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

41 End users access cloud-based applications through a web browser or a light-weight desktop or mobile application (app) while the business software and user's data are stored on servers at a remote location. We will continue to expand its infrastructure supporting and managing the virtual cloud hosting infrastructure and platforms that run the applications across the COIN for all its customers Proactive monitored Infrastructure Real-time monitoring enables us to quickly identify system vulnerabilities, enabling efficient proactive resolution. Remote monitoring utilises a secure, encrypted internet connection between a small software agent running on each device and the central monitoring server. This allows monitoring of critical systems on a 24/7 basis, giving a real-time view of device availability, performance data and utilisation statistics. Automatic alerts are issues when a defined threshold is breached meaning potential IT issues are addressed before they escalate into disruption and downtime Remote technology and security The HIS service will continue to deliver comprehensive, secure remote access to corporate and clinical resources for employees, partners, and vendors on managed and unmanaged PCs and mobile devices. Utilizing a combination of connectivity options, ranging from SSL VPN to Direct Access, as well as built in configurations and policies this will provide centralised and easy management of each organization's complete anywhere access offering. It will incorporate an understanding of the applications published, the state of health of the devices being used to gain access, and the individual user's identity and access privileges. Client Confidential - for use of St Helens and Knowsley Health Informatics Page 36

42 4.4 Emerging Technology Impacts Mobile systems and BYOD related Our Service is in common with many organisations having to face the challenges greater use of mobile technologies are introduced. These technologies (including BYOD) encompass a complex architecture: hardware, software and services that are consumer-driven, complicated by the need to provision and support a user workforce that wants a single device for business and personal use. Enterprise mobile systems are complex solutions that encompass at least three main technologies, including hardware, software and network services. Unlike other technologies in IT, a combination of these three capabilities is needed to create a specific enterprise solution. The fact that there are competing standards in most of these areas can make it even more difficult to create an enterprise solution. Gartner considers that the increased support of mobility in the enterprise is being driven by some key trends, which are common in enterprises worldwide. With the increased functionality of mobile smartphones and the popular introduction of media tablets, more companies are supporting mobile users and corporate data on a variety of platforms. It is observed that network traffic and usage that was once the primary domain of enterprise PCs is now shifting to the mobile device. A couple of major themes are emerging this in the wireless devices, software and services market. One is the increased use of mobile devices, smartphones and tablets, not just as communications devices, but as computing devices. Although still not common, enterprise information is slowly moving to these devices if not full-time, at least in part. Certain mobile user types are leaving behind their PCs for media tablets, as well as mobile workforce who primarily need messaging applications on the road or the mobile work force with cloud-based work force automation applications that work as if they were designed for this medium. Gartner sees a convergence in enterprise content, applications and the stores where apps reside to deliver them. Some key areas included on this year's Hype Cycle are: Bring Your Own Device (BYOD) Although there are different models for BYOD, the most common is enabling users to pay for their own smartphones and that have corporate . This is only the beginning of the BYOD revolution. Managed Mobility Services Companies don't have the resources or knowledge to manage the many aspects of the mobile enterprise (security, application development, and expense and device management) and are looking for companies that offer managed services in this market. Although this is a new and maturing space, it presents large growth opportunities. Enterprise App Stores Where once so long ago (last year) the emphasis was on mobile app stores, we are seeing a migration toward app stores to support mobile devices and PCs (laptops and desktops), as enterprises push toward a uniform method for supporting enterprise applications. Mobile Device Management (MDM) Interest in MDM continues for several reasons. During the past year, many companies have moved to Apple s ios as their main mobile device platform, with others to follow during the next 12 to 18 months, and these devices are more consumer-targeted than designed for the enterprise. Most companies started out supporting these devices, using the policies found in Exchange ActiveSync. As enterprises continue to offer multiplatform support, and new platforms continue to emerge, MDM continues to grow and to become the Client Confidential - for use of St Helens and Knowsley Health Informatics Page 37

43 technology choice. However, as MDM evolves into a broader platform that extends into security, content and application management, it will evolve into the next generation of MDM, which Gartner calls the enterprise mobile management system (EMMS). In the Gartner Hype Cycle, technologies are emerging to support mobile computing and communications for this new mobile age. It should be noted that this Hype Cycle is still crowded with initiatives, some of which have been maturing for a long time. Notably the BYOD initiatives are still at a peak of inflated expectations, partly a consequence of the crowded set of initiatives and many market players Data centre virtualisation and private cloud We are already adopting some of the concepts used in descriptions of cloud computing. The most notable is the transition towards improved virtualisation of certain computing services. A facet of cloud computing is that the terminology is being adjusted by the marketing departments of suppliers, based upon the perceived areas of success within cloud initiatives in the broader marketplace. This so named cloud-washing is the marketers attempt to broaden sales opportunities on the back of the cloud model. Gartner continues to track a hype cycle for this area but despite the market noise it is now clear that some areas are stabilizing as viable for business. User organisations are changing their buying behaviours, and, although it is unlikely that they will completely abandon on-premises models or soon buy complex, mission-critical processes as services through the cloud, there is a movement toward consuming services in a more cost-effective way and to enable capabilities not easily done elsewhere. The St Helens and Knowsley Health Informatics model is carefully tracking these developments and is positioned for improved virtualised services. These provide capabilities similar to those in a private cloud. The significance of this approach is that it retains controls Client Confidential - for use of St Helens and Knowsley Health Informatics Page 38

44 within the environment, thereby sidestepping some of the still-current issues affecting fully virtualised cloud services. This Gartner Hype Cycle for Cloud Computing identifies which aspects of cloud computing are still primarily in the hype stage, which applications/technologies are approaching significant adoption and which are reasonably mature. Early stable cloud areas are hosting, software as a service (SaaS) and virtualization.. The prevalence of inexpensive computing power, inexpensive bandwidth and companies that have developed extensive capabilities in managing large data centers are all relatively new and are all required for the cloud to come to fruition. 4.5 People Organisational structure Most people and organisational elements are described in the Control section of this Strategy. There are some specific IT related components, which are described within this section IT Training As a service all projects and plans are dependent on the use of the systems by staff and others across the health community. It is therefore essential to invest in all staff to ensure they make the best use of the systems available. Education and training are essential prerequisites for staff development. Education falls within the domain of the relevant ETD schema operated by the CCG for personal development. Client Confidential - for use of St Helens and Knowsley Health Informatics Page 39

45 Training on IT issues is a key success factor for the implementation of any information based system. The objective of the available training is to ensure that it is available to both IT Staff (for modernity) and to Healthcare staff (for effective use of the available systems) Training objectives The main objective is to ensure that training is: Of the highest quality. Available at the right time. Able to boost confidence on the use of systems. Maximising the use of IT systems. Perceived as an opportunity rather than a hindrance Benefits of effective IT Training Benefits of effective IT training include: Improvement of patient care. Round the clock on line access to patient s records. Awareness of technology with both clinical and non-clinical staff (research and general use internet etc.). Improvement of staff morale as they will have the knowledge to use systems to help carry out the duties of their role. Recording the correct data that accurately reflects the experience of patients. Consistent operational processes that can be successfully monitored and managed Approach to Training Role based training is an approach which will mean that training courses can be tailored to reflect the duties of each role. The continuing rollout of new and enhanced systems provides opportunities to deliver IT training for staff on the use of the new PAS, specific to their role. Using a phased programme, additional packages (e.g. , word processing) are being encompassed into the training. Refresher training will become significantly more important to the success of the service strategy. In general it has previously been neglected but if carried out effectively, it can provide the mechanism of ensuring that the knowledge and appreciation of issues is kept up to date. Often, staff can fall into using daily short cuts that they feel help speed up their use of systems. However, short cuts can result in information being incorrectly captured and therefore miss-reported. Refresher training needs to be supported as strongly as attendance on initial courses. Attendance is still required and assessment should be carried out on every delegate. Client Confidential - for use of St Helens and Knowsley Health Informatics Page 40

46 Every delegate will return for refresher training at least once per year, even if their role has not changed in that time. In addition, the IT Training Manager is to liaise with the Data Quality Team in order to discover if any users are consistently making errors with data collection etc. These members of staff will then be invited for refresher training and be provided with support from the training team until the situation has improved. The method of delivery for all courses that are provided will be structured in a consistent manner, ensuring that delegates become familiar with the formal approach to IT training. Course documentation/training manuals will be standardised and will include the following: Step by step/systematic descriptions of each field on relevant screens. Flow charts to aid the understanding of often complex processes. Data quality considerations and explanations. Question & Answer section. Areas will be provided within documents to enable delegates to make notes in the relevant locations. This will prove extremely useful to refer back to following return to the workplace. Scenarios that are relevant to specific roles. Documentation and on-line access to further resources are available to all delegates Trainer Capabilities An evaluation is to take place that will determine the skill levels of each trainer regarding both training techniques and knowledge of software packages. Once this information has been gathered, these skills will be levelled out and maximised, ensuring that all trainers will be competent to deliver all training courses that the IT Training service provides throughout the Health community. Trainers will be strongly supported in order to achieve recognised qualifications regarding their skills etc. This will be achieved on a rolling basis, ensuring that service delivery is constantly maintained. In addition to formal training sessions being available, an initiative is to be introduced that will entice users to seek guidance and support on the use of IT systems. Drop in sessions will be easily accessible to staff at lunchtimes across various locations. This service will be available to all staff and users will be able to receive help and advice on individual issues. Examples of this would include typing a letter, preparing a presentation etc. If certain issues become popular, mini training sessions can be provided that are tailored to the needs of a group of users. The aim is to develop the IT Trainers to become qualified ECDL trainers in order to become an ECDL accredited training centre making such courses more accessible to staff Timing of training The timeliness of IT training is a factor that needs to be considered. This is particularly pertinent regarding new starters both to the organisation and to the individual role. It is essential to provide training as early as possible to avoid staff having to seek guidance from elsewhere. Managers will be able to co-ordinate attendance for staff on relevant courses through the IT training administrator. This process is currently in operation; however, there is scope for improvement regarding the timeliness of notification from managers and methods of notification. IT training should be considered as an essential part of the training provided for all new staff to ensure that they are able to carry out the duties of their post effectively. Client Confidential - for use of St Helens and Knowsley Health Informatics Page 41

47 IT Skilling levels In addition to the training provided for Healthcare professionals, there is an ongoing need to ensure that IT staff are trained in the relevant systems and approaches to an appropriate level. This will ensure that IT skills are refreshed and kept modern. Key areas for consideration around this include: Appropriate skilling to support designated CMMI Levels (3 plus) Use at relevant levels of PRINCE2 Project and Programme disciplines Use of ITIL for maturity of IS/IT Processes Specific technical disciplines, particularly those related to use of selected Microsoft product sets and relevant business packages. 4.7 Sourcing The plan, within the IS Strategy period, is for the environment to continue to be run as a wholly insourced environment supported by St Helens and Knowsley Health Informatics. Client Confidential - for use of St Helens and Knowsley Health Informatics Page 42

48 4.8 Broader Strategic Considerations The decisions about the form and direction of the St Helens and Knowsley Health Informatics Strategy are driven from business need. There are decisions which will need to be taken in the latter half of the Strategy period related to selection of potential new suites to support the EPR related initiatives. These decisions should be made in light of the current backdrop of support solutions available to Healthcare Delivery Organisations (HDOs) based upon the prevailing Gartner technology Hype Cycle Healthcare Provider Hype Cycle The Gartner Healthcare Hype Cycle examines a wide range of potential solution areas for their applicability to a Healthcare Provider Organisation. It can be seen that there are many areas of solution that are still emerging for maturity. The solutions may also often be available in one territory ahead of others (often the USA). There are two key areas of particular note for St Helens and Knowsley Health Informatics EHR system deployment is still maturing Deploying EHR systems and optimizing their value remain a top priority for HDOs as the leading healthcare mega suite vendors round out their clinical, access and revenue management capabilities. As can be seen from the July 2012 diagram, the maturity of HER is occurring over the next 2-5 year period. Client Confidential - for use of St Helens and Knowsley Health Informatics Page 43

49 EHR-integrated capabilities for specific settings that require more than just the general functionality for lower-acuity hospital wards are maturing, but only for a subset of the overall EHR vendor landscape. The expectation and related maturity and scope evaluation criteria should be included in future EHR system RFPs. The same is true for integrated patient access and revenue management functionality from mega suite vendors. In other arenas, entrepreneurial specialists are competing with mega suite vendors for attention and market share. In the more uncharted waters of new ideas for managing hospital operations and support for chronic care coordination and population health management, a familiar cycle should be expected. In general, the first to have targeted offerings are entrepreneurs and best-ofbreeders, but HDO executives will continue to encourage mega suite vendors to take on new challenges, and they will prefer integrated versions if and when they are "good enough" 4.9 Related Analytics is predicted to be the next big thing Inevitably and appropriately, healthcare is catching up with other industries in its demand for more timely and robust performance analytics and dashboards. The double triggers will be the availability of rich data from the EHR system, and the increased internal and external demands for information to aid conformity to care standards and business best practices. There are also emerging new best practices in BI (logical data warehouse), but a related state of hype and future potential around so called big data providing comprehensive analytical data Assistive technologies There will be a rapid acceleration in the use of assistive technologies in the NHS, with the NHS aim to improve at least 3 million lives over the next five years. This will have a natural impact within the Informatics Strategy, where considerations will include further adoption of: Telemedicine: examples such as remote radiology and access to digital x-rays in outreach locations for patients. Telehealth and Telecare: subject to evaluations of equipment, cost benefit analysis and the related aspects of equipment, training and new procedures not covered by NTAC for introduction. Examples of such technologies can include non-invasive cardiac output measurement technologies such as Oesophageal Doppler Monitoring (CARDIOQ-ODM monitor) and Pulse Pressure Waveform Analysis technology devices. These are specialised equipment which requires new training regimes, as well as IS validation for suitability within the prevailing technology infrastructure. Client Confidential - for use of St Helens and Knowsley Health Informatics Page 44

50 4.11 Typical Strategic timing considerations Gartner arranges the elements of the Hype Cycle into a Priority Matrix to support strategic decision making related to choice of functionality based upon marketplace maturity. A version of the most up-to-date chart is as follows: The above diagram provides general guidance for the ordering of new solution areas, based upon marketplace readiness and in turn, cost effectiveness. Client Confidential - for use of St Helens and Knowsley Health Informatics Page 45

51 4.12 Informatics Strategy Major Systems Client Confidential - for use of St Helens and Knowsley Health Informatics Page 46

52 Notes on Major Systems Clinical Engagement related: Clinical 5 Implementation: This is well under way, but will continue to be enhanced during the Strategy period Order Communications : This has already been partly implemented, but there are significant uplifts to capability during the Strategy period eprescribing: This was evaluated in the previous strategy period. There were gaps to capability which can be better addressed in the new Strategy period. Maternity Systems: This will have been largely implemented in the previous planning period. New capabilities around Bed Management will add to functionality Theatre System: An evaluation of technical capability has already taken place. It is now planned to introduce new interfaces and capabilities during the Strategy period. EMEWS monitoring system: Procure and implement Electronic Medical Early Warning Score (EMEWS) system to enable capture of clinical observations and predictions. edischarge/ice: This has been partly implemented. Further enhancements will take place during the Strategy period. Core Systems Systems related: EDMS: The foundational system has been introduced and is working. Further extensions will take place in the new Strategy period. This will include using EDMS within internal referrals. enotes: This provides a new capability which will be a way to begin to capture information electronically ahead of a revision to the EPR Strategy. Primary Care Systems related Primary care systems of choice and interoperability including capabilities in areas of Core and Mandated services, Discretionary services and General Practice business systems support. Client Confidential - for use of St Helens and Knowsley Health Informatics Page 47

53 Systems Integration related: Clinical Wrap/ Portal: This will be an extended concept augmenting and in some cases replacing parts of the existing web portal capability. The included web portal based care record will be another building block towards the EPR design approach. Existing systems additions and developments: To further exploit capabilities introduced during the last strategy, certain key systems such as ICU Draeger, Laboratory Lab to Lab and a new Accident and Emergency capability will be introduced. Patient Monitoring and Telehealth : There will be extended links to patient monitoring systems to provide links to Primary, Secondary and Community Systems Systems Resilience A new single sign-on has been introduced. This will be extended for new device types and solutions as they come on-stream. Systems Accessibility Mobile devices and Bring Your Own Device (BYOD): This is an emerging area, with requirements for capabilities amongst healthcare professionals and beyond into patent areas. A strategy and implementation roll-out will form part of the Strategy Client Confidential - for use of St Helens and Knowsley Health Informatics Page 48

54 Section Informatics Strategy - Control Client Confidential - for use of St Helens and Knowsley Health Informatics Page 49

55 5. Control Principles Governance Financial Management Metrics 5.1 Principles Key Aims, Principles, Decisions and Processes The intended control processes for use within Informatics have been created from Key Aims (which determine Informatics Goals), through Principles (which inform decisions) and then into Processes (which drive outcomes) The intention is that the Informatics Strategy and related Principles will set a direction and that the service providers will then be able to create relevant processes to operate against the Principles Evolutionary nature of the Informatics Principles The Informatics Principles support the core strategy and are also used to underpin direction and decisions related to new technology selections. There will be an evolution of these principles as the Strategy matures. Key enabling elements for the delivery of the Strategy include: The Principles will include: IM&T needs to enable and facilitate the organisational aims of providers and commissioners both corporately and clinically. IM&T needs to enable interoperable health economy working. IM&T being seen as an enabler, not a blocker of transformational development and operating in the background underpinning and supporting service redesign and transformation. Client Confidential - for use of St Helens and Knowsley Health Informatics Page 50

56 5.1.3 Service Delivery Principles within a broad ITIL Framework The intent is to continue operating to an ITIL V3 based model and with relevant Service Level Agreements and Operational Level Agreements, supported via a Service Catalogue. At a broad principles level, St Helens and Knowsley Health Informatics is developing a range of IS Principles, which are to be published as part of the overarching Governance process. Client Confidential - for use of St Helens and Knowsley Health Informatics Page 51

57 5.1.4 Areas of Proposed Principles This includes proposed Principles for the following areas: Principles Business Process BP01 IS/IT assets are an organisation wide business resource BP02 Common Services, Reuse and Sharing BP03 Reuse and Buy before Build BP04 Compliance with Laws and Regulations BP05 Compliance with STHK Policies and Standards BP06 Design for Service BP07 Business Continuity / Disaster Recovery BP08 Optimise Non-discretionary Investments BP09 Partitioning and Decoupling Of Application Components BP10 Alignment of business processes to ERP / COTS products BP11 Life-cycle management BP12 Support for increasing delivery channels Applications AP01 Application Flexibility and Agility AP02 Patterns and Frameworks AP03 Open Standards and Interoperability AP04 Use of Industry-proven Technology AP05 Automated Component Management Data and Information DP01 Data is an asset DP02 Data is shared DP03 Data is accessible DP04 Common Vocabulary and Data Definitions Security SEC01 Level of Security SEC02 Security Control Management SEC03 Security Planning SEC04 Information Security SEC05 Security Control Default SEC06 Security, Confidentiality, Privacy and Protection of Information SEC07 Security Boundaries Governance GOV01 Value Driven Governance GOV02 Make Governance Easy GOV03 Adherence to Technology Frameworks, Policies & Directions Client Confidential - for use of St Helens and Knowsley Health Informatics Page 52

58 5.2 Governance Executive Director The St Helens and Knowsley HIS is hosted by St Helens & Knowsley Teaching Hospitals NHS Trust and is led by an Executive Director of Informatics HIS Board The HIS Board represents NHS Halton CCG, NHS St Helens CCG, NHS Knowsley CCG, St Helens & Knowsley Teaching Hospitals NHS Trust, 5 Boroughs Partnership NHS Foundation Trust, Bridgewater Halton & St Helens Division, and ratifies through this plan the strategic direction of IM&T across the LHC. Its membership comprises of senior members of each organisation, including non-executives and clinical representation. The Board meets monthly and is a sub-group of each of the organisations governance structures Organisational Implementation groups All stakeholders have, or are in the process of establishing, local Implementation Planning Boards / steering groups which oversee the implementation of the strategy in the local context to the organisation. In the St Helens and Knowsley Teaching Hospital, an overarching Clinical informatics committee has been established to engage and drive through strategy and clinical system development, as well as specific project boards established to provide governance and scrutiny on a project by project basis Services Provided by HIS The table outlines the services provided by the HIS to each of its customers. Client Confidential - for use of St Helens and Knowsley Health Informatics Page 53

59 5.3 HIS Staffing The HIS is structured into the following service delivery teams: Informations Communications Technology IT Operations IT Networks IT Development Systems Intelligence Executive Information Systems Data Quality Information Governance Systems and Training Programme Team Portfolio Management Project Management Primary Care Support for Primary Care Projects Knowledge and Library Services Documentations Support Communications 5.4 Risk and Issue Management The management of project and programme risks and issues is essential to the effective delivery of any IT related development. Risks and Issues will be captured in logs and escalated as appropriate to ensure timely resolution or management by the respective responsible officer or organisations. 5.5 Training The IT training section continues to demonstrate improving effectiveness in meeting learners needs. The approach is to consolidate IT system training into the main stream agenda by ensuring that it is owned by line managers. Its focus will be on learning outcomes which are clearly linked to the Knowledge Skills Framework (KSF). This begins with Awareness Raising pre-delivery and goes through to on-going Refresher Training post-delivery. Introduction of three tiered evaluation conducted between line manager and training team supports this process: First level immediate response to the training (including any briefing and awareness sessions). Second level evaluation pre-go live completed with line manager and staff. The line manager will feed back any further training needs to the training department in order for them to be addressed. Third level evaluation the purpose of this is to assess the staff s competence to use the system. Training will be reviewed to customers have easy access to different learning resources (e.g. e-learning, video delivery, streaming media, webinars and tutorials) accompanied by suitable classroom training when needed. Client Confidential - for use of St Helens and Knowsley Health Informatics Page 54

60 5.6 Financial Management Informatics total cost of ownership (TCO) will to be an important metric of efficiency. The Informatics Strategy will support the CIO function in its management duty to understand, monitor and control all Informatics expenditure in a way that seeks optimum business support for minimum cost. This is only possible with direct sight of, and ability to influence, all sources of IT cost within the business Investment Strategy The Informatics Strategy aims to: Manage the efficiency and delivery from existing environments. Continue the processes and direction set from the previous strategy Foundational work Review cautiously the introduction of any new all-embracing technology solutions, in light of experiences from the national initiatives which have illustrated that there is still some immaturity in solutions offered. Continue to rationalize the software and infrastructure supported in line with the preferred technical selections. To use the economies of scale (both in licencing and support) based upon consolidated solutions sets. Provide relevant reporting systems to ensure that Management and Business Information becomes available to make timely decisions related to investment. We will also consider cost savings and will create the metrics and business information to support this. The investment profile will move to one focused upon synergies and relevant consolidation of solutions, based upon a modern technology platform. Client Confidential - for use of St Helens and Knowsley Health Informatics Page 55

61 5.7 Information Governance Information Governance will be a key aspect of the Strategy, because of the interlinking of systems and provision of Clinical Wrap. The approach during this strategy cycle will also set direction for the subsequent cycle Information Governance Manager An HIS Information Governance Manager must support these roles including the following duties: To integrate with the existing Information Governance structures in the Trusts, providing expert advice and assistance To represent the Health Informatics Service in relation to Information Governance issues. To liaise with the Trusts Information Governance Managers and will provide advice on any relevant Information Governance, Data Protection and Freedom of Information issues as and when required. To act as the designated role of Information Governance Manager for St Helens & Knowsley Teaching Hospitals Trust. To support responsibilities to the organisation to include IG Management, implementation of the IG Framework, development of the IG Strategy and Policies and co- ordination of the IG Steering Group agenda and remit Information Governance process and escalation The continuing focus upon Information processes and governance requires specific exercise of duties and escalations as follows: The Local Health Community Caldicott Guardians and Information Governance Groups will be informed where any relevant Information Governance issues or risks come to the attention of the HIS. Relevant Policy documents will be provided to the Information Governance Groups for adoption and approval The Trusts Information Governance Groups will have ultimate responsibility for overseeing the implementation of the Information Governance Framework, and relevant Information Governance Strategy, Policies and Action Plans in their organisations. The HIS Information Governance Manager will attend group meetings and participate in the agenda. The Trusts annual Information Governance Toolkit return will be submitted by the HIS IG Manager to Connecting for Health prior to the 31 March where required. The Trusts Information Governance Steering Group will seek Trust Board sign off prior to submission Where the HIS has an identified responsibility to provide specified attainment levels and evidence to support the submission of the Trusts Information Governance toolkit, the HIS Information Governance Manager will co-ordinate the response to the Information Governance Steering Groups. Client Confidential - for use of St Helens and Knowsley Health Informatics Page 56

62 5.8 Performance Management Balanced Scorecard Performance Management of the HIS service is the responsibility of the Director of Informatics. The service will be monitored using the following balanced scorecard approach: This is a conventional Balanced Scorecard and can be tuned to manage the areas requiring the greatest attention as part of the Strategy. Typical performance metrics are used with the Balanced Scorecard, as follows: Service Delivery: Unplanned downtime during period Compliance with agreed downtime targets First line resolution of service desk calls Achievement of issues resolution targets (Cat 1 = x hours, etc.) Programme and Project Management Delivery of projects within agreed timescale and budget Benefits realisation People Staff turnover and sickness rates Productivity measures (number of desktops supported per WTE, service desk calls per WTE) Finance Delivery of the HIS service within contracted funding levels Customer Satisfaction Formal customer feedback (survey result) Informal customer feedback Level of complaints Client Confidential - for use of St Helens and Knowsley Health Informatics Page 57

63 5.9 Benefits realisation Benefits realisation is a critical element of any programme management structure and the HIS will work closely with individual stakeholders to both capture and demonstrate the benefits that are being accrued from the respective investment in Informatics services Benefit Classifications An additional form of performance management may involve the use of Benefit Classifications. A typical set of benefit classifications are illustrated below: Benefit Area Cost reduction Improved Business Functionality Platform For Change Reduced Risk Increased Manageability and Control Description Classification of an initiative in terms of its ability to provide cost reduction. This may be easier to translate for new business solutions compared with infrastructural cases. Classification in terms of improvements to business functionality. This can include new ways to work and would be likely to assess the effect of the wrap-around change created by the new process. Classification in terms of the ability of the new initiative to introduce viable changes to working processes. This can lead to savings in business processes away from the specifics of the technology used Classification in terms of risk reduction. This is also applicable to many of the security needs and related resilience solutions, which may carry specific demands in the Healthcare environment. Classification in terms of new management, metrics and business information. Moving into the logistical and workflow aspects of the new Strategy will create new metrics in this area. Overall management must ensure that the governance tracks and measures the impact against each of the planned benefit areas. This will also be tracked as part of the initial Portfolio Management stage. Client Confidential - for use of St Helens and Knowsley Health Informatics Page 58

64 5.10 Benchmarking and Best Practice The HIS will participate with NHS Infrastructure Maturity Model (NIMM), the Local Health Community IM&T Self-Assessment tool (LISA) and the Organisational Readiness Assurance Model (ORAM). The aim of this work is to provide a grading of our services against a national framework for the benchmarking and accreditation of NHS Health Informatics providers. It includes developing a set of indicators of quality and metrics that will be relevant to managed or shared services, single site services and any other types of service Programme and Project Management Programmes and projects delivered by the HIS are managed in line with PRINCE2 methodology, adapted to suit the requirements, size and scale of each individual project. The following standard processes will be followed Project Initiation Document Business Case Information governance impact assessment Project plan with programme plan dependencies Benefits Management The HIS Board will approve and oversee the informatics programme across the LHC and it is therefore essential that all stakeholder organisations are suitably represented at this Board. Client Confidential - for use of St Helens and Knowsley Health Informatics Page 59

65 Section Risks Client Confidential - for use of St Helens and Knowsley Health Informatics Page 60

66 6. Risks 6.2 Managing Strategic Risk Any strategy will have its share of risks and assumptions for management throughout the duration of the implementation. It is also customary to review risks and assumptions on a regular process within the Governance processes. In the case of this Informatics Strategy, it is clear that there is an existing strong track record of previous delivery, but that there will be additional challenges during the next stage of the strategy. A simple risk grid is proposed as a basis for identification of the top few risks, and this has been pre-populated with a Top Ten list of risk areas requiring careful management. Routine risks would be handled at a day-to-day level. Operationally visible risks would be reported at governance sessions The few High Focus risks will receive top level visibility. An early governance review of the Strategy should also be used to define a broader single, prioritised list of risks from the strategy, for ongoing management. Client Confidential - for use of St Helens and Knowsley Health Informatics Page 61

67 6.3 Top Risk Areas identified Provisional Top 10 risks identified are as shown in the diagram below: Descriptions of the risks are listed below: Ref LevelStrategy Area Summary Description Impact Areas Affected 1 1 Passive Systems EPR Marketplace Immature Maturity of EPR software in market limits practical choices until High All 2 1 All Strategic scenarios Possible variation in STHK strategy linked with merger or acquisitional High All behaviours 3 2 Accessibility Emerging BYOD area will require Management of BYOD infrastructure will require new technology and Medium All new infrastructure support 4 2 Core Support Systems Fragmented records require Processes to clean an validate data to achieve consistency will require Medium All cleansing additional effort 5 1 Clinical Engagement New processes must complement Adoption will be hindered if new processes are not produced Medium All approach consultatively 6 2 Systems Integration Multiple Community Multiple variants of solutions will need rationalisation Medium Community Infrastructures 7 2 Systems Integration Multiple GP Infrastrcutures Multiple variants of solutions will need rationalisation Medium GP 8 2 Systems Integration Silos need reduction Strategy plans to handle silo reduction Medium All 9 2 Systems Integration Non standard pathways Pathway standardisation will need focus Medium All 10 2 Systems Integration Incompatible Infrastructures Hot spots of incompatibility will require urgent attention Medium Community 11 3 Passive Systems Incomplete Information Data integrity will require ongoing attention and may need a project Low Community 12 3 All Emerging new technologies Manage via strategy watch process Medium All 13 1 All Portfolio Management Improved Portfolio management across Acute, Primary and Medium All Community areas 14 3 All Portfolio Costing and Benefits Management With many initatives in the future strategy, it is important to manage prioritisation based upon cost/benefit or similar processes Medium All Client Confidential - for use of St Helens and Knowsley Health Informatics Page 62

68 Section Acute Care Client Confidential - for use of St Helens and Knowsley Health Informatics Page 63

69 7. Acute Care 7.1 Acute Care Hospitals are managed by acute trusts. The acute systems provide clinical and administrative support to ensure the provision of high quality healthcare. Acute systems are also supported by a large proportion of the NHS workforce both directly involved in front-line healthcare and in the support services to ensure a smooth and effective organisation. 7.2 Clinical Engagement Many aspects of the Strategy provide support to Acute Care. The availability of useable, real-time, intelligent, patient-centred clinical systems provides the ability to transform the level of care delivered to patients. Work on clinical support has proceeded in the prior strategy with the introduction of support for the Clinical 5 processes of Patient Administration Systems, Order Communications and Diagnostic Reporting, Discharge summaries with coding, Scheduling beds, tests and theatres and eprescriptions. The next stage is based upon two fundamental elements: Clinical Content: the information building blocks. Essentially grouped/ categorised silos of clinical information which can be independently managed and supported. Clinical Wrap: 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. As the modernisation and digital conversion cycles continue, manual and paper processes will be absorbed and converted to improve digital content and coverage. Within the IS 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. 7.3 Development of Core Support Systems There will be continuing collaborative development towards creation of 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 which fits with the processes undertaken by the relevant healthcare professionals. It is intended that new systems should be introduced in a manner that augments rather than distracts current working processes and for the immediate strategy period this will build on systems already in use. At an appropriate time (probably in 2015), a review of the still maturing additional marketplace solutions will take place Client Confidential - for use of St Helens and Knowsley Health Informatics Page 64

70 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. 7.4 Systems Integration The systems integration 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: Extending the use of the electronic document management system (EDMS); Extensions to real time admission, discharge and transfer (ADT) functionality; Extending the use of the Picture Archiving and Communications System (PACS); Extension of GP and secondary care order communications systems; The ongoing development of the executive information system (EIS); Extensions to the Web based Library and Knowledge Updating Service. The ongoing development of the COIN network; Practical use of Summary Care Records linked with the EDMS initiative. 7.5 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 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. 7.6 Systems Accessibility There are a wide range of new features that can be provided as a progressive deployment of improved accessibility through the use of an improved mobile device strategy. These include: Consistent single sign-in Customisation for different environments such as inpatient and outpatient 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 65

71 7.7 Benefits of Strategy for Acute Care The Acute Care are principal drivers of the Strategy, along with the CCG drivers. 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 acute initiatives and the commissioning needs and intentions of Clinical Commissioning Groups (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. Client Confidential - for use of St Helens and Knowsley Health Informatics Page 66

72 7.8 Acute Care Strategy Key Outcomes The single set of overarching drivers complement the needs of Acute Care and are summarised below: Each of the areas listed has been matched to the major initiatives planned within the strategy period. From this, the resultant IS initiatives have been grouped according to their area of greatest support for the strategy. Client Confidential - for use of St Helens and Knowsley Health Informatics Page 67

73 7.9 Mapping Acute Care Objectives to the Strategy The areas of Acute Care Solutions can be mapped to the IS Strategy, as follows: Acute Primary Community Patient IM&T Commissioing Solution Areas x x Clinical Engagement Electronic prescribing Service release 2 x x x Electronic prescribing Business case development for Acute x x Enhanced Acute ADT, including bed management and barcoding technology, and A&E system x x x Order Communications and Results Reporting for Secondary care x x x x Electronic Discharge Summaries and Clinical Correspondence to Primary Care x x x x x Secondary Care Electronic Discharge information to Community x x x x x Vital PACS or equivalent MEWS monitoring system x x x x x Clinical Data Sharing x x x x x x Electronic Clinical Correspondence Provider to Primary Care x x x x x Electronic Clinical Diagnostics x x x x x QIPP Clinical Pathways x x x x x Map of Medicine x x Core Support Systems x x x Summary Care record / Integrated Electronic Primary Care Record x x x x x Enotes project, e forms and clinical decision support software x x x Maternity Information system for Acute and community x x Support Outcomes of 5BP Informatics Review x x x x Electronic Medical Education e-learning system x x x x x x Data Quality within systems x x x x x x Ensure systems are capable and configured to provide high quality information and intelligence x x x x x x Provision of information from systems to enable quality and performance monitoring x x System Integration x x Electronic Clinical Correspondence Primary Care to Provider x x x x x Integrated Primary and Community Records x x x x Theatre system evaluation x x Automated GP appointment management x x x x x Paper-light x x x x x x Pilot Clinical Portal Integration, including Patient Access (development phase only) x x x x x x Support the replacement of RIS / PACs system x x x x Local IM&T Projects and Developments x x x x x Network Services - Community of Interest Network x x x x x x IP Telephony x x x x x System Resilience COIN Virtualisation / private cloud services with Data Storage Review x x x x Windows 7 Upgrade x x x x Microsoft Office 2010 Upgrade x x Supported Printer rationalisation x x x x Desktop Management & PC replacement programme x x x Hosting Facilities and Cloud Data Centre x System Accessibility x x x Single Sign on x x x GP View of Acute Health Record (EDMS) x x x x Secondary Care & Tertiary Care EDMS access x x x x x Mobile Device Interoperability and Wi-Fi network extension x x Virtual Desktop Infrastructure (thin client mobile computing/) x x x Communications Technology, Collaboration using video, voice and documents x x Sharing Clinical Data Improving Efficiency Reduccing Demand Imprve diagnistics Support for Clinical 5 Electronic Correspondence Electronic Document Management Patient Access to records Integration Infrastructual Educational Client Confidential - for use of St Helens and Knowsley Health Informatics Page 68

74 7.10 Acute Care Objectives interaction with Primary, Community and Mental Healthcare As can be seen in the above chart, many of the Acute Care Strategy objectives also have an interaction with the Primary, Community and Mental Health areas. The cross referencing is shown as well as a reference to the individual items within the respective Primary Care and Community and Mental Healthcare elements of the Strategy. Client Confidential - for use of St Helens and Knowsley Health Informatics Page 69

75 Section Primary Care Client Confidential - for use of St Helens and Knowsley Health Informatics Page 70

76 8. Primary Care 8.1 Primary Care Primary care refers to services provided by GP practices, dental practices, community pharmacies and high street optometrists. About 90% of people s contact with the NHS is with these services. 8.2 Benefits of Strategy for Primary Care The benefit of the over-arching IS Strategy is wide ranging and easily understood: 8.3 Drivers for Primary Care The drivers for Primary Care have been published and can be expressed as: Client Confidential - for use of St Helens and Knowsley Health Informatics Page 71

77 8.4 Primary Care Strategy Key Outcomes The wider Informatics Strategy for St Helens and Knowsley Health Informatics sets the direction and classification for the development of systems and initiatives within Primary Care. The intention has been to create one single set of overarching drivers which can be adapted and complement the needs of Primary Care. In some cases the broad initiatives provide underpinning for the specific needs of Primary Care, in other cases they play directly to the Primary Care agenda. 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 IS initiatives have been grouped according to their area of greatest support for the strategy. Client Confidential - for use of St Helens and Knowsley Health Informatics Page 72

78 8.5 Mapping Primary Care Objectives to the Strategy The areas of Primary Care Driver can be mapped to the Strategy, as follows: Area Patient Ensure patient safety Enhance patient experience Quality Deliver high calibre Primary Care Solution Areas Minimise number of systems x Integrate Systems x Provide Electronic Document Management (inc NPSA and NHC record keeping standards) x Provide secure Partner access to Electronic Patient Records (inc IEC80001) x x Provide Single Access point to clinical guidelines/ procedures/ pathways/ drug formularies x Develop telehealth strategy (including home care) x x Create common user interface x Achieve ISB0129 (Clinical risk management) and ISB0160 (Patient safety risk management) x x x Integrate Systems x Provide Electronic Document Management (inc NPSA and NHC record keeping standards) x Provide remote access solution regardless of location x x Unified and mobile Communication x Single source of operational and management information x x Ability to 'record once' and share x x Streamlined pathways across all sectors x x x Provide high value services Minimise number of systems Single Solution Provide a single consistent information solution Ensure links with Acute and Community Care Process Provide improved organisational control Provide workforce development Single IM&T infrastructure (phones, , documents, network, internet, intranet, video) x Integrate Systems x Provide Electronic Document Management (inc NPSA and NHC record keeping standards) x Unification of technology x x Single organisational identity (eg website, documentation) x x Centralised system administration x x x Unified information governance x x Achieve a single IG Toolkit return x x Organisation wide reporting system x Standardised processes and information quality control x x Implement and monitor compliance against a Data Quality Framework x Provide infrastructure in a manner to support service innovation and business change x x x Provide innovative training solutions such as e-learning x x Record competencies x x Provide online knowledge services x Clinical Engagement Passive Systems System Integration System Resilience System Accessibility Client Confidential - for use of St Helens and Knowsley Health Informatics Page 73

79 8.6 Primary Care Areas of functional scope The Strategy supports primary care in a number of explicit areas of functional scope, as outlined in the table. Area Description IS Strategy Support Core and Mandated Services IT maintenance and Providing support services to ensure continued availability of all hardware and software which includes: Desktop support, Yes, Implemented Service Desk hardware configuration management, file management and data storage services for the clinical system, local and hosted servers, scanners, smartcard readers, data backup and disaster recovery, business continuity planning support, Service Desk and Technical Support GP Clinical Systems Ensuring the provision of an approved GP Clinical system provided by GP Systems of Choice (GPSoC) or Local Service Provider (LSP) contracts including planned implementation, system updates, clinical safety assurance, training and associated project management. This also includes all services to support any migration from one system to another. Yes, Implemented Networking Services Software licenses National System Implementation Information Governance Ensuring continued connection to national broadband services eg N3 and the provision of a wide area network or private branch links where necessary. Ensuring provision of up-to-date licences for all core and mandated systems eg Operating Systems, anti-virus facilities, MS Office Software, encryption software, internet browser, . Ensuring software licensing legal compliance. Planning and local implementation support for nationally mandated systems (e.g. GP2GP Summary Care Record, Choose and Book, Map of Medicine, N3, Calculating Quality Reporting Service, Electronic Prescription Service, Interoperability Toolkit (ITK) projects and initiatives). This includes project management, training, data quality programmes, data migration, and some business change. Advising and supporting practices in completing the appropriate sections of the Information Governance Toolkit and provide support to Practices on the investigation management of possible information security breaches & incidents. Yes, including planned updates Yes, Implemented Yes, implemented and ongoing Yes, ongoing operational process GP Extraction Service Providing support for any local responsibilities relating to GPES. Yes Hardware Replacement Ensuring all hardware is up-to-date and serviceable including the operation of replacement programmes, and Yes, Ongoing asset management responsibilities such as maintenance of asset registers. Providing a warranted secure hardware disposal service. Insurance will be responsibility of NHS CB. Registration Authority Ensuring all service users adhere to Access Security Policy and deliver the management of role-based access control and issuing of smartcards. Yes, Implemented Core Administrative Services Clinical Safety and Assurance Discretionary Services Local strategic initiatives to improve service delivery across local community and support commissioning plans possibly in collaboration with other providers at the discretion of the CCG. Providing administrative support for all mandated services eg) access and Local Officer Administrator support for NHS mail, including migration from local services to NHS Mail, file storage and backup services (on or off site), any relevant active directory services. Ensuring that the requirements of DSCN 14(2009) Application of Clinical Risk Management to the manufacture Yes of health software and DSCN 18(2009) Management of Clinical Risk relating to the deployment and use of health software are met. Providing hardware, software and support services (including clinical safety and assurance, project management, business change, training and service desk) for : Yes, implemented and ongoing Yes, ongoing operational process - Local shared systems or interoperability initiatives (eg INRStar, Scriptswitch and ICE) Yes, ongoing - Shared local infrastructure (eg Public Sector Networks, COIN/VPN, VOIP, WiFi,) Yes, ongoing - Systems that link into other services (eg web portal, Order Communications, Local Data warehouse and Patient Indexes. Yes - Primary care data quality and PRIMIS support services Yes Discretionary developments in individual general practices at the discretion of the CCG. - Asset management, disposal and replacement programmes Yes, Ongoing - Local Enhanced Services and GP Specialist Interest schemes agreed by the CCG. Yes, including procedural Providing hardware, software and support services (including clinical safety and assurance, project management, business Yes t change, training and service desk) for: - Add-on applications to Clinical Systems eg) patient arrival, appointment and calling systems, kiosks and websites and enhanced use of active directory services. Yes, including ability to pilot - services other than NHS Mail. Yes, where appropriate - Remote access facilities to practice and clinical systems. Yes and ongoing - Asset management, disposal and replacement programmes. Yes, t ongoing i - Providing advice and support for any business case relating to IT services in the development of GP Practice premises. Yes, where needed General Practice Business Support Systems Systems to support - Managing and maintaining systems that support the practice as a business (e.g.) payroll, HR systems, telephony systems, Yes individual general practices as a business and which are not funded nationally or by the CCG. photocopiers, faxes. - providing hardware, software, support and disposal/replacement and assurance for all practice funded systems and equipment. Yes, ongoing - PAT Testing and consumables for all IT equipment used by the practice Yes - Clinical Safety and assurance to comply with ISB 0160 (DSCN 18/2009) and ISB 0129 (14/2009) for manufacture and use of Yes healthcare software purchaed by the Practice. - Insurance for Practice owned IT equipment and cover for consequences of loss. Yes Client Confidential - for use of St Helens and Knowsley Health Informatics Page 74

80 8.7 Primary Care Information (non-clinical) This section sets out service aims for specific primary care issues. The information service will provide a regular reporting service to support key Clinical Commissioning Group (CCG) functions and responsibilities within the key areas listed below; The service will: Provide analysis, support and advice to the CCGs on new and existing data flows and reporting; Support the CCGs in meeting statutory reporting requirements; Facilitate the delivery of information and data to relevant CCG staff; Provide a limited ad hoc service to the CCGs; Provide external contacts, such as acute trusts and Strategic Health Authorities, with an information contact for the CCGs. Provide all services within agreed deadlines and to agreed standards Statutory Reporting: All statutory activity data to be collected, collated, analysed, validated, quality assured and submitted to the Department of Health, Strategic Health Authority; that the data are accurate, signed off by an identified CCG Senior Manager and submitted within agreed timetables. New reporting requirements and significant changes will be discussed with the relevant contacts Provider of Services This includes the provision of monitoring information for the CCGs as service providers eg Child Health; community nursing; therapy services; Locality Counselling Services. Informatics analysts will work with the CCGs Finance Departments to support their submission of reference cost data Information Provision to address evolving needs This includes needs arising from new agenda such as clinical governance; NSFs; Health Commission; GP practice indicative budgets Support to GP practices and CCGs This incorporates support for GP practice performance and quality of care, to include: Ensuring the smooth operation of QMAS across practices to provide the tools for the extraction and analysis of data for monitoring GP practice quality of care as defined in the Quality Outcome Framework. Implementation and roll-out of Central Audit Manager within GP practices, to enable extraction of data from GP systems to support NSFs; primary care analyses and monitoring etc. To link with the EIS, once implemented, as a data source for primary care information. To review primary care clinical information and make recommendations for improvements in the collection, management and use of clinical information. Client Confidential - for use of St Helens and Knowsley Health Informatics Page 75

81 Data collection from clinical systems in GP practices, using system supplied search facilities such as extraction of data on Flu vaccination rates for Public Health. GP practice data quality - extraction of data at each practice, using Miquest queries to ensure standard data collection. Data to be compiled and sent to the PRIMIS Comparative Analysis Service for processing. Results to be fed back to practices and action plans developed to address data quality issues arising. Ensuring data is available to meet clinical governance requirements. Working with practices to ensure the development and maintenance of accurate and accessible disease registers. Input to relevant groups for example CHD, Heart Failure, Severe Enduring Mental Illness, Cancer, Respiratory, Diabetes and Stroke Modernisation. Publication of performance monitoring information in whichever media is required including web-based material that is useful and accessible to users. Provision of expert advice: and support on data availability, data definitions and data validity in order to help managers interpret and analyse the data correctly Ad hoc requests: Provision of information for ad hoc requests 8.8 Information Governance This section sets out the approach to be taken within the LHC to provide a robust Information Governance framework for the future management of information The Scope of the Information Governance Strategy Relevant to Primary Care, there are two key components underpinning the IS Strategy within informatics which are:- Engagement during creation of Information Governance Policies, which outline the objectives for information governance; and An annual action plan arising from a baseline assessment against the standards set out in the NHS Information Governance Toolkit (IGT). The Information Governance manager will be required to integrate with existing governance structures, ensuring corporate accountability and responsibility at appropriate levels. The relevant governance groups will have overall responsibility for overseeing the implementation of this strategy, the pertinent Information Governance Policy and the Information Governance Action Plan following the baseline assessment against the standards set out in the IGT. All will be subject to periodic review and progress reporting. Engagement with the appropriate Freedom of Information Leads and Trusts Caldicott Guardians will continue to be essential. The Health Informatics Service Head of Information is the senior manager responsible for managing the Information Governance agenda and will project manage the work of the Information Governance Manager. Client Confidential - for use of St Helens and Knowsley Health Informatics Page 76

82 The Information Governance Manager will monitor performance through the IGT. An annual return on progress will be submitted to the Department of Health in line with the implementation of the IGT. The Trust Boards will sign this off prior to submission. Client Confidential - for use of St Helens and Knowsley Health Informatics Page 77

83 Section Community and Mental Healthcare Client Confidential - for use of St Helens and Knowsley Health Informatics Page 78

84 9. Community and Mental Health Community and Mental healthcare care includes health visitors, community nursing, midwives as well as related social care provisions such as mental health. 9.2 Benefits of Strategy for Community and Mental Health The benefits of the integrated and robust over-arching Strategy are wide ranging and easily understood: 9.3 Drivers for Community and Mental Health The drivers for Community Care have been published and can be expressed as: Client Confidential - for use of St Helens and Knowsley Health Informatics Page 79

85 9.4 Mapping Community and Mental Health Care Objectives to the Strategy The areas of Community and Mental Health Driver can be mapped to the Strategy, as follows: Area Patient Ensure patient safety Enhance patient experience Quality Deliver high calibre Community and Mental Healthcare Solution Areas Minimise number of systems x Integrate Systems x Provide Electronic Document Management (inc NPSA and NHC record keeping standards) x Provide secure Partner access to Electronic Patient Records (inc IEC80001) x x Provide Single Access point to clinical guidelines/ procedures/ pathways/ drug formularies x Develop telehealth strategy (including home care) x x Create common user interface x Achieve ISB0129 (Clinical risk management) and ISB0160 (Patient safety risk management) x x Provide high value services Minimise number of systems x Single Solution Provide a single consistent information solution Ensure links with Acute and Primary Care Process Provide improved organisational control Provide workforce development Integrate Systems x Provide Electronic Document Management (inc NPSA and NHC record keeping standards) x Provide remote access solution regardless of location x x Unified and mobile Communication x Single source of operational and management information x x Ability to 'record once' and share x x Streamlined pathways across all sectors x x x Single IM&T infrastructure (phones, , documents, network, internet, intranet, video) x Integrate Systems x Provide Electronic Document Management (inc NPSA and NHC record keeping standards) x Unification of technology x x Single organisational identity (eg website, documentation) x x Centralised system administration x x x Unified information governance x x Achieve a single IG Toolkit return x x Organisation wide reporting system x Standardised processes and information quality control x x Implement and monitor compliance against a Data Quality Framework x Provide infrastructure in a manner to support service innovation and business change x x x Provide innovative training solutions such as e-learning x x Record competencies x x Provide online knowledge services x Clinical Engagement Passive Systems System Integration System Resilience System Accessibility Client Confidential - for use of St Helens and Knowsley Health Informatics Page 80

86 9.5 Community and Mental Health Strategy Key Outcomes The wider Informatics Strategy for St Helens and Knowsley Health Informatics sets the direction and classification for the development of systems and initiatives supporting Community and Mental health care, allied to the needs of Primary and Secondary Care. The intention has been to create one single set of overarching drivers which can be adapted and complement the needs of Community and Mental Health Care. In some cases the broad initiatives provide underpinning for the specific needs of Community Care, in other cases as shown by individual initiatives, they play directly to the mental Health agenda. 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 use of St Helens and Knowsley Health Informatics Page 81

87 Section Supplementary Information Client Confidential - for use of St Helens and Knowsley Health Informatics Page 82

88 10. Supplementary Information 10.1 Guiding Principles for operation of the HIS The Guiding Principles to which the HIS operates are: Achieving a consistent, consensus-based and community wide approach, reflecting the pan- organisational nature of the modernisation agenda. Developing services on a partnership basis in line with the local health economies and national information strategy. Providing a high quality efficient responsive service, that meets and understands clinical needs and is capable of delivering solutions that support innovations. Sharing data and sharing information and developing infrastructures that achieve a considered risk balance between confidentiality, the law and the safety of patients, public and staff. IM&T is a crucial enabler in developing improved clinical services, delivering quality information with context to the right place at the right time 10.2 Data Quality The importance of data for NHS bodies and the patients and public they serve has never been higher. Good quality information underpins the delivery of effective patient care. Quality cannot be effective as the organising principle of the NHS without good data to underpin it. The majority of hospital funding is already dependent on accurate activity and costing data under Payment by Results (PbR). World Class Commissioning and the development of practice based commissioning rely on good data being available, and regulators are placing increasing importance on information and data in their assessment and screening processes. There are a set of dominant drivers, plus a more extensive set of other Data Quality considerations. Client Confidential - for use of St Helens and Knowsley Health Informatics Page 83

89 Primary Data Quality Drivers Additional Data Quality Drivers Client Confidential - for use of St Helens and Knowsley Health Informatics Page 84

90 10.3 Systems Access and Identity Flexible working methods Digital working has provided systems users and clinical staff with flexible ways of working and communicating that is allowing staff roles and place of work to be more diversified, unifying both community and secondary care professionals and departments, sharing information and redefining patient care pathways that transpose the traditional clinical organisation boundaries Remote working The modern health service is placing demands on remote working, access to systems from within the community, integration of social care, local government, community clinical and secondary care staff. For an efficient modern service its important to place a strategic focus on delivering a strategy to empower the end user of the services with methods to share and access data regardless of physical location, organisational or departmental boundary. Access will be controllable through the remit of approved policy, data sharing agreements and processes which will be underpinned through proven and robust technologies. The strategy will address information access, offline working, security, and identification of functions that will benefit from a shared workspace Fitness for purpose of systems Fit for purpose Clinical Information Systems are crucial as part of any Clinical Service and it has been identified that integration and improved information capture and delivery are essential to maximise the organisational investment in these systems. However, as the number of these systems increase so does the complexities placed on users in terms of systems access Systems Integration Clinical IT Systems have matured and embedded themselves as crucial cogs within effective patient care with the number of clinical systems for various clinical disciplines throughout the health economy increasing year on year. These systems provide more outputs and have become more complex. Often they have the ability to integrate themselves with other clinical systems, passing results and demographics and interfacing in the organisation information systems for reporting purposes. However not all systems communicate in a standard way and some still duplicate data input such as demographics. Furthermore those systems that do integrate with others often work to varying methods which makes a truly integrated information highway limited. To address this, a strategic initiative to provide a standard framework of inter-system connectivity will be established. This will identify the systems silos which restrict full information delivery organisationally, identifying business processes that can be improved to drive efficiency through integration developments, implementation of standard interconnections between systems through robust and fit for purpose technology to allow for swift integration between any systems. Ultimately, this will support the realisation of the complete patient care record which, in turn, will improve the quality of patient care. Client Confidential - for use of St Helens and Knowsley Health Informatics Page 85

91 10.5 Big Data Delivery via web-based reporting The principal method of delivering information is the evolving Executive Information System (EIS). EIS is a web-based reporting package using modern technologies to meet the information reporting and analysis needs of the NHS. It can deal with large and complex multi-source data-sets and can present information in a variety of ways to ensure that it is meaningful to users of the system. Information can be presented in tables and/or charts with full drill-down capabilities for those users who wish to get down to the detail. For those that prefer high-level summary information, a suite of dashboard reports is available Flexibility for changing organisational needs EIS also needs to retain flexibility to support changes in organisational structure, including future needs which may result from new business approaches. The EIS is being developed to achieve a balance of management-style reports and those relating to individual patients. One of the inherent benefits of drawing data in from a variety of sources is that a more complete picture of patient care delivery can be formed. Over the life-time of this strategy, all major departmental systems will feed data into EIS Data sharing Where supported by appropriate data sharing agreements, information across the whole health economy will be linked to provide a view of patient care across settings. Further geographic reporting capabilities of EIS will be developed. This will enhance the decision making process regarding the delivery of services, future developments or identifying any hot-spots Library and Knowledge Service support The Library and Knowledge Service will integrate knowledge and data to provide a comprehensive information system that will support all of the evidence needs of our customers. In the future, customers will be able to access or receive updates on the latest research, best practice, guidance and local data from one location. The Informatics Service provides a Library & Knowledge Service that provides ad hoc updates as well as monthly bulletins. These include latest research, guidance, grey literature and a horizon scanning service on 18 topics. A wide range of data is also available through the Executive Information System and, in future, appropriate outputs will be linked to the aforementioned research and guidance. Client Confidential - for use of St Helens and Knowsley Health Informatics Page 86

92 Knowledge and Training Service The Library & Knowledge Service currently has a presence on the Intranet of the three CCGs. This current online access includes portals to online resources, online request forms and an interactive Online Public access Catalogue (OPAC.) This current on-line access is restricted to NHS staff using an NHS computer. The Library & Knowledge Service will work with national virtual evidence services (e.g. Map of medicine and NHS Evidence) and integrate them into the local virtual environment. The virtual environment is essential for a service to both clinical and non-clinical staff within primary care, where remote working is common. The access to services is being extended to provide capability no matter where staff are: with a patient, in a meeting, on a home visit or working from their own home. Key concepts to support this are as follows: Clinical Librarian support: Professional members of the Library & Knowledge Team will be able to support the evidence based planning for core business and commissioning decisions. This uses a clinical librarian to create the role of the Business Support Librarian. The clinical Librarian role, within the acute setting, is to provide evidence at the point of need e.g. the ward. The role of the Business Support Librarian will be to provide evidence support at the point of need, e.g. meetings, commissioning committees, Board meetings. Knowledge management: A knowledge management tool utilising SharePoint and Web 2.0 concepts to ensure that organisation knowledge is not isolated and lost within teams and departments. This allows knowledge and expertise created within customers organisations to be captured, retained and shared across the whole organisation. Evidence service: A comprehensive Evidence Service to support the knowledge needs of customers. This service provides a source of evidence that is needed to support the decision process Communication to Patients The population as whole has an increased understanding, access to and use of computerised information, predominately through the Internet. With such services as on-line shopping, service booking and banking being common-place it is natural to expect a desire to access generic and personal health information and advice on-line. This would be delivered through a local health portal. Access to book appointments, check into consultation, physical or virtual, obtain records, diagnostics, medication, and public health information could all be done via 24/7 accessible systems and integration with widely used consumer technologies. With the advent of improved communications, robust IT infrastructure and integrated systems, there is an opportunity to extend information and advice to patients and service users. Client Confidential - for use of St Helens and Knowsley Health Informatics Page 87

93 This would assist patient self- managed programmes of care, particularly chronic disease management, improving patient engagement and compliance. In turn this would improve patient care and have the potential to free-up clinical time to concentrate on more complex care programmes, for example further expansion of mobile phone text reminder services, into community and primary care. There will be challenges and measures required to ensure patient data remains confidential and that policies, business processes and frameworks exist to support this method of information delivery. Client Confidential - for use of St Helens and Knowsley Health Informatics Page 88