NHS Board Meeting 25 March 2009 Paper 6 NHS Board Meeting Wednesday, 25 th March 2009 Subject: Purpose: Recommendation: Knowledge Management and ehealth Annual Report 2007 08 This report sets out the progress that has been made in delivering NHS Ayrshire & Arran s ehealth Strategy The NHS Board is asked to note the report. 1. Background 1.1 An Executive Summary of the second Annual Report on Knowledge Management and ehealth is attached as Appendix 1. The full report (23 pages) is available on AthenA for internal staff members or a hard and/or email copy can be requested from Marlene Mair, telephone no: 01292 513787 or email: marlene.mair@aapct.scot.nhs.uk 1.2 On 19 April 2006, the NHS Board approved the ehealth Strategy 2006 2008, which set out a vision for the application of technology to support the delivery of frontline services and improved patient care, in NHS Ayrshire and Arran. The report included a number of guiding principles on which implementation of the strategy would be based together with a programme of work which required to be undertaken, to provide a sound basis for future ehealth developments. The report also identified priority projects for inclusion in a three year Development Programme to underpin the strategy. 2. Current Situation 2.1 The report sets out the progress that has been made to date in implementing the ehealth Strategy and includes a summary of the agreed development priorities for the coming year. The report was considered and approved by NHS Ayrshire & Arran s Knowledge Management & ehealth Steering Group at their meeting on 15 th December 2008.
3. Recommendation 3.1 The NHS Board is asked to note the report. John Wright Director of Information and Clinical Support Services 5 th March 2009 [Denise Brown, Assist Director of ehealth & Infrastructure Services, Sally Smith, Assist Director of Information Services ] 1
Appendix 1 KNOWLEDGE MANAGEMENT & ehealth SERVICES ANNUAL REPORT 2007 08 Executive Summary 1. ACHIEVEMENTS DURING 2007-2008 During 2007/08 good progress has been made with implementing NHS Ayrshire & Arran s ehealth Strategy including the procurement of a number of new clinical systems for A&E, Maternity and Laboratories. Implementation of these new best of breed clinical systems is well advanced. Work is well underway to procure a new Patient Management System (PMS) which is due to begin implementation in 2010, providing many clinical benefits including the ability to track patients through treatment and improved management information. In addition, a number of ehealth systems have been developed locally to fill gaps and provide clinical benefits in line with the organisation s service objectives. Waiting times data has been consistently submitted on time to the Scottish Government Health Department, despite a number of technical difficulties with extracting this data from our existing Patient Administration Systems (PAS). Information Governance and IT Security have been given a critical focus by the Department as a result of the high profile given to problems in Government in the national media. This has resulted in a number of unplanned activities for the Department. The teams have worked effectively together to ensure that all staff are fully aware of Information Governance issues. This has ensured that NHS Ayrshire & Arran has robust and effective policies in place, concerning appropriate use of the internet and email as well as the secure storage and transportation of sensitive and patient identifiable data. The Information Services Teams, previously split across several locations, have now been consolidated into a single, unified Business Intelligence service within the Department, and relocated to Ailsa Hospital. 2
The Department was able to deliver the full 2% efficiency savings target whilst continuing to deliver our services. This has proved to be extremely difficult and challenging, at a time when NHS Boards need to be looking to increase their investments in ehealth if they are to improve service delivery. We have also extended the range of Key Performance Indicators (KPIs) to better manage the quality and performance of the services which we provide. 2. DEVELOPING OUR STAFF A new integrated organisational structure for ehealth Services was successfully implemented during the year. Technical and IT security training has continued to ensure that our staff are technically competent and their skills are kept up to date. 3. INVOLVING SERVICE USERS AND PROVIDING SOUND GOVERNANCE The established governance structure has proved to be very effective in managing the implementation of the ehealth strategy. Chaired by senior service users and clinicians, the groups ensure that real benefits are delivered to healthcare staff and patients through the implementation of new technology and the modernisation of working practices. A local NMAHP (Nursing, Midwifery and Allied Health Professionals) group will also be established to ensure that the ehealth needs of this important group of staff and the services they provide, are effectively supported by the use of technology. In the course of the year, Dr Ken Ferguson, Associate Medical Director and Professor Craig White, have been appointed to the posts of Clinical ehealth Lead and Clinical Care Systems Lead respectively. Ken and Craig will work closely with Dr Jim Campbell, Clinical Director of ehealth, to ensure that the information needs and priorities of clinicians are clearly understood and articulated. 4. ehealth SERVICES Key highlights for 2007-08 include: Service Management First line support has been consolidated within an integrated single Service Desk function. All calls are now taken by the Service Desk who triage the incidents and provide first line fixes or allocate the calls to the appropriate technical team. The management information from the service desk system has been used to monitor performance and improve services to users. 3
IT Security In order to improve the security of NHS Ayrshire & Arran s data and information systems, a number of wide ranging changes have been implemented including the implementation of encryption software and the provision of secure storage facilities for data. The Infrastructure Further investments have been made in the technical infrastructure to ensure business continuity for a number of key IT systems which will allow the quick restoration of systems and data. Wireless technology has been installed within Crosshouse Hospital and some parts of Ailsa Hospital to support mobile working on the wards and clinics Patient Management System (PMS) During 2007/08 NHS Ayrshire & Arran embarked on a procurement of a new Patient Management System (PMS) with a consortium of other NHS Boards including, NHS GG&C, NHS Lanarkshire, NHS Borders and NHS Grampian. The new Patient Management System will be implemented in 2010 in the Acute and Community Hospitals with links to GP systems. The new system will be more than just a Patient Administration System (PAS), and will include functionality to support clinical care and allow clinicians, nurses, AHPs and other health professionals to manage their patients through their treatment, providing a consistent view of the patient s journey. Laboratory System Implementation of the new Laboratory system supplied by Clinisys started this year and is due to be completed by March 2009. Radiology Information System (RIS) And Picture Archiving Computer System (PACS) A major project to implement the national RIS and PACS systems, across the Ayr and Crosshouse Hospital sites and their satellite sites has been completed in Crosshouse and Ayr Hospitals. An electronic ordering system called RISWeb has also been implemented providing the ability to track orders against reports, provide audit information and eliminate paper card based ordering. Maternity The procurement of a new maternity system was completed during 2007/08 and implementation has commenced. The system will be operational early in 2009 and will be followed by implementations in the community and neonatal units. This will provide a single maternity record linking the hospital and community teams with the ability to produce the 4
hand held maternity record for mothers. The system will also be capable of receiving child protection messages from Social Work staff. A&E During 2007/08 a new A&E system has been procured and implementation in Ayr and Crosshouse Hospitals is due to complete by the end of March 2009. The new system will provide a single A&E system available across all sites including local Community Hospitals. The system will also be capable of receiving child protection messages and alerts. Electronic Referrals SCI Gateway is a national system which allows referrals to be sent from GP Practices to the hospital in an electronic format. The system was developed to support the HEAT target for electronic triage in support of the 18 Week Referral to Treatment Target (RTT). Approximately 95% of referrals from General Practice are currently being sent electronically to Consultant led services in secondary care and to Physiotherapy Services across Ayrshire & Arran. Emergency Care Summary Record (ECS) Front line staff in the Out Of Hours Centre (ADOC) can now access the Emergency Care Summary (ECS) information, providing information about a patient s recently prescribed drugs and allergies. The system has also been rolled out to Pharmacy staff working within the acute hospital receiving wards at both Crosshouse and Ayr Hospitals. Cross border access across all Health Boards in Scotland has now been switched on. Local Developments A number of local ehealth developments have been completed to address gaps in system provision for a range of requirements. Face Care Pathway And Assessment Systems There are now over 1500 users of the FACE system, which provides electronic recording of care pathway, activity records and assessments, with powerful reporting built in. Wider implementation of the FACE system has provided additional clinical benefits within Adult Mental Health Services; Older peoples Services; Learning Disabilities; CAMHS; Single Shared Assessment; and Podiatry. New developments this year have seen the system used to display child protection messages and the system will also be made available to accident and emergency staff for this purpose. GP IT Systems During 2007 the Scottish Government has been formulating their plans for the replacement of GPASS which is used in the vast majority of our GP Practices. In Ayrshire & Arran it has been decided to make use of the time available to test the implementation process involved with changing to the two alternative systems. Two Practices migrated from GPASS onto a new system from EMIS and a new system called Vision. Development staff worked with the practices to evaluate the effectiveness of the migration processes and training provided. 5
In addition to the trial migrations the clinical systems and software in all GP Practices have been upgraded. Practices were also provided with new software called Bluebay which allows them to collect additional clinical data and run reports. This system is also being used to collect data for the Keep Well project. Community Pharmacy The national epharmacy programme continues to progress with the completion of the rollout of the electronic Minor Ailments Service (emas) and the introduction of the new Electronic Transfer of Prescriptions (ETP). ETP provides the technology to support two of the four services of the Community Pharmacy Contract, the Acute Medication Service (AMS) and the Chronic Medication Service (CMS). Dental Services Dental Practices are now linked to the NHS network using secure connections and NHSmail. A national procurement is likely to commence in 2009 for a clinical system to support General Dental Practitioners similar to that used by the Community Dentists in NHS Ayrshire & Arran. Community & School Nursing NHS Ayrshire & Arran has been working closely with the CHP Professional Nurse Advisors, Children s Services and the CHP s to provide Health Visitors and School Nurses with mobile laptop computers and a system which will support the development of an electronic child health record. The FACE system has been developed to allow the recording of the full dataset associated with the child health record. Implementation will commence on a phased basis in 2009. Safer Patients Initiative (SPI) The SPI initiative in NHS Ayrshire & Arran approached ehealth Services to develop a system which allows the real time electronic recording of hand washing episodes and audit information collection and reporting. This is in use in a number of wards. National Sexual Health System (Nash) The new national sexual health system went live within NHS Ayrshire & Arran. This provides a clinical and scheduling system for the Sexual Health Service accessible from all relevant locations. 5. KNOWLEDGE MANAGEMENT SERVICES A Knowledge Management Services strategy has been developed which aims to support NHS Ayrshire & Arran in achieving a key objective of improving the patient experience by providing quality patient care based on needs of the patient; equity of access and the best available clinical evidence. Key highlights for 2007-08 include: 6
AthenA NHS Ayrshire & Arran s Knowledge Management Portal AthenA, a Knowledge Portal, based upon Microsoft SharePoint, has been developed and implemented during 2007/08. AthenA is available to all staff with a login to the NHS Ayrshire & Arran network. The early focus has been on developing a small number of early adopter sites which include Pharmacy Knowledge Management & ehealth Organisational & Human Resource Development (Workforce Futures) Communications Service Futures Infection Control. Training programmes have been developed and delivered to support service users including an elearning solution which allows staff to undertake training within their workplace at a convenient time to them. Information Governance Within NHS Ayrshire & Arran the Information Governance team has worked with the IT Security team to deliver Information Governance training to a wide range of staff and departments, to raise awareness of information governance and best practice. Advice and guidance on data protection and information governance is now readily available through the AthenA Portal. The Information Governance Team, have worked with departments to ensure the timely submission of assessments in order to comply with the Information Governance Toolkit and promote improvements to ensure compliance with each of the standards. Data Warehouse A project manager has been appointed to oversee the development of a local data warehouse which will provide a single repository for data, fed from a myriad of systems within NHS Ayrshire & Arran. Through the use of Business Objects tools, we will support the linking of data and the development of reports and dashboards to meet the information needs of NHS Ayrshire & Arran. Developments include: Data feeds from Theatre System and provision of suite of reports to support monitoring of Theatres utilisation Creation of British Association of Day Surgery (BADS) dataset for local use by the General Managers and their supporting staff to monitor the level of day surgery provision. Access to national datasets including SMR data. 7
Community Health Index (CHI) The former Health Minister announced that from June 2006 all NHS clinical correspondence should contain the patient s Community Health Index Number (CHI) as the key patient identifier. Since April 2007 Boards have been required to monitor CHI utilisation as part of the HEAT performance framework and CHI compliance is monitored each month. Significant progress has been made during the last year with Laboratory services achieving 97% for 3 consecutive months. The next phase of development mandates the use of CHI as the sole patient identifier by 2011. Cancer Tracking A local cancer tracking module has been developed to track 8 key cancers that have been referred by GPs, as being potentially urgent and in addition, those that have been upgraded by consultant review. The system is well embedded operationally and reports are made each Tuesday to the National Waiting Times Unit. Significant progress has been achieved in focusing effective patient care within the required national time scales. Waiting List Tracking and National Returns. The Business Intelligence Team continues to support operational managers and clinical staff in the achievement of the 126-day target wait for in patient and day case treatment. This target was achieved in December 2006 and been consistently maintained since then. Information Management s contribution to this involves the creation of a daily monitoring database, identifying patients without an admission date who are nearing the target date as well as ad hoc requests from operational teams dealing with specific waiting list issues. Various monthly national monitoring templates including MMI (Clinical services), DMMI (Diagnostics) and CMMI (Cardiology) are also prepared and distributed. Considerable effort has been applied in Information Management, ehealth, Health Records and Waiting Times Access to implement New Ways. This is a national programme designed to eliminate the deferred waiting list and to ensure that all patients who are available, appropriate and clinically ready for treatment can be seen and treated within the 18 week timescales for Out patients and In Patients / Day Cases. A substantial work programme has been undertaken in order to meet the specified requirements for data recording and reporting. The system became operational on 1 st January 2008. Library Services Library services have been focusing this year on a number of new developments including the implementation of a new Library Management System which has enabled all libraries to be electronically accessible to users via SHELCAT the online national catalogue of books. This has also 8
allowed all library sites in Ayrshire to automate all their lending procedures for the first time. NHS Ayrshire & Arran is also piloting the automation of journal circulation on the new system for NES. Access has been improved through the launch of a Library Services site on AthenA, enabling our users to view information about services available to them and to make requests electronically for services e.g. literature searching, to be carried out on their behalf. In December 2007 the library at Boswell House was closed and the service is now provided via the Ailsa library. A new library combining the former Boswell House Library and the ageing Ailsa Library is due to be opened in March 2009. In order to make resources more accessible, journal holdings for all the libraries have been reviewed and consolidated into one complete archive held, primarily at Crosshouse. The Review of Services project was supported through the provision of literature searching and articles supplied to the Independent Review Panel. 6. NATIONAL AND REGIONAL COLLABORATIVE WORKING Recently a new national ehealth Strategy was agreed and approved by the Cabinet Secretary. A number of national and regional procurements are underway. This includes a Chemotherapy Prescribing System (CEPAS) which is nearing contract conclusion and a new Renal System. Whilst the PMS procurement is being taken forward by a consortium of NHS Boards it will provide a framework contract for all NHS Boards in Scotland. During 2007/08 NHS Ayrshire & Arran established and chairs a new West of Scotland ehealth Leads Group. The group have developed their terms of reference and now take a proactive role in regional ehealth initiatives. A number of pieces of work have been commissioned including a review of infrastructure in the relevant Boards, with a view to implementing a regional infrastructure, allowing regional systems to communicate and share information securely. This reflects the model of clinical service delivery for many services such as cancer and renal. Recently NHS Ayrshire & Arran was successful in obtaining national funding to develop a demonstrator system for a Patient Portal. ehealth staff will be working closely with clinical leads in the field of Long Term Conditions and patients, to develop a proof of concept which will allow patients to securely book appointments online, view their test results, order prescriptions and manage their conditions in partnership with clinicians. A West of Scotland Information Services Collaborative Group has been set up and chaired by NHS Ayrshire & Arran. The group is working on cross boundary issues and is seeking to influence thinking by ISD on information issues relating to data definitions, uses and governance issues. The group meets quarterly at various locations through out the West of Scotland. 9
A number of our local developments have been provided to other NHS Boards and we continue to share experience and skills for maximum benefit. 8. LOOKING FORWARD PRIORITIES FOR 2009 2010 The coming year will focus on the completion of the new system implementations and pre-planning for the new PMS in 2010. We will be developing a new revised Knowledge Management, ehealth and Health Records Strategy for 2009 2012. The priority areas for the coming year will be as follows: SERVICE DELIVERY Key Performance Indicators will continue to be developed and extended across all of the new Information and Clinical Support Services Department s Services We will extend the unified Service Desk across the new Information and Clinical Support Services Department s services We will continue to invest in training to ensure that our staff are equipped with the most up to date skills and tools, underpinned by the KSF framework and the support of line managers We will implement remote support tools which will allow us to support our end users more effectively, without the need for an engineer s visit MAJOR PROJECTS New hospital systems including Laboratories, RIS, PACS, Maternity, and A&E will complete their implementations We will procure a new Patient Management System (PMS) with other NHS Boards to replace our existing aging systems and in preparation, data clean up of systems will continue Electronic Prescribing will be implemented at Biggart and Crosshouse Hospitals Community nursing systems will be implemented to allow electronic recording of the child health record Systems will be developed to support the organisation s objectives in relation to SPI, Infection Control, 18 weeks RTT and Long Term Conditions Management We will implement clinical systems to support the Mental Health Service Support for the epharmacy and Dental programmes and the introduction of the national systems underpinning the new pharmacy and dental contracts Subject to the procurement of a new national system for GP practices we will commence implementation of a new GP system A new scanning system will be introduced into Paediatrics to provide electronic access to the Paediatric record A new bed management system will be implemented at Crosshouse Hospital to provide real time information on bed occupancy. We will work with Data Sharing Partnership colleagues to develop and implement systems to support data sharing across Ayrshire & Arran INFRASTRUCTURE & SECURITY 10
We will implement technology which will allow the use of single sign on solutions We will deliver an education communication programme to support staff in the use of IT and information security We will work with colleagues in Estates to agree an integrated data and voice communications strategy for the organisation We will undertake a programme of installing encryption software to ensure that data on mobile devices such as laptops and memory sticks is secure The regional focus will be to provide solutions to support cancer services and renal systems. In addition we will begin the development of a regional network to support regional clinical services KNOWLEDGE MANAGEMENT SERVICES We will continue to develop the Business Intelligence Service which will provide comprehensive reporting on 18 weeks Referral to Treatment, Long Term Conditions and Mental Health Service Improvement Programmes We will continue to develop the Data Warehouse as a main resource for the provision of comprehensive information analysis, reporting and performance management including Ayrshire & Arran Performs We will continue to develop our Knowledge Portal, AthenA, as a vehicle for sharing knowledge and supporting collaborative working across NHS A&A We will support the implementation of CHI as unique patient identifier by the implementation of the Phase 3 action plan We will increasingly apply the use of Lean techniques in conjunction with healthcare colleagues, as an integral part of our development processes We will improve access to library services through the gateway of the AthenA Portal and increase access to IT for all staff groups, by extending the use of the IT facilities available in libraries. We will implement the NHS Scotland Quality assurance framework for Library services in the NHS We will continue to raise awareness of and actively promote Information Governance issues through regular communication and training sessions We will encourage and support safe and secure sharing of data with partnership organisations through working with local authority and police colleagues, to review and develop protocols for the safe and secure sharing of data We will develop a unified, responsive ehealth Training and Facilitation Service, providing learning and support in the use of IT to service users Information and Clinical Support Services (Knowledge Management and ehealth Services) 5 th March 2009 11