Lincolnshire Health and Care Local Digital Roadmap

Lincolnshire Health and Care Local Digital Roadmap 2016 2020 1 P a g e

Version Control Date Ref Author/Editor Changes Circulation 27/5/2016 1.0 Gary James First Draft IMTEG 27/6/2016 1.1 Gary James / Additions from Steve Lidbetter on IMTEG Steve Lidbetter current state 28/6/16 1.2 Gary James Appendix 1 & Current state diagrams - 29/6/16 1.3 Gary James, Liz Jones 19/10/16 1.4 Liz Jones, Dave Smith 21/10/16 1.5 Dave Smith, Rachel Howlett refreshed. Appendices incorporated, Universal Capability Delivery Plan signed off; Capability Deployment Schedule signed off Amendments following NHSE review to narrative document; Capability Delivery Plan amended Amendments as agreed following IMTEG meeting (20/10/16). IMTEG IMTEG IMTEG 2 P a g e

Contents 1 Introduction... 5 2 LDR Governance... 6 2.1 The IM&T Enabler Group... 7 2.2 Contributing Organisations... 7 2.3 Clinical engagement and involvement... 8 2.4 Patient and user involvement... 9 3 Developing the Roadmap... 9 3.1 LHAC Clinical Design Objectives... 10 The digital enablers... 10 3.2 Technical baseline... 11 3.3 Current and planned adoption... 13 3.4 Maturity Assessments... 14 3.5 Rate Limiting Factors... 15 3.6 Conclusion... 15 4 The vision for the Lincolnshire LDR... 16 4.1 The care and quality gap... 16 4.2 The finance and efficiency gap... 18 4.3 The Health and Wellbeing Gap... 20 5 Change management and benefits realisation... 21 5.1 Pan-organisational programme and benefits management... 22 6 Sources of investment... 22 7 Capability Deployment... 22 8 Universal Capabilities Delivery Plan... 23 9 Information Sharing... 23 9.1 Common information sharing... 24 9.2 Lincolnshire Information Sharing Approach... 24 9.3 Standards for information sharing... 25 10 Infrastructure... 25 11 Minimising risks from technology... 26 11.1 GS1 Standards... 26 Appendix 1 : Membership of the IM&T Enabler Group (IMTEG)... 27 Appendix 2 : Membership of the Clinical Reference Group... 28 Appendix 3 : Current State Assessment (2014)... 29 3 P a g e

Appendix 4 : Gap Analysis (2014 baseline)... 30 Appendix 5 : Future State Model and Requirements (2014)... 31 Appendix 6 : Universal Capabilities Delivery Plan... 32 Appendix 7 : Capability Deployment Schedule... 33 Appendix 8 : Capability Trajectory (Secondary Care)... 34 4 P a g e

1 Introduction In 2014 Lincolnshire health and social care community commenced a programme of strategic review and planning called Lincolnshire Health and Care (LHAC). LHAC was conceived as a response to the challenges faced by the health and care community. These challenges arose from a combination of demographic changes, workforce issues, public health challenges, patient expectation, and a financial environment for the NHS locally and nationally that was becoming unsustainable. LHAC responded by engaging in a process of service redesign across six domains, led by clinical design groups: Planned care Urgent Care Women & Children s Care Proactive Care Primary Care Mental Health and Learning Disability LHAC established seven enabling work streams to support the clinical design groups. These were: Estates Workforce Information Management and Technology (IM&T) Diagnostics Transport Finance Commissioning and Contracting Models The 2015-16 planning guidance introduced the drive toward Sustainability and Transformation Plans (STP) for health and care communities. STPs are five year plans describing the strategic direction and service redesign that will move health and care communities toward a sustainable state, and address three gaps or challenges: Health and wellbeing Care and quality Finance and efficiency There are close links between the STP and LHAC Programme, and Lincolnshire has adopted an integrated governance and delivery approach for the LHAC and STP. The IM&T component of LHAC and the STP is led by the IM&T Enabler Group (IMTEG). IMTEG is thus the digital design authority for Lincolnshire Health and Care and Lincolnshire Sustainability and Transformation Plan and the author and owner of this Local Digital Roadmap (LDR). 5 P a g e

2 LDR Governance As the digital design authority to LHAC and the STP, IMTEG shares and benefits from the governance structure of those programmes. The governance structure provides regular access to all Chief Officers and clinical leaders of commissioning and provider organisations for decision making, escalation and engagement. Each component of the structure has established terms of reference and membership which is detailed in the main STP document. This is represented in Figure 1. Figure 1 LHAC and STP Governance Structure CCG Governing Bodies and NHS Provider Boards represent the statutory governance processes of the stakeholder NHS organisations. The Joint Commissioning Board (JCB) represents the commissioning functions of the Clinical Commissioning Groups and Lincolnshire County Council (LCC). The JCB has delegated authority from CCGs and statutory responsibility for a number of jointly commissioned services through Section 75 and other legal processes. Membership includes the Accountable and Chief Officers of CCGs and the Chief Executive and Directors of LC The System Executive Team meets weekly and comprises the Chief Executives of Provider organisations and the Chief Officers of the CCGs, and the Director of Adult Social Care. The Lincolnshire Co-Ordinating Board membership consists of the Chairman of the Provider organisations and the CCGs. 6 P a g e

The STP Programme Board leads the programme management of the LHAC programme and is integrated with the programme management of the STP. The Chairman is the SRO for the STP and membership includes all programme leads and SROs for each LHAC programme and enabler including the IM&T Enabler Group. The Lincolnshire NHS Leaders comprises the Accountable Officer of each CCG and the Chief Executive of each provider organisation plus the Medical Director of the Local Medical Committee. It provides additional leadership and oversight of the STP programme in order to maintain pace and focus. The LHAC and STP programmes are serviced by a single Programme Management Office with dedicated project and programme managers, administrative support, and a communications and engagement function. The PMO has dedicated office and meeting facilities. Programme Management is facilitated by a fully accessible cloud-based programme management system called Project Vision. The Lincolnshire Health and Wellbeing Board is briefed and consulted on the LDR though briefings on the LHAC and STP programmes. 2.1 The IM&T Enabler Group The IM&T Enabler Group (IMTEG) is the digital design authority for the LHAC and STP programmes and the author of this Local Digital Roadmap. Membership IMTEG has representation from all stakeholder organisations. The Group is chaired by Gary James, Accountable Officer of LECCG and SRO for Lincolnshire s Digital Roadmap. Membership is the most senior manager with IM&T responsibility within the organisation. Membership is listed in Appendix 1. All organisations have dedicated input into IMTEG and are committed to deploying in-house resources to the delivery of key components of the LDR. Where necessary, this is supplemented by bespoke resource such as the dedicated PMO and specific funded posts such as the Care Portal Administrator. BY working together in a single shared enterprise such as the LHAC/STP, the health community optimises it capacity and capability. In support of IMTEG there is a Clinical Reference Group. Membership is listed in Appendix 2. 2.2 Contributing Organisations The organisations contributing to the roadmap through the governance system described above are listed below. Those that have made significant contributions are marked with an asterix. 7 P a g e

Commissioners NHS Lincolnshire East CCG (LECCG)* NHS Lincolnshire West CCG (LWCCG)* NHS South West Lincolnshire CCG (SWLCCG)* NHS South Lincolnshire CCG (SLCCG)* Lincolnshire County Council (LCC)* Regulators NHS England NHS Improvement Providers United Lincolnshire Hospitals NHS Trust (ULHT)* Lincolnshire Healthcare NHS Trust (LCHS)* Lincolnshire Partnership NHS Foundation Trust (LPFT)* EMAS* St Barnabas Hospice* Representative bodies Healthwatch Lincolnshire Local Medical Committee (LMC) Lincolnshire Carers Association (LINCA) Commissioning Support Units Arden and GEM CSU 2.3 Clinical engagement and involvement The LDR has developed as a direct consequence and analysis of the work of the LHAC and STP Clinical Design Groups and, as such, the LDR is completely grounded in the clinical requirements identified by the system. In addition each organisation has a clinical engagement forum in which the work of the IMTEG is presented and discussed, such as the Digital Board of ULHT and the Council of Members of each CCG. In addition clinicians have been engaged in specific aspects of the LDR development and its components, such as the specification and procurement of the Lincolnshire Care Portal. Delivery boards of significant LDR programmes, such as the Clinical Portal Programme, included clinical reference groups as part of the programme governance structure. 8 P a g e

2.4 Patient and user involvement Patients and service users have been involved in the development of the LHAC and STP service designs though direct membership of Clinical Design Groups and through the LHAC engagement and communications programme which, at time of writing, has engaged with over 15,000 people. The LDR will be incorporated into the formal public consultation process on LHAC and STP options during 2016-17. In this way patients and service users have informed the clinical designs that IMTEG has used to inform the LDR. Patients and service users will be actively engaged in specific components of the LDR as they approach deployment, such as the clinical and patient portals and the exploitation of Patient Online developments. 3 Developing the Roadmap This Local Digital Roadmap has been developed through an iterative process based upon service drivers and capability drivers: Service Drivers LHAC clinical design objectives STP Enablers NHS Policy Ambition Capability Drivers: Technical Baseline Current and planned technology adoptions Maturity assessments of the key organisations 9 P a g e Figure 2 Roadmap development

Throughout the development process alignment was maintained with the STP and LHAC processes though the governance arrangements described in Section 2. 3.1 LHAC Clinical Design Objectives IMTEG consulted with the clinical design groups for the STP and LHAC programmes and determined the service ambitions and enabling digital technologies: Figure 3 The service ambitions and digital enablers The digital enablers Integrated health records were identified as the key enabler to the STP and LHAC service ambitions. There is evidence that integrated records projects can: support new integrated models of care reduce duplication and improve capacity drive up quality through improved access to information for decision making and risk reduction Improve the experience of care Release time to care and improve staff productivity by reducing the time spent finding key information Serve as a platform for patient portals and patients contributing to their own records On-line and remote patient focussed processes such as on-line self-service, e-referral and e- consultation (clinician to patient and clinician to clinician) can improve decision making, improve productivity and support patients in the best least intensive care setting. This is particularly pertinent to rural economies with sparse populations such as Lincolnshire. Self-service technologies 10 P a g e

empower patients to be active partners in their care and though self-help functionality also improve productivity of staff. Capacity Management solutions allow the entire capacity of the care and health system to be used more effectively and patient flows to be managed intelligently. Integrated communications such as IP telephony support new and virtual ways of working and improve communication between teams in different organisations Networking and mobile services are critical infrastructure elements if our staff are to be able to access these new digital innovations in care settings and is particularly challenging in Lincolnshire Collaboration services such as cloud based office platforms cut across organisational server silos and enable staff to work together more productively irrespective of organisational boundaries Directories of Services need to go beyond the current DOS service which is supporting NHS111 and Clinical Assessment Services to incorporate community services and resources for social prescribing such as local support groups, faith groups, lunch clubs, activity and hobby groups, self-help and support organisations, and carer support. Figure 4: Digital enablers and proposed solutions deployment process. Decisions support technologies aim to improve clinical and service decision making. Key solutions in the LDR are E- prescribing and community health analytics. IMTEG took each digital enabler through a scoping and IMTEG has also mapped the digital enablers to the STP Enablers and confirmed alignment. Progress has been made on all digital enablers and these are discussed in Sections 3.2 and 3.3 3.2 Technical baseline IMTEG conducted a technical baselining exercise to determine the current state and degree of service functionality available across the roadmap community. An example for integrated care is shown in Figure 5. The full baseline exercise carried out in 2014 is included in Appendices 2, 3 and 4. Across the community two of the three statutory health providers have full EPR s which has removed the need for paper going forward with the ability to scan paper documents into the patient record. All are available with web browser access. The issue of archived paper records remains for 11 P a g e

all with a scan on demand solution being adopted at present. ULHT has implemented a new PAS and all Trusts have bed management capabilities. The pathology system (WebV) is used and shared across the health community. There is extended use of this system for electronic Observations and Charting in the acute trust. A community of interest network (CoIN) has been in place in excess of 5 years and connects the healthcare trusts and GPs across the community. There is a degree of Unified comms and telephony shared across the three main healthcare trusts including Microsoft OCS R2/Skype for business, and IP telephony (Avaya) which is being rolled out. As can be seen from Figure 5 self-service portals for patients emerge as a significant baseline gap across the footprint, with GP practices rating amber because of patient on-line but not yet green because of the relatively low rates of active adoption and use by patients. Contact centres for patients fare better but the green ratings across providers does not reflect the fact that each provider has separate contact arrangements for patients rather than a true single point of access across the footprint. Care planning and management is largely red when considered in the context of whole system care planning GP practices all have mature clinical systems for the management of care within the practice. Mobile working requires significant improvement if the benefits of digital innovations are to be delivered across the footprint Figure 5: and Baseline in all care exercise settings. for integrated care Reading vertically down the baseline the footprint main acute provider, ULHT, is significantly challenged by patient portal, care management, electronic patient record and interoperability requirements for integrated care. ULHT has a significant integration challenge of its own with up to 50 electronic sources of patient information requiring integration in order to deliver a single view of the patient in hospital. 12 P a g e

3.3 Current and planned adoption IMTEG conducted an assessment of the footprint infrastructure in terms of existing and planned deployment. A summary is presented in figure 6 and a more comprehensive report is in Appendix 3. The assessment shows that the footprint benefits from existing work on networking with a shared Community of Interest Network (COIN) across all health agencies except EMAS, the ambulance provider. This supports useful levels of interoperability and access across the footprint and common directory services which improves communication between organisations. Local Authority and ambulance service are not incorporated into this network and this will be a priority for future development to support true whole-system integrated working. Mobile working between agencies even in health requires improvement, with some degree of interoperability at present but Figure 6: Current and planned technology adoption insufficient to support whole system working. Wifi access in community and primary care setting will be a priority moving forward. There is planned adoption for App development with a focus on off-line mobile clinical working and referral apps. There is also further development planned for electronic discharge and the implementation of new clinical systems. Data management and capture tools are also being expanded including RFID, Digipens and digital recording and transcription. Use of mobile devices is increasing and the use of tablet and smartphone devices has increased significantly. 13 P a g e

TPP SystmOne has a significant presence in the footprint, being the system of choice for 80% of GP practices and the community provider, LCHS. All but two remaining practices use EMIS Web with the final two moving to TPP SystmOne imminently. LPFT, the mental health services provider, has three core clinical systems which require integration in order to improve patient management and safety. This was highlighted in recent reports from the CQC. The Local Authority is currently migrating to a new client management system, MOSAIC. This will bring benefits to the system including improved use of NHS Number but may limit the scope for interoperability in the first year of the footprint due to the timing of system migrations and subsequent bedding in periods. Overall, figure 6 shows a system with a moderate degree of interoperability capability but with a significant range of clinical and client systems that require integration in order to provide a whole person view. This aligns with the needs assessment from the LHAC programme which highlighted integrated records as the most important service enabler. 3.4 Maturity Assessments IMTEG conducted maturity assessments for NHS providers and CCGs using the national assessment process. All providers participated with IMTEG providing oversight to assure consensus and alignment of responses where relevant. An overview of provider maturity assessment is shown in figure 7. Figure 7 shows good strategic alignment between providers which is an excellent basis for the development and delivery of the digital roadmap. Information governance also shows good convergence with the exception of EMAS, which will need attention going forward. This provides a good environment for integrated records and information sharing. Records, assessments & plans and transfers of care show the greatest diversity between providers and clearly an integration approach is required to achieve better convergence. The shared areas of least maturity occur between 6 and 11 o clock in the spider diagram. These show a lack of maturity across the footprint in terms of orders and results management, medicines management, decision support, remote and assistive care, asset and resource optimisation and standards. These are all capabilities that underpin joint working and are priorities for attention in the roadmap. CCG and Local Authority maturity assessments were not available in time to support this iteration of the LDR and will be incorporated into a future version. 14 P a g e

Figure 7: Provider Maturity Assessment 3.5 Rate Limiting Factors Consideration of the LDR technical baseline, current and planned adoption, and maturity assessment, shows that the Lincolnshire LDR is in a good position to progress with paperless at point of care. A strong foundation of well-established joint working has enabled a strong shared infrastructure, standards adoption, and governance. Key rate limiters that emerge are: Access to care records integration and sharing technologies Mobile working and connectivity constraints Technologies to empower patients as active partners in care Interoperability Standards Change management and benefits realisation capacity 3.6 Conclusion The Lincolnshire Digital Roadmap has been developed over a period of two years by conducting thorough assessments of the capability drivers and service drivers. This has been an inclusive process of development involving all key stakeholders and endorsed by the system leaders through a comprehensive governance arrangement. Capability and maturity assessments have highlighted gaps and priorities in the current state and there is good convergence between these and the service requirements, confirming the direction of travel for the digital roadmap. 15 P a g e

This has ensured that the Roadmap is, first and foremost, a supporting programme that is firmly focussed on the delivery of new service models and the strategic direction of the STP footprint. This in turn informs the vision of the Lincolnshire Local Digital Roadmap. 4 The vision for the Lincolnshire LDR The Lincolnshire Local Digital Roadmap is firmly grounded in the strategic ambition of the Lincolnshire Sustainability and Transformation Plan and Lincolnshire Health and Care strategic programme. In five years time the health and care system in Lincolnshire will be offering a radically different experience to patients. The balance between hospital and out of hospital care will have moved significantly; care in the community rather than admissions to hospital will the norm for all but those for whom it is essential. The boundaries between services that obstruct care will have been eliminated, and patients will have a single relationship with their care provider not many separate relationships as happens today there will be a single view of the patient. The overarching vision for the roadmap is: To deliver an integrated, single view of the patient and make silos of information a thing of the past. This will extend to the patients and carers themselves, who will be active partners in their own care and participating in their care narrative. Patients will be empowered to help themselves and make informed choices about their care and services. Improved information will drive better decisions about patients and support care in the most appropriate setting System navigation (self- help and signposting) will become a core part of the NHS, with simpler choices for patients relating to all aspects of their care. Our services will be working from a single, shared understanding of the service model, encompassing the capacity and capability of every part of the health and care system. Meanwhile care providers and leaders will have an integrated view and understanding of system demand, capacity and availability. We will be more proactive as a service, assessing and anticipating demand on an individual and system basis and intervening earlier. 4.1 The care and quality gap Our LDR will support the narrowing of the care and quality gap by supporting improved decision making decisions taken in the management of the individual, and in the management of the system. Key technologies in closing the care and quality gap are the care and patient portals, capacity management systems, and directories of service Care portal Lincolnshire has specified and procured the Healthshare technology from Intersystems. Healthshare is a suite of products to support integrated patient management. It incorporates Information 16 P a g e

Exchange which delivers on-demand integration providing real-time access to an integrated view of a patient s health and care records. Commencing in June 2016 Information Exchange will be deployed to services commencing with core systems and urgent care settings and rolling out to further systems and settings throughout 16-17. There is sound evidence that integrated care records can: Improve clinical decision making Improve patient management through alerting and case finding Improve quality of care Improve patient experience Improve cost effectiveness through reduced duplication Increase time to care through reduction in administrative burden Decision making is improved by providing access to comprehensive information about the patient and their care history, current services and carers, relevant tests, results and diagnostics, letters and communications. Alerting is provided within Information Exchange allowing staff to subscribe to alerts generated by patient events across the whole system such as attendance at A&E, out of hours or crisis intervention; admission or discharge from hospital; re-admission within 30 days; contact by the ambulance service. The Health Insight product of Healthshare provides more sophisticated alerting based on combined information and trending. Health Insight also provides smart programmes, assembling collections of patients based upon pre-determined criteria. This will improve the system s ability to identify deteriorating patients and intervene proactively. This could be deployed, for example, to automatically identify cohorts of patients most likely to attend A&E based on analysis of known patient data and risk factors. Healthshare incorporates Care Community, an integrated care planning product that supports the production and sharing of care plans across the health and care community. In partnership with My Right Care this will support improved multi-agency patient management. Patient Portal The Healthshare product incorporates Personal Community. This is a patient portal product that empowers patients as active partners in their care. In addition to providing access to the patient s health records from across the footprint in a single source Personal Community also supports patient contributions to their care record. This makes patients active partners in their care and can incorporate near patient testing and telehealth connectivity, enabling patients to submit their own regular status and biometrics such as blood pressure or respiratory function. 17 P a g e

Capacity Management Lincolnshire will invest in an enterprise-wide capacity management system. Cayder is the most widely used system in the footprint at present and a strong contender. An enterprise capacity management system will support informed decisions on care navigation, helping to get the patient into the most appropriate care setting quickly and efficiently. Directories of Service In addition to the NHS DOS Lincolnshire will build a directory of services to support social prescribing using the Lincs2Advice platform. This will increase the levels of social support options available to patients and carers. Alternatives to traditional health system support will be strengthened and the range of dispositions and support of options available will be widened. Decision support E-prescribing technologies are already deployed throughout GP Practices and community hospital settings. The LDR proposes the extension of e-prescribing to secondary care settings. This could bring significant system benefits by unifying prescribing support and policies across the system. The proposed capacity management solution will improve decisions about patient disposition and increase the likelihood of getting the patient into the most appropriate care setting. Our health analytics proposal linked to the care portal will provide system wide intelligence about patient flows and the effectiveness of care pathways, empowering proactive care and service redesign. 4.2 The finance and efficiency gap The Lincolnshire LDR will address the finance and efficiency gap in a number of key ways: Care Portal There is good evidence that integrated records technologies can significantly increase time to care by 18 P a g e Figure 8: STP Challenges and our Digital Enablers

reducing the time spent by staff searching for key information such as care and treatment histories, and identifying staff involved in a patients care. One study of the use of summary care record by hospital pharmacies showed a reduction in the time taken to manage medication issues by 29 minutes per patient, and a reduction in telephone calls and faxes between hospitals and GP practices by 60%. Records integration has also been shown to reduce costs in diagnostics in some cases by as much as 30% - by raising awareness of and providing access to previous test results from elsewhere in the system. The Lincolnshire economy spends 33m per annum on diagnostics imaging and pathology testing and reducing duplication and costs of diagnostics will be a core focus of the portal work stream. Lincolnshire STP has attributed 2m per annum cost saving to a reduction in diagnostic tests through exploitation of portal technologies. Decision Support Lincolnshire is one of the first systems in England to deploy a Clinical Assessment Service (CAS). The CAS serves as the clinical decision support service to NHS 111 and out of hours. The deployment of the Cayder capacity management system and the Healthshare portal will empower decision making in the CAS, helping to ensure the patient is managed in the least intensive care setting. Ambulance services will be informed through the care portal and capacity management system, with the CAS finding the most appropriate disposition to avoid hospital transfer when at all possible. The capacity management system will empower the health and care community to make best use of all available capacity across the system. The deployment of e-prescribing support to the hospital sector will complement its use in GP practices and community hospitals. It will support compliance with system wide dispensing and medicines management policies ensuring conformity and best value for money. Personal Community Healthshare s patient portal product, personal community, will provide access to the care portal for patients and their carers, making them active partners in care. Patients will be able to help themselves by accessing key information such as appointment dates, key contacts with personnel, and test results. This will increase the potential for self-care, increasing the overall capacity of the system. Personal Community supports patient entered records, enabling patients to record their own observations and results and to connect near-patient testing solutions and communicate with their clinicians. With appropriate controls, carers such as parents and family members will be able to access the portal for their families and children, empowering them to participate in care and reducing the demand on services for access to information. Mobile working and connectivity, collaboration services and integrated communications These all increase the ability for teams to work together effectively across organisational boundaries. The use of a single IP telephony solution enables the CAS and out of hours services, for example, to work flexibly with a range of remote working clinicians. These technologies will become increasingly important to support the new ways of working envisaged in the Five Year Forward View and have a key role in closing the finance and efficiency gap. 19 P a g e

On-line and remote patient services In combination with the care and patient portals, on-line and remote consultation technologies offer exciting scope for new ways of working. Easy access to core information through the portal, combined with the potential for patient access through personal community, opens the possibility for remote patient management and consultation in ways that were not possible previously. Virtual out-patient appointments and follow-ups and Skype-style consultations with care homes are two examples. Clinician to clinician and multidisciplinary working are also empowered by access to the same view of the patient through the portal technologies. Directory of Services In addition to the NHS Directory of Services the LDR proposes the development of a web based directory of community resources such as support groups, expert patient groups, faith groups, hobby and activity groups, luncheon clubs, sport and activity support. This will support social prescribing and self-help, help to build resilient communities, and contribute to the finance and efficiency challenge within the Lincolnshire system. 4.3 The Health and Wellbeing Gap Personal Community The Healthshare patient portal product, Personal Community is the logical second stage in Lincolnshire s care portal programme. Personal Community enables patients and carers to log in and use the care portal with a bespoke patient-friendly interface with support for a range of smart phones and web devices. This empowers patients as partners in their care and enables patient contribution to the health record. Near patient testing devices can be interfaced to the portal supporting the true empowerment of patients as partners in their care. IMTEG has commenced the scoping of personal portals and have made links with communities elsewhere who have deployed this type of technology including HIXNY in New York. Lincolnshire is an early adopter of personal health budgets and this cohort of patients and service users are good candidates for early adoption of the personal community patient portal. This will strengthen the patient s position as active partners in their care and its management. The offer of tangible tools to engage the patient in their care management though personal community may accelerate the take up of the personal health budget offer. Health Insight Health Insight is the health analytics product of the Healthshare portal technology. Health Analytics captures portal messages and activity and supports the analysis of service activity and pathways. Health Insight also supports the creation of smart programmes which can identify patients according to a set of rules. For example, patients who are at risk of frailty or who have a series of symptoms or characteristics in common could be identified automatically, grouped and presented to a clinician or team. The Information Exchange care portal (in deployment) supports simple alerting in response to system messages such as an admission, discharge or attendance at A&E but the 20 P a g e

Health Insight product supports more sophisticated decision support and alerting. For example, Health Insight could monitor a trend in a patient s observations and alert a clinician or even book appointments in response to patterns and changes in a patient s recorded condition. 5 Change management and benefits realisation IMTEG has adopted a structured approach to change management and benefits realisation based upon the NHS Change Model. This is illustrated in Figure 9 in relation to the care portal. Programme management including change management and benefits realisation is managed through a unified PMO that supports the overall STP and LHAC programmes. In this way mainstream programme leads and change managers are engaged in the Digital Roadmap deployment and delivery (see also Figure 1, LHAC and STP Governance Process). Figure 9: NHS Change Model applied to the Care Portal P Figure 10: Benefits Register Excerpt 21 P a g e

Project/Programme management and benefits tracking are supported by a common PMO system, Project Vision. This is a cloud based system and is thus available to all project managers and stakeholders irrespective of organisation. Benefits are tracked and where appropriate quantified. Portal benefits with a financial component have been scrutinised by organisations chief finance officers and directors and incorporated into STP financial forecasts. 5.1 Pan-organisational programme and benefits management For the purposes of the LHAC and STP strategic programmes Lincolnshire has adopted a wholesystem approach, as described in Section 2, Governance. Lincolnshire has a single PMO and a unified approach to change management and benefits realisation within the programme. Programme managers work across the whole system. This makes the delivery of the Local Digital Roadmap much more robust and integrated than any stand-alone informatics programme could achieve. 6 Sources of investment Lincolnshire LDR organisations will align their digital strategies and system investment with the LDR to ensure that organisational priorities and investment align with the STP digital enablers. Our sources of funding will be: STP shared investment through the JCB and BCF, such as shared PMO capability Commissioner revenue where justified by return on investment and system capacity optimisation and reform Provider capital and revenue, with ETTF projects focussed on system-wide benefits and provider projects focussed on organisational benefits. For example, IMTEG has prioritised eprescribing for ETTF support because it enables system-wide benefits, but e-dispensing technologies have been directed at organisation s own digital programmes because the benefits are largely organisational efficiency. ETTF funding where projects align with STP priorities and bring system-wide benefit. 7 Capability Deployment The capability assessment for United Lincolnshire Hospitals NHS Trust, Lincolnshire s only secondary care provider is presented in Figure 11. This is shown here for completeness and has been submitted separately into the LDN process. The ambition within the capability groups has been captured in the LDR information sharing approach and will be monitored through the governance arrangements described in Section 2. 22 P a g e

Figure 11: ULHT Capability Deployment 8 Universal Capabilities Delivery Plan The Universal Capabilities Delivery Plan (UCDP) summarises Lincolnshire s baseline against the 10 capabilities, informed by the digital maturity assessment results. It then sets out the ambitions and actions that will be taken to ensure Lincolnshire not only meets, but exceeds the defined aims. The ambitions and actions are informed by and aligned with the ambitions and vision for LHAC and Lincolnshire s STP. Progress of all schemes will be monitored by IMTEG as part of the governance structure set out in Section 2. The UCDP is reproduced for completeness at Appendix 6. 9 Information Sharing Lincolnshire has been operating on the basis of a common sharing agreement for a number of years. With 80% of GP Practices, out of hours, and the community provider all on the same information system (SystmOne) detailed records sharing has been possible for a number of years. 23 P a g e

9.1 Common information sharing NHS and care agencies, including social care, have had a common information sharing agreement in place for a number of years. A single information governance forum leads and oversees multi-agency IG issues for all major agencies including health, social care, police, and the voluntary sector. A network of health agency Caldicott Guardians meets regularly by teleconference to discuss pansystem information sharing issues. IMTEG is able to consult with the Caldicott Guardians across the health system through these arrangements. The Healthshare Information Exchange is capable of managing access and information sharing on the basis of legitimate relationships, with the system automatically inferring relationships where this can be established within the data flows for example, automatically enabling sharing for the recipient of a patient s referral request. This enables information flows based on legitimate relationships to be more readily configured. 9.2 Lincolnshire Information Sharing Approach The Lincolnshire Information Sharing approach is summarised in Figure 12. Intersystems Healthshare has been procured by Lincolnshire and deployment has commenced with the Information Exchange core portal product. Much of the capability illustrated in the Lincolnshire Information Sharing Approach is built upon the subsequent deployment of further Healthshare products for patient portal, care planning, and health informatics. The Information Exchange care portal is in deployment in 2016-17 which will achieve multi-agency sharing of 8 or more core patient records. This will deliver a number of the national policy ambitions for Lincolnshire including: The sharing of core patient information with staff in urgent care settings Care trigger subscriptions for patient events captured through HL7 messaging such as admission, discharge, attendance at accident and emergency or contact with a crisis team Multi-agency access to an integrated view of the core records for a patient based upon legitimate relationships Rapid access to information about a patient s care team across the health and care system, including the ability to message and contact members of the team Knowledge of past and planned contacts and interactions with the patient across the health and care system. 24 P a g e

9.3 Standards for information sharing Core EPR and PAS systems in the Lincolnshire LDR providers are spine compliant and use of NHS number is consistently high at 96-100% (ULHT, LPFT and LCHS). United Lincolnshire Hospitals Trust currently use ICD-10 and OPCSv4.6. Dictionary of Medicines and Devices (dm+d) has good adoption within ULHT. RFID has been adopted and its use is expanding. GS1 barcoding standards are beginning to be adopted. Lincolnshire s Care Portal will provide routine exposure of NHS number to social care staff. In addition to this work, it is planned to incorporate the NHS number within the social care core system (MOSAIC). 10 Infrastructure The Lincolnshire LDR infrastructure baseline was discussed in Section 3.2 and Appendix 3. In summary, the Lincolnshire LDR community has been working towards shared infrastructure development and standards for a number of years. Key developments and achievements are 25 P a g e

A single CoIN (Community of Interest Network) serving all Lincolnshire providers, health commissioners, and larger GP Practices. The Lincolnshire CoIN is currently being reviewed for re-procurement and this opportunity will be used to look toward more Public Sector Networking and the multi-agency benefits and costs savings this can bring. A single directory and authentication infrastructure. In practical terms this means all health professionals including GP Practices share a common email address book, and authentication can be managed in a centralised and structured manner. Integrated telephony. Lincolnshire has invested in a shared integrated telephony infrastructure, initially to support the Clinical Assessment Service (CAS). This supports virtual working and IP telephony, greatly enhancing workforce productivity and access. A programme of wireless operability within GP practices during 2016-17, with the aim of supporting whole system mobile access for peripatetic staff. All three main providers working on interoperable wifi access during 16-17 including solutions for patients and the public Adoption of the Newcastle Declaration to commit to joint working underpinned by general and technical interoperability principles and standards. Collaboration technologies have been identified as one of the key enablers in the Lincolnshire LDR. 11 Minimising risks from technology Through the CoIN Governance Group the Lincolnshire LDR organisations have agreed and implemented a technological and policy approach to security threat assessment and management and standardised the tools used for security and compliance management. Business continuity planning is assessed annually for providers as part of the review of emergency planning response and resilience (EPRR) standards and, for GP Practices, incorporated into the IG Toolkit assessment. Lincolnshire has a single Countywide Information Governance Group to agree standards for information sharing, manage cross-agency governance issues and deal with pan-system information sharing requests. All public-sector organisations are represented and health are joined by members from local authorities and third sector agencies including social services and police. Each provider organisation has one or more Clinical Safety Officers including the LDR Lead CCG. The CSOs represent a resource that can be deployed in multi-agency projects such as Lincolnshire s Care Portal. 11.1 GS1 Standards GS1 barcoding standards are beginning to be adopted across the health community and we expect this to continue and increase. 26 P a g e

Appendix 1: Membership of the IM&T Enabler Group (IMTEG) Names Job Title Organisation Adam Lavington Head of Primary Care Systems Enablement AGEMS Alan Williamson Information Security Manager EMAS Andrew Wall Associate Director of IT Services Delivery AGEM Carolyn Holmes Head of Informatics LPFT Dan Dring IM&T Systems Manager LCHS Chris Jugg Head of IMT St Barnabas David Smith Project Lead for Integrated Care Record Portal LHAC Gary James IMTEG Chair and SRO for Lincolnshire s Digital Roadmap Accountable Officer LECCG Dan Dring Acting Head of Information Management & Technology LCHS John Wickens ICT Enterprise Architect LCC Judith Hetherington Smith Chief Information & Commissioning Officer LCC Kevin Turner Deputy CEO ULHT Liz Jones Project Manager-IMT LHAC Lloyd Baker Assistant Director Health Informatics NHSE Michael Conibear Service Improvement Manager EMAS Michael Humber Associate Director of ICT / CIO ULHT Neil Sturge ICT Service Delivery Manager AGEM Nigel Gay Assistant Director ICT Operations ULHT Paul Fleming Regional Head - Digital Technology NHS England Paul Miller Head of IT Service Management AGEMS Ron Cook Programme Manager LCC Shaun Caig Head of Information ULHT Simon Oliver Chief Technology Officer LCC Stephen Creasey ICT Technical Services Manager ULHT Steve Bowyer Head of IM&T at East Midlands Ambulance Service EMAS Ian Baldam Deputy Director of Informatics LPFT 27 P a g e

Appendix 2: Membership of the Clinical Reference Group Names Job Title Organisation James Howarth Chair GP LECCG Alun Roebuck Vice Chair Cons Nurse Cardiology/Assoc Chief Nurse ULHT Conrad Bosman Consultant (Paeds) ULHT Jane Scrafton Queens Nurse & Clinical Pathway Lead LCHS Ruth Taylor Interim Clinical Lead LCHS Fiona Milner Deputy Named Nurse Safeguarding: Domestic Abuse LCHS Lead Amanda Goldsbrough Modern Matron LPFT Amanda Black Acute Care Nurse LPFT Lesley Lashmar Matron LPFT Nick Endley Service Mgr, Older Adult Community Service LPFT Samantha Francis Adult Social Care LCC Tracey Perrett Adult Social Care LCC Andrew Pilbeam GP SWLCCG Tim Ryder GP SWLCCG Daniel Petrie GP SLCCG Franklin James GP LWCCG Lawrence Pike GP (retired) St Barnabas Kieran Sharrock GP & Medical Director LMC LECCG & LMC Kate Pilton Development Manager LMC Liz jones IMT Project Manager LHAC Dave Smith ICT Specialist Adviser LHAC 28 P a g e

Appendix 3: Current State Assessment (2014) This is not incorporated in the submitted LDR document and is attached separately. 29 P a g e

Appendix 4: Gap Analysis (2014 baseline) This is not incorporated in the submitted LDR document and is attached separately. 30 P a g e

Appendix 5: Future State Model and Requirements (2014) This is not incorporated in the submitted LDR document and is attached separately. 31 P a g e

Appendix 6: Universal Capabilities Delivery Plan This is not incorporated in the submitted LDR document since it has been submitted separately. 32 P a g e

Appendix 7: Capability Deployment Schedule This is not incorporated in the submitted LDR document since it has been submitted separately. 33 P a g e

Appendix 8: Capability Trajectory (Secondary Care) This is not incorporated in the submitted LDR document since it has been submitted separately. 34 P a g e