Informatics Strategy 2014 2019 V 9 Refresh May 2015 Jonathan Reid Director of Finance and Estates 0 of 26
CONTENTS 1. DOCUMENT PURPOSE 2 2. STRATEGIC CONTEXT 3 2.1 National Drivers 3 2.2 SCT Strategic Context 4 3. STRATEGIC FOCUS FOR INFORMATICS 7 3.1 Delivering the Vision 8 3.2 What will this look like by 2020 18 4. RISKS TO DELIVERY AND MITIGATIONS 21 4.1 Affordability 21 4.2 Organisational change/re design 22 5. APPENDICES 23 1 of 26
Informatics Strategy 2014-19 1. DOCUMENT PURPOSE The Sussex Community NHS Trust (SCT) Informatics Strategy sets out the strategic context, vision, and outcomes for informatics over the next five years. It describes how informatics directly supports delivery of our Clinical Care Strategy, acting as an enabler for the Trust s vision of excellent care at the heart of the community. The purpose of Informatics is to: Enable, promote and support the effective use of data, information, knowledge and technology to support and improve health and health care delivery The document sets out the direction of travel in key strategic areas with the outcomes associated with them and a high level road map for delivery and it is expected that this will evolve over time. This Strategy document proposes actions in the following area in particular and in achieving the outcomes associated will ensure that we are able to deliver the informatics requirements of the clinical care strategy: Strategic focus Outcome 1. Electronic Patient Record Paper lite organisation 2. Business Intelligence and application Risk of business intelligence impacting on delivery of Trust business is minimal 3. Systems Integration A shared record 4. Use of innovative technology to support home based care Technology in place to support delivery of clinical care strategy An audited informatics function and 5. A best of breed informatics function infrastructure assessed independently as meeting the needs of the organisation 2 of 26
2. STRATEGIC CONTEXT 2.1 National Drivers The pace of technological change presents challenges and opportunities to the Trust and to the wider NHS. The national debate is continually evolving; much of the aspiration for informatics supporting the necessary changes is reflected in the Five Year Forward View. More detailed elements of the National Strategic direction is covered in the Personalised Health and Care 2020 Forward Plan and many of the elements in this Strategy are based upon the direction outlined in these two papers. National developments around informatics are both an enabler and a constraint for the Trust, as they support the development of a shared vision across health and social care, and within local developments. However, national timescales can be distinct from those of the Trust and the organisation has to work within the developmental process adopted across the NHS and social care as whole. The table below sets out the key components of the national strategy for informatics and the impact on SCT. National Drivers and Targets National Drivers and Targets Impact on strategic outcome From March 2015 All patients will have on line access to their GP record From April 2015 Use of NHS Number as primary identifier in clinical correspondence for identifying all patient activity to be mandated in all health and social care settings By Oct 2015 HSCIC, CQC, Monitor and TDA will publish data quality standards for all NHS Care providers. HSCIC will publish enhanced data security standards and requirements and will re-launch the Info Governance toolkit. Digital Maturity index key indicators for NHS trusts will be published via NHS choices. From April 2016 CQC to take performance against the data quality standards into consideration By April 2016 When a single integrated record is achieved this will be available to all patients SCT use of NHS number as a primary identifier will support the implementation of single record Paper lite organisation will facilitate use of NHS number NHS number will support governance of home based technology Auditable data quality standards reduce business intelligence risk National development of information governance will support shared record and home based care Auditable information governance and data quality standards can be used to assess delivery of informatics function Core dataset will support business intelligence and 3 of 26
National Drivers and Targets National Information Board will agree a core secondary uses dataset that all NHS- funded providers will have to make available reduce risk Impact on strategic outcome Ability to produce core dataset will be an indicator of informatics function By 2018 Clinicians in primary care, urgent and emergency care and other key transitions of care contexts will be operating without use of paper records and from March 2018 all individuals will be able to record their own comments and preferences on their care record April 2018 Procurements under GP system of choice will be used to stimulate the supply of new and innovative systems for outpatient services by 2020 All care records will be digital, real time and interoperable Focus for SCT as a paper lite organisation A key element of business intelligence is patient feedback A likely benefit of this is support for moving to a shared record Supports a shared patient record Facilitates home working 2.2 SCT Strategic Context The organisation has three established strategic goals that support the delivery of trusts vision of excellent care at the heart of the community: We will provide excellent care every time to reinforce wellbeing and prevention Working with our partners we will personalise services for the individual We will be a strong sustainable organisation grounded in our communities and led by excellent staff We have set out how we will achieve these goals in our Clinical Care Strategy which describes: 4 of 26
Population (list) based provision which ensures that we consider the specific needs and outcomes of our local communities and their distinct characteristics when designing and delivering our services. If we do this properly we will be able to see the differences we make with improved health and care outcomes for local people over a period of time. It means that we can deliver the requirements of each person within the community when they need our care and when they are not actively using our services they know how to look after themselves and ensure their wellbeing; prevent deterioration in their health and care needs; and access our support if and when they need it. Business intelligence tools that enable shared information on population needs and outcomes between commissioners and providers Web based portals for access, booking and signposting and information. Risk stratification tools for targeting populations NHS number enables tracking of patients along pathways for improved quality through best practice and financial flows Electronic patient record including reported outcomes Shared care record including contingency planning contingency planning Infrastructure for data storage and information sharing Information governance enables sharing of patient and population level information Individual care Working with the individual and their carer or family to make sure we shape their care to meet what they want, rather than what we think they need. To do this effectively we need to be able to respond to how people want to access their care. Because we will be working much more closely with general practice in particular as well as other partners and other mental health, health, social care and voluntary sector providers in the community we have altered our way of describing our clinical care provision to align with their practice. This should make it easier for patients who are used to accessing care through their general practice in this way. At every opportunity we will be supporting our principle of improving people s wellbeing, supporting selfcare and preventing deterioration in their health care needs. 5 of 26
On line information and apps to support wellbeing and self-care On line/apps for practitioners to enable immediate referral, booking and access to support Home screening and telemedicine Interactive self-assessment for wellbeing and activation Urgent Response When people need an urgent response all of their information will be available where ever they access their urgent care and it is available immediately and on discharge, it will be uploaded into a single record and available to practitioners involved in their ongoing care and to the person and their family and carer. A single point of access for all health and care practitioners A single phone number for patients to call when they are unwell and need urgent support Planned Short Term Care Secure Web based booking and tracking of appointments Apps to support self-treatment between appointments Real time feedback mechanisms to comment on care provided Telemedicine to deliver expert care in the community Long Term Care Telehealth and telecare to support people in their homes Apps to support self-care and symptom control Access to single care record for practitioners and for patients and carers A single phone number for people to call when they need help and support from their key care coordinator Shared care plan To make this new approach possible; understanding and working in our local communities, making sure that we can deliver care in the way that each individual wants we recognise that we will need a new way of organising our services and enabling our staff to deliver excellent care which we are calling a new operating model. We will be working in teams that are integral parts of naturally occurring local communities such as towns and their surrounding areas, or local neighbourhoods in our larger towns and cities. These teams will be connected with groups of general practices, supporting the care of the patients on their lists, and as part of a wider team including mental health and the voluntary sector - so that as much care as possible is provided in the local community. We are calling these communities of practice. Where expertise or urgent support is needed which is not available at a local level we will make sure that it is readily and easily accessible. 6 of 26
Community of Practice In all communities Shared record Shared care plan Mobile technology and remote monitoring Electronic ordering of tests and sharing results Near patient testing Scheduling Electronic budget management Locality Access To make locality working effective Telemedicine enabling specialist practitioners to advise and treat Single point of access for local practitioners when urgent response is needed Trust Business Intelligence Business Intelligence data and data collected on outcomes will facilitate the identification of patient needs in the communities of practice and localities Standardising best practice care through System1 tailored to local need Intelligence about activity and outcomes and finance To move from the description of the future towards making this happen we have a portfolio of work described in our Transformation Plan. The enabling programmes such as informatics are formed by this strategy and encompassed in the Organisational Design programme. 3. STRATEGIC FOCUS FOR INFORMATICS Our vision for informatics A future that uses informatics to expedite delivery of the care described in our Clinical Care Strategy. This will be possible because: We will have the right business intelligence - with the systems, information and competencies in the organisation to use it effectively Our staff will have access to the information they need for care electronically through an electronic paper record The information we have about the patient will be shared, legitimately, with the other people involved in their care We will have used the technology available to us to support caring for the individual at home or in local communities wherever possible Our informatics function is delivered in a way that supports staff in our business of caring. 7 of 26
3.1 Delivering the Vision Strategic focus Outcome 3.1.1 Electronic Patient Record Paper lite organisation A fully integrated Electronic Patient Record ensures that all information relating to the care of an individual is accessible by those needing to care for that person. This is foundation for enabling other aspects of the informatics strategy and will require a major investment and significant allocation of resources to bring it about over time. The approach should be guided by what can be practically implemented and what provides the best benefit; success will depend absolutely on clinical engagement and support. At the moment we are committed to the deployment of SystmOne which has the potential to deliver an electronic patient record if we invest in all of the modules and if they represent the best solution and value for money for the Trust. The components of an electronic record include: 1. Summary Care record This is part of the current deployment of the SystmOne and will allow community healthcare staff at SCT to view all relevant GP information (subject to patient consent) every single time that a patient is treated. 2. Access to Order Communications and diagnostics reporting Electronically recorded pathology and radiology tests; with reported results straight from the laboratory to the patient record; automatically notifying the GP and other health professionals through the patient record. Standardised best practice rules can be included to enable clinicians to make appropriate requests and reduce duplication and waste. It will improve diagnostic reporting response times, give automatic alerts that can be tailored for specified results and provide integrated reporting on types of request, speed of turnaround etc. 8 of 26
3. Scheduling and referral management Scheduling enables appointments to be booked, best practice standards waiting times and appointments along pathways, reductions in administration for managing booking and re booking and for community teams travel routes can be optimised and information provided on locations via maps to schedule the most effective journeys for staff 4. E-prescribing Electronic pharmacy and prescribing supports the ordering, prescribing, dispensing and administration of medicines medicines optimization. With formulary management and automatic recording of prescription it will lead to fewer instances of mis-prescribing and patient serious incidents due to illegible handwriting. 5. Electronic document management Paper based medical records present both a clinical risk, (e.g. paper records not always being available) and an information governance risk (e.g. loss of paper records). Other benefits from the use of an electronic document management system (EDMS) include: Costs savings in record storage and management: reduction in un coded activity: time saving for practitioners: ability to fill empty cancelled slots because records would be immediately accessible. Each of these components for an EPR will be subject to a separate options appraisal and business case to test the validity of the SystmOne module against other best of breed products. Strategic focus 3.1.2 Business Intelligence and application Outcome Risk of business intelligence impacting on delivery of Trust business is minimal Internal to the Trust The National Information Board Framework for action Personalised Health and Care 2020 Framework sets out how real time data will be available to paramedics, doctors and nurses, ensuring patients receive safe and effective treatment at the point of care. At the moment the Trust follows a traditional approach to data analysis by providing a historical perspective on data that has been taken from Trusts systems, many of them paper based, and 9 of 26
therefore predominantly not based on real-time events. Furthermore because of the lack of data and information in community trusts people are not prepared for the application of information to inform care and business decisions. The development of the Trust data warehouse and digital dashboards will move the trust away from historic reporting to the ability to take proactive decisions in real time and based on a predicted future. Data will be incorporated into our data warehouse and made available real time; this is an opportunity to provide a real time digital dashboard delivered to both clinical and managerial staff to make day to day operational and clinical decisions and will include quality measures such as falls, infections rates, pressure sores, VTE assessments etc. The real time nature of the system will support enhanced oversight of patient safety risks allowing greater responsiveness and improvement to overall quality of care. Longer term planning models can be developed to allow the assessment of the impact of changes to bed availability, community team capacity or outpatients slot availability. Future modelling would include financial predictions in relation to the costs and income generated (Service Line Reporting), or the impact of Cost Improvement Programmes that are not being achieved. As we build up electronic data available to us as we move toward a full Electronic Patient Record this will flow through the data warehouse to digital dashboards to produce the correct information and knowledge for the people who need to act upon it. (Training need identified) Sharing data To create information on the whole pathway of care we should gather and share as much information as possible with other providers and with commissioners of care. This will help in delivering several aspects of our clinical care strategy: 10 of 26
Supports care co-ordination and improves handovers between parts of the patient journey, such as from discharge from hospital Helps SCT and the commissioners identify and measure the value (quality/cost) of prevention and treatment and measures change in population or pathway outcomes commissioned and provided within the health and care system Helps support research development and innovation as people consider the implications on other parts of the system This can be applied using the Commissioning Support Unit (CSU) information hub. The activity has a pseudo key applied and is provided back to us along with other pseudonomised Health economy activity - to enable matching of organizational data to provide picture of complete pathway (termed commonly big data ). Information Governance The holding of data and use of patient information within the Trust brings with it a duty of care not only to patients but to all of those accessing and using the information to deliver care. Patients have a right to expect that their information will be treated confidentially; clinicians will expect that such information is available when and where it is needed while both parties will expect the information to be accurate. These concepts are the foundations of the national information governance standards such as: Security; Information technology; Consent; Records management; Freedom of information; Data protection; Data quality. The trust is fully committed to continuous improvement in information governance and acknowledges that this a major factor in delivering effective health informatics. We are working locally to share expertise on managing information governance across systems and in partnership and welcome the Government s commitment to reviewing the national information governance guidance in support of integrated patient care. Strategic focus Outcome 3.1.3 Systems Integration A shared record The Health Secretary has spelt out that organisations need to have plans in place to enable secure linking of electronic health and care records where wherever they are held, so there is a complete a record as possible of the care someone receives. The system should be able to 11 of 26
allow for those records to be able to follow individuals, with their consent, to any part of the NHS and social care system. In the first instance this might need to be achieved through the system we are implementing across West Sussex called ROCI Read Only Clinical Information. This will enable a single contextual view of information drawn from existing systems across the health and social care system so that practitioners can see in one place information held on separate systems about the patient. This will enhance the quality and safety of clinical care as clinical practitioners have access to all of the current information regarding a single patient. In the short term, through the Medical Interoperability Gateway (MIG), data will be shared seamlessly between the GP clinical systems EMIS, Vision and SystmOne. This will allow community healthcare staff at SCT to view all relevant GP information every single time that a patient is treated, allowing them to make informed clinical decisions, improving patient care. Ultimately, as information governance and system integration evolves, this will become a single record for all patients that they will be able to access through a patient portal and their own personal care account. Strategic focus 3.1.4 Use of innovative technology to support home based care Outcome Technology in place to support delivery of clinical care strategy Innovation is not just about the originating idea, but also the whole process of successful development implementation and the spread of an idea into wide spread use. IT has the ability to support, enable and deliver innovation but only though close working with the people who will be benefiting from the use of the new technology. The approach we are taking to develop innovation and spread practice is in line with our culture of excellence through continuous improvement. People working in the trust are encouraged to introduce innovative approaches to issues that need to be resolved; such as using the falls sensor mat that has been introduced into one of our bedded units or the docobo remote monitoring in nursing homes. The impact and learning of these innovations are then spread throughout the rest of the organisation and shared with the commissioners. 12 of 26
Telehealth, Telecare and Telemedicine Telehealth involves the use of electronic information and telecommunication technologies to support long distance clinical health care, patient and professional health-related education, self-care, prevention and the promotion of wellbeing and health administration. Telehealth equipment can monitor health in the persons own home. For example it may be equipment to measure blood pressure, blood glucose levels or weight. This can reduce the number of visits to the GP and unplanned visits to the hospital. People are taught how to do the tests on themselves and the measurements are automatically transmitted to your doctor or nurse, who can then see the information without the person having to leave home. Further developments in Telehealth are a logical development for patients and include cloud computing where patients can: Keep patient diaries: input clinical trials information, view their appointment history, allow motion devices to send back information to the trust for management of falls, allow data from remote testing to send back information to the trust. When interacting with SCT, patients will be able to perform all services through a single point of access platform, which includes allowing them to book appointments and online repeat prescriptions for all care services. Patients are able to give feedback to the Trust online through simple surveys. The Trust, in turn, is able to view these results on using intuitive dashboards that give an overview as well as having access to the raw data so that a comparison can be made against the business key quality indicators and the cash releasing, non-cash releasing and societal benefits of transformation schemes can be reported and monitored. Telecare We already use telecare in supporting people to stay in their home or while people are staying in our in-patient units. They are particularly useful for people living alone or with cognitive impairment. These are mainly alarm systems available for using in peoples home, some of 13 of 26
which can let a family member, friend, neighbour, nurse or warden know by phone when there's something wrong. Examples include: a personal alarm, where someone can raise an alert by pressing a button that is kept on them at all times; it's usually on a small wristband or a pendant that you wear around the neck motion sensors, which make accidents and falls less likely by automatically switching on bathroom or hallway lights at night when someone gets out of bed Other sensors can raise the alarm that something is wrong. These include a mattress pressure mat, or a door sensor on a door that can tell if it's open or closed. Telemedicine Telemedicine will play a particularly important part of our new operating model which is based in communities of practice where most of the care is provided locally in natural communities such as towns and neighbourhoods. In these circumstances it will be possible for specialists to receive or view test results and offer advice and consultation to other health professionals or patients over the internet such as Skype. For example, the district nursing teams are able to hold a virtual meeting with the tissue viability team in order to seek advice on wounds when with a patients, thereby saving a specialist referral. This should also apply to advice and support through the urgent care networks where people have accessed local urgent care services such as our urgent care service in Crawley and the doctors there can share x rays, tests and scans with the urgent care specialists at the hospital, preventing the need for a transfer to the Accident and Emergency Department. Mobile working will ensure staff are more visible to their patients, able to spend more time caring for patients and also enabling them to increase efficiency and see more patients during the day. Staff morale is boosted by the ability to spend more time using their skills for caring and less time duplicating information for the patient s clinical record. They are able to receive their caseload electronically at home, avoiding a trip into the office. Weekend workloads are discussed using video calls over Skype and teams are able to holds video-conferences to avoid additional trips to a patient s home. 14 of 26
Mobile working and Unified Comms will enable staff to work out of any site enabling the Estates Strategy and release more time to care as clinicians will spend less time tracking down information about the patient. Tests and assessments will reduce as information from these will be readily available with no need for repetition. Mobile working also includes information and support for operational management, as well as clinical services such as electronic rostering, e-expenses, and the use of electronic data to manage appraisals, supervision, training and development of staff. Strategic focus Outcome 3.1.5 A best of breed informatics function An audited informatics function and infrastructure assessed independently as meeting the needs of the organisation IT Infrastructure Recent IT capital investments in hardware, infrastructure and technology have improved both performance and resilience of the trusts underlying IT infrastructure so that the Trust now has a platform on which to build to provide disaster recovery and future developments. Using of the National Infrastructure Maturity Model [NIMM] as a benchmark we will continue to use unified technology to create a centralised, resilient data centre hosted at BGH that provides resilience at all levels to ensure business continuity. Working with other NHS and social care stakeholders in Sussex we will develop and maintain a common IT communication infrastructure, with appropriate security measures in place to preserve confidentiality, allowing our staff to work from any NHS organisation within Sussex. At the same time we will review options for replacement of the wide areas network (WAN) in partnership with the other stakeholders, for example opportunities for PSN [public sector networking] will be considered and evaluated. 15 of 26
SCT will improve and replace ageing and piecemeal IT infrastructure. We will employ greater use of Thin Client and VMware [virtual] platforms to disaggregate us from legacy hardware shared with other Organisations across a number of different platforms, servers and geographic locations and to reduce expenditure on maintenance and warranties. It is the vision for all of our community sites that virtual technology will be used through virtual desktops and applications. The building blocks to achieve this are in place with the investment that we have already made. With additional investment on our community sites we can eliminate many of the issues they are having with support, speed of access, security and hardware replacement costs by taking advantage of this technology. We will work with our Strategic partner Capita to implement VOIP communications solutions across the Trust. We will look to do this in a way that will support unified communications, follow me extensions and soft phones to deliver unified communications across the organisation. We will continue to promote the use of cloud-based applications wherever possible provided that they are hosted on secure and resilient environments that meet the needs of NHS Governance and security standards. The Trust will implement and promote the use of WebEx, audio and video conferencing. Our wireless networking capabilities will cover meeting rooms, hot-desk areas and touchdown points within key Trust areas. We will work with our local partners to develop the Electronic Staff Records including developing management and employee self-service giving immediate access to information about pay and other employment queries and electronic expenses claiming minimising need to raise queries about staffing issues and assurance that payments etc. are correct. We will ensure benefits from ESR2 are implemented to ensure improved sickness and absence reporting enabling improved staff capacity planning. We will provide access to online training and recording of competencies for all staff. Informatics and business intelligence Support Team The SCT strategy proposes quite a different future for the way in which we provide services and relate to our communities. As a consequence we need a corporate support organisation that is equally different to the way in which it operates at the moment. The first step is to create an 16 of 26
informatics team that can respond to the delivery of the strategy and its five key strategic themes. This means that we will need to bring together the functions that support the strategy under one informatics team: IT infrastructure and support Programme management Data quality assurance Information management and reporting Information analysis Business intelligence reporting System development and design Informatics training and education This structure will require senior leadership, expertise and experience in developing the team, delivering these functions and preparing for an organisational structure in which by 2020 will be formed to support our communities of practice. Training and Education Throughout this strategy there is a recognition that the need for training and support is key to the success and the costs of the training function and time to release to train where necessary must be included in any business case. Assessment of staff skills will be carried out will be carried out to inform our Informatics Training needs analysis. Training delivery will be where ever possible through in situ training and support; remotely or if needed through workshops. Care without Carbon Staff within the trust will work within environments that allow safe and secure use of technology and processes put in place to ensure that the environmental impact of IT and related equipment as associated consumables is minimised including: Disposal of equipment, environmental impact: recycling; Print management; Power Management. Appendix 1 details the outcomes, benefits of the outcome, KPIs and the associated projects to deliver these outcomes. 17 of 26
3.2 What will this look like by 2020 For Patients All patients will have online access to their full health record and will be able to view copies of that data through apps and digital platforms of their choice. The platforms will give individuals access to both read and write, so that patient preferences and input of data from other relevant sources, such as patient wearable devices/home monitoring, can be included. Although patients will not be able to edit clinician entries, they will be able to make comments and enter self-monitoring results which will be made visible. When interacting with SCT, patients will be able to perform all services through a single point of access platform, which includes allowing them to book appointments and online repeat prescriptions for all care services. Patients will be able to give up to date feedback to the Trust through simple online surveys and apps. The Trust, in turn, and clinical staff will be able to view these results on using intuitive dashboards that give an overview as well as having access to the raw data so that a comparison can be made against the business key quality indicators. Business Intelligence identifying patient need by geography, ethnicity and age will drive changes to the Clinical Strategy and how services are to be provided. In bedded units there will be a significant improvement to patients experience of care (as well as savings for the Trust and local health economy) due to a reduction in length of stay and an improvement in clinical outcomes. Length of stay will be reduced by enabling patients to go home sooner and receive high quality care in the home enabled through telemedicine and patient-worn wearable devices tracking vital signs. Patients with life-limiting illnesses and their families will be given ownership of and will help coordinate their personalised urgent care plan that is shared electronically with all agencies and professionals involved in their care. This will help palliative care patients who die on the programme to do so in the place of their choosing, at home, in a hospice or care home. Care is personalised for patients to create a coordinated support network for patients. Patients and carers are able to feedback to multi-disciplinary care teams through online portals and apps allowing them to monitor the impact medication and other treatments to those adjustments can be made when required. Patients will have their own personal care account so that they can 18 of 26
choose the most helpful support. Digital tools, digital infrastructure and services will enable carers of patients to gain better access to clinicians. For Staff The use of mobile technology will change SCT staff s working lives. Mobile devices, such as laptops, tablets and smartphones, coupled with an effective EPR and further supporting mobile application software, will allow for effective and efficient recording of observations, as well as secure handover of patient information. Nurses will carry out routine observations using a handheld device, which is automatically transferred into the patient s health record. Patients are able to use home monitoring equipment in the home enabling staff to monitor vital signs remotely and enter results on their record. This data becomes instantly available to all staff responsible for that patient s care allowing staff elsewhere in the organisation and the system who will routinely review progress against their care plan. Clinicians and administrative staff will no longer spend hours chasing updates by phone or fax. Staff will be more visible to their patients - able to spend more time caring for patients and also increasing efficiency. Staff morale will be improved by the ability to spend more time using their skills for caring and less time duplicating information for the patient s clinical record. Mobile working teams will be truly mobile. They will be able to receive their caseload electronically at home, avoiding a trip into the office. Weekend workloads are discussed using video calls over Skype and teams are able to hold video-conferences to avoid additional trips to a patient s home. For example, the district nursing team are able to hold a virtual meeting with the tissue viability team in order to seek advice on wounds when with a patients, thereby saving a specialist referral. Social care workers will also complete financial assessments digitally whilst in a patient home and will share the details of the patient s social care with clinicians responsible for their care. Immediate access to information about pay and other employment queries will be available through self-service. Training will be delivered electronically where possible, and managers will have access to the data they need for delivering their responsibilities. 19 of 26
For the Trust Steadily rising costs, an ageing population and growing expectations for more affordable and higher-quality care are putting huge pressures on UK healthcare. At this challenging time, NHS Trusts are working to cut costs and achieve more modern, efficient, patient-led health services. We are also facing new demands for information for patient-level costing and service line reporting, for new patient outcome measures and commissioning for quality and innovation data, as well as accurately reporting on cost improvement programmes. This all comes on top of the long-standing need for robust financial data to underpin contracting with commissioners. In order to have the capacity to meet the changing need of the NHS we have to be flexible and adaptable. Through innovative informatics, our Trust will be able to grow service provision supported by a business intelligence function that is capable of informing strategic and business decisions. Through the implementation of a new Electronic Patient Record (EPR), and the deployment of mobile working, staff will capture a greater volume of relevant information electronically in real-time improving operational efficiency and driving safer, more connected, patient care. The use of analytics will allow us to pinpoint where we are doing well and what we need to improve in our organisation. Data from our EPR will provide an analytics function that is able to help patients before they need it. Our improved performance function will drive success in our organisation moving forward. We do not work in isolation. The tools and systems we use in one organisation will need to link with those being used in other organisations in health and social care. This is what we mean by interoperability. Our patients and staff span care boundaries. Illness does not recognise borders and care boundaries. To combat it, we need to work beyond the borders of our estate by collaborating with others. The Enhanced Data Sharing Model (EDSM) is a significant part of that. Sharing data creates greater benefits for patients, clinicians and organisations when used as a tool in order to connect health in a region. We are signed up to deploying the Summary Care Record and an Electronic Patient Record (EPR). Our EPR system is built on the principle of One Patient, One Record and hosts over 34 million shared patient records. The value of this implementation is realised by sharing information across healthcare settings, enabling truly connected care in the local and wider community. Through the Medical Interoperability Gateway (MIG), data will be shared seamlessly between the GP clinical systems EMIS, In Practice and SystmOne. This will allow community healthcare staff at SCT to view all relevant GP information every single time that a patient is treated, allowing them to make informed 20 of 26
clinical decisions, improving patient care. Electronic prescribing and E-scheduling functionality will provide real-time information to the wider community and will allow healthcare professionals outside of the Trust access to the patient s journey through SCT improving pathways of care. Our current system - SystmOne is also available to Nursing and residential homes at no charge, where homes do not chose to deploy the system in full, we will encourage them to use EPR Core to enable viewing of the record. We will support nursing and residential homes to become a more integrated part of the health and social care community. 4. RISKS TO DELIVERY AND MITIGATIONS 4.1 Affordability As a community trust with a low asset bases the Capital Resource Limit is low which is a constraint on IT investment. Benchmarking data for revenue costs for Informatics also indicates a lower investment in the service than with our peers. Part of the deployment costs and the licence fee for SystmOne is currently funded from the Health and Social Care Information Centre and this will become a cost pressure going forward once the funding ceases in the summer of 2017 and needs to be considered alongside the risks presented from the current clinical system supplier. This risk will be mitigated by: During 2015/16 the service will review the services required and how the options could be provided and funded for consideration by the Board. This will include options around funding some of the services on a subscription basis to limit the costs falling to the Capital Programme. Provision of hardware will be considered through operating leases and/or managed equipment services. Further mitigation will be provided through business cases with clear benefit identification to ensure cash releasing elements cover investment costs where applicable. Our Strategic partners, Capita will also provide innovative funding and provision models. 21 of 26
4.2 Organisational change/re design As a Trust with previous low investment in IT some staff s familiarity with IT will not be as advanced as in other organisations where investment has been higher. There may also be a reluctance to work with new technologies. This risk will be mitigated by: A training programme which encompasses basic IT training as well as training on use of applications/systems and support from the Organisational Development Programme on introducing these changes. 4.3 Staffing Capacity and Capability This has previously presented a risk, particularly with regard to staffing in the Performance team however with the launch of the Informatics Service and renewed leadership along with uncertainty in other sectors recent recruitment has been more fruitful. The Service has also begun recruiting training posts and has started taking informatics trainees from the general management training scheme (GMTS). This risk will be mitigated by: Continued building of the Informatics Service, through regular communication, departmental wide team briefings and links with other organisations Commissioning support Units, Kent and Medway Health Informatics Service, CCG Strategic IT and other providers and participation in Network events and meetings. Summary Historically community trusts have had very little business intelligence or informatics infrastructure and this means that SCT started from a very low base. However over the past few years significant strides have taken place with good data quality, deployment of SystmOne and sound infrastructure which is a solid base on which to develop the future described in this strategy. This informatics strategy describes the changes that are needed to achieve our clinical care strategy and the outcomes that we can expect as a result. The roadmaps describe the extent of the work to be done and the timeframes in which this work will be done so that by 2019 we are able to achieve the informatics vision of A future that uses informatics to expedite delivery of the care described in our Clinical Care Strategy. 22 of 26
INFRASTRUCTURE 5. APPENDICES Appendix 1 High level road map for delivery 23 of 26
CLINICAL APPLICATIONS 24 of 26
ORGANISATIONAL CHANGE 25 of 26