Implementing Carecast: The UCLH Experience Kevin Jarrold Director of Information Management & EPR Project Director
Issues to Address Communications and getting staff on-board The effect of having a new build going on at the same time: has it helped or hindered? Technical matters such as configuration, data migration, functionality, etc. The supplier's understanding of the NHS Resourcing and training
Planned Agenda Some background on UCLH Overview of the new hospital scheme The EPR project Progress to date UCLH EPR and the CRS Key issues moving forwards
Overview of UCLH The Middlesex Hospital University College Hospital The Obstetric Hospital & Elizabeth Garrett Anderson Hospital National Hospital for Neurology & Neurosurgery Eastman Dental Hospital Hospital for Tropical Diseases The Heart Hospital Royal London Homeopathic Hospital
Eight Hospitals - One Vision
Key Facts Annual turnover of circa 400m Staff employed 6,000 1000 beds One of the largest NHS Trusts National specialities - some world class One of the largest build projects in the NHS Association with University College London Part of the North London hospital network
New Hospital The Middlesex Hospital University College Hospital The Obstetric Hospital & Elizabeth Garrett Anderson Hospital Hospital for Tropical Diseases National Hospital for Neurology & Neurosurgery. Eastman Dental Hospital The Heart Hospital Royal London Homeopathic Hospital
New Hospital - the Vision Where we are now World class health care delivered from Victorian buildings Huge underinvestment in maintenance Struggle to meet modern standards Green screen technology Where we want to be... 422m PFI scheme for state of the art hospital Vision for a University/Health campus Designed on the assumption that it will be paper light Clinical commitment
The New Hospital The Reality
IT The Challenge Work to a fixed date for the opening of the New Hospital Deliver paper light operation to fit with the vision and design assumptions Retain four existing hospitals so it is not green field Do it under PFI and traditional procurement process Change software part way through the project Do it while the National Programme is emerging and changing the world
EPR Project Scope EPR environment Organisation-wide scheduling Clinical noting and alerts Electronic ordering and results reporting Delivery of Managed IM&T Service Provide the Trust IT Department Network the new hospital Data and voice
Selection process & timetable No OJEC Advert responses July 2001 32 Preliminary Invite to Negotiate (ITN) Sept 2001 14 Long List for demos & discussions Oct 2001 7 Shortlist agreed, ITN issued May 2002 3 Responses, Negotiations, Demos Jun-Dec 02 3 Final Negotiations, visits Jan-April 03 2 Preferred supplier July 2003 1 Contract signed Sept 2003 1
Aims of the deal Robust specification of what will be delivered Solution that meets user needs Provides value for money Is affordable Can be delivered in time for the new hospital Provides a migration path to CRS
Trust commitment... Clinical buy-in to the EPR - seen as critical to the vision of world class patient care Resources for project - procurement costs were over 1m Plan to commit at least 85m of trust resources over 10 years
Key Features of the Contract IDX are prime contractor LogicaCMG provide managed IT service 20 staff TUPED from McKesson to LCMG LCMG now employ 40 staff plus 20 on EPR work 24/7 helpdesk Marconi are installing active network in the new hospital Wireless LAN has gone into retained hospitals 2,400 new PCs plus 1,000 upgrades Standardised on XP with Active Directory Refresh every 4 years
Original EPR Phase Plan Phase 1 PAS plus Maternity and A&E Phase 2 Orders/Results, Theatres, TTOs Phase 3 Clinical applications for movers Move into New Hospital Phase 4 Clinical applications the rest Phase 5 Electronic Prescribing July/August 2004 October 2004 December 2004 April 2005 October 2005 December 2005
UCLH IDX EPR Project Board EPR Implementation Steering Group EPR Project Team Chief Exec (Chair) Finance Director Medical Director Director of Cap. Invest HR Director Senior Clinician UCLH Project Director Clinical Boards x3 Nurse lead Consultant lead Corporate Services UCLH Project Director UCLH Project Manager Phase leads and stream leads MD for IDX UK Chief Operating Officer for IDX US IDX Project Director IDX Project Manager IDX Project Director IDX Project Manager Phase leads and stream leads
Streams Application development Application tailoring Training Testing Data Migration Interfaces Management Information PC roll out Disaster Recovery Security Cut-Over Plan
Streams Application development Application tailoring Data Migration Training Testing Interfaces Management Information PC roll out Disaster Recovery Security Cut-Over Plan
Application Development Key issues: Lastword to Carecast migration Anglicisation of the Carecast product IDX software development process
Lastword to Carecast Made the decision to migrate to Carecast in Feb/March 2004 IDX gave an assurance it would have no impact on timescales London and the South were doing it The product is better It has saved re-training But IDX seriously underestimated the effort needed
Anglicisation C&W had concentrated on clinical benefits rather than admin functionality Key issues Real time commissioning Compliance with NHS data model and production of Clearnet extract Outpatient scheduling
IDX Software Development An implementation project turned into a software development project Challenges have included: Fully communicating NHS needs Development effort split between London and Seattle Product integration Ensuring tight project management so that the software that gets delivered matches expectations
Where we are now We do now have a product Code Drop 9 has delivered most of the go live software for Phase 1 Final delivery in December will complete the picture Software Development project now turning back into an Implementation Project Other streams like data migration and interfaces can now plan in earnest.. Currently re-cutting plan for Q1 2005 go live
Data Migration Is part of the scope of the services IDX have to deliver Users PMI inc address history & GP history Waiting List A&E Outpatients Inpatients Casenote movements Some manual and some electronic transfer For example: Outpatient clinic templates will be manual Appointments electronic DM is now on critical path Additional UCLH testing resources
Training Train the trainer training was part of scope End user training an option Have gone for mixed economy 20 Deverills trainers 10 UCLH Suite of 12 training rooms (x12 training places) dedicated for the purpose Developing training materials to reflect UCLH processes Training mandatory On line assessment
Security Two factor authentication part of scope Keen to use NPfIT approach as it becomes available Have team in place: 1wte IT 0.5wte HR Setting up Registration Authority Issue card to the right person Complete competency test Have authorised access
Resources Planned investment of 85m over ten years IDX contract value is circa 70-75m Balance is investment within the Trust
UCLH Resource Project Manage ment Process Review Manage ment Reporting Tailoring Training Project Director & Manager Phase Project Managers Process Review Lead Process Analysts x 5 Information Analysts x2 Tailoring Lead Tailoring Analysts x 4 Training Manager UCLH Trainers x10 Deverills Trainers x 20 Admin support x2
UCLH Resource (2) Other Key Roles Clinical Board QA Communications PC Roll Out Clinical Advisor Interfaces Security x1.5 Testing x3 Data Quality x4 Clinical Board Implementation Lead Key Users and Super Users Testers and Trainers Leads on Training and PC roll out
User Engagement Key to clinical engagement is: A product that supports the workflow Is easy to use Ready to deliver Flexible to tailor For UCLH EPR supports the vision of modernisation Input from PR team Regular items in staff paper and briefing Roadshows to explain what will happen and when Clinical input to process NB they are the paymasters
UCLH and NPfIT IDX only have one product UCLH has wider scope and earlier delivery Anglicisation issues are generic NHS issues NPfIT is taking UCLH output to build on UCLH will migrate from local database Working closely with BT to ensure integrated approach
Key issues going forwards Final delivery of software for Phase1 Developments for Phase 2 on Orders Re cutting the plan for Q1 2005 go live Delivering Phase 1 and 2 before the New Hospital opens Moving forwards the clinical functionality Planning work in: A&E Urology Diabetes Delivering electronic Prescribing Integration with NPfIT
Issues to Address Communications and getting staff on-board The effect of having a new build going on at the same time: has it helped or hindered? Technical matters such as configuration, data migration, functionality, etc. The supplier's understanding of the NHS Resourcing and training