it is required; Communication: information to effectively communicate the key messages. The approach in the preceding strategy has developed the foundational frameworks which can now be further exploited by the introduction of the Logistical and Clinical Wrap capabilities. The Key areas are described as: Clinical Engagement: with clinician involvement to provide logistical continuity across clinical systems Development of Passive Systems: collaborative development of the Electronic Patient Record Strategy, including further development of EDMS components towards the EPR approach Systems Integration: Increased integration of systems including relevant cross system linkages to Primary and Community systems System Resilience: Balanced assessment of risks within the development and integration of new and existing systems. Systems Accessibility: Collaborative development of a mobile device strategy, along with customisations for differing environments (e.g. inpatient and outpatient) Client Confidential - for use of St Helens and Knowsley Health Informatics Page 16

22 3.8 Key Areas of Strategy Clinical Engagement The Clinical Engagement areas of the strategy will require clinician involvement to ensure that the solutions are designed in a manner that provides logistical continuity across clinical systems. The availability of useable, real-time, intelligent, patient-centred clinical systems provides the ability to transform the level of care delivered to patients. The approach is based on 2 fundamental elements: Clinical Content: the information building blocks. Essentially grouped/ categorised silos of clinical information which can be independently managed and supported. Clinical Wrap and enotes: The Intelligence that profiles the clinical content, schedules the information delivery and provides the interface and access logic to transform the information silos into health economy wide clinical knowledge. The local health community has silos of clinical information systems or clinical content, which are being built as a direct result of digital conversion from paper recording and manual processes through modernisation and business change to adopt more efficient standards. This digital conversion creates the content and if performed in conjunction with modernisation strategies, generates high quality and ongoing digital clinical information. As the modernisation and digital conversion cycles continue, the manual and paper processes are absorbed and converted to improve digital content and coverage. Within the Strategy, the refinements will take place as part of: Ongoing operational effectiveness within a current system Enhancements to functionality and/or data collection Modernisation to business or business processes within an organisation. Reconfiguration of business and services Targeted IM&T modernisation projects. Client Confidential - for use of St Helens and Knowsley Health Informatics Page 17

23 3.8.2 Development of Core Support Systems Core Support Systems (Sometimes referred to as Passive Systems ) include collaborative development towards the Electronic Patient Record, specifically featuring further development of EDMS components towards the EPR approach. There are a variety of systems included within this data capture area. Part of the challenge is to develop the capture mechanisms in a manner that fits with the processes undertaken by the relevant healthcare professionals. It is intended that new enotes systems should be introduced in a manner that augments rather than distracts current working processes. A range of systems in use which provide the core parts of the data capture process as illustrated: These systems have been established to a good quality during the preceding Strategy period. Client Confidential - for use of St Helens and Knowsley Health Informatics Page 18

24 In the Strategy, logistical links can be exploited, forming the basis for the Clinical Wrap. Category EDMS Patient Administration System (PAS) Clinical speciality systems Out of Hospital systems Knowledge, reference, governance and reporting Clinical system content Health Records, A&E CAS cards, Diabetes case notes Maternity case notes, sexual health notes potentially community documentation Patient Master Index, ADT, Order communications E documents, E Discharge, A&E / WIC Inpatient, Outpatient, Clinical coding, 18 weeks Pharmacy, Laboratory, Radiology, PACS Theatres, Maternity, Endoscopy, ECG ICU, Ophthalmology, Audiology GP systems, Child health, Community Information systems ESAP, Mental health systems, interim PAS /SQL systems Policy and procedures Library systems Evidence based web content Executive Information Systems for primary and secondary care NICE guidance Other approved external clinical reference When moving from foundational levels to logistical levels in the Strategy there is a need to build the relevant information in each category in a consistent manner with suitably aligned data content, data quality, timeliness and usability The workflow and logistical part of the Strategy expect to provide the relevant bridging processes, which can provide first the timing and sequencing prior to subsequent layering of clinical content Systems Integration This area encompasses increased integration of systems including relevant cross system linkages to Primary and Community systems. This approach continues to provide foundations for the exploitation of information technology with the installation of a robust network and the implementation of applications such as web portal technology, support and enhancement of Clinical 5, Community Information Systems and EIS platform reporting. Major initiatives over this Strategy period will include: The development of a generic digital clinical noting system - enotes The ongoing development of the COIN network; Practical use of Primary and secondary care information portals; Improvements to the LHC full health care record portal by integration of information systems between health organisations and councils, which can capitalise on the implementation of tele-health remote patient monitoring systems Changes and enhancements to the Community and Child health systems ; Client Confidential - for use of St Helens and Knowsley Health Informatics Page 19

25 Extending the use of the electronic medical early warning systems (emews); Extending the use of the Picture Archiving and Communications System (PACS); Extension of GP and secondary care communications systems; The ongoing development of the executive information system (EIS); Mobile app development and medical calculators System Resilience This area encompasses the range of capabilities required to protect the system and its use. By its nature, this area also incorporates some modernisation initiatives related to the underlying infrastructure. Example areas of improvement include: Hosting system modernisation and virtualised consolidation Improved desktop and mobile systems and their management Network (including telephony) improvements Archival of non-current records It will include assessment of risks within the development operational environment as well as the integration of new and existing systems. There will be particular considerations related to the adoption of new systems and technologies alongside the current environment, with an emphasis on non-disruptive working as well as ways to ensure that systems are straightforward to operate procedurally. Typical areas within this part of a strategy will also include sign-on (including simple single sign-on processes usable across the widest practical communities), data protection and general systems recoverability. Client Confidential - for use of St Helens and Knowsley Health Informatics Page 20

26 3.8.5 Systems Accessibility This area encompasses collaborative development of a mobile device strategy, along with customisation for differing environments (e.g. inpatient and outpatient). There are a wide range of new features that can be provided as a progressive deployment of improved accessibility. These include: Consistent single sign-in enotes clinical data capture GP view of Acute health records Core systems support including integration of EDMS towards EPR Relevant community care access to health records The introduction of patient access to relevant information The use of Health Information Portals Improved patient participation Patient self-management plans Use of other new information channels (supported by information technology) Client Confidential - for use of St Helens and Knowsley Health Informatics Page 21

27 Section Informatics Strategy - Supply Client Confidential - for use of St Helens and Knowsley Health Informatics Page 22

28 4. Supply The Supply areas comprise: Strategy for Supply Side IT Services Enterprise Architecture People Sourcing A typical strategy content for Supply side will include the Informatics solutions relevant to the organisation. An additional section is included describing the overarching strategy for the supply side and featuring commentary on the prevailing marketplace. This has a high relevance because of the emphasis within the strategy on the considerations around Electronic Healthcare Record (EHR). Client Confidential - for use of St Helens and Knowsley Health Informatics Page 23

29 4.1 Strategy for Supply Side The Strategic approach that has been developed over the last Strategy period and into the Strategy, is the progressive introduction of practical capabilities moving towards an Electronic Health Record system. The Strategy is being governed also by the practical rate of introduction of mature capabilities from marketplace products. As an interim approach, it is likely that there will be a continued emphasis on incremental solutions. The basic strategic approach has been summarised as follows: This illustrates that the functionality is being progressively introduced. An expanded version of the supply side model to support the capabilities described is as follows: Client Confidential - for use of St Helens and Knowsley Health Informatics Page 24

30 This model is consistent with well-recognised industry models for the core components of an Electronic Healthcare Record system. We are building towards this model, but taking a market-aware view of practical capabilities. This still raises challenges in the marketplace at because the varied solutions are still maturing towards the functionality required, as evidenced by various UK-based marketplace experiences in other health authorities Describing the Electronic Health Record (EHR) Components An enterprise EHR system is an integrated, not interfaced point-of-care system that provides functionality for an acute care facility and its attached ambulatory/outpatient clinics. The acute care functionality must include pharmacies. Such an enterprise EHR contains patient-centric, electronically maintained information about an individual's health status and care, focuses on tasks and events directly related to patient care, and is optimized for use by clinicians. The component parts can be described with reference to the above model, as follows: EHR system management Interoperability Data model Clinical decision support Client Confidential - for use of St Helens and Knowsley Health Informatics Page 25

31 Clinical workflow Clinical documentation and data capture Clinical display/dashboard enotes and Clinical wrap, which includes direct entry of orders, such as computerbased physician order entry (CPOE) or e-prescribing by physicians for medications and non- medications (for example, lab tests, radiology) A mature enterprise EHR system, in addition to the minimal requirements listed above, will cover the continuum of care emergency, intensive care units, operating theatre, behavioural health, maternity and delivery suites, and long-term care facilities. These point-of-care solutions must meet clinicians' requirements in taking care of patients, even when they aren't physically at a bedside or in a clinic room for example, by facilitating remote medication ordering, telemedicine and e-visits. Because there are many interrelated systems, conventional wisdom assumes there are advantages to having an integrated suite of systems. In practice, many of the additional systems required are not included in the strict definition of an EHR. Examples of exclusions are usually imaging (radiology and cardiac) and departmental systems such as laboratory or pathology. Furthermore, nonclinical functionality (such as financial, administrative, ERP and analytics) is not included in the base EHR definition. Client Confidential - for use of St Helens and Knowsley Health Informatics Page 26

32 4.1.2 Marketplace dynamics applied to EHR Solution Suites Despite increased interest in clinical automation, only a handful of vendors have successfully developed, marketed and sold an enterprise EHR system in more than one region. A challenge is the breadth of customisation of a core product required when moving it to a new territory (such as US systems being deployed in the UK). This can mean that areas of emphasis in the product set are aligned to common needs in a system that operates with Patient Billing or Pay for Performance as areas of extension. Some of these product adaptations do not fit well within the UK Marketplace Marketplace EHR vendor considerations EHR vendors include firms that sell only an EHR system, and "megasuite" vendors such as Cerner, Epic and Siemens that offer EHR systems and a broad range of other applications for hospitals (such as departmental, imaging, administrative, financial and analytic applications). Because of the huge R&D investments needed to meet the expectations of end users, only large, well-funded companies will likely be able to survive long term in the EHR market. Many companies have substantially underestimated the time and effort required to succeed in this market Single country solutions Many EHR vendors serve only one country. They often began selling administrative systems, and their products are designed to meet the specific administrative requirements of their countries (such as scheduling, coding, billing and reporting). However, these EHR offerings usually lack advanced features, such as medication order entry and clinical decision support. Client Confidential - for use of St Helens and Knowsley Health Informatics Page 27

33 4.1.5 Extending reach for UK based solutions To gain an international reach (e.g. to include the UK), some vendors have pursued a strategy of acquiring many single-country vendors for example, CompuGroup, isoft, McKesson and Shared Medical Systems (subsequently acquired by Siemens). These firms have tended to maintain their country-specific applications, making needed enhancements but not trying to move customers to a new global application. The risk of this strategy is that customers become impatient with the limitations of the country-specific EHRs, get tempted by the promise of more-advanced EHRs from global players and soon look to other vendors to support their needs Single system to multiple countries Another category of vendors is those that have built a single enterprise EHR system and deployed it in many countries for example, Alert, Agfa HealthCare, Allscripts, Cambio, Cerner, Epic, InterSystems, Meditech and Siemens. One of the biggest challenges these companies face is adapting their EHRs to meet the needs of different countries. Too often, they haven't taken this challenge seriously enough, resulting in deployment delays and disruption to customers' finances and business operations. This has been a specific challenge with some of the UK implementations of HER-based systems Strategic choices for EHR adoption We must scrutinise the vendors' history of modifying their applications for the needs of their environment. We should also join with their peers to build the necessary scale to make it financially worthwhile for EHR vendors to modify their applications and create an effective customer support model. These two points together suggest the need for caution and potentially a review when there is a more mature set of offerings and perhaps a larger target environment, perhaps as a consequence of business changes. The still evolving marketplace, coupled with the existing work on the Strategy suggests that an interim approach may be more appropriate at present. Broadly, this would allow the continued exploitation of existing initiatives, consistent with the move towards broadening functionality in line with the expected demands of an EHR environment. Such an approach would delay the point of a product selection, instead enhancing and adding to existing systems until the marketplace choices become clearer in the next 2-3 years. This would also give time to evaluate other future strategic scenarios which may also affect the wider St Helens and Knowsley Health Informatics environment. Client Confidential - for use of St Helens and Knowsley Health Informatics Page 28

34 4.1.8 Potential Future Scenario Summary Such potential future scenarios can be summarised as follows: The two situations together, namely the still evolving marketplace options and the possible variety of future options create a decision point potentially 2-3 years into the current Strategy period. At such a decision point, it should be practical to determine the appropriate business scenario and a related matured marketplace solution. Client Confidential - for use of St Helens and Knowsley Health Informatics Page 29

35 4.2 Systems Initiatives Stated first, these are the systems, which provide the support for the new and evolving initiatives within the Health Community. These have been divided into areas, which broadly track to the Key areas of the Strategy comprising: Each of the listed areas is first summarised in general terms and then a more detailed table of the constituent initiatives is listed. Client Confidential - for use of St Helens and Knowsley Health Informatics Page 30

36 4.2.1 Clinical Engagement Core Support Systems Client Confidential - for use of St Helens and Knowsley Health Informatics Page 31

37 4.2.3 System Integration System Resilience Client Confidential - for use of St Helens and Knowsley Health Informatics Page 32

38 4.2.5 System Accessibility Client Confidential - for use of St Helens and Knowsley Health Informatics Page 33

39 4.3 Enterprise Architecture The St Helens and Knowsley Health Informatics infrastructure has been developed over a long period of time to provide a resilient technology base which is progressively moving towards a Microsoft underpinning. As a general statement, the preferred technologies in use are Microsoft based which has simplified the interconnectivity of technology components. There are also other components, such as Oracle databases and limited Unix in the environment, but the intention of the Strategy has been simplification on product choices System Topology There are varied diagrams available to illustrate system topology. The one selected for an overview shows the main data centres, use of Storage Area Networks, support for data replication and the use of networking technologies to support the Primary Care and GP environments. Client Confidential - for use of St Helens and Knowsley Health Informatics Page 34

40 4.3.2 Support for technical client diversity A feature of the planned environment will be the extension of the technical client support available. Throughout the previous strategy, desktop and laptop devices were certain to be running Windows and would be configured according to the IT department s precise specifications. This has been based around Microsoft Windows and is progressively moving to a broader model that can also support thin clients (devices without full disk and software support requirements) and specialised devices (for dedicated purposes). There is also an increasing need to support new types of devices such as tablets and access to services from mobile devices such as phones. Today, however, the client-computing environment is poised to become an increasingly complex, diverse and changeable element of business infrastructure. The emerging strategy also includes specific consideration for these changes as part of the BYOD (Bring Your Own Device) initiative, which is becoming a commonplace requirement in many organisations. Overall the strategic ICT solutions delivered throughout this strategy will include, desktop virtualization, application mobility solutions, clinical software context and single sign on solutions enabling devices at every clinical location, from consulting room, to bedside to patient s home with the proliferation of Telehealth. All solutions will ensure: Availability: non-stop access to the clinical desktops and applications) Mobility: ability to access the desktops and applications from anywhere, using any devices, including tablet computers) Security: secure access to the desktops and data without limiting mobility and user experience) COIN services (Virtual private Cloud computing) Cloud computing is the use of computing resources (hardware and software) that are delivered as a service over a network. The name comes from the use of a cloud-shaped symbol as an abstraction for the complex infrastructure it contains in system diagrams. Cloud computing entrusts secure remote services with a user's data, software and computation. Client Confidential - for use of St Helens and Knowsley Health Informatics Page 35