Board of Directors 26 th June 2015 AGENDA ITEM: 19 PRESENTED BY: PREPARED BY: Craig Black Helen Beck DATE PREPARED: 17/06/2015 SUBJECT: PURPOSE: E Care Update To provide The Trust Board with an update on the progress and current status of the E-care programme. Executive Summary The E Care Programme Board met on Friday 5 th June 2015. This report provides a summary of the key agenda items discussed and the decisions made. The Programme Board supported the recommendation to confirm a go live date of 15 th November 2015, noting that additional resources would be required from both Cerner and the West Suffolk to achieve this. Operational readiness planning has now commenced to support a successful go live. The Programme Board agreed an essential increase to the Hardware budget of 92K, noting that the anticipated savings from the mini tendering exercise had not been realised. The Programme Board received an update on the latest situation related to the deployment of a new pathology system by TPP. A recent deployment in Bristol has encountered significant issues as the hardware appears to have been under specified. E Care is required to interface with this system (CliniSys) at go live and TPP will face similar issues with the hardware specification at WSH. A project plan has now been received from TPP but there are concerns that this is inadequate. The Director of resources is meeting with TPP to take this issue forward. Whilst efforts are being made to develop an interface with the current system APEX as a back-up, it is unlikely that this is technically possible due to the age of this system. The programme Board approved a revised budget position of 19.2m, subject to confirmation of delegated authority at this board meeting, noting that this was a significant cash risk to the organisation but had resulted form a number of unavoidable issues. The Trust has engaged Four Eyes Insight to undertake a programme of operational efficiency as part of the overall transformation agenda. The work of Four Eyes when aligned to the E care programme should be considered as an enabler of the full benefits
realisation programme, however it was noted that there is a risk of double counting of benefits if these two programmes are not managed in a co-ordinated and cohesive manner. The Deputy Director of Finance and The Deputy Chief Operating Officer are working together to avoid this risk and ensure that there is clarity and transparency across both programmes. A peer review of the programme to date and the preparedness for go live has been undertaken by Carrie Armitage on behalf of Baker Tilley the Trust Auditors. The draft report was received by the Trust on Friday 5 th June and is currently being checked for factual accuracy following which the Trust will develop an action plan in response to the recommendations contained within the final report. A more detailed report on this review will be provided to the board in due course. Go Live Date The e-care Programme Board approved the original programme plan for delivery of e-care at their meeting in Dec 18 th 2014 This plan was developed around the assumption that phase 1 of the e-care programme would go live at the beginning of November 2015. The original plans were approved on the following assumptions: That we would be implementing the Cerner Millennium product as an off the shelf product with minor localised changes. That the testing requirements would be minimal in light of implementing the off the shelf product. That sensible and reasonable contingency had been built into the overall project timeline. As our understanding of the Millennium product and our own local workflows has matured we have identified that the off the shelf product does not meet all of the Trust requirements and as such we have undertaken significantly more localised tailoring than was originally anticipated or planned. This in turn has had the following impact on the project: The workload of the build teams is significantly greater than was originally envisaged. The build testing requirements have increased significantly over and above that which was originally planned. The degree of integration complexity has increased and therefore the testing workload is greater than originally planned. (this can be seen with the work currently undertaken by Cerner testing colleagues) That we have used all 6 weeks of the contingency that was built into the project to deliver the increased workload to date. Furthermore the Trust also agreed to take the recently released 2015 code in order to address clinical safety concerns regarding Meds and general system problems. Testing by Cerner was also put back by several weeks to allow an upgrade to be undertaken and to improve the testing process. This has further impacted on the contingency built into the programme plan. The programme group has undertaken a detailed piece of work to asses a number of options in relation to the go live date as a result of the issues identified above. Option 1: Continue with planned go live date of beginning of November 2015 Our plans state the original go live date as beginning of November. Under this option it would be proposed that this is moved to 15 November which would have minimal increase to operational risk (i.e. still avoiding period of winter pressures) but would give the project team back the two weeks slippage on testing round 1.
Option 2: Reduce the scope of modules that go live in Phase 1 Our original plans were built around proposing to go live with the majority of modules in Phase 1 with a smaller go live in Phase 2. In this option we would propose to reduce the number of modules in Phase 1 and move the remaining to: Phase 2.a) Proposed modules for phase 1 would be PAS, order comms and ED or Phase 2b) all modules included but remove Meds Further detailed work is required to fully assess the benefits and risks of these option but it is considered to be unlikely to achieve the anticipated reduction in workload due to the complexity of separating out the work streams at this late stage in the build. Option 3: Delay go live until March 2016 Whilst the project itself would only require an additional month within the plan, this would place go live at the start of winter pressures which would not be supported operationally. At this stage we have proposed a delay until March as our current PAS support expires at this time, however it is unlikely that the nursing and operational teams could support the release of staff for training during the winter pressures. There is therefore a high risk of a further delay until April or May 2016. Recommendation After full consideration of all of the risks and issues identified, the Programme Group were unanimous in the decision to recommendation option one: extended Go-Live date of the 15th Nov 2015 and this recommendation was accepted by the Programme Board at the meeting on 5 th June 2015. Additional staff from WSH and Cerner will be required urgently to address the current gaps and to keep the Programme on plan. The plan has been updated to identify any other contingency and reworked with work streams and managers to ensure it meets the latest requirements. Despite the additional resource requirements this option was noted to have the least financial impact on the overall programme costs and benefits profile. Operational Readiness Plans will now be enacted to prepare the organisation for a successful go live with the focus being on data migration, patient safety, support to front line staff and reductions of activity where possible. The first operational readiness meetings for senior managers took place on Monday 8 th June and will take place monthly initially, increasing in frequency as we get nearer to the go live date. Regular updates of progress will be provided at future board meetings. Training schedules will be completed and are due to be published by 13 th July with courses running from mid September through to mid November. Class room training will be limited to one day per person wherever possible. Hardware Profile This report was provided as an update to the e-care Hardware Profile paper submitted and approved for procurement to progress at the 12th March Programme Board. The paper set out the requirements to deliver a workstation on wheels based solution to bay based inpatient areas, with wall mounted equipment in side rooms used for isolation, drug trolley IT enablement, laptops for pharmacists and nurse specialists and peripherals to support bedside sample labelling and positive patient identification. Requirements for the number and type of devices and specification were reviewed with clinical teams in order to achieve the minimum profile needed to support all phase 1 e-care activities. As a result the original budget was uplifted from 616k to 735k based on costs that were anticipated at November 2014 when the hardware options were first appraised.
Orders have been placed and goods received for Pharmacist laptops and wristband label printers as well as Microsoft software licenses required to support the additional devices (at a cost of 126k). These devices are in the process of being configured and tested for deployment through June, with the laptops initially being used to support e-care promotional activities and maintenance training sessions, thus negating the need for separate IT and to minimise cost. Total cost 126k Therapies had previously been missed out but still met within the overall budget at a cost of 20k The mini-competition for the inpatient hardware bids closed on the 15th May, with evaluation now complete on the only 2 responses received out of the 5 requested. The cost of this element of the hardware profile was estimated at 523k, with the minimum proposal being returned at 600.8k, therefore an over spend of 67.8k after a reduction of 10k for Zebra printers Total cost 590.8 k In Summary Total cost of 736.8k against a 735k budget However as part of the initial hardware agreement further technical solutions are still required for the recovery unit; drug preparation rooms; therapies outpatient area; phlebotomy cart IT enablement, case note tracking printers, theatres anaesthetic rooms and ipads for clinicians at a cost of 90.4k, bringing the expected total spend to be 827.2k, subject to procurement and resulting in a total overspend of 92.2k The Programme Board agreed an essential increase to the Hardware budget, noting that the anticipated savings from the mini tendering exercise had not been realised. TPP Integration It was brought to the Trusts attention on the 4 th June that the underlying architecture which the CliniSys Winpath application resides on within their data centre is not suitable to host the WSH / Partnership application in a live environment. This issue has arisen from their delivery of Winpath in Bristol at a similar pathology partnership at the Bristol Royal Infirmary, where it was identified that there were significant issues with application performance within the data centre when going Live. The net effect is an expected delay of between 4-5 weeks for WSH implementation. The new work that is underway is to deploy a significantly redesigned architecture to support the application. The Trust has requested an urgent updated plan from TPP by 12 th June and essentially believes this is an area TPP and its suppliers can resolve through increased resourcing of the project. This additional activity within the data centre should not compromise the current testing schedule for interfaces which would mean that the impact to the Cerner build should be minimised in the meantime Financial Position- Revised Budget The business case for E-Care was prepared and approved in June 2014. Costs in the business case were kept to the minimum on the basis that the Trust was submitting a bid to the DH Technology Fund. The assumption was that if the bid was successful additional items could be re-considered. Unfortunately the bid was unsuccessful and a number of items are now considered unavoidable that were not included in the original business case. In addition there have been delays in the project for a variety of reasons which means the phase 1 go live date planned for 1 November 2015 has had to be re-considered. The Project Group has decided that the only viable plan is to aim to implement phase 1 by 15 November 2015. The Programme Board were asked to approve a revised budget subject to confirmation of delegated power. The original business case estimated that the implementation would cost 17.2m cash over 10 years. Since then an additional 851k capital contingency has been identified for e-care pay and 275k from the general IT capital programme for E-care non pay so the approved budget to date is 18.3m. Overall the cost of implementing E-care is now estimated to require a cash outlay of 19.2m. The cost has increased because: In order to address the delays and ensure implementation by 15 November 2015
additional staff are required as approved at the E-care Programme Group 293k (agency rates); Recruitment for a number of planned posts has not been successful and as a result agency and contractor staff are having to be used at premium rates; Items have been identified that are considered to be essential for the implementation of the new system but that were not identified when the business case was prepared; and The cost of equipment for wards is now 92k higher than previously estimated. Although these increased costs do not impact on the Trust s revenue deficit position immediately because E-Care is treated as a capital project, the increased demand on cash is a significant risk for the Trust which will need to be managed carefully. Going forward the increased costs of implementation will increase our revenue costs as the system is depreciated over its useful life. The revised budget does not include the 180K for optimum disaster recovery. There are on going discussions between Cerner and WSH regarding this issue as it was assumed to have been included in the original contract. In addition the revised budget does not include the following costs which would need to be subject to a separate business case: -access to support simplified access for clinical staff 320k lve Hardware 40K The Programme Board accepted the revised budget subject to confirmation of delegated authority, noting that whilst it was significant in cash terms it was felt to be unavoidable. Benefits Realisation The Trust has engaged Four Eyes Insight to undertake a programme of operational efficiency as part of the overall transformation agenda. A meeting has taken place between the Trust, Cerner and Four Eyes to align the benefits of both programmes of work and identify further opportunities through collaboration. In line with the E Care transformation strategy it is recognised that the full benefits of the E care implementation will only be delivered through organisational change. The work of Four Eyes when aligned to the E care programme should be considered as an enabler of the full benefits realisation programme, however it should be noted that there is a risk of double counting of benefits if these two programmes are not managed in a co-ordinated and cohesive manner. The Deputy Director of Finance and The Deputy Chief Operating Officer are working together to avoid this risk and ensure that there is clarity and transparency across both programmes. Peer Review A peer review of the programme to date and the preparedness for go live has been undertaken by Carrie Armitage on behalf of Baker Tilley the Trust Auditors. The draft report was received by the Trust on Friday 5 th June and is currently being checked for factual accuracy following which the Trust will develop an action plan in response to the recommendations contained within the final report. A more detailed report on this review will be provided to the Trust Board in due course.
Linked Strategic objective Building the Future (link to website) Issue previously considered by: E Care Programme Board, Scrutiny Committee, Trust Executive Group (e.g. committees or forums) Risk description: (including reference Risk Register and BAF if applicable) Description of assurances: Summarise any evidence (positive/negative) regarding the reliability of the report Legislation / Regulatory requirements: Other key issues: Recommendation: The Board is asked to note the content of this paper.