King s College Hospital ICT Strategy 2014

King s College Hospital ICT Strategy 2014 Contents Contents... 1 ICT for King's College Hospital... 1 Introduction... 1 Key elements of a paperless hospital... 2 Research... 7 Reporting... 8 New EPR... 8 ICT for King's Health Partners... 8 ICT for Local Health and Social Care... 10 Non clinical systems... 10 Infrastructure... 10 ICT for King's College Hospital Introduction This document is an update of last year s King s College Hospital ICT Strategy. Over the last year there have been a number of significant developments in the Trust, not least the acquisition of Princess Royal University Hospital and the services it provided at other sites. This has had a major impact on our plans for the coming years, with the highest priority now being bringing all sites that form King s College Hospital to one infrastructure and set of ICT solutions that support moving towards our previously stated vision: Making progress towards a safer, faster, paperless hospital A significant amount of work has already taken place to build towards this goal, including: Network connections between the various sites that now form King s Consolidating all staff on to the same NHS Mail domain Joining of the old Bromley and King s domains to enable staff to access the network from wherever they are at King s 1

Migrating the services at the Queen Mary s Hospital site to using the King s i.pm Patient Administration System The introduction of a 5 digit dial plan for the telephone systems The next year the priority will be to put in the building blocks to enable the EPR and associated solutions that have delivered so much to the old Denmark Hill site to the PRUH. It is expected that in the next year we should have: Implemented a single Patient Administration system (i.pm) across all sites Implemented the Symphony A&E solution at the PRUH in line with the Denmark Hill site Implemented an interim Pathology solution (Apex) at the PRUH with a goal of moving to a single King s pathology solution Determined and part implemented our approach regarding the provision of a single Radiology and Imaging solution Agreed and worked towards implementing a single solution approach for theatres, whether this is an upgrade of Galaxy or a re-procurement Rationalised/upgraded/replaced a number of other departmental systems such as Maternity Upgraded the wireless network at Denmark Hill while at the same time implementing the same solution at the PRUH and other King s sites Replaced a significant number of old PCs at the PRUH and newly acquired sites while at the same time increasing the amount of equipment to the appropriate levels required to effectively run the solutions that are available on these sites. At the same time that we are carrying out this work we will also aim to continue to support developments at the Denmark Hill site and this document has been updated to reflect that. Additionally, we are aware that we need to address a longer term view of the future of our Electronic Patient Record solution and will start the process of market testing, working with our partners in KHP. Key elements of a paperless hospital Clinical Notes o Clerking The majority of clerkings are now carried out in TEAM using the KSSF tool. The aim over the next year will be to widen the use of this. o Inpatient Notes The ICUs are now the only areas where clinical noting is not used at Denmark Hill. 2

Work will continue to look at ways by which structured data can be captured. Some work has been carried out in this area but the usability of the solution needs addressing. There is a need for more structure and sharing of information between applications e.g. a common past medical history, problem list, drug list shared between applications. This will apply to our own systems. The sharing of data should be based on information standards. KSSF (King s specialty systems framework the web framework that hosts eclerking) is now seen as the main tool to develop the capture of structured data. Develop a proposal for the ICT strategy group that relates to mobile computing and application development. We favour mobile computing as opposed to a computer at every bedside. Our experience has shown that no single device meets all needs and therefore the likelihood for the time being is that we will continue using a variety of devices. We do though need to agree an approach to app developments. o Discharge Summaries The drivers for change are new national standards, local GP requests, and the fact that we are using old technology. We will attempt to use standardized headings (CDA-Clinical Data Architecture). We plan to make use of KSSF to progress this but it will need significant Pharmacy involvement as they are key to the process. o Risk Assessments E.g. Falls, Tissue viability, Bedrails, nutrition. The current strategy is that we will use either Wardware or KSSF to capture this information depending upon the requirement. The rule of thumb is that if a requirement is of the point and click variety we will use wardware whereas if it involves significant amounts of free text we will use KSSF. We will review where the risk assessment information is captured as part of our mobile device strategy. WardWare (the bedside vital signs software) has the capacity to allow nursing risk assessments to be carried out but this needs to be further developed to actively escalate issues. We need to know what of these assessments needs to be visible and where in the patients record? o Historic notes Funding has been received from the Safer Hospitals Technology fund for an Electronic Document Management System (EDMS) to resolve the issues around the availability 3

of the paper notes particularly at the old PRUH service sites. We plan to pilot this solution at the Queen Mary s site for the King s services there. Electronic Prescribing and Medicines Administration o We aim to complete the roll out icm Electronic Prescribing and Medicines Administration everywhere outside the ICUs o We will increase decision support in Electronic Prescribing and Medicines Administration o We will support chemotherapy prescribing through Mosaiq. o The ICU procurement will be progressed. We will explore how the ICU prescribing system can safely relate to icm (EPR) Electronic Prescribing and Medicines Administration. o We have carried out a proof of concept for the view of medication and other patient information from GP IT systems using the Medical Interoperability Gateway (MIG). This work will be progressed as part of the Integrated Care Programme. At the same time we will also review the Summary Care Record solution for practices that are outside our local cathment areas. Vital Signs WardWare o Electronic vital sign recording will be rolled out across all wards and A+E The Denmark Hill site and Orpington will be covered this year. o We will explore escalation policies and integrate with the safer faster hospital programme. o We will get access to all the data so that it is accessible in real time to our other applications. o We will extend the functionality in wardware to cover other functionality in line with the rules highlighted above. Real time quality reporting as part of the safer, faster hospital. o WardView is the current application of choice for seeing summary clinical quality data in the clinical setting. o WardView will be referenced at handover and will be made visible on the TV screens. o There will be daily email shots of ward and consultant based quality views o There will be a review of how the data is accessed. There will be consideration of the development of a Big Data Store. 1 o There will be a review of configurability of WardView ie can it be configured individually, at ward or divisional level? Handover 1 The Big Data Store is a consolidated arrangement of all our clinical data from whatever source that will allow real time access. 4

o For H@N. A mechanism for managing cold (identified by the day team) referrals to the H@N team has been developed and is in use in TEAM. It uses EPR.KDF based lists and clinical notes. The method needs some refinement to make it more usable in other departments. o Patient transfers between wards. A structured document has been created in EPR.KSSF but is not being used. The reasons for this will be reviewed. The output documents are visible in EPR documents and information from KSSF is now available in the patient notes. Lists o We will review the EPR.KDF list functionality to improve its utility, for instance for managing the medical take. This is now accessible through EPR. Develop strategy for Bed Side computing o This relates strongly to our app. Development strategy. Develop a proposal for the ICT strategy group that relates to mobile computing and application development. Develop strategy for enhanced Clinical Communications e.g. H@N o We continue work on our communications strategy with a view to minimizing the number of systems and devices we support. We will continue to explore suppliers such as ASCOM and NerveCentre who offer to integrate messaging, workflow and communications. An agreement is in place to implement a proof of concept in Neurosciences and ED and the results of this will be considered for wider implementation. Improve staff and patient experience in outpatients o Continue to develop and support patient check in system requirements. o A patient calling system has been implemented in Suite 3 of the Golden Jubilee Wing. This has been successful but the case for wider roll out needs to be approved by the Trust. o Explore obstacles to paperless outpatients What is the truth about how many notes are pulled? Information can be obtained from: Service managers. Notes team. Document presentation o Outpatient eprescribing How can we make the letters easier to navigate? o Will our EDMS solution enable better presentation of documents? 5

We intended to roll out electronic prescribing to clinics last year but this was put on hold by Pharmacy as a result of the outsourcing of the Outpatient dispensary. We still intend to roll out prescribing gthere and will work with pharmacy to progress this. o Outpatient noting future state Look at standards (RCP) Look at standards set by GPs for communication Review the potential increased use of EPR.KSSF in an outpatient setting to meet noting and specialty requirements. o Communicating clinical information with patients electronically. Letters - options Allow patient to take risk of using standard email. Give patient secure email (e.g. Egress) Use My Healthlocker Develop ICU ICT strategy o There will be a new system procurement o There will be a strong emphasis on integration with EPR o For instance we will focus on: Information transfer to KCH.EPR, Drug transfers in and out of ICU, Possible back-end integration of ICU notes with KCH.EPR.KDF.Clinical Notes, IT support for safe patient transfers in and out of ICU. Theatres o We will review the options around the provision of Theatre functionality with the departmental management in line with the rationalization of the systems for the PRUH. e-consent o A solution has been developed which now needs to piloted. Telehealth o The GP/Maxfax Telehealth pilot had a number of process issues which has stalled progress in this area. o The number External consultations using Webex are being used and the number is increasing. o A Secure Skype option with patients will be considered Capture of diagnoses and procedures o We believe that clinical coding, by clinicians, will need to be Snomed based. o Consider capture mechanisms and presentation options EPR.Health Issues A EPR.KDF development 6

A mobile app development A service triggered from clinical notes. o This will not remove the need for translation by the clinical coders to ICD 10 codes. o Coders will be assisted by improved past medical history capture in eclerkings. o Some work was carried out looking at an option that provided much of this functionality but the cost proved to prohibitive Non-PACS images and digital media (plus links to EPR) o The storage issues have now been resolved and a supplier for the digital media solution has been selected. The aim for the coming year will be to implement the solution. Increase capture of clinical information and letters into EPR o ECG Cardiology department will implement the MUSE software which will allow output of ECGs to EPR using the EPR.documents interface. o The MediSoft Ophthalmology system will output CDA compliant documents to new integration engine. Consolidate and improve existing interfaces between clinical systems o Exploit capability of new KCH integration engine to create better interfaces. Implement Liver/Neuro path system o MIDAS, DISH, Neuropathology will be replaced and incorporated into the new GENESYS system. This is continued progress. Upgrade Maternity system o The existing Euroking maternity system was upgraded last year o We are in the process of replacing the system in line with our PRUH system rationalization programme. PACS/RIS replacement o We will extend current contract with General Electric (GE). o We will develop requirements for Trust-wide solution. o We will tender for procurement. o We will also look at the potential of XDSi soultions to meet the need of services such as Muscular Skeletal (MSK) which requires access to images from other organisations PACS. Clinical Audit o We will provide advice in relation to data capture options Research We will consolidate the use of IMPARTS as a means to document patients psychological health, quality of life. 7

We will include further integration of assessments in EPR results in order to view trends for instance mood scores. Develop reporting/research database using open data principles. We will develop The Big Database. Engage further with KHP to exploit clinical data for research purposes. Support the use of data from the EPR to evaluate quality, efficiency and safety. Reporting We will continue to work closely with the KCH Business Intelligence Unit (BIU) to develop reporting functions. We expect the Big Data Store to be a common repository for real time quality reporting, Audit and Research. New EPR There will be ongoing discussions with our partners in KHP that will evaluate, which are the best technologies or packages (e.g. new core EPR) to meet our needs. We will initiate a series of reference site visits to market test the solutions that have recently been implemented in the UK and elsewhere. ICT for King's Health Partners Focus on information sharing rather than EPR replacement Key Facts All three clinical partners have mature established EPRs including administrative and diagnostic systems. Mechanisms for information sharing based on web services and NHS numbers are starting to be used. What we will do: We will continue to support current technologies such as secure mail, video conferencing, radiology information services, and terminal service views of partner s applications. We will continue to work on an improved KHP clinical information sharing solution. Given that it is likely to be the key to information sharing we will seek to improve NHS Number coverage for our patients. We will seek to identify and minimize the limitations of clinical information sharing based on NHS number. We will explore MyHealthLocker as tool for communication with patients. Undertake show and tell of KHP IT solutions that will expose similarities and differences in approaches to ICT solution development. We expect this to lead to consideration of a KHP IT development team. 8

Use the ICP to ensure a united KHP approach to how we work with General Practice (GP), Community and Social Care partners. Consider whether we want a unified approach to departmental systems such as A&E, Maternity, Theatres across KHP. We will explore how we can work with KHP to improve efficiency and effectiveness with respect to ICT services (sharing datacentre, storage requirements, technical support, application development) 9

ICT for Local Health and Social Care Improved access to information for all partners in the care pathway We will continue to work with the Integrated Care Programme to support improvements in information sharing within and outside King's Health Partners. We will be as economical as possible with financial and human resources while at the same time aspiring to be innovative. We will seek to minimize duplication and maximize software use. We will support the use of existing systems, where possible, and improve information sharing between the systems. We will try to limit the number of systems that users must access. We will take approaches that are as generic as possible and therefore maximize benefit to our patients and users. We will try to ensure that our approaches to communication within KHP are aligned with our approaches to communication with partners outside King's Health Partners. Non clinical systems o We understand that there are potential linkages between corporate systems (such as Human Resource and Financial systems) and clinical applications. o We will seek to ensure that these interactions are considered as we acquire or develop non-clinical IT systems. Infrastructure o We understand that our clinical systems are totally dependent on fast reliable networks and servers. We will continually seek to improve network performance and access speeds. We will review the capability of our wireless network. This may be done in conjunction with a wireless network implementation at the PRUH. We will review business continuity and disaster recovery taking into account our new physical location at the PRUH. Support and Staffing We will review our support structures to improve their effectiveness across the wider area that they cover We will review the technologies that we support 10

We will look to users being more self sufficient We will review how we expect the ICT services to be provided in the future. 11