UPDATE ON ehealth NHS Highland Board 24 July 2018 Item 4.7 Report by Iain Ross, Head of ehealth on behalf of Deborah Jones, Director of Strategic Commissioning, Planning and Performance The Board asked to: Note the contents of this report. 1 BACKGROUND The terms of reference of the ehealth Delivery Group states that The ehealth Delivery Group will provide a bi-annual update to the NHS Highland Board. This is the third update and covers the period from the last report to the Board in November 2017. The ehealth Department exists to support and to be an enabler in the delivery of the Board objectives via the Health & Social Care Partnership (HSCP) and the Integrated Joint Board s (IJB) Quality & Sustainability Plans. This report provides an update on the ehealth activities in support of these plans 2 GOVERNANCE Since the last update minor changes have been made to the governance arrangements for the ehealth function. The ehealth Strategy Group remit remains unchanged, however, the membership has been revised to fit in with the new structure of NHS Highland. The ehealth Delivery Group remit has been changed to remove the oversight of the ehealth function role. This oversight role is now the responsibility of a new group called the ehealth Accountability Group which consists of the Director of Strategic Commissioning, Planning & Performance, ehealth Clinical Director and Head of ehealth. This group will ensure that the ehealth function is held to account for service delivery. 3 NHS HIGHLAND ehealth STRATEGY The NHS Highland ehealth Strategy was last reviewed on 10 July 2018 where agreement was reached to modify slightly the existing strategic vision to: 1 Electronic Patient/Person Record Access to an electronic patient/person record that replaces the existing paper records integrated across NHS Highland (primary, secondary, community and social care) with access available as required regionally and thereafter nationally. This would also be available to the patient/person or appointed representative with appropriate access controls.
2 Equity of Access to Systems and Services Integrate the different environments in use across NHS Highland and regionally to ensure that all users have access to similar services and systems, ensuring that NHS Highland is consistent with the emerging national and regional digital maturity models. 3 Digital Infrastructure Delivery of a digital infrastructure that is appropriate to the needs of the service (primary, secondary, community and social care). 4 Cyber and Data Security Compliance with the cyber security, information governance and data security standards that are being mandated by the Scottish Government. 4 NHS HIGHLAND ehealth DELIVERY PLAN At NHS Highland s Board meeting in November 2017 the ehealth department provided an update on the work currently being undertaken within the department. The following is a summary of the position in November with an update on the current position: Delivery of a clinical information sharing solution across primary, secondary, community and social care that will display a patient centric view of clinical information At the last meeting it was reported that we were working on the business case to purchase and implement a clinical portal on a regional basis with colleagues from NHS Grampian, Shetland and Orkney. The four Boards have now purchased a clinical portal from a company called Orion Healthcare and this has been regionally branded as the Care Portal. Work on implementing phase 1 of the Care Portal has commenced and will be ready in the summer of 2018. Phase 1 includes regional links with the main systems in use within secondary care and will mean that a clinician (with the appropriate access control) will see all clinical information about a patient s hospital episode across all four Board areas. Planning for Phase 2 of the Care Portal has also started. Phase 2 will include: Linking of primary and social care data within the Care Portal (this work requires data sharing agreements to be in place) Linking Emergency Department (ED) episodes within NHS Highland within the Care Portal. The other Board s ED s are already included Establishing links with the existing portals in NHS Western Isles, Tayside and the Golden Jubilee. Phase 2 will also include an option for building clinical workflows across the region so clinical information can be captured digitally and updated in any location within Highland, Grampian, Shetland and Orkney. Reduction in length of stay Allowing patients to remain in their own homes longer
Reduction in beds As well as the above the regional clinical portal is required to support the patient and information flows associated with the planned Elective Care Centre in Inverness. Delivery of an information sharing solution within the community sector which will reduce the duplication of information being recorded thereby increasing the time available to care for patients At the last meeting we reported on the work being undertaken in North Highland with the implementation of a mobile system to support community staff called Morse as well as the work in Argyll & Bute on options for using the CareFirst system to support community staff. The Morse solution is now live with the first group of staff (83) using the system via a dedicated ipad. This number is due to increase to 130 over the next few weeks as Badenoch & Strathspey community teams start to use the system. The Argyll & Bute HSCP have now started a formal project to implement the community functionality with the CareFirst system; this work will include the migration of existing data from the MIDIS application. Allowing patients to remain in their own homes longer Reduction in beds Delivery of a patient status (production board) view of a patient which will allow staff to view the current status of all patients under their care from GP/Community care, into hospital care and back to GP/Community At the last meeting we provided an update on the continued rollout of the digital ward solution. Digital Ward includes the following modules: Admission View Ward view including community hospitals Paediatric View Pharmacy View InfoView Clinical bridge Since the last meeting we have been working with the supplier on a new version of Admission View as the initial version was deemed not fit for purpose. The new version is due to go into user acceptance testing in the middle of July. Once Admission view has been signed off work will start on reviewing the implementations of the other modules with a view to providing Real Time updates on patient and bed information via the InfoView module. Reduction in length of stay Allowing patients to remain in their own homes longer Reduction in beds Improved flow of patients across the health/social care system
Support for the Technology Enabled Care (TEC) Programme At the last meeting an update was provided on the work to support the Attend Anywhere solution (now branded as NHS Near Me). This work has continued and we have supported the Highland Quality Team with their work on establishing a service initially based in the Caithness area. As well as supporting the NHS Near Me work the ehealth department has developed a link between the Florence telehealth service and the NHS Highland SCI Store so that summary clinical information can be shared across clinical staff. Quality improvements Reduction in travel for both patients and clinical staff Delivery of electronic information gathering functionality within the clinical setting to replace the need for paper Since the last update this is an area where ehealth has not been very active. The intention over the coming months is to implement a technical solution that will enable Health Records to start the scanning of appropriate legacy records which will then be viewable in the Care Portal. Work has also started on the digitisation of paper based clinical documents and this work will continue with the development of systems to support the recording of the National Early Warning Score (NEWS), nursing documentation and cross Board clinical documents e.g. Pre-op assessments. Improved flow of patients across health/social care New models of care Quality improvements Delivery of a solution that will allow primary and secondary care clinicians to have an online clinical dialogue about a patient with a view to reducing outpatient attendances At the last meeting we provided an update on the testing of a technical solution that would enable two way clinical dialogue between primary and secondary care. This testing is now complete and the solution has been signed off as a solution which can be implemented across NHS Highland. ehealth are engaging with the HSCP s on their plans for implementing this solution further. Reduction in the number of outpatient appointments being requested Improvement in flow of patients with health and social care Quality improvements
5 NHS HIGHLAND ehealth DELIVERY PLAN 2018/19 The ehealth Department, in partnership with the HSCP s, has been working on a revised ehealth Delivery Plan for the next two years which builds on the work reported in the November update and supports the HSCP s operational delivery plans. This plan includes the following Programmes of work: Service Delivery The number one priority of the ehealth Department is service delivery. NHS Highland has over 8,000 users of digital services, 7,000 desktop devices and 230 systems all of which are managed and supported to ensure the maximum availability at all times. When problems do arise these are dealt with as quickly and efficiently as possible. Resilience and Security At the November meeting we provided an update on the recovery work associated with the flooding incident in October 2017. Working with colleagues in the Scottish National Heritage we have created a second data centre off site and work is now progressing on transferring services to this new facility. Following the Wannacry virus incident in May 2017 the Scottish Government has instructed public bodies to comply with the Public Sector Action Plan on Cyber Security. This action plan includes the need for public bodies to achieve a cybersecurity standard, called Cyber Essential, by October 2018. NHS Highland has already been pre-assessed, and passed, this standard and are now planning for the formal assessment to take place. This work programme is also tasked with the implementation of the new cyber security tools that the Scottish Government Health Department are funding. NHS Highland will be one of the first Boards to implement these new tools. Modernising Agenda The Scottish Government has provided funding to allow Boards to migrate from unsupported software (Office 2007) and soon to be un-supported software (Windows 10), this funding has been provided to ensure Boards are able to comply with the Cyber Essentials + standard. NHS Highland has started a programme of work to migrate 7,000 devices from windows 7 to windows 10 and users from Office 2007 to Office 365. The implementation of Office 365 will transform the way staff across Highland work and collaborate with colleagues including colleagues in the Councils As part of the modernising agenda ehealth has setup a voice recognition service that removes the need for dictation and typing of letters. This service is being evaluated by medical and admin staff in Raigmore. The results of this evaluation will determine how this solution is used in the future.
Electronic Patient Record (EPR) This work programme is all about transforming services from Paper to Digital. At the core of this programme is the implementation of the Care Portal (as described above). The other components of this work programme include The scanning of elements of the physical case record (rules for scanning are being defined by the EPR Governance Group) The creation of digital forms that will replace the need for paper to be produced. A number of forms have already been converted to a digital format. The implementation of a specialised EPR to support Maternity services The ability to digitally request diagnostic tests and receive the results from secondary and primary care. The ability to send Primary Care the discrete values of a lab result (outstanding for a number of years) Work to support the modernising out-patients agenda The continuing rollout of systems to support community staff Support for the Transformation Programmes and Regional Working There are a number of regional programmes being implemented which require significant input from ehealth both locally and regionally. These regional programmes include: Support for the Scottish Radiology Transformation Programme (SRTP). Part of this programme is the implementation of a cross-board reporting solution that will improve the turnaround times for the reporting of Radiology imaging. This technical work is being led by NHS Highland on behalf of NHS Scotland. The move of Upper GI surgery to Aberdeen Royal Infirmary. The technical work on this programme includes digital solutions for the management of the multidisciplinary team meetings, cross-board activity recording and reporting and clinical document flows between Boards. The establishment of the North of Scotland Major Trauma Centres. The technical work on this programme includes the creation of clinical document that can flow across Board boundaries and be updated in the location where a patient is being cared for. The trial of a solution to transform the Pathology service regionally by implementing digital solutions that will change the way this service operates including the digitalisation of the pathology slides with the potential for using artificial intelligence to read and report pathology samples. Digital Ward Following discussions with the HSCP s it has been agreed that having a fully implemented Digital Ward solution is a priority for patient management on the ward and the provision of real-time bed management information. The plan over the coming months is to implement the Admission View module (used in acute receiving units) and then re-launch in partnership with the HSCP s the Ward View module (to be used now in all wards including community).
As well as the implementations above, development and proof of concept work will continue on Clinical Bridge (the link between primary care, community and hospital care) and a view that is appropriate for a mental health hospital. Support for New Builds NHS Highland has a number of new building projects in progress and these new builds will require many of the digital solutions described above to be in place as they transform their ways of working e.g. virtual records rather than physical records. As well as the development and implementation of the digital solutions required to support the new builds ehealth is involved in the specification of the digital infrastructure required within the building. 6 OTHER INITIATIVES As well as the core work described above ehealth are also involved in work programmes that support: The redesign of pharmacy services across NHS Highland Investigation of options for digital solution to support the workflows within NHS Highland Care Homes Continuing support for the Technology Enabled Care (TEC) Programme Support for the workstreams being identified via the Primary Care Modernising Project) These are significant programmes of work in their own right and will require considerable ehealth support to progress. 7 CONTRIBUTION TO NHS HIGHLAND BOARD OBJECTIVES The ehealth Delivery Plan is consistent with the aims of the Board s Quality and Sustainability Plan. 8 GOVERNANCE IMPLICATIONS 8.1 Staff Governance There are no particular staff governance issues around the ehealth Delivery Plan. Each individual project will have its own staff engagement plan. 8.2 Patient and Public Involvement Each project will have appropriate patient and public engagement. 8.3 Clinical Governance Each project will comply with clinical governance as part of the project delivery. 8.3 Financial Impact The financial impact of the ehealth Delivery Plan is being analysed and where required, business cases will be developed and presented to the appropriate governance groups.
9 RISK ASSESSMENT The individual projects will have their own risk assessments and risk governance arrangements. 10 PLANNING FOR FAIRNESS The ehealth Delivery Plan will ensure equity of access to patients by improving the access to clinical information across NHS Highland. 11 ENGAGEMENT AND COMMUNICATION Each project will develop its own communications plan which will include communications to staff and patients as required. IAIN ROSS Head of ehealth 06 July 2018