Agenda Item 10 Tuesday 17 April 2018 Report of Priority 7: All Wales Accelerating Cardiac Informatics (AWACI) Project Paper prepared by Michelle Cook, Project Manager, AWACI Project, NWIS Action/Decision Required The HCIG are asked to: RECEIVE and NOTE the Project Closure Summary.
PCR-ID PROJECT CLOSURE SUMMARY All Wales Accelerating Cardiac Informatics Version No. 0.3 Status: Draft Date: 22/03/2018 Tŷ Glan-yr-Afon 21 Heol Ddwyreiniol Y Bont-Faen, Caerdydd CF11 9AD 21 Cowbridge Road East, Cardiff CF11 9AD Ffôn/Tel: 02920 500500 www.cymru.nhs.uk/gwybodeg www.wales.nhs.uk/informatics Page 2 of 15
TABLE OF CONTENTS 1 DOCUMENT HISTORY... 4 1.1 Revision History... 4 1.2 Reviewers... 4 1.3 Authorisation... 4 1.4 Document Location... 4 2 PURPOSE... 5 3 BACKGROUND... 5 4 REASON FOR CLOSING THE PROJECT... 5 5 PROJECT PERFORMANCE... 6 5.1 Against Objectives... 6 5.2 Against Costs... 8 5.3 Challenges... 8 6 Continuation Activities... 9 6.1 Project Staff... 9 6.2 Project Scope... 9 6.3 Financial Management... 11 7 POST PROJECT REVIEW... 11 7.1 Membership... 11 7.2 Quorum... 12 7.3 Frequency of Meeting... 12 7.4 Reporting Arrangements... 12 7.5 Draft Agenda... 12 8 RECOMMENDATIONS... 12 9 REFERENCES... 12 10 GLOSSARY... 13 Page 3 of 15
1 DOCUMENT HISTORY 1.1 Revision History Date Version Author Revision Summary 22.03.2018 0.1 Michelle Cook Initial draft 06.04.2018 0.2 Michelle Cook Amendments following DS review 09.04.2018 0.3 Michelle Cook Amendments following TH review 1.2 Reviewers This document requires the following reviews: Date Version Name Position 06.04.2018 0.1 David Sheard Deputy Director of Implementation, NWIS 06.04.2018 0.2 Tracey Hill Transformation Lead, Wales Cardiac Network 1.3 Authorisation Signing of this document indicates acceptance of its contents. Author s Name: Role: Signature: Michelle Cook Project Manager Date: Approver s Name: Role: Signature: David Sheard Deputy Director of Implementation Date: 1.4 Document Location Type Electroni c Location http://externalsharepoint.cymru.nhs.uk/sites/cardiac/shared%20documents/forms/al litems.aspx Page 4 of 15
2 PURPOSE The All Wales Accelerating Cardiac Informatics (AWACI) project submitted an application to the Efficiency with Technology Fund (ETTF) in August 2017 to supplement the existing bid which would continue to build upon the achievements from the original bid awarded in 2015. The project has received confirmation that it has not been successful in attaining these funds, but it continues to pursue alternative funding streams. However, this does result in the end of a contractual relationship with the ETTF programme. This summary report aims to provide assurance of the achievement over the past twenty-two months through utilisation of the funds, insight into the challenges faced so future projects can benefit and provides the opportunity to demonstrate the future movement of the project. 3 BACKGROUND In the original bid submitted to the ETTF in autumn 2015, the project set out to act as a trailblazer to bring about efficiencies and improvements to cardiac services through the application of informatics. It focussed on accelerating the implementation and adoption of electronic referrals, diagnostic requests and results and clinical communications between primary, secondary and tertiary care, which is essential to enable efficient management of patients through the cardiology pathway. The AWACI project was initiated on 14 th June 2016. The overall objective was to enable patients to receive diagnosis and care in the most appropriate setting, from the right clinician, in the shortest possible time and in a safe and auditable pathway. To achieve this, cardiac services need to move to a paperless electronic referral process for patients along the cardiac care pathway. This should markedly reduce the time patients wait to be seen for their referral, diagnosis and treatment. This is essential to enable and maximise the benefits from new community cardiology services. First year monies were lost due to delayed release of funds, which left inadequate timescales for the recruitment activity required. The project carried underspend in 2016/17 due to its inability to recruit into a number of the technical and clinical vacancies despite continued efforts to raise awareness and prioritise recruitment for the necessary posts. Following successful recruitment of technical and clinical roles in 2017/18, the project preceded to get back on track with its delivery, with a balanced finance forecasted for 2017/18. 4 REASON FOR CLOSING THE PROJECT As outlined above, the projects contractual obligations and financial commitments with the ETTF will end in March 2018. However, due to the trailblazing ethos of the AWACI project and the perceived service need to deliver electronic mechanisms like hospital to hospital referrals, NWIS has continued project delivery against a revised scope. Page 5 of 15
5 PROJECT PERFORMANCE 5.1 Against Objectives The table below lists the original objectives for the project, comments on achievements with reasons for non-achievements: Objective Status Comment Electronic referral management of GP referrals to Cardiology national deployment Electronic clinical dialogue with Primary Care colleagues which enables care closer to home rather than hospital settings (community cardiology) Secondary to Tertiary electronic referrals and communication Uplift Cardiology as a priority specialty for Welsh Patient Referral Service (WPRS) implementation Incorporate Practitioners with Special Interest into WPRS Ongoing Priority delivery completed in Cwm Taf and ABMU (East) Go-Live scheduled in ABMU (West) on 18.04.18 Go-Live TBC in Hywel Dda, however priority status achieved. Go-Live TBC in BCU, dependency on initial WAP deployment. Clinical Champion identified to lead on local readiness activities. Priority status for Cardiology. Cardiology maintains priority specialty for all new Health Board WPRS uplifts. Ongoing Inclusion of Practitioners with Special Interest as part of ABMU (East) deployment. Extension to ABMU (West) outlined for deployment, however both roles have since resigned. Parked Additional WPRS development has allowed for interim test request solution providing better visibility and management of diagnostics. During early project planning and a result of the number of project vacancies, this deliverable was parked to allow focus on the extension of the Welsh Patient Referral Service for hospital activity. Ongoing Agreement for national standardised outpatient referral electronic document (process attached in Appendix B) Page 6 of 15
(internal and external) across health board boundaries. Inclusion of mandated Pathway Start Date field with supporting clinical justification to allow for better identification and improved tracking. All development has completed across the four applications, Welsh Clinical Portal, Welsh Admin Service, Welsh Clinical Communications Gateway and Welsh Patient Administration Service. System Integration Testing underway with User Acceptance Testing scheduled in May. Deployment scheduled as part of v3.10.1 of WCP in June 2018. Electronic requesting of Cardiac diagnostic services at point of clinical prioritisation when required Ongoing National consensus for standardised cardiac service electronic request (attached in Appendix B) Electronic reporting of Cardiac diagnostic services at point of clinical prioritisation when required Visibility of cardiac related activity to other clinical specialities to enrich patient record and point on the clinical pathway is visible to all clinicians Ongoing Deployment of National messaging service linked to the Welsh Results Report Service with interfaces for each Health Board Visibility of MEDCON, MUSE and HD Clinical reports within Cwm Taf Delivery of National Technical Specification for ORU and ORM messages, which will be adopted across all Welsh Results Report Service (WRRS) integrations. Ongoing The All Wales organisational constraint was lifted in December 2017, enabling WCP users to view documents about their patient regardless of where in Wales they were created. Visibility of the following Health Boards clinical documentation: BCU epoc ABHB Medsecs ABMU DMS WCCG referrals (all Health Boards) Successful rollout of the WRRS to Cwm Taf, Powys, Velindre, Cardiff & Vale, ABMU, Hywel Dda and ABHB. BCU to go-live w/c 16.04.18 Page 7 of 15
In addition to achieving the aforementioned objectives, the project has made significant progress in bringing together experts within cardiac services from across NHS Wales to agree national standards ultimately reducing unwarranted variation in patient care. Understandably, corralling opinion across such a geographical and culturally diverse area has been a challenge yet has afforded us opportunities to utilise these groups for future service and pathway redesign, it has also been utilised by some of the project s partnership organisations. Following the WHSCC commissioned Delivery Unit evaluation in October 2017, which highlighted areas of concerns with regards to accurate pathway and waiting times reporting across Cardiac Services, the AWACI project were able to demonstrate an electronic referral solution, ultimately providing a solution for the concerns raised in the evaluation. Further enhancing the AWACI position as an innovative, dynamic and transformational project across NHS Wales. The project has been reflexive in its development and pursued the opportunity to utilise the Wales Cardiac Networks National Informatics Manager to support the development of robust and trustworthy data generation. 5.2 Against Costs The table below highlights budget against actual cost, the variance at year end and total costs for the duration of the Efficiency Through Technology funded project: 2015/16 2016/17 2017/18 Total Project Costs Budget - 367,865.00 367,860.00 735,725.00 Actual - 312,407.20 362,669.22 675,076.42 Variance - - 55,457.80-5,190.78-60,648.58 Comments Underspend returned to Welsh Government Awaiting confirmation of final position 5.3 Challenges One of the key challenges throughout the lifespan of the project has been the recruitment of both technical and clinical resource to be able to deliver the project objectives as per the agreed timetable of delivery. Key learning point; A collaborative approach for recruitment for clinical positions (Wales Cardiac Network and NWIS) is likely the most effective method to recruit the strongest candidates with the relevant clinical background. Given the challenges, this should be considered as a priority on project initiation to secure resource for project delivery. The period of employment offered must be considered as it may present itself as a barrier if under 2 years. Page 8 of 15
Key learning point; The project lacked dedicated Business Analyst support - projects must be mindful that management of business requirements should be robust to prevent several iterations, avoid high level requirements and ensure corresponding use cases are drafted. Key learning point; Collaborative working across NWIS/Wales Cardiac Network has prompted challenges to align conflicting priorities and management of resource across two organisation boundaries. Positive and fruitful opportunities have occurred because of having resource across the two organisations, including closer links to policy leads in Welsh Government, Clinical Leads and Directors. Key learning point; Limited release of Health Board clinical staff for Clinical Reference Group attendance hindered discussions and impacted on productivity due to the requirement to revisit discussions. 6 Continuation Activities The following sub-sections cover the various activities required to continue the project. 6.1 Project Staff NWIS has extended agency staff for the following durations against the revised scope: 3 month extension: - Software Developer (National Operational Database and Integration) 6 week extension: - Technical Architect (Applications Design) Substantive posts remain assigned but will be reviewed further once other funding understood: - Project Manager (Implementation) - Test Analyst (Test) - Software Developer (Hospital Applications) - Software Developer (NODI) Additionally, Heart Conditions Implementation Group (HCIG) approved a 3 month extension for both the Clinical Programme Manager and Service Transformation Manager. 6.2 Project Scope With the current funding position unknown, the AWACI Project Board proposed a revised scope for 2018/19 delivery, which would reduce resource requirements and ultimately associated costs. Given that the initial follow up bid for ETTF exceeded 1 million across a two year period, the project board were realistic in their expectations in seeking alternative funding sources both to NWIS and HCIG. Page 9 of 15
Given the political pressures associated with the WHSCC commissioned Delivery Unit evaluation of the transition point along the referral to treatment pathway and the national consensus from the clinical communities, it was agreed that the revised scope would include Hospital to Hospital, electronic Requesting and electronic Reporting in support of the benefits that will be realised through the delivery of these work-streams: Hospital-to-Hospital Electronic Referrals (reduced scope): As previously mentioned, the development for hospital to hospital has completed across a number of applications. A pilot for Cardiology and Cardiac Surgery outpatient activity is due to commence in June 2018, which will include Abertawe Bro Morgannwg, Cardiff and Vale and Cwm Taf University Health boards. The pilot will run and an evaluation completed over a 3-month basis. During the pilot and evaluation, continued efforts to sustain the well-established Clinical Reference Group and utilise the Subject Matter Experts to further define requirements for the extension to inpatient activity including ward reviews. If no further funding for the project is secured, following pilot evaluation, progression would form part of the existing Welsh Patient Referral Service roadmap. Electronic Requesting (reduced scope) As per the deliverables outlined in 5.1 Against Objectives, the intention with electronic requesting was to develop a full end-to-end electronic workflow with third party integration. Due to the timescales and resource available, the AWACI Project Board proposed to de-scope any third party integration, in favour of the creation of electronic work lists. This would enable the receipt of the nationally standardised electronic document already agreed through use of the electronic Requesting Clinical Reference Group which would be completed within the Welsh Clinical Portal. To date this would include all cardiac diagnostics, which do not require any form of vetting by a Consultant Cardiologist. The AWACI project team have identified two senior Cardiologist who have volunteered to undertake a thorough proof of concept to evaluate the clinical acceptance of this prototype. The project will continue efforts to sustain the well-established Clinical Reference Group and utilise the Subject Matter Experts within to further define requirements for the extension of requesting to include diagnostics which require a vetting process. Additionally, continuing collaboration with the radiology requesting project team to ensure inclusion of requirements, design and delivery for Cardiac MRI and CT. Electronic Reporting (reduced scope): The National Standards for ORU and ORM messages will be further utilised for welsh Results Report Service (WRRS) integrations, in particular the completion of: MEDCON (McKesson) and HD Clinical in Abertawe Bro Morgannwg and Aneurin Bevan UHB s Cardiobase South Wales Congenital Heart Unit (diagnostics) MUSE (GE) across all remaining Health Boards Additionally, integration with the Welsh Care Record Service (WCRS) for: Cardiobase - South Wales Congenital Heart Unit (clinical letters) Dendrite PATS (Cardiac Surgery) Operation notes within Abertawe Bro Morgannwg and Cardiff & Vale UHB s Page 10 of 15
The AWACI project team will ensure this work-stream is achieved by maintaining priority for Cardiac Service content. Creation of robust and trustworthy data The project will continue to collaborate with the SNOMED-CT Implementation team to understand and map clinical coding requirements to underpin certain data items within the e-forms developed. Further to discussions held at the Network and Implementation Group Informatics Priorities meeting in March 2018, the project will ensure it continues it collaborative efforts with other clinical networks. This will further maintain AWACI as a trailblazer and ensure that delivery meets the wider service needs. 6.3 Financial Management In addition to the resource secured within NWIS, the project submitted a bid for the reallocation of the Heart Conditions Implementation Group Delivery Plan monies. Outcomes from this process will be reported back to HCIG in April. 7 POST PROJECT REVIEW The primary purpose of the Post Project Review is to assess what happened throughout the Project what went well and what didn t go according to plan. Additionally, to establish lessons that can be passed on to future Project Teams. The output from this meeting goes into the Post Project Review report. Each participant in a Post Project Review meeting has different responsibilities for the preparation, procedures, and follow-up of the Post Project Review but there are also some responsibilities that may be shared or common to participants. Representatives from Local Health Boards, NWIS Project Management and AWACI Project Board will be involved in the meeting to determine the overall Project s Success and whether functionality has successfully integrated into the Local Health Boards. 7.1 Membership Name Organisation Role Robert Bleasdale Cwm Taf University Health Board Senior Responsible Owner (Executive) Richard Cowell Betsi Cadwaladr University Health Board Senior User (Representative) Navroz Masani Cardiff & Vale University Health Board Senior User (Representative) Paul Das Betsi Cadwaladr University Health Board Senior User (Representative) Dave Tyler Cwm Taf University Health Board Senior User (Representative) James Barry ABM University Health Board Senior User (Representative) Tracey Hill Wales Cardiac Network Project Assurance Mike Ogonovsky Aneurin Bevan University Health Board Project Assurance Page 11 of 15
David Sheard NHS Wales Informatics Service Senior Supplier Robert Jones NHS Wales Informatics Service Senior Supplier Rebecca Cook NHS Wales Informatics Service Senior Supplier Michelle Cook NHS Wales Informatics Service Project Manager 7.2 Quorum The quorum of the Post Project Review meeting is defined as follows: Senior Responsible Owner; At least 2 Senior Users or agreed delegates 1 ; At least 2 Senior Suppliers or agreed delegates 1 ; Project Manager; At least 1 Project Assurance or agreed delegates; Project Support (for Notes). 7.3 Frequency of Meeting The initial meeting will take place after final project closure, following delivery of the reduced scope. Any benefits/objectives unable to be completed, an additional meeting can take place by agreement of Post Project Review members (by majority vote). 7.4 Reporting Arrangements The Post Project Review meeting provides a Report to the Heart Conditions Implementation Group and Welsh Clinical Informatics Council for review/comments. 7.5 Draft Agenda An example Agenda of the Post Project Review meeting is defined in Appendix A. 8 RECOMMENDATIONS NOTE the content of this report 9 REFERENCES Document Efficiency through technology application form September 2015 Version V4 20160115 ETTF NWIS Devt of Cardiology ereferrals Grant Award 1 Delegates are agreed by the Senior Responsible Owner Page 12 of 15
PID-AWACI-Project Initiation Document V0.9 10 GLOSSARY Term Electronic Requesting Electronic Reporting Welsh Clinical Communication Gateway (WCCG) Welsh Patient Administration System (WPAS) Welsh Clinical Portal (WCP) Welsh Patient Referral System (WPRS) Welsh Results Report Service (WRRS) Welsh Care Record Service (WCRS) Explanation A request to the Cardiac Service diagnostic department for a cardiac service investigation such as ambulatory monitoring or exercise testing. The transfer and storage of diagnostics and clinical letters to the Welsh Care Record Service and Welsh Result Report Service for visibility by authorised users of the Welsh Clinical Portal The Welsh Clinical Communication Gateway (WCCG) is a secure clinical messaging service and is used to send e-referrals between GP practices and hospitals. It is also used to send e-discharges from hospitals to GP practices. The Welsh Patient Administration System (WPAS) holds patient ID details, outpatient appointments, letters and notes. The WCP is a secure health space, uniting key patient information from the different computer systems and databases used in NHS Wales. It gives doctors and nurses a single immediate view of the important data needed to support vital clinical decisions and functionality for key tasks. The Portal s current functionality includes patient lists, electronic pathology test requesting and results viewing, and Radiology Reporting. WCP provides a patient record associated with all patients registered on the local Patient Administration System. The Welsh Patient Referral System (WPRS) refers to the combined systems and processes that make up a patient referral from a GP practice to a Hospital Consultant. The Service uses the Welsh Clinical Communications Gateway (WCCG) to make the referral in the GP practice, and then the Welsh Administration Portal (WAP) in the medical records department of a hospital receives the referral and matches it with patient details from the Welsh Patient Administration System (WPAS). The Welsh Clinical Portal (WCP) is used by the consultant to view the referrals for prioritisation The Welsh Results Report Service (WRRS) is a database which provides WCP users with the ability to view diagnostic reports and test requests for their patients. The Welsh Care Record Service (WCRS) is an electronic document repository which stores the many different clinical documents that make up a patients record. Page 13 of 15
Welsh Administration Portal (WAP) User Acceptance Testing (UAT) The Welsh Administration Portal (WAP) is used by medical and health records staff in hospitals. When the referral arrives at the hospital the administration portal is used to verify the patient s administration details, create a record on the hospital s Patient Administration System or to link the referral to an existing record on the PAS. If the Health Board is live with full WPRS (clinical prioritisation) the referral is then directed electronically to the relevant consultant. If the Health Board is not yet live with full WPRS including Clinical Prioritisation, this is known as WAP Lite. User acceptance testing (UAT) is the last phase of the software testing process. During UAT, actual software users test the software to make sure it can handle required tasks in real-world scenarios, according to specifications. UAT is one of the final and critical software project procedures that must occur before newly developed software is rolled out to the market. UAT is also known as beta testing, application testing or end user testing. Appendix A AG-PRG-AWACIPost Project Review Agen Appendix B Cardiac Service Request Hospital to Hospital Referral GEN-AWACI-Cardia c Diagnostic Reques PRS-AWACI Hospital to Hospital Page 14 of 15
Appendix C Health Board Readiness Table Organisation Welsh Clinical Communication Gateway WAP Full Clinical Prioritisation Welsh Patient Referral Service Primary Care Welsh Patient Referral Service Hospital to Hospital Patient Administration System Welsh Clinical Portal Software Clinical letters WCRS integration AB Yes No No No WPAS Pilot - v3.9.2 Convergence Plan Medsec Yes ABM Yes Yes East: Yes West: Apr 18 Pilot Jun 18 WPAS Pilot - v3.9.1 Convergence Plan Cellma DMS Yes C&V Yes Completed Pilot Jun 18 PMS v3.9.2 Generic Letters Yes HD Yes Yes May 18 No WPAS v3.9.2 Cellma WPAS Jun 18 CT Yes Completed Pilot Jun 18 WPAS v3.9.2 WPAS Apr 18 BCU Yes Spring 18 TBC No Mixed v3.8.6 2 East - epoc Central & West PiMS Yes No Powys Yes No No No WPAS v3.9.1 WCCG Referrals Yes Vel Yes No No No WPAS V3.9.2 Canisc No 2 Scheduled to receive release v3.9.2 of WCP on 11.04.18 Page 15 of 15