NHS ROTHERHAM Rotherham NHS IT Strategy 2010-2015 Final Version 5.0 Date: 8 th April 2010 Author: Andrew Clayton Owner: Robin Carlisle Page 1
Approvals This document requires the following approvals. Name Signature Title Date of Version Issue Andy Buck Chief Executive 19/04/10 V5.0 Revision History Date of this revision: 19/04/2010 Date of Next revision: 01/04/2015 Revision date Previous revision date Summary of Changes Version 01/02/2010 NA First draft V1.0 03//02/2010 01/02/2010 Second draft: revised structure and additional V2.0 content 17/02/2010 03/02/2010 Third draft: further revised structure, new V3.0 content, additional sections added 18/02/2010 17/02/2010 Added content to section 3.10. Errors revised V3.1 19/02/2010 18/02/2010 Added additional content to section 3.10. V3.2 Formatting standardised 05/03/2010 19/02/2010 Additional content added to the RDaSH sections V3.3 11/03/2010 05/03/2010 Executive summary added V4.0 24/03/2010 11/03/2010 Content added to section4.8.1 to reflect planned V4.1 RCHS telehealth project 31/03/2010 24/03/2010 Statement added re accessibility of the IT V4.2 Strategy 08/04/2010 31/03/2010 RFT content added, programme plan added, indicative financial plan added, sections on Integrated Identity Management and SystmOne V3 added, typing errors corrected V5.0 Page 2
Rotherham NHS IT Strategy 2010 2015 Contents: 1. Executive Summary 5 2. Introduction and Context 8 3. Current IT Services in NHS Rotherham 9 4. NHS Rotherham IT Strategy 11 4.1 Clinical Data Quality and Safety 11 4.2 Information Governance 13 4.3 System Interoperability 14 4.4 GP Systems Rationalisation 15 4.5 Information to Support Community Management and Commissioning 16 4.6 Developing the Use of InterQual 18 4.7 IT Infrastructure and the NHS Infrastructure Maturity Model 19 4.8 Supporting QIPP - Across the Healthcare System 19 4.8.1 Use of telehealth and telecare 19 4.8.2 Hospice telehealth system 21 4.8.3 Windows Desktop Automation 22 4.8.4 Community Staff Digital Pen Project 23 4.8.5 Choose and Book Optimisation 23 4.8.6 Home Working 24 4.8.7 Remote Working 25 4.8.8 PACS Optimisation 26 4.9 Supporting QIPP IT Initiatives 26 4.9.1 Review and rationalise existing IT Services 26 4.9.2 Shared Informatics Services 27 4.9.3 NHS Mail Adoption 28 4.9.4 N3 VOIP Implementation 29 4.9.5 epex System Decommission 29 4.10 Delivering National Initiatives 31 4.10.1 SystmOne Out Of Hours 31 4.10.2 SystmOne Walk In Centre 32 4.10.3 SystmOne Community Hospital 32 4.10.4 Electronic Prescribing Service Phase 2 33 4.10.5 Summary Care Record 34 4.10.6 Pseudonymisation Implementation Programme 35 4.10.7 Map of Medicine 36 4.10.8 SystmOne Version 3 Data Sharing Model 36 4.10.9 Integrated Identity Management 37 5. Provider IT Strategies 38 5.1 RFT 38 Page 3
5.1.1 Electronic Patient Record 38 5.1.2 Order Comms 39 5.1.3 System Interoperability 39 5.1.4 Delivering the Clinical 5 39 5.1.5 Use of SystmOne (A&E/Paediatrics/ Pharmacy) 39 5.1.6 Approach to telehealth/telemedicine 40 5.1.7 NHS Mail Adoption 40 5.1.8 IT Infrastructure and the NHS Infrastructure Maturity Model 40 5.1.9 Information Governance 40 5.2 RDaSH 41 5.2.1 Electronic Patient Record 41 5.2.2 System Interoperability 41 5.2.3 Delivering the Clinical 5 41 5.2.4 Use of SystmOne 41 5.2.5 E-consultations 41 5.2.6 NHS Mail Adoption 41 5.2.7 IT Infrastructure and the NHS Infrastructure Maturity Model 42 5.2.8 Information Governance 42 5.2.9 Other Strategic Initiatives in RDaSH 42 6. High Level Programme Plan 43 7. Indicative Costs 2010-2015 45 Page 4
1. Executive Summary This IT strategy has been developed to support NHS Rotherham in the delivery of the Adding Quality and Value strategic refresh and the associated programme of work to reconfigure the delivery of health services in Rotherham Shaping the Future. The strategy identifies the work that needs to be carried out across the health community to enable these strategic goals to be achieved. The main clinical systems that are currently in use or under implementation by NHS Rotherham and its partners are: General Practices - use a mix of systems predominantly supplied by SystmOne and EMIS but there are also a small number of Vision system users NHS Rotherham SystmOne Community Rotherham Foundation Trust Meditech RDaSH Maracis RMBC Childrens and Young Peoples Services and Neighbourhoods and Adult Services SWIFT It is not the intention of any of the organisations covered in this strategy to move to the Connecting for Health provided Lorenzo system. General Practices using the EMIS LV system will need to migrate to other systems as this product has recently ceased to be developed and will not support new strategic initiatives such as the Electronic Prescription Service. The most significant requirement for information technology arising from the new strategy is the need to seamlessly share patient information across the health community to support the provision of quality clinical care in differing locations at any time of day and to enable healthcare commissioners to be fully informed of the needs of the population. In support of this requirement there are three key priorities for this strategy which are summarised below: GP Systems Rationalisation The General Practices in Rotherham have all been using clinical IT systems to hold their patient records for over a decade. Practices have always been able to choose from a wide range of system suppliers when implementing a clinical system and this has resulted in a number of different systems being used across Rotherham. These traditional GP systems are practice based and only allow information to be shared within the practice. The information held in a patient s primary care record is an important resource for clinicians working outside of general practice to aid them the delivery of high quality care and therefore it is essential that this information is shared appropriately to support an integrated health care system. New generation General Practice clinical systems are designed to support interoperability with other healthcare systems and to provide access to their data outside of the practice setting. The GP system of choice for the Yorkshire and Humber region is SystmOne, this is a hosted system that is fully integrated with the community system already widely used in Rotherham. Therefore SystmOne will be our preferred clinical system for all primary and community care services. We will work closely with GPs to encourage and support more of them to migrate to SystmOne. We will also ensure that there is an effective interface between SystmOne and the RFT's new electronic patient record system. Page 5
NHS Rotherham will work with GPs to design a package of optimal support to assist all practices that wish to migrate on to SystmOne to ensure that this is done quickly and efficiently with minimal disruption to the practice. System Interoperability System Interoperability is used to connect disparate information systems together to enable information to pass between them. The need to leverage the connectivity between IT systems in different clinical care settings is essential to supporting the plans for Shaping the Future. Without effective information sharing between NHS Rotherham and its partners the aims of vertical integration will not be realised. Access to a shared care record showing the detailed patient history will improve the quality of care for patients and enable the patient to move efficiently through the healthcare system and be treated in the most appropriate setting. The reduction in scope of the National Programme for IT presents an urgent need to identify technical solutions that will enable information to be shared at the local level. Work will be carried out with system suppliers to identify solutions to these connectivity issues. Clinicians will be engaged in identifying what information is required to support the delivery of care and how systems will be configured to pass information between each other. Appropriate governance structures and information sharing frameworks will be put in place to ensure that patient information is transferred securely between systems and is only accessible to those with a requirement to view it. Data Warehousing Data warehousing is used to collect information from disparate information systems to enable it to be joined and linked to support operational management and for the purposes of querying and manipulation. Data on the Rotherham population held in General Practice systems and data on children held in the Children s System are the most comprehensive and detailed sources of information available on the health of the local people. In most cases, however, this information is held separately and is not readily available for sharing. To support the management of services and to enable commissioners to be as fully informed as possible it is essential that this information is gathered together to form a comprehensive population database. NHS Rotherham will work with commissioners and clinicians to identify how this population database should be delivered and what functions it should be used for. We will then work with suppliers to identify a suitable platform to deliver these requirements. The complex governance issues surrounding the sharing of this information will be addressed as an integral part of the programme of work. Page 6
Clinical Data Quality An over arching requirement to support all of the above priorities is the need to maintain consistently high quality data in all areas of the health care system. NHS Rotherham will support data quality initiatives in primary and community care and will seek to assure data quality across all of our providers. Supporting QIPP and Delivering the National Programme for IT As well as the key priorities identified above there are also a range of other initiatives that need to be delivered to support the NHS in Rotherham in meeting the requirements of the Quality, Innovation, Productivity and Prevention (QIPP) agenda and to deliver the outstanding elements of the National Programme for IT. The aim of the QIPP initiatives will be to introduce quality and efficiency into the delivery and management of health care through the use of information and digital technologies. Some of these initiatives will be focussed across the whole healthcare system and in particular there will be a drive to implement telehealth solutions to support the delivery of health care. Other initiatives will be focussed internally and will seek to drive efficiencies in the delivery of IT services. The initiatives relating to the National Programme for IT will focus on the further rollout of SystmOne to all appropriate areas of the health care system and the delivery of the Summary Care Record and the Electronic Prescription Service. Page 7
2. Introduction and Context This strategy has been developed to ensure that NHS Rotherham has the IT capabilities to fully support the delivery of its refreshed strategy Adding Quality and Value and also of Regional initiatives and national policies. It is written in the context of the change in financial outlook for the NHS and the need for enabling programmes including Information Technology to drive the QIPP agenda to deliver increased Quality, Innovation, Productivity and Prevention. The main focus of this document is the development of the strategic IT initiatives that NHS Rotherham will take forward in support of delivering the objectives of Adding Quality and Value, the QIPP agenda and the National Programme for IT. Subsequent sections of this strategy address the strategic direction and intentions of NHS Rotherham s key providers and detail how their respective IT strategies will support and integrate with that of NHS Rotherham to deliver benefits across the whole healthcare system. This document reports on the current position of IT delivery within NHS Rotherham and summarises progress with delivery of the National Programme for IT before moving on to describe the new initiatives required meet the challenges of the future. The main clinical systems that are currently in use or under implementation by NHS Rotherham and its partners are: General Practices - use a mix of systems predominantly supplied by SystmOne and EMIS but there are also a small number of Vision system users NHS Rotherham SystmOne Community Rotherham Foundation Trust Meditech RDaSH Maracis RMBC Childrens and Young Peoples Services and Neighbourhoods and Adult Services SWIFT It is not the intention of any of the organisations covered in this strategy to move to the Connecting for Health provided Lorenzo system. General Practices using the EMIS LV system will need to migrate to other systems as this product has recently ceased to be developed and will not support new strategic initiatives such as the Electronic Prescription Service. Page 8
3. Current IT Services in Rotherham Page 9 IT Services in Rotherham are currently provided by organisation based IT departments within Rotherham Foundation Trust, RDaSH, RMBC and NHS Rotherham. The NHS Rotherham IT department also provides IT services to RCHS and all of the General Practices in Rotherham. Section four of this strategy looks in detail at the strategic initiatives that will be lead by NHS Rotherham. The sections which follow on from that look at the contribution that the IT strategies of Rotherham Foundation Trust, and RDaSH will make to the overall delivery of IT services for the Rotherham healthcare system. The Adding Quality and Value strategy will require changes to the structure of organisations across the health community. In response to these changes it may be necessary to change the form of IT services from those detailed above and a later section of this strategy details an approach to reviewing IT and Information Services. However the focus of this strategy is the functions that must be delivered across the health community to achieve our strategic objectives. NHS Rotherham IT Services: NHS Rotherham currently delivers its IT Services through an in-house IT department that forms part of the Directorate of Intelligence and Performance. The IT Department is managed by the Head of IT and Deputy Head of IT. Service is delivered by the six teams listed below: IT Customer Services IT Infrastructure IT Application Development IT Projects Information Governance IT Education, Training and Development The IT Department delivers services to NHS Rotherham, Rotherham Community Health Service and all the General Practices in Rotherham. It provides IT infrastructure and support in premises across the borough of Rotherham, including in some Local Authority premises where NHS staff are located there. NHS Rotherham has invested significantly in its IT Infrastructure since 2006 and has implemented: Virtual servers to replace traditional application servers A fully mirrored Storage Area Network A managed WAN across the Rotherham borough Secure remote access to the network from mobile and fixed telephone extensions Secure wireless networks at key facilities As at January 2010 NHS Rotherham had delivered the following elements of the National Programme for IT: Adopted the regional LSP (Local Service Provider) Community system across all of its community services Adopted the regional LSP Child Health system Migrated eighteen of its forty one General Practices onto the regional LSP GP System
Page 10 Rolled out GP2GP records transfer to all GPs Deployed EPS Phase one across all pharmacies and General Practices Implemented a Registration Authority for access to CfH hosted applications
4. NHS Rotherham IT Strategy The following sections detail the strategic initiatives that will be led by NHS Rotherham. The scope of this document does not include finance, intelligence, performance or the Intranet/Internet. This strategy is aligned to the operating plan and sets the strategic direction for IT services over the next five years, with an emphasis on delivery over the next three years through to 2013. A high level programme plan and indicative costs for the duration of the strategy are provided in sections six and seven of this document. NHS Rotherham will ensure when delivering this strategy that information and new technology is equally accessible across vulnerable groups. At the point of implementation of each project a full Equality Impact Assessment will be carried out and this will be subject to regular monitoring. NHS Rotherham s partners will also be required to share evidence that they have carried out Equality Impact Assessments on their developments 4.1 Clinical Data Quality and Safety Why is Data Quality important? High quality data underpins informed and hence good patient care and safety. In February 2008 the Audit Commission published a discussion paper, In the Know using information to make better decisions, which sets out their overarching framework: Good quality data which is collected, captured and stored in the right way, should then be turned into fit-for-purpose information which is well analysed, relevant and right for the context.and used to inform good quality decisions which improve outcomes for local people. It advocates that if data and information is used smarter and more effectively, better decisions which improve the lives of local people can be made. It defines good quality data as: the raw material the statistics, facts, numbers and records which can then be organised and analysed into information which answers a specific need. The quality of this raw material matters because, if you have poor data, anything that s based on this becomes unreliable. Being confident in your data means that: It is reliable, accurate and trustworthy. Legal and security obligations are met. Robust supporting information systems are in place. The right systems, processes and skills are in place to support sharing of data with other departments and organisations. Rotherham is now in position to build on benefits realised by the data quality programme introduced to improve electronic record keeping across GP practices during 2002, and reap benefits from the electronic record keeping system it has deployed within community services since January 2007. This facilitates PCT level reporting and the provision of statistics on the health of the local community and current trends. The GP programme has supported QOF, Page 11
National, Local and Direct Enhanced Services (NES, LES and DES), progress towards introduction of the summary care record and paper light working. Prescribing information is now easily available to identify trends and cost savings by swapping branded to generic, identify patients missing from chronic disease registers and highlight any unsafe prescribing. The introduction of the electronic prescribing service will further reduce data quality issues bringing the relationship between pharmacies and GP s closer and advocating that patients use a nominated pharmacy. Safeguarding of patients is enabled by the use of flags, warnings and alerts, audits, shareable information and tools to identify where data is either incorrect or missing to name but a few examples. Continuity of care is one of the main benefits of a shareable record which contains complete, accurate, relevant, accessible (by multiple users at any place at any time) and timely information. Test results can be transferred directly from labs electronically, reducing the risk of inaccuracies and loss of information and enabling timely decisions to be made about a patients care and treatment. All these factors contribute to more efficient and effective care of patients resulting in better outcomes which can be reported on. Rich reliable clinical data forms the basis for sound dependable intelligence upon which to base decisions and streamline services to benefit patient outcomes and offer cost efficiencies. It is therefore, important to support the Better Health, Better Lives, 6 major efficiency programmes and other programmes of work. Where are we now? GP Practices The data quality programme in NHS Rotherham was first launched to support GP practices during 2002. Over the years benefits for patients, practices and commissioners have become apparent, particularly upon the introduction of the new GMS Contract and since the purchase of an audit tool to interrogate the systems holding the data. There are currently 41 GP practices within Rotherham which are supported by the data quality programme with mixed levels of engagement. 25 are approved as paperlight and 20 of these have achieved data accreditation status. Across the Yorkshire and Humber area NHS Rotherham is benchmarked as average for data accreditation. 27 practices are engaged and actively working on the data quality programme, however the other 14 have limited involvement. Community Services During 2007 the integrated electronic patient record was introduced within community services and the data quality programme was expanded to support this. Rotherham Community Health Services has in excess of 46 community units which have gone live with an electronic patient record. The introduction of a single record has highlighted the need to bring community data quality up to the standard of the GP records. The quality of the electronic patient record has not been assured by the organisation and much work is required to get this up to an agreed standard. Due to the rapid roll out program of the new system, data quality has been provided by means of templates designed and built by the Data Quality Specialists in conjunction with relevant clinicians and then approved at the Clinical Care Records Committee. This process sufficed for the roll out but has recently been reviewed due to problems with resourcing, lack of engagement and approval bottle necks. NHS Rotherham Page 12
During the early stages of the GP data quality programme implementation, NHS Rotherham purchased an audit tool to extract data from GP practices. All GP practices in Rotherham have now signed up to use the tool QUEST. It has been developed from initially running a quarterly audit on practice data for key health information required by the PCT and also requested by GP s, to a data extraction tool to aid the retinopathy recall service, and various other NHS Rotherham initiatives such as extraction of data regarding performance for DES s and LES s such as the CVD enhanced service. Awareness has been raised regarding the data quality team and they are usually invited to participate in groups and committees driving forward key NHS Rotherham initiatives. It is the corporate strategy to fully deploy an electronic shared record within the Rotherham community and GP services. This strategy is well under way with community services already live on a single system and 18 GP s surgeries with a further 3 scheduled to go live this year. The aim of the data quality programme is to facilitate excellent quality data across GP and community services so it fits together seamlessly as a single record and to continue to support practices on other systems to improve data to the accredited standard. The ultimate aim is to pass on the knowledge and skills to hand over responsibility for data quality to services and additionally to develop knowledge within the commissioner arm to understand how we should do this. In order to satisfy ourselves and other stakeholders of the quality of our data we will need to manage this by ensuring the following: The governance of data quality Policies and procedures in place for data recording and reporting Systems and processes in place to secure data quality Knowledge, skills and capacity of staff to achieve the data quality objectives Arrangements and controls in place for the use of data What are the options? The options are:- Carry on supporting as currently Develop a plan to engage teams and train and support data quality within services and pass responsibility over in a phased approach Leave services to improve data quality themselves Next steps Develop a data quality academy consisting of a blended learning approach and support for nominated data quality leads within service. Pass responsibility over to services in a phased approach. Support practices in the migration to the single system Support practices to achieve a 100% paperlight target in support of the summary care record deployment by August 2011 4.2 Information Governance NHS Rotherham will continue to manage its Information Governance capabilities through an annual programme focussed on the requirements of the Information Governance Toolkit. The Page 13
Information Governance Steering Group will oversee the delivery of and assessment against this programme and will be responsible for ensuring that appropriate policies and strategies are in place to support effective Information Governance practice. 4.3 System Interoperability Background System integration is used to interface disparate information systems together and pass information between them. It can be achieved in several ways commonly through direct interfaces between systems or through intermediate systems called integration engines. The interface engine that is provided and promoted by the Yorkshire and Humber Strategic Health Authority in called Ensemble. Where are we now None of the main information systems currently used in the Rotherham health community are interfaced together. Work on the Common Assessment Framework has looked at the possibility of integration between health and social care systems but no work has been carried out to deliver this. Delivery of the Adding Quality and Value strategy will require systems to be integrated together to provide the necessary flow of information between different levels of the health and social care system. Therefore it is our objective that systems integration will be achieved between the key information systems of NHS Rotherham, The Rotherham Foundation Trust and RMBC. Initially it is expected that this will be integration between NHS Rotherham s instance of SystmOne Community, TRFT s Electronic Patient Record System Meditech and RMBC s Social Care System SWIFT. Other systems will be integrated as the need becomes apparent. What are the options At this stage there are the options to either wait for the outcomes of work ongoing centrally in the NHS around integration with SystmOne or to immediately pursue integration between systems using a locally designed technical solution. These two options are outlined below. SHAs are currently in discussion with the LSP and CfH relating to integration from SystmOne and this may also be provided within the Total Contract Value (TCV). If this is the case, then the SystmOne messaging set would be developed and would come free as part of the system. NHS Rotherham would not need to do anything further with their system. TRFT would need Ensemble (and they already have it) to integrate to their Meditech system. In addition, NE Lincolnshire are piloting links between SystmOne and the Swift Social Care system, and again this interface would be provided free in SystmOne. If the option to pursue integration locally is adopted then the Y&H SHA will fund a development licence for the Ensemble integration engine. This allows NHS organisations to train staff up and Page 14
develop interfaces/integration not funded by CfH. It is difficult at this stage to judge if NHS Rotherham needs this immediately. However, if there is an identified need the SHA will fund it. Another possibility may be to take the product now in case those discussions with the LSP and CfH don t progress quickly enough. The SHA provides 50k and this buys the Ensemble development licence, the first year maintenance and support for the development licence, two places on a five day training course and a contribution to buy a server. The Trust then picks up maintenance and support from year 2 (approx 8.1k) so this is the only recurring cost to the trust. The SHA advise us that we may want to wait before we commit to the Ensemble product, but that it may be worth expressing interest pending current discussions on the Interoperability Tool Kit. Next steps The next steps are: Establish a project that will define the information that needs to be shared across systems with representation from across the health community Express interest in Ensemble with the Y&H SHA Determine when the outcomes of the Interoperability Toolkit programme and the CAF Demonstrator pilots will be available and take a community wide decision on whether to proceed with local interfaces or not 4.4 GP Systems Rationalisation Background General Practices have traditionally used standalone systems to support their clinical practice and hold the records of their patients. While these systems have been very effective for the practices their standalone nature has been a barrier to the sharing of information that could be of great benefit to patients when available to the wider health community and they have not supported the integration of information with community workers allied to the practice. Under the Connecting for Health Programme the LSP began to offer the hosted GP clinical system SystmOne. This system holds information in a data centre connected to the NHS network which makes it possible for the data to be shared and used by appropriate people outside of the patients practice. This system also has an integrated community solution, allowing the practice and community health workers to share a common record. Since the release of SystmOne the other major GP clinical system provider used in Rotherham, EMIS, have developed a centralised system called EMIS Web. Where are we now Currently of the forty one General Practices in Rotherham: eighteen are using SystmOne nineteen are using EMIS LV one is using EMIS PCS three are using Vision Page 15
The mixed economy of clinical systems we currently have is restrictive when trying to develop and deploy consistent solutions for information sharing across the local health community. Other local health communities have demonstrated the clinical safety benefits and efficiencies that can be delivered when a detailed local care record is held in a manner that allows it to be shared appropriately across the healthcare system. Therefore our objective is to have a single primary care system, which is integrated to the community system and holds a shared primary/community care health record, in use in every General Practice in Rotherham by 2013. What are the options? The options to achieve our objective are: Migrate the twenty-three General Practices not currently using SystmOne on to the system Review in detail the EMIS Web product to Identify if it can offer the level of integration and availability that is required. If this is a suitable solution, migrate all General Practices and community services on to the system Next steps The next steps towards achieving our stated objective are: Work is already progressing to review the EMIS Web product and compare and assess the two product options with a view to selecting the most suitable one for the Rotherham health community. The outcome of this work will be shared with the Professional Executive for their endorsement An event demonstrating the potential benefits of SystmOne to members of General Practice took place in March 2010 NHS Rotherham will actively promote their chosen preferred system and work with General Practices, the PE and the LMC to generate commitment to it A scheduled program of migrations will take place between 2009-2012 to ensure that each Practice receives the full support necessary for a smooth transition between systems NHS Rotherham will lead on programmes of work to maximise the benefits of a single system and shared care records across the health community 4.5 Information to Support Community Management and Commissioning Background To enable effective service planning and the commissioning of services programme managers need to be supported by information generated across the healthcare system, which is gathered, analysed and presented in a timely and meaningful way. Where are we now NHS Rotherham currently receives some data from primary care and secondary care though this is not always complete or at the level of detail required to effectively inform commissioners. Page 16
Primary care data is drawn from GP systems using the Quest query tool to support a number of different initiatives. Each initiative requires a specific query to be written by a third party and cannot be easily amended. Secondary care information comes in the form of SUS data and other specific data sets submitted by acute providers. The information held by NHS Rotherham is in a number of disparate databases. NHS Rotherham needs access to all the information that is necessary to aid them in their vision of delivering World Class Commissioning. To do this they will need to develop the sources of information that they receive from both primary and secondary care providers and will need to invest in an effective tool to gather, analyse and present this information. What are the options GP data is an essential source of information for a commissioning organisation as it relates to virtually the whole population. An overarching data warehouse solution that combines the population data across all of the Rotherham General Practices could be used to provide: Admission risk stratification Support for health screening programmes GP referral data Prescribing data Practice Based Commissioning dashboards Support the implementation of Common Assessments Integration of GP data with InterQual data Clinical effectiveness and audit data Data quality reviews Performance data for World Class Commissioning In addition to GP data it has been identified that more information to support service planning is required from acute providers particularly to support the programmes for long-term conditions and emergency care. Initially more information in the following areas is required: Unscheduled admissions for ambulatory care sensitive disorders Stroke including re-admission data Falls Care home liaison Community matrons A&E Hospital discharge There are a number of commercial data warehouse products in the healthcare market each with their own particular strengths and weaknesses in terms of what information sources they can connect to and gather information from and the care programmes that they have developed solutions to support. NHS Rotherham will assess the market for these before moving to a formal procurement exercise when a clear proposal has been developed. Page 17
Next steps Assess the market for data warehouse solutions Draw together a project with input from IT, Intelligence, Programme Management, Contracting and PBC to develop a specification for the data warehouse solution Work with Providers to develop an understanding and agreement of the new data sets required to support Commissioners Address the Information Governance issues associated with the data warehouse Determine a funding source for the data warehouse, potentially from savings from cessation of RCHS systems Carry out a procurement exercise to select a suitable data warehouse solution 4.6 Developing the Use of InterQual Background InterQual is a evidence based clinical decision support tool that provides assistance in determining when and how individual patients progress through the continuum of care. Where are we now The InterQual tool is used to conduct patient reviews in TRFT and RCHS though the two organisations use the tool in very different ways. TRFT has case managers employed specifically to undertake reviews whereas the reviews in RCHS are undertaken by staff in clinical roles as an addition to their general work. So far the focus of reviews in both organisations has been mainly in an audit capacity to review historical episodes of care to generate data for planning services and care provision. In order to deliver the expected efficiencies from vertical integration of nursing services set out in Adding Quality and Value it will be necessary to use a tool in real time which supports the transfer of patients through the healthcare system. Therefore our objective is to establish how the InterQual tool can be used during patient contact to support effective patient care at all levels of the care continuum. This will include identifying how to use the tool outside of care premises and in the home. Next steps The next steps are to: Gain a greater understanding of the InterQual product and how it is implemented and used in established integrated care services Establish the issues encountered when using the tool in practice Assess the possible ways of delivering the tool for use outside of a care premises Page 18
4.7 IT Infrastructure and the NHS Infrastructure Maturity Model Background The NIMM (NHS Infrastructure Maturity Model) has been developed by Connecting for Health in association with Microsoft to enable organisations to self-assess their IT Infrastructure maturity against a specific NHS designed model. This NIMM is based on successful and recognised existing models developed by the likes of Gartner and Microsoft. The NIMM is also linked to the NHS EWA (Enterprise Wide Agreement) which the NHS holds with Microsoft for the provision of software and licensing. Certain types of advanced software can only be accessed when the organisation reaches level four of the NIMM. It also forms part of the SHA assurance model and is being closely monitored. Where are we now A self assessment against the NIMM was carried out during December 09 which found that most areas scored a level 3 out of a possible 4 and some areas were not applicable. It is the recommendation of both the SHA and CfH that level four is achieved by all organisations wherever possible. This will allow the SHA and CfH to standardise changes to working practices and procedures and allow the organisation to access Enterprise class licenses which unlock many of the advanced features available in the software already in use. Next steps Due to the size of the NIMM (73 controls over 13 areas), two or three particular areas will be concentrated on during 2010/11 to ensure a level 4 is achieved/achievable with subsequent areas being looked at in future years. It is expected that level 4 is achieved across all areas applicable to NHSR by 2012/13. The project will be managed by the IT Infrastructure Manager with support from the server and network technicians and should involve very little, if any capital or revenue costs. This is due to the amount of investment in the NHSR IT infrastructure in recent years. The majority of the work required will be in the form of documentation and re-structuring of the existing infrastructure. 4.8 Supporting QIPP Across the Health System Background 4.8.1 Use of telehealth and telecare The NHS Operating Framework 2009-2010 sets out that all NHS organisations should consider how they will deploy digital technologies to improve services for citizens and patients and improve working practices over the course of the next twenty four months. Page 19
There is a widely supported view that the use of digital technologies in the NHS particularly in the field of telehealth can deliver significant improvements to patient care and aid in prevention while at the same time delivering system efficiencies and driving down costs. Where are we now At present most NHS telehealth projects are in the demonstrator stage being co-ordinated at national or regional level. The Rotherham health community has not been involved in these demonstrator projects, but completed a pilot of community telehealth monitors in 2008 across patients with COPD and Heart Failure The pilot showed qualitative benefits but was too small to evidence quantitative benefits such as a reduction in admissions and clinician time. A local telehealth project initiated by Rotherham Hospice is in the planning stages and this is detailed in the following section of this strategy. The equipment used during the 2008 pilot is still available and a proposal is being progressed to utilise it for a joint Breathing Space and Community Matron project. To support this, RCHS has recently invested in a web based triage system that will allow wider multi disciplinary access to patient results. NHS Rotherham will actively seek to develop and deploy telehealth and telecare solutions that support its objective of delivering the best quality services for its patients. What are the options A major barrier to the implementation of telehealth has been the costs involved in the initial setup and delivery of possible systems, a lack of clear technology standards and the difficulties with testing and evaluating models of telehealth care. In response to this the Y&H SHA has established a regional telehealth programme called the T Health Programme. This programme aims to leverage the scale of Y&H NHS to develop telehealth systems in the three modes detailed below: Tele-consulting: using teleconferencing and diagnostic equipment such as digital stethoscopes to bring health care to virtually any patient, anywhere, anytime without the need for any travel for either the clinician or the patient Tele-monitoring: enabling patients who need to monitored or reviewed at frequent intervals to be safely managed in their own homes without the need for expensive and inconvenient hospital stays Tele-education: enabling staff to receive relevant training and patients to receive relevant education to support the management of their own illness NHS Rotherham will review the outcomes of national whole system demonstrator projects and work with the Y&H SHA T Health Programme to identify the best opportunities for telehealth deployment in the local healthcare system Next steps Move forward with the proposed telehealth solution for Rotherham Hospice Move forward with the proposal to utilise the existing telehealth monitors in a joint project between Breathing Space and Community Matrons Page 20
Review the outcomes of the demonstrator project for e-consultations and determine how this could be deployed locally for diabetes care Continue to review ongoing evidence from other areas including Whole System Demonstrator sites to identify opportunities to utilise telehealth in Rotherham Background 4.8.2 Hospice telehealth system As part of its transformational initiative for end of life care, NHS Rotherham has a target of reducing hospital deaths by 100 per year. Telehealth is seen as an enabler to achieve this target, and as such the hospice has submitted a bid for funding to the NHS Yorkshire and the Humber Regional Innovation Fund (RIF) for financial support to initially deliver a pilot video conferencing solution. This solution will offer both clinical and emotional support to terminal end of life care patients and their families/carers. Scope The solution will initially consist of a pilot of six homes being linked back to the hospice. Upon successful completion of the pilot, the plan is to rollout the solution to an additional twenty five homes. The technology requirements are for a two-way video link via a set-top box solution to enable an interactive consultation to take place utilising two-way bandwidth. Progress To Date Costs and suppliers for the solution have been sourced, Saville s AV will supply the equipment and technical expertise and Digital Region will provide the bandwidth. A proof of concept will take place in April 2010 utilising the hospice and the hospice manager s home broadband connection. This will prove the technology and provide an insight into how the solution will operate and what can be expected in terms of visual and audio quality. Outcome Improvements It is expected that the Telehealth solution will help the hospice to achieve the following quality and efficiency gains: Improved choice for the home as a place of care/death Improved experience of the patient/family Reduction and avoidance of unnecessary admissions to hospital Reduction in staff lone-working out of hours Provision of a more personalised service to patients/carers through the use of a visual image in addition to telephone communication Next Steps Should a positive outcome from the innovation bid be achieved, the first steps of the project would commence in April 2010 as follows: Purchase seven sets of equipment (one for the base and six for patient/family use). Identify a project manager Set-up a steering group to implement, steer and evaluate the project Page 21
Background 4.8.3 Windows Desktop Automation PC s are used extensively by staff in NHSR. Most PC users will find that some of their work involved repetitive tasks on PC s, or may be aware that their IT applications can provide them with additional useful functionality but they don t have the time to fully use it. Robotics technology can be used to solve this problem by automating repetitive tasks on PC s. Where are we now We are currently in the process of automating the download and processing of SystmOne monthly activity reports, utilising the.awl tool from NDL. Currently these reports take a member of staff 1 full day of processing per month due to the navigation through several screens, report generation, downloading to MS-Excel, editing in MS-Excel then importing to MS- Access. The process is repeated over 44 times during the day for different units on SystmOne. The automated version is almost completed and is expected to reduce processing time from 1 day to less than 1 hour. We see huge potential for this robotics technology. The technology can read the screen and apply logic to decide what actions to perform. The technology will work on any application which runs on a Windows PC. Potentially this technology could be used throughout the organisation to: Reduce the amount of time it takes staff to carry out repetitive tasks on PC s. Improve data quality by reducing potential human input error. Automate data quality testing between IT systems which would have previously been too time consuming and laborious for staff to do. Fully exploit our existing investment in IT applications by utilising more functionality through automated processes. Enable better integration between different IT applications. What are the options Currently the IT Development Team are assisting the RCHS Information Department with the initial pilot of the system. We are currently looking into the option of testing out the technology within the IT department and ensuring IT Development staff are trained to build, test and support the automation process. We will then look at the options of carrying out further pilots in other departments. Next steps Complete the pilot for the RCHS Information Department 2 x IT staff to receive training Carry out further pilot projects within the IT. Identify further potential pilot projects Page 22
Background 4.8.4 Community Staff Digital Pen Project There are some types of clinical recording of data which for various reasons are not quickly replicated on SystmOne, the IT system used in Rotherham as its main patient electronic record. For example, services which use special clinical symbols as a form of short hand recording could not do so and had instead to write, longhand, very extensive descriptive notes. This was so time consuming that fewer patients were being seen. The use of digital pens and associated stationery has been viewed as a possible solution. Where are we now In association with the company Ubisys, a pilot has been undertaken in the physiotherapy and speech and language therapy services to use the pen technology. In brief, the consultation is written on to the special pixellised stationery with the digital pen which captures what is written. When docked, the pen sends its information electronically to a secure area of the network. The resultant files are then forwarded on to SystmOne, authenticated by the user and finally attached as an image within the patient record. Evidence so far is that this method has freed up time for extra patient appointments. Further time savings for clinical staff, providing the solution is cost effective. Further streamlining of the solution so that a more seamless transition from pen to SystmOne is achieved. What are the options Continue the trialling currently in place Extend to other areas Next steps Awareness of the possibilities of this functionality is being extended throughout the Yorkshire And The Humber (YaTH) Strategic Health Authority in an attempt to gain extra support for its development and adoption, and possibly attract resource from this area. Further trialling is planned in the Health Visiting Unit, using a section of the children s Red Book. Should this prove successful, further time saving possibilities in clinical areas should be identified and, if feasible, introduced. Background 4.8.5 Choose and Book Optimisation Choose and Book Provider functionality has been available to community based services since 2006, allowing patients and GPs a greater and more instant range of choice when planning the first outpatient attendance. Page 23
Where are we now Ear Care, Orthopaedic Triaging, Podiatry, Male Sterilisation, and Podiatric Surgery have benefited from this functionality using the legacy system epex-3 since 2006. As this system has now been largely replaced by SystmOne, a programme of work is currently in place to re-direct these services on to the new system. The aim is to achieve this by summer 2010. Roll out of additional services to SystmOne. These are GPwSI (including Vasectomy, Dermatology, Minor Surgery, and Community Geriatrician), Contraception and Sexual Health, Tissue Viability, Cardiac Rehabilitation, Heart Failure, Continence, and the Wheelchair Service. What are the options There is no technical restriction to providing the deployment of the new services. The resources required are principally training and set up/configuration. Next steps Agree with commissioners a planned roll out. Background 4.8.6 Home Working A solution was required to allow users to have access to work files from outside of the confines of the NHSR offices including email. Where are we now NHSR IT Services have implemented a home working solution allowing staff to use an NHSR laptop for connectivity back to the Trust. This utilises an NHS provided security token for connection via a VPN (Virtual Private Network) on to N3. Once connection is established and the user verified using two-factor authentication, a Terminal Server at the Trust allows authenticated users access to a network environment not dissimilar to the one they would have access to if actually sat within Trust premises. The advantages of this are: Allows end users to work from anywhere there is a connection (wireless or wired) Allows end users with 3G/GPRS connections to work from anywhere Allows end users full access to the files and folders normally only available at work Allows end users full access to email and Intranet Allows the trust to consider home working as a viable alternative to providing desk space Allows users who are unable to attend the workplace through illness or injury the ability to carry on working Allows users to connect to work in the event on severe inclement weather Allows the IT Technical team to remotely connect and diagnose/fix network issues Very little cost to the Trust (Laptop and a small monthly connection charge) Page 24