Northampton General Hospital NHS Trust

Northampton General Hospital NHS Trust Information Management & Technology Strategy 2006-2011 Document ID IM&T Strategy 2006-2011 Version 1.0 Status Final Date December 2006 Author K. Foster Review Date December 2007

CONTENTS 1. Executive Summary 2. Context and Strategy Drivers 3. IM&T Requirements 4. Current IM&T Baseline 5. The Strategy 6. Strategy Delivery 7. Investment 8. Risk Management 9. Conclusion Appendices A. Baseline Review B. Programme Plan C. IM&T Subcommittee Terms of Reference D. Glossary of Terms IM&T Strategy 2006-2011 - Final V1.0 Dec 2006 Page 2

1. EXECUTIVE SUMMARY 1.1 Introduction This document sets out an information management and technology (IM&T) strategy for NGH over the next five years (2006 2011). It has been produced in a climate of considerable change and uncertainty, and will need to be regularly reviewed to ensure continued fit with Trust and national direction. 1.2 Context and Strategy Drivers Strategic Aim The strategy aims to develop and improve the utilisation of information, and information technology, in the delivery of high quality care at NGH. National Context National drivers for strategic IM&T investment and support include: The NHS Plan The National Programme for IT (NPfIT) Choice (Choose and Book) The Patient-Led NHS 18 Week Referral to Treatment target Payment by Results (PbR) NHS Foundation Trusts Healthcare Commission Performance Ratings Local Context Trust strategic drivers include: The DGH+ Vision Foundation Trust status The Trust Five Year Plan 1.3 Strategic Objectives The primary objectives of the strategy are: Alignment of local IM&T development with the National Programme for IT (NPfIT), and in particular the NHS Care Records Service (CRS). Provision of more complete, accurate, and timely information for clinicians and managers. Using IM&T to improve Trust services and the patient experience. Using IM&T effectively to support new ways of working, increase efficiency, and control costs. 1.4 Current IM&T Baseline In developing the strategy, a review of existing IM&T systems and services, and work in progress was undertaken. Strengths, weaknesses, and gaps were assessed, and developments planned, or underway, were reviewed for strategic fit. IM&T Strategy 2006-2011 - Final V1.0 Dec 2006 Page 3

The review showed that, whilst generally sound, the majority of existing systems are either at, or near, the end of useful life, or else will require attention in the context of achieving the strategic objectives. Significant work has been done in recent years to improve the use of IM&T to support clinical processes, for example: test requesting, result reporting, and discharge summaries. However, much work remains to be done in providing effective modern information technology for clinicians and moving towards electronic health records. Electronic sharing of information with GPs is well established but is limited at present to Pathology, Radiology, and discharge information. Management information needs to be improved. Management information systems are largely departmentally based, and integration of information for senior management is very labour intensive. Administrative processes could be improved through wider use of ICT (information and communication technology) collaboration and workflow tools. Storage of paper health records is a major problem, and tracking records is an increasingly difficult and time consuming task. Demand on IM&T department resources has increased significantly in recent years as a result of developments such as patient choice, treatment targets, PbR, and NPfIT, and the department now struggles to fully meet this demand. The review showed that there is scope for improving the utilisation of existing resources, but current investment in IM&T is relatively low at around 2%, slightly below the national average, and substantially below that recommended by the Wanless report in 2002 (4%). The review found evidence of non-strategic IM&T development occurring, and of 'piecemeal' development; developments started but not fully followed through as a result of lack of resources, or of commitment and ownership. It was also clear that, although good project management principles are always applied in larger IM&T initiatives, they are applied less consistently in smaller ones. 1.5 The Strategy The key elements of the strategy are: Care Record Service (CRS) Development of a fully integrated electronic care record including: patient administration, emergency care, comprehensive clinical / diagnostic functionality, digital imaging, care scheduling, decision support, electronic prescribing, real-time bed management, clinical documentation and messaging. The strategy aims to align the development of the local CRS with NPfIT, using national products as far as possible, but deploying interim, non-npfit, components ahead of national timescales where Trust business strategy demands. The immediate requirement for NGH is to complete the implementations of PAS, Pathology, PACS (digital imaging services), and Radiology systems, currently in progress as part of NPfIT. Maternity and A&E systems are then the next priorities IM&T Strategy 2006-2011 - Final V1.0 Dec 2006 Page 4

Choose & Book Choose and Book (CaB) is the national electronic appointment scheduling system supporting the patient appointment process throughout the NHS. Once PAS deployment is complete the Trust will begin the migration from the current interim booking service to the fully integrated CaB service. Data Repository A comprehensive data repository to aggregate and analyse patient data for outcome measurement, clinical governance, clinical audit, reporting, and management information will be developed. Business Systems Continued development of business systems and improved provision of management information is key to the future success of the Trust. The implementation of the national ESR (HR and payroll) system, and the rollout of the e-procurement system will be completed. High priority will be given to improving management information, particularly the introduction of a balanced scorecard /digital dashboard application. Greater use will be made of collaboration / workflow support tools to improve the efficiency of administrative processes. Development of a comprehensive Trust internet presence and more dynamic internal web services will be undertaken. Infrastructure The ICT infrastructure will continue to be enhanced to ensure that it is of the highest standard, and has the capacity and resilience to support the CRS and other developments. Data quality High quality data is critical to the success of the strategy and Trust business processes. Continued improvement of data quality will be addressed in a number of ways including: moving to a single master patient index, mandatory use of the NHS number, positive patient identification processes, enhanced clinical coding processes, enhanced system security, and more training. Security Individual user registration and role based access controls, with single sign-on, will be implemented to ensure security and confidentiality of electronic clinical records. IM&T Resources IM&T resources will be reviewed, and restructured where necessary, to ensure that they are utilized as effectively as possible. Additional investment in IM&T resources will need to be made to meet increased demand, and increased dependency on clinical ICT services. The technical architecture underlying this vision must provide robust and reliable integration of systems and data sources, and an easy to use, secure, single access point that can be tailored to individual user requirements. IM&T Strategy 2006-2011 - Final V1.0 Dec 2006 Page 5

1.6 Strategy Delivery The programme of development work needed to deliver the strategy is challenging. It will not happen without commitment at the highest levels in the organisation: Trust Board. Clinical Directors, Directorate Managers, and Nurse Managers. Given the importance and scope of the programme, it is essential that it is appropriately managed. A structured approach, using appropriate programme and project management methodologies, will be employed and overall direction of strategy delivery will be through the IM&T Subcommittee. 1.7 Investment The strategy sets out an ambitious programme of IM&T development for the Trust. In order to successfully deliver the strategy, year on year increases in Trust spend on IM&T will be required over the five years of the programme. These increases should, over the five year period, bring Trust IM&T investment broadly in line with Wanless report recommendations, which indicate that the NHS should be allocating around 4% of total spend to IM&T. This represents a substantial additional investment in IM&T over the next five years. This increased investment must deliver commensurate benefit. As part of the normal annual business planning cycle, detailed investment plans to support the strategy will be produced, and will be supported by business cases that clearly set out the benefits of each investment and link these to the local and national objectives. IM&T Strategy 2006-2011 - Final V1.0 Dec 2006 Page 6

IM&T Strategy 2006-2011 IM&T Strategy 2006-2011 - Final V1.0 Dec 2006 Page 7

2. CONTEXT AND STRATEGY DRIVERS 2.1 Introduction This document sets out an information management and technology (IM&T) strategy to support the provision of clinical, operational, management, and patient information for NGH over the next five years (2006 2011). It has been produced in a climate of considerable change and uncertainty, and will need to be regularly reviewed (preferably annually) to ensure continued fit with Trust and national direction. IM&T investment must align with the business and clinical needs of the Trust; both NHS strategic objectives, and NGH corporate objectives, identify a particular requirement to focus on the direct support that IM&T can provide for clinical and operational practice in order to improve the patient experience. 2.2 Strategic Aim The strategy aims to improve the completeness, accuracy, and timely utilisation of information and information technology (IT) in the Trust in order to: support clinicians in the delivery of high quality care achieve local and national objectives for the rapid introduction of modern IT systems and better information to support the goal of a patient-led NHS achieve Trust business objectives. The Trust will continue to participate actively with partner organisations in the Northamptonshire local health economy to ensure a cohesive and cost effective approach to the delivery of new patient and business information requirements across the community. 2.3 Context 2.3.1. National Context National drivers for strategic IM&T investment and support include: The NHS Plan The NHS Plan recognises the need for modern IT systems in every hospital and GP surgery as a key enabler to modernisation and reform of the NHS. Choice (Choose and Book) Giving patients more choice about how, when and where they receive treatment is a cornerstone of the Government s current health strategy. Choose and Book is a national service that combines electronic booking and a choice of time, date, and place for a first outpatient appointment. Patients are able to choose where and when they go by phoning an appointments line, booking over the internet, or booking at the GP surgery. The Trust must have systems in place to fully support this service by the end of 2006. The Patient-Led NHS The White Paper Our health, our care, our say sets out a vision to provide people with good quality NHS services in the communities where they live. To enhance the range of secondary care services available near to patients homes, many acute hospitals IM&T Strategy 2006-2011 - Final V1.0 Dec 2006 Page 8

including NGH will have to be reconfigured. IM&T services will also need to be reconfigured to support the new care models and pathways. 18 Week Referral to Treatment Target The NHS Improvement Plan (June 2004) sets out an ambitious new aim that, by the end of 2008, the NHS will have 18 weeks to refer, diagnose, and start treating a patient. For the first time, patient journey time will have to be measured as a whole, including diagnostic and outpatient appointments that are currently largely unmeasured. National Service Frameworks (NSFs) NSFs are long term strategies for improving specific areas of care. They set measurable goals for the provision of care within set time frames, national standards, and key interventions, for a defined service or care group. Information systems must continue to develop to support NSFs. Payment by Results (PbR) The aim of the PBR system is to provide a transparent, rules-based system for paying Trusts. Payment will be linked to activity and adjusted for casemix. PBR is intended to ensure a fair and consistent basis for hospital funding rather than being reliant principally on historic budgets. NHS Foundation Trusts (FT) NHS Foundation Trusts are key to the Government s strategy for the decentralisation of public services and the creation of a patient-led NHS. NHS Foundation Trusts have been created to devolve decision-making from central Government control to local organisations and communities so they are more responsive to the needs and wishes of their local people. Healthcare Commission Performance Ratings The Healthcare Commission annual health check scores organisations on many aspects of their performance including use of resources, quality of services, and achievement of national targets. 2.3.2 Local Context Trust corporate objectives and other local strategic drivers include: The DGH+ Vision This envisages the Trust providing specialist services such as a regional cancer centre, interventional cardiology, renal services, level 3 neonatal care, and plastic surgery alongside the range of services expected from a District General Hospital. In addition, the creation of the patient-led NHS presents the Trust with the opportunity to deliver other services traditionally provided outside of the Acute setting. In support of this vision five key principles have been defined: Improving access to services Providing value for money Delivering clinical excellence Improving the patient experience Improving the organisation s capacity to deliver IM&T Strategy 2006-2011 - Final V1.0 Dec 2006 Page 9

Foundation Trust Status NGH recognises the benefits of FT status and is actively engaged in the application process with the intention of becoming an FT in 2007. To operate successfully as a foundation trust NGH must have IM&T services that are fit for purpose and which provide the necessary information to ensure that it can maintain financial stability, effective governance, can deliver health priorities, and will be locally responsive. This strategy has been developed in the context of the Trust FT application and five year service delivery plan. Other Corporate Objectives Effective use of IM&T services will contribute to the achievement of other corporate objectives including: Achievement of the 18 week referral to treatment target (18 week RTT) 13 week maximum outpatient wait 6 month maximum wait for inpatient treatment Maximising payment by results and achieving financial balance Efficiency savings 2.3.3 The National Programme for IT The National Programme for IT was introduced to deliver new, integrated, IT systems and services to help modernise the NHS and centre care around the patient. Information will move around more quickly with health care records, appointment details, prescription information, and up-to-date research into illnesses and treatment accessible to patients and health professionals whenever and wherever they need it. The NHS Care Record Patient-centred care requires information to follow the patient so that it is available wherever and whenever it is needed. The NHS Care Records Service (NHS CRS) is intended to achieve this aim. Information about patients will be mobile and not remain in filing stores in the buildings where treatment or care has been received. The care record will be formed from information held in a number of places, which is automatically brought together when it is needed. A summary of care and clinical history will be held on a national database known as the spine to ensure that particularly important patient information is always accessible. This will include data such as name, address, NHS number and date of birth, and clinical information such as allergies, adverse reactions to drugs and details of visits to A&E. Achieving this requires the development of new models of working and standardised information systems which cross organisational boundaries. The Local Care Record More in-depth details will be held locally, where most care is delivered, in the local care record system (Local CRS). This will include detailed personal health information such as records of conditions, medication, operations, tests, X-rays, scans and other results. Links to local information will be available from the summary record. The Trust is committed to the vision and objectives of the NPfIT and this is reflected in the IM&T strategy. IM&T Strategy 2006-2011 - Final V1.0 Dec 2006 Page 10

2.4 Strategic Objectives Within the overall aims of the strategy the following primary objectives were identified: NPfIT / CRS to align the development of IM&T services in the Trust with the National Programme for IT. In particular, to enable the Trust to benefit from the implementation of the NHS Care Records Service. Clinical Support to provide clinicians with complete, accurate, and timely information, and rapid access to electronic health records, to support the delivery of high quality care. Foundation Trust to contribute to the achievement of Foundation Trust status, through effective of use IM&T and to provide timely information to support the Trust in operating successfully as a FT. DGH+ Vision to contribute to the achievement of the Trust DGH+ vision, using information and IT to improve services and the patient experience. Systems Integration to provide a fully integrated clinical information systems environment, with a single patient index employing the NHS number as the key identifier. Standardisation to continue the process of standardisation of systems, infrastructure, and data definitions, in line with national standards, to improve systems usability, interoperability, and data quality. Availability and Use of IM&T to increase the availability and use of IM&T across the Trust in support of improved clinical and business processes, and service development. Clinical Engagement to involve clinicians in specifying, planning, and implementing IM&T developments that impact clinical processes. IM&T Skills Base to continue to develop the IM&T skills base of the Trust workforce to ensure that maximum benefit is gained from improved information systems. Reduce Paper Usage to continue progress towards a paper light information sharing environment, where paper based information flows and records are minimised as far as possible. IM&T Strategy 2006-2011 - Final V1.0 Dec 2006 Page 11

3. IM&T REQUIREMENTS & PRINCIPLES In order to deliver against national targets and realise its corporate vision, the Trust has IM&T requirements at a number of different levels: Clinical / Operational requirements: test requests and results, images, communications, guidelines, pathways, ordering rules, financial rules, etc. Management requirements: activity statistics, outcome measures, audit, clinical governance, risk management, quality review, financial management, human resources, etc. Strategic / Planning requirements: corporate governance, service planning, strategy development, etc. External reporting requirements: statutory reports, commissioning information, information for the public, etc. All of this information must be underpinned by a set of common data definitions and information standards that apply to all data flows and information systems. Trust IM&T Requirements Strategic Management External Reporting Operational & Clinical Support / Outcome Data Information / Data Standards & Definitions IM&T Policies 3.1 Operational and Clinical IM&T Requirements The provision of information to support the delivery of clinical processes (i.e. the CRS) is the main focus of the strategy. Information to be held in the CRS will include: Patient demographics Hospital stay / appointment record Clinical history and diagnoses Clinical coding Clinical alerts (e.g. penicillin allergy, MRSA) IM&T Strategy 2006-2011 - Final V1.0 Dec 2006 Page 12

Details of treatments and procedures Orders for diagnostic tests, transport, portering, etc. Results (pathology, x-ray reports, etc.) Images, (X-rays, Ultrasound, ECGs, etc.) Care plans / pathways Notes (medical, nursing, therapists, dieticians, etc.) Drugs and medications prescribed and administered Letters, discharge summaries, other clinical correspondence The key requirement is for integrated, patient based, information, accessible at the point of care, anywhere in the Trust. This includes the ability to place orders, receive results, send messages, view images and clinical communications, and monitor progress all through a common access point. Clinical activity reports should be provided for clinicians to reflect the full range of clinical activity including referrals, outpatient appointments, wait times, inpatient events, and outcomes. Ideally, these should include the capability to 'drill down' into the underlying data. Integrated Clinical and Operational Information Care Record Demographics Care Pathway Appointments Orders Results & Images Medications Notes CRS Support Infrastructure Protocols Guidelines Pathways Scheduling Decision Support Knowledge Bases Evidence Audit Standards Resources Performance Indicators IM&T Strategy 2006-2011 - Final V1.0 Dec 2006 Page 13

3.2 Management IM&T Requirements The strategy necessarily focuses primarily on the CRS. However, to fulfil statutory duties, and operate successfully as a Foundation Trust, NGH must continue to maintain and develop its management and administrative information systems particularly performance management, finance, and human resources. Management information is required for a variety of purposes including: Integrated corporate governance (clinical, finance, information) Financial management and control Operational performance management Human resources management Risk management Strategic planning Audit / outcome measurement Research Quality management Training and Education Information needs to be appropriate to the level of management activity it is intended to support. Data needs, therefore, to be collected and combined in a structured manner to allow flexibility in the retrieval, processing, analysis, and presentation of management information. Management Information Levels Long Term Strategic Tactical Operational Short Term 3.3 Business Intelligence and Data Warehousing The Trust needs to have flexible and responsive management information tools to be able to provide timely and relevant information about clinical and organisational performance. IM&T Strategy 2006-2011 - Final V1.0 Dec 2006 Page 14

Data warehousing allows data to be drawn from operational systems and stored in a structured manner designed specifically to facilitate flexible analysis and reporting. Business intelligence can be described at three levels: Monitoring - at this high level, Board members and senior management are provided with a view of performance against a range of agreed targets / indicators. Information is necessarily summarised but is presented in such a way as to alert managers to issues that may need attention, for example using 'traffic light' indicators. Analysis - the ability to 'slice and dice' the information behind the indicators to produce more detailed management reports, trends, analyses, etc., that inform decision making, performance management, planning etc. Detail - provision of access to underlying detailed transactional data to investigate problems, initiate corrective action, review processes, etc. Business Intelligence (BI) software tools can be used with data warehouse solutions and/or with operational systems to provide information (if necessary, in real time or near real time) at all of these levels, together with the ability to 'drill down' through the levels as required. The Trust has used BusinessObjects BI tools for 15 years but does not currently use all of the tools available. Balanced Scorecard / Digital Dashboard The balanced scorecard is a high level approach to the provision of performance management information. It uses a set of key indicators to provide senior management with feedback around internal business processes, finance, and external outcomes in order to continuously improve strategic performance and results. The digital dashboard is a visual representation of performance information (such as that in the balanced scorecard). It extends the traffic light indicator approach and provides alerts against agreed key measures and targets, allowing users to drill down through the indicator results for deeper analysis of the underlying information. Balanced scorecard / digital dashboard provision is viewed as a key requirement to support Foundation Trust management. 3.4 Basic IM&T Principles Development of information systems should adhere to a set of basic principles: 3.4.1 Data input processes should be rapid and accurate, and require minimum effort by clinical staff. The fundamental principle of data collection is that data should only need to be entered once. Capturing and recording clinical data should occur as part of the process of delivering care and should not require a separate data collection process. 3.4.2 Information should be collected and presented through a single, common, user interface. There should be no need for users to frequently log into, and out of, separate systems to view the information that they need. There should be one common interface and a single security sign-on. IM&T Strategy 2006-2011 - Final V1.0 Dec 2006 Page 15

3.4.3 Operational and clinical systems should provide, as a by-product of their use, timely, relevant, and accurate management information. 3.4.4 Standard data and information definitions, standard coding structures, and robust data quality measures, are key requirements for the production of good management information. 3.4.5 Information should be provided in a timely manner relevant to use to which it will be put. Static historical information may be perfectly adequate for record keeping, invoicing, or research for example, but decision making requires prompt, preferably 'realtime' information provision. 3.4.6 System users should be held individually responsible for ensuring that data is entered in a timely and accurate manner. 3.4.7 Systems should maintain a chronological audit log of all transactions, including a comprehensive record of which users have accessed the system and the actions they have performed. 3.4.8 Access to information systems should be provided through technology that is fit for purpose, easily accessible, and easy to use. 3.4.9 The NHS number should be used as the primary patient identifier in all information systems and in clinical messaging. 3.4.10 Clinical information should be patient focused and based around pathways of care. Pathways of care will provide the link to a complete record of all interventions, all professionals involved in a patients care, notes related to that care, etc. IM&T Strategy 2006-2011 - Final V1.0 Dec 2006 Page 16

4. CURRENT IM&T BASELINE A review of existing IM&T systems and services showed that the Trust needs to make more effective use of modern information technology and improve the provision of information, in particular for clinicians. Whilst generally sound, the majority of existing systems are either at, or near, the end of useful life, or else require attention in the context of achieving national and local service modernisation objectives over the period of the strategy. New systems and services will also need to be introduced if strategic objectives are to be met. A synopsis of the review is presented below, fuller details are provided in Appendix A. 4.1 Status of IM&T Systems and Services 4.1.1 Clinical and Operational Systems A number of systems are currently in the process of being replaced with NPfIT solutions: PAS Pathology PACS Radiology There are some existing systems that will not support the achievement of Trust strategic objectives and these must be made a high priority for replacement: Maternity A&E Systems that are relatively new but will, nevertheless, need further review in the context of Trust strategic objectives are: Theatres Child Health Electronic requesting and results reporting Systems identified as being at or near the end of useful life are: Pharmacy Oncology Echocardiography Areas where new systems or further development of existing systems is needed are: Choose and book Cardiology Diabetes Blood tracking Further development of clinical messaging Further development of clinical image capture and sharing Electronic prescribing IM&T Strategy 2006-2011 - Final V1.0 Dec 2006 Page 17

4.1.2 Management Information Systems Management information systems are mainly departmentally focused, and integration of information for senior management is labour intensive. 4.1.3 Business Systems Systems that are currently in the process of being replaced are: HR and Payroll Systems that need further review in the context of Trust strategic objectives are: Finance system Areas where new systems or further development of existing systems is needed are: e-procurement system Business intelligence Business support / collaboration tools Document management Rostering, bank/agency staff management 4.1.4 Infrastructure PCs - a comprehensive PC replacement / upgrade programme is in progress but a significant proportion of PCs remain at or near end of life. Network - the trust has a reasonably up-to-date fixed local area network (LAN) with adequate capacity for current needs. New NHS network (N3) connection is in place. There is no wireless LAN capability at present. Servers/data storage - the Trust has many old, inefficient servers, and data storage is based on outdated technology. Urgent upgrade and development is needed in this area. Web services - Trust web services are very limited. Early development is needed in this area and planning for a comprehensive, integrated, internet presence has commenced. 4.1.5 IM&T Resources IM&T department resources were examined in the light of current and anticipated demands (resulting from, for example: NPfIT, FT, PbR, 18week target). This showed that IM&T is under-resourced and struggles to fully satisfy current demands. Current investment in IM&T is at around 2%, slightly below the national average and substantially below that recommended by the Wanless report in 2002. The review shows that there is scope for improving the utilisation of the overall existing Trust IT staffing resource. Clinical coding services need to be further strengthened. High quality clinical coding is fundamental to data quality, Trust business processes, and payment by results. 4.1.6 Other Current Gaps / Issues with IM&T services There are several different patient identifiers in use across the Trust. This makes system integration difficult and has the potential for clinical risk. IM&T Strategy 2006-2011 - Final V1.0 Dec 2006 Page 18

There is no single security sign-on process. Users often have to remember several different username and password combinations, and log into and out of a number of systems in the course of carrying out their job. A significant level of frustration with current IM&T is felt by clinicians: More clinical information needs to be provided electronically both in real time and for retrospective analysis. More clinical messaging needs to happen electronically. Better IT support for specifically clinical processes is needed. Current systems are regarded as inflexible. Data is often felt to be poorly presented. Multiple systems need to be accessed to find information (there is no single view of all the information required). IT needs to be better used in positive patient identification processes to reduce the potential for clinical risk. Although there has been improvement in recent years there can still be seen a tendency for 'vertical' developments and 'islands of innovation' to occur (often not in line with Trust strategy). Also, there is still evidence of 'piecemeal' development; developments started but not fully followed through as a result of lack of resources, or of commitment and ownership. PRINCE2 project management principles are always applied in larger IM&T initiatives, but are not consistently applied in smaller ones. Storage of paper health records is a major problem, and tracking records remains a difficult and time consuming task. 4.2 SWOT Analysis The broad findings of a SWOT analysis, carried out as part of the review are: Strengths Long history and experience of integrating systems in the Trust Investment in integration software tools and skills Modern high performance network with unused capacity IT literate user base Good data quality Opportunities Many CRS components are already in place or being rolled out and can be built upon Enthusiasm for increased ICT support for clinical processes Strong board level IM&T representation and support for the modernisation agenda Weaknesses Currently several different patient identifiers remain in use in different systems. This complicates system integration and presents a potential for clinical risk The large number of small departmental clinical systems would be difficult to integrate into the CRS IM&T Strategy 2006-2011 - Final V1.0 Dec 2006 Page 19

The current IT staffing infrastructure does not make most effective use of key resources and skills Project management principles are inconsistently applied Threats Inability to achieve organisational and cultural change at a sufficiently rapid pace to meet ambitious targets IT staff recruitment and retention can be difficult in an increasingly competitive market for scarce skills Poor perception of the National IT programme and its capacity to deliver, particularly amongst clinical staff Increasing demands on IM&T resources SWOT Diagram Strengths Integration experience and capability Modern network IT literate user base Good data quality Opportunities Good foundation for CRS, ready to be built upon Enthusiasm and demand for better IT Strong Board level support Weaknesses Multiple patient identifiers Large number of departmental systems Inefficient use of IT resources Inconsistent project management Threats Ambitious pace of change IT staff recruitment and retention Poor perception of NPfIT Increasing demands on IM&T services IM&T Strategy 2006-2011 - Final V1.0 Dec 2006 Page 20

5. THE STRATEGY This section sets out the intended strategy for the development of IM&T over the next five years (2006-2011). The strategy represents significant change in the way NGH utilizes IM&T services over the five year period, and recognises that high quality information is critical to the future development of the organisation and the services it provides. There is a particular focus on the provision of IM&T to support clinical processes and decision making. Indicative timescales for delivery of the various elements of the strategy are indicated in Appendix B, but successful delivery of the strategy will depend upon developing the necessary IM&T capacity within the Trust and securing appropriate levels of investment. (See Section 7). The key components of the Trust IM&T strategic vision are as follows: Care Record Service - 24 hour / 365 day access to an integrated health record which supports patient care, across all care settings, at the point of delivery. Clinical Systems - Modern clinical / operational support systems accessed through a common web based clinical portal application. Clinical systems will incorporate decision support facilities that assist health professionals in the delivery of optimum models of care and reduce avoidable errors. Digital Imaging (PACS) - Comprehensive digital imaging facilities to improve the availability of clinical images and archived records. Clinical Messaging - Electronic requesting, results reporting, discharges information, clinical correspondence, and other clinical messaging. Choose & Book - National web-based appointment scheduling system supporting the patient appointment process throughout the health community. Data Repository - A data repository to aggregate and analyse patient data for outcome measurement, clinical governance, clinical audit, reporting and management information. Business Systems - Continued development of business systems and improved provision of management information. Infrastructure - A robust, resilient, infrastructure with the capacity to support timely access to all systems and handle increasing volumes of data transmission. Data quality - Deliver the high quality data critical to the success of the strategy and Trust business processes. Security Implementation of individual user registration and role based access controls, with single sign-on, to ensure security and confidentiality of electronic clinical records. The technology architecture underlying this vision must provide robust and reliable integration of systems and data sources and an easy to use, secure, single access point that can be tailored to individual user requirements. (See diagram below). IM&T Strategy 2006-2011 - Final V1.0 Dec 2006 Page 21

Systems and Technology - Architecture PATIENT MASTER INDEX CLINIC AL INFO RM ATIO N SYSTEM S BUSINESS SYSTEMS INTEGRATION ENGINE / MESSAGE HANDLING DATA REPOSITORY MANAGEMENT INFORMATION SYSTEMS ORDER COMMUNICATIONS PRESCRIBING SYSTEMS USER PORTAL / CLINICAL WORKSTATION SPINE SERVICES (PDS, PSIS, SUS, SECURITY) W EB SERVICES LOCAL INFRASTRUCTURE N3 5.1 CRS / Clinical Systems The Trust is committed to the National Programme for IT, and has already deployed some national products: N3, Choose and Book interim service, Map of Medicine. It is also in the process of deploying the NPfIT PAS, PACS, RIS, and Pathology solutions. However there have been some significant delays in delivery of national systems and further delay cannot be ruled out. This strategy aims, therefore, to align the development of a local CRS with NPfIT, using national products as far as possible, but deploying some interim non-npfit components, ahead of national timescales, where Trust business strategy demands that this should be done. This approach will minimise operational risk to the Trust ensure the delivery of business objectives as the Trust progresses to Foundation Trust status. Alignment of local and NPfIT deliverables will be achieved through: Overall management structure: the NPfIT Programme Executive Board is a subset of the Trust IM&T Sub-committee which will act as the overall strategy delivery board (see section 7). Technical standards: the Trust will meet or exceed the NPfIT specified technical environment standards for all strategic IT projects. Data standards: Trust data quality standards, data cleansing activities, use of the NHS number, and PMI integration will meet NPfIT (IQAP) requirements. Improved training and change management capacity: IT training resource has been strengthened, training facilities and capacity improved, and business process change skills will be developed further to support IT developments. IM&T Strategy 2006-2011 - Final V1.0 Dec 2006 Page 22

NPfIT has two phases for CRS delivery: Interim solutions will be provided between 2006-2008/9. The full strategic CRS solution is due to become available in 2009, although some components may not be available until 2011. The full CRS solution is intended to provide a fully integrated electronic health record including: patient administration, emergency care, comprehensive clinical / diagnostic functionality, care scheduling, full decision support, electronic prescribing, real-time bed management, clinical documentation / messaging. The longer term strategic intention is that the Trust will migrate to the full CRS when it is available. In the shorter term (at least to 2008/9) there is a need to improve the integration of existing systems, replace systems where necessary, and introduce new systems where this is critical to support strategic objectives. The immediate requirement is to complete the implementations of PAS, Pathology, PACS and Radiology systems currently in progress in the Trust as part of NPfIT in the Eastern Cluster. The baseline review identified other CRS components and clinical systems where interim action / development will be needed: Requesting and Results Reporting - electronic requesting for Pathology has been implemented for all GP practices and is in the process of being rolled out in the Trust. The rollout will continue and ordering will be extended to include Radiology. The existing results reporting system will need to be replaced. The option of migration to the NPfIT integrated order communications solution will be evaluated. Maternity - the existing Maternity system cannot support strategic objectives and will need to be replaced as early as possible. The date for delivery of the NPfIT maternity solution is not clear. An urgent options appraisal to include alternative non-npfit products will be undertaken. A&E - the existing A&E system cannot support strategic objectives and does not integrate reliably with PAS. A 'stand-alone core' NPfIT solution is available, or an upgrade to the latest version of the current system could be taken. These two options will be evaluated. Theatres - the existing theatre system functionality will be reviewed, and compared with NPfIT specification and standards. An options appraisal for possible migration to the NPfIT 'stand-alone core' product will be undertaken. Child Health - the status of the existing Child Health system needs to be kept under review. The Trust is committed to the NPfIT aim of having a single, county-wide, Child Health system. An NPfIT product is available but does not currently satisfy the Trust business requirements; the existing system will be retained until the necessary changes to the national solution have been made. Pharmacy - the existing Pharmacy system is old and becoming increasingly costly to maintain; this will need to be replaced. It is intended that, subject to evaluation, the NPfIT Pharmacy product will be implemented. IM&T Strategy 2006-2011 - Final V1.0 Dec 2006 Page 23

Clinical Correspondence - the roll-out of the current e-discharges system will be completed as NPfIT does not offer similar functionality ahead of the full CRS release. Implementation of e-referral letters linked to CaB will be investigated further along with methods for secure transmission of other clinical correspondence. Digital imaging - After completion of the first phase of PACS implementation which will cover Radiology services, other digital imaging services / modalities (e.g. echocardiography, retinopathy, antenatal ultrasound) will be progressively integrated into the central digital image store. The local image store will also be integrated into a Cluster wide store as part of NPfIT to allow image sharing across the wider health community. Integrated Care Pathways - the development of an ICP framework (in conjunction with partner organisations) will continue in preparation for the full CRS. Other Clinical / Diagnostic systems - it is not yet clear how specialist clinical / diagnostic systems are to be delivered through the national programme. Some interim clinical products may be made available through NPfIT, but it is likely that the majority will not be available until release of the full CRS. A number of interim requirements for NGH were identified through the baseline review: Cardiology (particularly a replacement echocardiography system) Chemotherapy prescribing Oncology systems replacement Blood tracking system enhancement Lab to Lab links Tele-radiology Other requirements may be identified through the annual planning process and as part of wider strategic service developments such as the Shaping the Future programme. All investment in interim clinical systems will be made with reference to NPfIT standards and with a view to migration to NPfIT products when available. 5.2 Choose and Book Once PAS deployment is complete the Trust will begin the migration from the current interim booking service to the fully integrated Choose and Book service. 5.3 Data Repository and Clinical Activity Reporting The Trust data warehouse will progressively be enhanced, both in richness and completeness of the data held, and through introduction more flexible, timely, and user friendly reporting facilities, tailored to end user requirements. 5.4 Business systems The Trust will continue to maintain and develop its management and administrative information systems particularly performance management, finance, and human resources: IM&T Strategy 2006-2011 - Final V1.0 Dec 2006 Page 24

Electronic Staff Record (ESR) - the Trust will complete its implementation of the national ESR (HR and payroll) system. E-procurement - the rollout of the e-procurement system will be completed. Finance - a review of Finance systems functionality will be undertaken to assess the need for replacement systems. Management Information Systems (MIS) - developments to improve management information reporting will include the introduction of a balanced scorecard /digital dashboard application. The BusinessObjects software will be upgraded, and additional BusinessObjects tools will be deployed to enhance the Trust's management information analysis capability. Reporting Integration - further integration of Finance HR and activity data and reporting will be undertaken. Rostering - electronic rostering systems will be investigated. This function may eventually be provided through the ESR. Collaboration and workflow support - the Trust will make greater use of collaboration / workflow support tools to improve the efficiency of administrative processes. For example, video-conferencing facilities, digital dictation software. 5.5 Internet / Intranet services Development of a comprehensive Trust internet presence and more dynamic internal web services will be undertaken. 5.6 Email The Trust will assess the benefits of migration to the national NHSmail service. 5.7 Technology The key elements of the technical architecture needed to deliver the strategy are: a high standard, resilient, IT infrastructure integration of systems strong access controls Infrastructure The IT infrastructure will be enhanced to ensure that it is of a high standard, has the capacity to support the CRS and other developments, is more resilient, and can be managed more effectively and efficiently: All PCs/ workstations will be migrated to the Trusts standard technical build. All user data on PCs will be moved to central network storage to improve backup and recovery capability, and the facility to share data more effectively. IM&T Strategy 2006-2011 - Final V1.0 Dec 2006 Page 25

A formal PC refresh programme will be introduced. This will be based on a three-year replacement cycle for PCs and strict compliance to prevailing NPfIT standards. Remote software installation and update facilities will be implemented to allow PC software and operating system upgrades to be delivered to all users quickly and costeffectively. The email server and Windows networking domain will be upgraded. The Trust currently has in excess of 80 servers, these will progressively be consolidated, and virtualisation technology introduced, to provide a more flexible server architecture that is both more resilient and more cost effective to manage. The capacity of the Trust network will be reviewed to ensure that it is able to support future development needs and a regular networking technology refresh programme introduced. Wireless networking capability will be implemented. This will allow the use of more mobile workstations which will become an essential part of providing rapid access to clinical information. The use of scanning and electronic document management will be extended to nonhealth records to support information governance and reduce pressure on document storage space. The use of barcoding, RFID, and other rapid data entry techniques will be extended to improve processes, workflow, and data quality. ICT security and business continuity measures will be reviewed and updated to ensure that they are commensurate with the increased dependence on ICT in clinical and business processes. Integration The strategy will deliver an integrated local CRS, and improved integration of data for management information and reporting. It is not possible to achieve this through piecemeal linking together of systems. As part of the PAS implementation the Trust has already introduced improved integration engine technology. This will become a key central component of the systems architecture necessary to achieve the strategic objectives. Use of the NHS number as the key patient identifier will be fundamental to integrating care records. Access controls System access will progressively be moved to a single web based portal with single sign-on for all systems. This will be linked with the NPfIT role based Registration Authority / smart card access control process. IM&T Strategy 2006-2011 - Final V1.0 Dec 2006 Page 26

As electronic methods of record keeping and correspondence are introduced more widely, the use and acceptability of electronic or digital signatures will need to be considered. Telecommunications The telecommunications strategy is outside of the scope of this document but there are increasing areas of technological overlap. In particular there have been significant developments in recent years related to the convergence of data and voice traffic transmission, and IT based solutions for improving internal communication amongst mobile workers. The IT department will work closely with the Facilities Directorate to ensure that these areas of overlap are managed effectively and coherently. The introduction of wireless networking will be a significant enabler in this area. Systems and Technology - Strategic Development CLINICAL INFORMATION SYSTEMS PMI PAS A&E Maternity Pathology Theatre Child Health Finance Systems Procurement PACS Pharmacy Cardiology BUSINESS SYSTEMS HR Business Support RIS Oncology Others Payroll Document Management INTEGRATION ENGINE / MESSAGE HANDLING DATA WAREHOUSE ORDER COMMUNICATIONS Ordering Chemo MIS PRESCRIBING SYSTEMS Results Full PORTAL / WORKSTATION APPS SPINE SERVICES (PDS, PSIS, SUS, SECURITY) WEB SERVICES LOCAL INFRASTRUCTURE Data Storage LAN Wireless PCs / Workstations Portable Devices Access Controls N3 KEY: Replace New Enhance Review No Action 5.8 Data Quality High quality data is critical to the success of the strategy and Trust business processes. Data quality measures must be applied rigorously to both computer systems and paperbased health records. Continued improvement of data quality will be addressed in a number of ways including: maintaining and reinforcing the culture of accurate, timely recording of data. IM&T Strategy 2006-2011 - Final V1.0 Dec 2006 Page 27

eliminating duplicate or non-matching records in the PAS system and departmental system patient indexes. migration to a single master patient index based on the national patient demographic service (PDS) with the NHS number as the key identifier. ensuring that all users of computers systems are properly trained in the principles and practice of good data quality. implementation of individual user accounts and security logins, progressively covering all systems, ensuring that only authorised users have access to computer systems. strengthening the capacity of the clinical coding function. ensuring consistent use of the NHS number as a means of positive patient identification including use on casenotes and other patient related documents. Use of barcoding, RFID, and other rapid data entry techniques. 5.9 Health Records Management The longer term strategic intention (local and national) is to move away from the use of paper records as far as possible. Meanwhile management of the paper health record will continue to be a significant element of IM&T services and will need to be developed: paper health records and electronic records will have the same status, and the principles of data quality and data standards will be applied to both. casenote tracking will be improved. filing and storage capability will be improved, and options for moving the records store will be examined as part of the site configuration proposals. the recommendations from the review of records storage and archive solutions will be implemented. the NHS number will be used routinely on the casenote cover and contents. the scanning and electronic document management system will continue to be developed and its scope and coverage extended. 5.10 Clinical Coding Clinical coding services will be further extended and enhanced. The clinical coding team will be further strengthened, and software tools utilised to assist in improving the depth and accuracy of coding. Clinical staff involvement in the coding process will increase, ultimately be as a by product of the use of clinical systems as part of day to day work. 5.11 People and Organisation 5.11.1 IM&T Staffing Resources ICT Department: The ICT department will be reviewed and restructured as necessary with a progressive increase in resources to meet increased demand as services are developed and for NPfIT service desk operation: Over the period of this strategy, current front-line support provision will gradually evolve to provide 24/7 cover, to respond to the needs of more IT dependent clinical services. The capability of the IT Service Desk will be developed further to support 24/7 cover, and the interface to the NPfIT national service desk. IM&T Strategy 2006-2011 - Final V1.0 Dec 2006 Page 28

The role of the ICT department and its relationship with the rest of the organisation will change. The department will become more customer-service driven, ultimately operating as a trading centre. Information Services (IS) Department: Information Services (including the clinical coding function) will be strengthened to meet increased internal demands for management information, and external demands for information for commissioners and statutory data submissions. IS primary role in the provision of statutory and commissioner information will remain a core function and this responsibility must be met. PbR, 18 week RTT, and FT status will present new challenges. To ensure IS has the necessary resources and skills (data analysis, data quality, coding, etc.) a review will be carried out and the department will be restructured and strengthened as required. Over the course of time IS has taken on additional workload in areas such as capacity planning and activity modelling, and managers have become very dependent on the department to meet their information needs. The department will need to review the extent of its direct support to managers. It may be that the department operates more in an enabling role where managers and other information users are guided, supported and trained to become more self-sufficient in information analysis and usage. 5.11.2 IM&T Service Users The Trust employs around 3800 staff. This strategy will further increase the requirement for staff to use some form of electronic system to access or record information in order to carry out their duties. The success of the strategy depends on users recognising they have a critical role, and a personal responsibility in ensuring overall data quality. Every person working for the Trust should be personally accountable for the accurate, complete, and timely collection of data as part of their job. Maintaining the security and confidentiality of data is key to the wider use of electronic health records. Users must recognise this as a fundamental responsibility and be aware of the need for the stricter access controls introduced as part of this strategy. This will be reinforced in Trust IM&T policy and in HR policy. Changing the way people work with IM&T will necessitate changes in the way the Trust recruits, inducts, appraises, and trains its employees. Scheduled clinical systems training, and refresh training, will be a core IT service. Current opt-in arrangements will be replaced by mandatory requirements, with new entrants being required to attend training as part of the induction process and existing staff being actively encouraged through the Knowledge and Skills Framework (KSF) appraisal process. There will be tighter controls over user accounts, users will be properly trained before system access is permitted. Agency, bank, locum and temporary staff will also need to use the Trust s computer systems and a fast track training and registration authority facility will need to be put in place to cater for the needs of these individuals. IM&T Strategy 2006-2011 - Final V1.0 Dec 2006 Page 29

IT Training capacity will be significantly increased with ICT training staff working in close collaboration with HR Training and Development staff. IT training will be linked with relevant parts of KSFs. 5.12 IM&T Policy IM&T policy will be developed and updated as necessary, to reflect the changes brought about through the delivery of this strategy. IM&T Strategy 2006-2011 - Final V1.0 Dec 2006 Page 30

6. STRATEGY DELIVERY The programme of development work identified in the strategy is challenging and will have to be delivered alongside IM&T department day to day support commitments. Currently the Trust does not have the necessary IM&T resources to undertake this level of work. Delivering the strategy will, therefore, require additional investment. (See Section 7). Directorates and departments involved in the programme will also have operational commitments that will constrain the resources they can allocate to projects. This will need to be addressed when drawing up development proposals and business cases. 6.1 Managing the Programme and Projects Given the importance and scope of the programme, it is essential that it is appropriately managed. A structured approach, using appropriate programme and project management methodologies, will be employed. 6.1.1 IM&T Sub-Committee The IM&T Sub-committee (a sub-committee of the Trust Board) will act as the overall Strategy Programme Delivery Board. The Terms of Reference and membership of the sub-committee will be reviewed accordingly. (See Appendix C). 6.1.2 Programme Management The Managing Successful Programmes (MSP) methodology will be adopted for management of the overall programme. This is recommended and approved by NPfIT. 6.1.3 Project Management All projects will be managed using PRINCE2 methodology, this is the Trust and NHS standard for project management. Larger projects will appoint a dedicated Project Manager, who should be formally PRINCE2 trained. Smaller projects will allocate the role of project lead to a responsible person as part of their day to day role and who will have, or be given, project management awareness training. 6.1.4 Project Initiation Before being approved for the annual work programme, a Project Brief must be produced for all projects, and larger projects will need a supporting business case plus a full Project Initiation Document. 6.1.5 IM&T Responsibilities IM&T will provide advisory and technical support to project teams. IM&T will lead and coordinate NPfIT programme work streams. Where projects are classified as purely technical they will be managed by ICT. 6.1.6 Directorate and Departmental Responsibilities Directorates and departments will be involved in delivering the work programmes. Unless a project is purely technical in nature, directorate or department staff must be involved in the planning and delivery of projects that affect their area at both Project Board and Project Team levels. A senior member of the directorate or department should take the role of project sponsor. IM&T Strategy 2006-2011 - Final V1.0 Dec 2006 Page 31

6.1.7 Clinical Involvement Given the objectives of the programme it is essential that clinical staff are involved in the specification, planning, and control of all projects which affect clinical processes. 6.2 Projects Appendix B provides an overview of the strategic developments planned over the five year period covered by this document with an indicative time line. This will be converted into an annual work programme, and specific projects identified and approved, as part of the annual planning cycle and through the Business Group / IM&T Sub-committee development proposal process. Programme Management HMB IM&T Subcommittee Delegated executive authority for overall control of IM&T strategy, investment, and development programme. Programme Boards Control groups of related projects Project Board Project Board Project Board Project Board IM&T Strategy 2006-2011 - Final V1.0 Dec 2006 Page 32

7. INVESTMENT This strategy sets out an ambitious, but crucial, programme of IM&T development for the Trust. In order to successfully deliver the strategy, year on year increases in Trust spend on IM&T will be required over the five years of the programme. These increases should, over the five year period, bring Trust IM&T investment broadly in line with national recommendations, which indicate that the NHS should be allocating around 4% of total spend to IM&T. Currently, annual IM&T baseline spend is around 2% of Trust turnover. 7.1 Benefits from Investment This represents a substantial additional investment in IM&T over the next five years. The increased investment in must, therefore, deliver commensurate benefit. The Trust five year plan identifies many service and business objectives that cannot be achieved without more accurate, comprehensive and timely information, better ICT support, and the implementation of modern systems to support improved clinical and business processes and new ways of working. Achievement of national targets, such as Choose and Book, and 18 week referral to treatment wait require new IM&T solutions. The strategy provides a long term development framework for IM&T. As part of the normal annual business planning cycle, detailed plans to support the strategy will be produced, and will be supported by business cases that clearly set out the benefits of each investment and link these to the local and national objectives. 7.2 Capital The strategy assumes the continued availability of a baseline of operational capital to cover technology refresh, and repair and replacement. This baseline will need to increase in line with the size of the ICT 'estate' and will be driven more and more by the requirement to comply with national standards. 7.3 Revenue Increases in IM&T revenue funding will be needed to cover the costs of: Increased IM&T support requirements as the Trust becomes more reliant upon on electronic information systems in the delivery of patient care. Costs of moving to 24/7 support. NPfIT implementation costs. NPfIT service desk costs. Increased IM&T support requirements as the Trust implements more sophisticated management information systems. Increased technical complexity and rapid change. Higher IM&T skill levels required. Additional training. Meeting the revenue consequences of increased capital investment. IM&T Strategy 2006-2011 - Final V1.0 Dec 2006 Page 33

7.4 Funding Sources A range of funding sources and methods will be used in securing the necessary additional funding and keeping additional costs to the minimum: Internal review of Trust wide ICT spend to channel resources appropriately. Business cases to support proposals for IM&T developments. Identification of appropriate external funding streams against which bids for IM&T development funding can be made. Redirection of efficiency savings released by IM&T enabled developments. Resource sharing with partner organisations, to make best use of scarce skills, and provision of out of hours support. Continued close working with Supplies department to obtain best prices, and value for money, for equipment and services. IM&T Strategy 2006-2011 - Final V1.0 Dec 2006 Page 34

8. RISK MANAGEMENT A risk management strategy will be developed for the overall programme. This will include risk analysis at three levels: Organisation Level Risks to the organisation and its business plans from non-delivery either of the overall strategy, or specific elements of the strategy will be identified. Strategy / Programme Level Risks to delivery of the strategy and the overall programme will be identified. A programme level issues log and risk register will be produced and maintained by the Programme Manager. Project Level As part of project initiation and ongoing project control, individual projects will maintain an issues log and register of risks that may affect delivery of that project. The types of risk that will need to be considered include: Clinical risk Financial risk Funding constraints Resource constraints IM&T capacity Skills shortages NPfIT scope and delivery changes Legacy system supplier issues Lack of ownership / commitment to projects Actions to mitigate and manage each risk will be identified in the appropriate risk register. Risk registers will be regularly reviewed and updated as delivery of the strategy progresses. IM&T Strategy 2006-2011 - Final V1.0 Dec 2006 Page 35

9. CONCLUSION This document sets out a vision and strategic direction for the development of IM&T at NGH over the next five years. It aligns national and local IM&T requirements and sets a clear framework and direction for the introduction of modern IT systems and better information to support the Trust 5 year business plan and the national goal of a patientled NHS. IM&T Strategy 2006-2011 - Final V1.0 Dec 2006 Page 36

APPENDICES IM&T Strategy 2006-2011 - Final V1.0 Dec 2006 Page 37

Appendix A CURRENT IM&T - BASELINE REVIEW Introduction In seeking to determine the future strategic direction, a review of existing IM&T systems and services was carried out over a six month period, between January and June 2006, with input from a wide range of staff including Trust Executive Team, Clinicians, Directorate Managers, Heads of Department and IM&T staff. The review also drew upon several other source documents, including national IT strategy documents, audit reports, and the Clinical IT Review undertaken by Clinical Matrix in 2003. The review examined current systems and services in the context of national IM&T targets, particularly the national electronic care record service (CRS), and the Trust five year plan. Strengths, weaknesses, and gaps were assessed, and developments planned or underway were reviewed for strategic fit. Summary The process revealed that, whilst generally sound, the majority of existing systems were either at, or near, the end of useful life, or else would require attention in the context of achieving national and/or local modernisation objectives over the period of the strategy. A number of systems were currently in the process of being replaced with NPfIT solutions, and there were some systems that, although relatively new, would need further review. It was clear that new systems and services would also need to be introduced if strategic objectives were to be met. A key finding was that the Trust needed to make more effective use of modern information technology to support clinical practice and improve the provision of information for clinicians. Detailed Findings The detailed findings are presented below: a) Clinical and Operational Systems PAS The current IRC PAS system functions well along with the OpenGuide graphical front end. However, it is 20 years old and no longer being developed. This means that no changes to the software will be made, including changes to meet DSCN notice requirements. It is not NPfIT compliant, not able to support Choose and Book (CaB), and at the time of the review had a support termination date of September 2006. This has since been extended to March 2007. A PAS replacement project is in progress as part of NPfIT Pathology Replacement of the main Pathology system is almost complete with only the Blood Transfusion module remaining. However the need for further investment in other IM&T Strategy 2006-2011 Final V1.0 Dec 2006 Page 38

modernisation / clinical risk areas has been identified (e.g. blood tracking, lab to lab links). PACS The current partial PACS system introduced in 2000 was deemed not suitable to support whole Trust / community PACS, and not NPfIT compliant. Preparation for a replacement system through NPfIT has commenced. Radiology At the time of the review the Trust was operating a very old RIS system. The system was becoming increasingly difficult and costly to maintain, had unreliable interfaces, and inadequate integration with the Trust patient index. The inadequacies of the system had contributed to serious business process issues and a significant potential for clinical risk. Preparation for a replacement system through NPfIT has commenced. The directorate is very keen to explore the use of Teleradiology and has a particular need for improved voice recognition software. Maternity The existing maternity system (Ciconia SMMIS) is very old, and unable to support planned service improvements, new national data sets, or to be integrated into the CRS. Planning for a replacement system through NPfIT has commenced although at the time of the review the timescale for this was unclear due to uncertainties about the national solution. The Trust needs urgently to replace the system and it is possible that alternatives to the national solution will need to be examined. A&E The existing A&E system (Footman Walker FWII) system is very old, has an unreliable PAS interface, and is not able to be integrated into the CRS. Planning for a replacement system had commenced although this has been severely delayed due to changes in the deliverables from the NPfIT contract and the extended work on the PAS replacement project. Theatres This is a new Theatre system (Newgate), only relatively recently implemented in Main Theatres, and full rollout to other theatres needs to be completed. The Trust will need to review functionality against the national reference solution to ensure that integration into the CRS is possible. The system is not being used to it's full potential, possibly due to configuration problems, or training and process change issues. Child Health The main Child Health system was upgraded in 2003 and is considered fit for purpose by the Child Health department. There were plans for Child Health to move to the NPfIT solution county-wide but this has been halted. Several critical issues need to be resolved before this can be restarted. The situation is being kept under review. It is not clear whether the current system could be integrated into a county-wide solution although it is accepted that there are significant benefits to having a single county-wide database. The department also has a number of smaller locally developed systems which are only partially integrated with other Trust systems. IM&T Strategy 2006-2011 Final V1.0 Dec 2006 Page 39

Pharmacy The current EDS system has been upgraded relatively recently, but it is fundamentally an old system, and becoming increasingly expensive to support due to the rapidly declining user base. The Trust has no electronic prescribing system, although a limited amount of electronic prescribing is done through the Discharge Summary system. Oncology The directorate has several systems. The main Oncology database is a locally developed, system originally dating back more than 10 years. The Trust does not currently have a Chemotherapy prescribing system which is now a national requirement. At the time of the review plans were being developed for this and a business case being developed. Directorate systems need improved integration with PAS, Pathology, and Pharmacy as well as external links to Milton Keynes and Kettering. Electronic transfer of cancer data to various sources is required. Cardiology The department has mixture of stand alone and small networked systems. There no significant integration across the department, or with PAS and other Trust systems. Developments in Cardiology services are creating a significant demand for better IT support. The echocardiography system is in urgent need of replacement. Results reporting All GPs receive pathology and radiology reports electronically. The current internal results reporting system Revive is adequate for this process, but not considered robust enough for longer term strategic requirements. Evaluation of the NPfIT results reporting solution and other suitable systems is planned. (See also electronic requesting). Electronic requesting A new electronic requesting system, initially for Pathology tests, was introduced internally in 2005 after successful implementation in GP practices. Rollout of this system is ongoing and there are plans to extend coverage to include Radiology. This system is considered suitable for longer term strategic requirements, although it will be need to reviewed against the national reference solution. The requesting system has a reporting module which could be used to replace the current results reporting system at very small cost. Other Clinical messaging The Trust has a functionally rich electronic discharge summary system which is currently being rolled out Trust-wide. There is also limited use of electronic referral letters alongside Choose and Book. There is considerable desire for widening the scope of electronic messaging although this is currently restricted by the need to comply with strict security and confidentiality requirements. IM&T Strategy 2006-2011 Final V1.0 Dec 2006 Page 40

b) Business Systems Finance system The main Finance system is over 10 years old and, although it is considered adequate at present, alternatives are being examined. The department has several smaller systems used for specialist functions. HR / Payroll system Planning has commenced for the Trust move to the national ESR system. The department is very keen to utilise ICT to modernise its processes and has done a significant amount of work around e-recruitment in particular. Procurement systems Internal procurement processes are labour intensive, time consuming, and inefficient. E- procurement was being piloted at the time of the review and there are plans to roll this out Trust-wide as soon as possible. Business support / collaboration tools There is currently no Trust-wide solution. Local databases, shared drives / directories are used in some departments. There is a clear need to share best practice and to make available tools such as voice recognition software and video conferencing facilities to facilitate new and more efficient ways of working. Document Management An enterprise capable document management solution was installed in Medical Records in 2005. This incorporates the NPfIT standard Documentum document management software. c) Management Information Systems There are various management information systems in use, but these are largely departmentally based and integration of information for senior management is very labour intensive. There is a significant and urgent demand for more comprehensive, accurate management information, delivered or accessed in a flexible, timely, manner and presented in a user friendly format. Of particular interest is 'balanced scorecard' type information delivered electronically in real-time, or as near to real-time as possible, to improve decision making and management response to rapidly changing situations. d) Infrastructure Network The Trust has a reasonably modern fixed local area network with adequate capacity for current needs. Full N3 connection is in place. There is currently no wireless LAN capability but there is growing demand for wireless services to improve ways of working. PCs Significant recent PC replacement / upgrade has taken place as part of the PAS replacement project but a significant proportion of PCs remain at or near end of life. IM&T Strategy 2006-2011 Final V1.0 Dec 2006 Page 41

Some are as much as seven years old. PCs will need to be kept to a national minimum specification in future in line with NPfIT. Servers/data storage The Trust server infrastructure and computer room configuration reflects the incremental growth and development that has taken place over the last 20 years. Whilst there has been a gradual move toward rack-mounted server technology in recent years, the Trust still has many old, inefficient servers, and data storage is largely based on technologies that are rapidly becoming outdated. This makes efficient use of processing and storage capacity very difficult, and disaster recovery procedures are cumbersome and expensive. Internet / Intranet Services These were, at the time of the review, limited to the Trust intranet, the Northamptonshire NHS page, and a small number of departmental sites. Planning for the development of a proper integrated Trust internet presence has commenced. There are also plans for more dynamic internal Web services, but resources to do this are severely limited. Systems Integration The Trust has a long history and considerable experience of linking systems. The majority of systems are linked to PAS. The integration engine software introduced as part of the Trust NPfIT programme will help to ensure that the integration of legacy systems with new CRS solutions is improved and managed effectively. e) IM&T Resources IM&T department resources were examined in the light of current and anticipated demands (resulting from, for example: NPfIT, FT, PbR, 18week target). This showed that IM&T is under-resourced and struggles to fully satisfy current demands. Investment in IM&T at the time of the review was at around 2%, slightly below the national average and substantially below that recommended by the Wanless report in 2002. ICT Department The review showed that there was scope for improving the utilisation of the overall existing Trust ICT staffing resource. The ICT department has provided 24/7 cover using an on-call arrangement for many years but the increasing demands of supporting more systems, particularly clinical systems mean that the current arrangement is unlikely to be adequate for the future. Support for systems is fragmented, some being managed directly by ICT, others by user departments. Whilst there is good liaison between ICT and the user departments, this arrangement remains inefficient and risky. Only limited service level measures exist. Substantial progress has been made recently in improving service desk performance and service quality measures. There are plans to build on this and to become a CfH accredited service desk. IM&T Strategy 2006-2011 Final V1.0 Dec 2006 Page 42

Information Services Department The examination of the performance and information management department showed it to be well organised for its basic role, in providing corporate information, statutory information, information for commissioners, and statistics. However, the demands on the department have increased significantly in recent years and it has taken on additional workload in areas such as capacity planning and activity modelling. PbR, 18 week RTT, and FT status will present additional challenges. Health Records Department The Health Records department is well organised for its role but struggles to meet the demands on its services. Storage space is a significant issue along with tracking patient notes. Plans are in place to introduce electronic casenote tracking with the new PAS. Clinical Coding Clinical coding resources have been increased in recent years but need to be strengthened further to meet increasing demands for the high quality clinical coding services fundamental to PbR, Trust business processes, and data quality. f) Other Issues with IM&T Services Patient ID There are several different patient identifiers in use across the Trust. This makes system integration difficult and has the potential for clinical risk. Use of the NHS number as the unique patients ID is now mandatory as part of NPfIT. Positive patient identification is crucial in clinical services, and use of barcodes and scanning in this context as well as in rapid data entry was seen as something the Trust should be doing much more. Access Controls There is no single security sign-on process. Users often have to remember several different username and password combinations, and log into and out of a number of systems in the course of carrying out their job. Clinical User Frustration A significant level of frustration with current IM&T is still felt by clinicians. Commonly cited shortcoming are: More clinical information needs to be provided electronically both in real-time and for retrospective analysis. More clinical messaging needs to happen electronically, it is a source of great frustration that email can not routinely be used in corresponding about patient care. There is a great desire for better ICT support specifically for clinical processes. Clinicians can see many ways in which ICT could improve processes, quality of care, and efficient use of their time but are often frustrated by the slow pace of development and investment. Current systems are generally regarded as inflexible and often of very little direct benefit. Even where examples of direct benefit can be seen, the perceived inability of the systems to fit with clinical practice is often seen to outweigh the benefits. For example, systems timing out in the middle of consultations, or the inability to present data in an acceptable way. IM&T Strategy 2006-2011 Final V1.0 Dec 2006 Page 43

Lack of systems integration. Multiple systems often need to be accessed to find information (i.e. there is no single view of all the information required). 'Non-strategic' IM&T Development Although there has been improvement in recent years there can still be seen a tendency for 'vertical' developments and 'islands of innovation' to occur (often not in line with Trust strategy). Also, there is still evidence of 'piecemeal' development; developments started but not fully followed through as a result of lack of resources, or of commitment and ownership. Project Management Good project management principles and methods are consistently applied in larger IM&T initiatives but less so in smaller ones. SWOT Analysis The broad findings of a SWOT analysis, carried out as part of the review are: Strengths The Trust has a long history and experience of integrating systems and has invested in appropriate software tools to meet the increasing requirement for systems integration. The Trust LAN is modern and has sufficient capacity to support planned national and local developments. The majority of the user base is familiar with using IT and there is a high level of competency. Good IT training and development facilities are available. Data quality levels in the Trust are very good and there is a corporate commitment to maintaining and improving data quality. Opportunities Many of the components of the CRS are already either in place, or being rolled out, and can be built upon. There is a demand and an enthusiasm from management and users to increase IT support for clinical processes. There is strong board level IM&T representation and support for the IT modernisation agenda. Weaknesses Currently there are several different patient identifiers in use in different systems across the Trust. This complicates system integration and presents a potential for clinical risk. The large number of small departmental clinical systems in place throughout the would be difficult to integrate into the CRS. The current IT staffing infrastructure does not make the most effective use of key resources and skills. Project management principles are inconsistently applied leading to poor implementation of some systems, and benefits not being achieved. IM&T Strategy 2006-2011 Final V1.0 Dec 2006 Page 44

Threats Some of the IT modernisation targets are very ambitious and it may not be possible to achieve the necessary organisational and cultural change at a sufficiently rapid pace to meet them. IT staff recruitment and retention is difficult in an increasingly competitive market for scarce skills. There is a poor perception of the National IT programme and its capacity to deliver, particularly amongst clinical staff. The demands on IM&T resources are rapidly increasing and will continue to do so. This may impact on the development programme necessary to deliver the strategy. SWOT Diagram Strengths Integration experience and capability Modern network IT literate user base Good data quality Opportunities Good foundation for CRS, ready to be built upon Enthusiasm and demand for better IT Strong Board level support Weaknesses Multiple patient identifiers Large number of departmental systems Inefficient use of IT resources Inconsistent project management Threats Ambitious pace of change IT staff recruitment and retention Poor perception of NPfIT Increasing demands on IM&T services IM&T Strategy 2006-2011 Final V1.0 Dec 2006 Page 45

Appendix B HIGH LEVEL PROGRAMME PLAN IM&T STRATEGY 2006-2011: PROGRAMME TIMELINE (CRS) PAS Full CaB PAS develop / exploit Order comms / reporting OC / reporting replacement Maternity A&E PACS / RIS Digital Imaging Theatres rollout Theatres replacement Pathology Child Health Pharmacy replacement Electronic Prescribing Clinical / Diagnostic systems Clinical correspondence ICP Decision Support Clinical coding development Clinical / Activity reporting Document Management MoM Rollout / development 2006 2007 2008 2009 2010 2011 Legend: NPfIT Solution Phase1 Local Development NPfIT Phase2 / Full Strategic Solution In Progress Planned Possible Anticipated IM&T STRATEGY 2006-2011: PROGRAMME TIMELINE (OTHER DEVELOPMENTS) 2006 2007 2008 2009 2010/11 Internet / Intranet Infrastructure: Active Directory Remote desktop management SAN / Virtualisation Wireless LAN Mobile / Remote Access Technology refresh Systems integration Business Intelligence: Data Warehouse upgrade MIS Business systems: E-procurement ESR Finance system Rostering Collaboration / workflow Security / Business Continuity Service Desk upgrade / accreditation NHSMail Migration Legend: In Progress Planned Possible IM&T Strategy 2006-2011 Final V1.0 Dec 2006 Page 46

Appendix C IM&T Subcommittee Terms of Reference PURPOSE The IM&T Subcommittee (IM&TSC) is responsible for ensuring that the Trust makes effective use of IM&T resources to meet Trust business objectives and support clinicians in the delivery of high quality care. Specifically the subcommittee will steer the use, and continuing development of IM&T in the Trust to deliver: benefit to patients, through provision of better information to support the delivery of care, benefit to the Trust workforce, through providing better access to information to assist them in undertaking their roles, support for Trust business objectives. AREAS OF RESPONSIBILITY The subcommittee will: 1. Ensure regular review of IM&T strategy and gain approval for IM&T strategy through Hospital Management Board (HMB). 2. Ensure alignment of IM&T strategy with business strategy, business development, service improvement, clinical governance, and national and local targets. 3. Monitor the delivery of IM&T strategy and report progress to HMB. 4. Provide overall direction for IM&T programmes of work. 5. Agree and prioritise annual IM&T development plans and investment. 6. Secure resources for IM&T development through Trust Capital Group. 7. Ensure that IM&T developments remain within overall IM&T capital allocation. (Responsibility for control of specific IM&T capital budgets will rest with the Director of Performance and Development) 8. Consider all IM&T development requests and associated business cases, ensuring strategic fit. 9. Ensure that planned benefits from investment in IM&T are realised. 10. Provide direction for IM&T change management, ensuring appropriate clinical involvement where necessary. 11. Ensure adherence to Information Governance standards and data protection regulations. 12. Maintain links to training and education services, both in ensuring adequate provision of these services, and in developing the use of ICT to deliver and support training and education. 13. Ensure effective electronic and paper health records management. IM&T Strategy 2006-2011 Final V1.0 Dec 2006 Page 47

14. Manage risk associated with overall IM&T strategy delivery, and ensure that adequate risk management measures are put in place for all IM&T programmes of work. 15. Approve IM&T policy and ensure regular review of IM&T policy. GOVERNANCE ARRANGEMENTS IM&TSC is part of the Trust committee structure and will adhere to Trust governance standards applying to bodies within this structure. A Chair will be appointed, preferably from a clinical background. Normally this will be the Trust Clinical IM&T Lead. A Vice-chair will be appointed. Normally this will be the Director of Performance & Development. IM&TSC is an Executive subcommittee of HMB. The Chair of IM&TSC is accountable to, and will normally be a member of, HMB. Information Governance Subcommittee and Health Records Subcommittee will report to HMB through IM&TSC. IM&TSC is nominally the National Programme for IT (NPfIT) board for the Trust. In practice an executive sub-group acting as a proxy programme board, reporting to IM&TSC, will be formed to direct all NPfIT workstreams in the Trust. MEETINGS Meetings will be held on a monthly basis. Papers will be circulated to members one week before the meeting date. MEMBERSHIP Membership will comprise the following voting members: Clinical IM&T Lead (Chair) Director of Performance & Development (Vice-chair) Chief Executive Chair of Information Governance Group Chair of Health Records Committee Associate Medical Director Director of Finance (or nominated deputy) Director of Nursing (or nominated deputy) Head of ICT In addition, the Trust Non-Executive Director with responsibility for IM&T will be a member of the subcommittee but without voting rights. The subcommittee will be deemed quorate provided that four voting members are in attendance, and provided that there is at least one clinical and one Trust Executive member present. IM&T Strategy 2006-2011 Final V1.0 Dec 2006 Page 48

Membership Notes: i. Non-voting members may be co-opted onto the subcommittee if a specialist contribution is required to address a particular issue. Such co-opted arrangements will be time limited. ii. IM&T programme or project managers may be required to attend meetings from time to time to report progress. December 2006 IM&T Strategy 2006-2011 Final V1.0 Dec 2006 Page 49

Appendix D Glossary of Terms and Abbreviations CaB CfH Choose and Book Clinician Cluster Choose and Book Connecting for Health an agency of the Department of Health responsible for delivery of the National Programme for IT. National electronic appointment booking system, offering patients choice of date and time of their appointment, and choice of hospital or clinic. A person who is professionally qualified to provide care for patients. In the context of this strategy this term is used to include consultants, doctors, nurses, and therapists. A group of strategic health authorities who work together by region to implement NPfIT. CRS Care Records Service (also NHS Care Records Service) an integrated electronic patient record system and a major NPfIT product. DGH ESR FT ICT IM&T IM&T SC IRC PAS IQAP IS District General Hospital Electronic Staff Record. The new national NHS Payroll and HR system. Foundation Trust (also NHS Foundation Trust) Information and Communications Technology Information Management & Technology IM&T Subcommittee - NGH Trust Board executive subcommittee responsible for ensuring that the Trust makes effective use of IM&T resources. The existing Trust Patient Administration System. Information Quality Assurance Programme. Part of NPfIT, responsible for ensuring the data quality standards crucial for the success of NPfIT. Information Services IM&T Strategy 2006-2011 Final V1.0 Dec 2006 Page 50

IT ITIL KSF LAN LSP Map of Medicine N3 NHS Number NHS Plan NPfIT NSF PACS PAS PbR PDS PRINCE2 Information Technology IT Infrastructure Library. ITIL is the NHS accepted IT service management methodology. ITIL provides a set of best practice standards in IT service management. It has an associated qualifications scheme. Knowledge and Skills Framework Local Area Network NPfIT Local Service Provider. One of the organisations contracted nationally to deliver NPfIT systems and services. A clinical knowledge support tool. Developed and owned by the NHS. Delivered as part of NPfIT A localisable framework which integrates information about national and local best practice linked through care pathways across primary and secondary care. 'New NHS Network '. The new NHS broadband network. It replaces the existing private NHS network, NHSnet. The unique 10 digit NHS patient identification number. Published in 2000, a plan for modernisation of the NHS. The NHS Plan outlines a vision of a health service designed around the patient. The National Programme for IT National Service Framework Picture Archiving and Communication System. Captures, stores, displays and distributes digital clinical images. Patient Administration System Payment by Results Patient demographics service. Part of the NHS Care Record Service 'Spine'. Contains NHS number, date of birth, name, address. Projects IN a Controlled Environment (Version 2). NHS standard project management methodology. IM&T Strategy 2006-2011 Final V1.0 Dec 2006 Page 51

RFID Spine Virtualisation Radio Frequency Identification (RFID) is an automatic identification method, for storing and remotely retrieving data using devices called RFID tags or transponders. An RFID tag is attached to or incorporated into an object or product (for example a wrist band) for the purpose of identification using radio waves. The Spine is part of the NHS Care Record Service. It is the name given to the national core record containing key details about the health and care of individual patients. These will include NHS number, date of birth, name and address, and some clinical information such as allergies, adverse drug reactions and major treatments. In the context used in this document, this describes the technique of consolidating many physical IT resources (such as servers, operating systems, applications, or storage devices) by making single physical IT resources appear to function as multiple logical resources. This can deliver significant benefits in data storage and management capacity, and business continuity. IM&T Strategy 2006-2011 Final V1.0 Dec 2006 Page 52

Acknowledgements Thanks are extended to all those who have contributed to the development of this strategy whether through consultation, interview, discussion, comment, or provision of information. In particular: Members of the IM&T Subcommittee Members of the Hospital Management Board Clinical Directors Directorate Managers Heads of Department IT Managers and Departmental IT Leads Rushmore Consulting Bromley Hospitals NHS Trust Special thanks to Tina Allen and Jean Davidson for their diligent proof reading. IM&T Strategy 2006-2011 Final V1.0 Dec 2006 Page 53