The Royal Wolverhampton NHS Trust
Trust Board Report
Meeting Date:
22 July 2013
Title:
ICT Five Year Strategy
Executive Summary:
This updated ICT Strategy for RWT has been completed
following significant input from many areas both internally,
support staff, executives and patient facing personnel, and
externally, GP’s and external DoH publications. It is
presented for approval by TMT and Trust Board in July
2013 and will be updated formally on a minimum bi-annual
basis, with a formal update on progress each year.
The documents is intended to provide a direction of travel
for ICT which will be reviewed and updated as necessary
and highlights the key components required for its delivery.
Each outcome is detailed within the report with a 5 year
roadmap and financial plan in the appendices.
Action Requested:
To approve the Strategy
Report of:
K Stringer
Author:
Contact Details:
K Cantrill
Resource
Implications:
Financial forecasting and long term planning
Public or Private:
Public Session
Tel 01902 695903
Email
[email protected]
(with reasons if private)
References:
na
(eg from/to other committees)
Appendices/
ICT Strategy 2013-14 Appendices 1 and 2.pptx
References/
Background Reading
NHS Constitution:
(How it impacts on any
decision-making)
In determining this matter, the Board should have regard to
the Core principles contained in the Constitution of:
Equality of treatment and access to services
High standards of excellence and professionalism
Service user preferences
Cross community working
Best Value
Accountability through local influence and scrutiny
Background Details
1
This ICT strategy is an update to the one approved 2010
ICT Strategy 2013-2018
Chris Wanley & Kay Cantrill
Contents
1
Executive Summary ..................................................................................................................... 4
2
Background ................................................................................................................................. 5
2.1
Introduction ............................................................................................................................ 5
2.2
The Role of an ICT Strategy ..................................................................................................... 6
2.3
Approach ................................................................................................................................. 6
2.4
Strategic Background .............................................................................................................. 6
2.5
Strategic Progress at RWT ....................................................................................................... 7
3
Considerations and Principles ................................................................................................... 10
3.1
External Drivers ..................................................................................................................... 10
3.2
Internal Drivers ..................................................................................................................... 11
3.3
Basic Principles ...................................................................................................................... 12
3.4
Standard versus bespoke ...................................................................................................... 12
4
Integrated Electronic Patient Record ........................................................................................ 12
4.1
Elements of an EPR ............................................................................................................... 12
4.2
Patient Admin System (PAS) ................................................................................................. 13
4.3
NHS National Number ........................................................................................................... 14
4.4
Order Communications/Clinical Notes/Referrals ................................................................. 14
4.5
EPrescribing and Enterprise wide Healthcare Applications .................................................. 15
5
Electronic Document Management .......................................................................................... 15
5.1
Documents and Notes........................................................................................................... 15
5.2
4.6. Clinical Portal ................................................................................................................. 16
6
Service/Trust Transformation ................................................................................................... 16
7
Business Intelligence ................................................................................................................. 17
7.1
Data Warehouse ................................................................................................................... 17
7.2
Data Quality .......................................................................................................................... 18
8
Commercial Opportunities........................................................................................................ 18
9
Information Access and ICT Infrastructure ............................................................................... 19
9.1
General.................................................................................................................................. 19
9.2
Desktop Systems ................................................................................................................... 19
9.3
Devices .................................................................................................................................. 19
9.4
Wired Network:..................................................................................................................... 20
9.5
Servers and SAN(s) ................................................................................................................ 20
9.6
Telephony ............................................................................................................................. 21
9.7
Wi-Fi ...................................................................................................................................... 21
9.8
Desktop and Server Licensing ............................................................................................... 22
9.9
Email and Groupware ........................................................................................................... 22
10
People Governance and Policies ........................................................................................... 22
10.1
Portfolio Management.......................................................................................................... 22
10.2
Governance and communication of ICT................................................................................ 23
10.3
Security ................................................................................................................................. 23
10.4
Testing ................................................................................................................................... 24
10.5
6.5. Single sign-on (SSO)........................................................................................................ 24
10.6
ICT People and Structure ...................................................................................................... 24
10.6.1
Resources – Staff ............................................................................................................... 25
11
Culture, Process Change and Data Quality ........................................................................... 25
11.1
Training and Skills ................................................................................................................. 25
11.2
7.4. Social Media and Public Interaction............................................................................... 26
Appendix 1 – Roadmaps by Outcome, Enabler and Foundation Stones .............................................. 27
Appendix 2 – Financials......................................................................................................................... 28
1 Executive Summary
This updated ICT Strategy for RWT has been completed following significant input from
many areas both internally, support staff, executives and patient facing personnel, and
externally, GP’s and external DoH publications. It is presented for approval by TMT and
Trust Board in July 2013 and will be updated formally on a minimum bi-annual basis, with a
formal update on progress each year.
The documents is intended to provide a direction of travel for ICT which will be reviewed as
updated as necessary and highlights the key components required for its delivery.
The document starts by summarising key progress against strategy, highlighting both
successes and some of the more challenging initiatives. It then introduces the ICT
framework which has been developed to structure this strategy and the detail held within.
The ICT framework is made up of the key
outcomes, enablers and foundation
stones required all of which are essential
to ensure success. Detail for each
outcome, enabler and foundation can be
found within this report.
ICT needs to move to fewer significant
initiatives rather than the plethora
currently in the portfolio. By setting up
the Portfolio Framework and helping to
enable true leadership and drive/focus
the aim to ensure a move to this during
2013-14.
The appendices detail the 5 year plan by outcome, enabler and foundation together with a 5
year financial plan based on must do’s and should do’s.
2 Background
2.1
Introduction
This document sets out the Information and Communication Technology (ICT) Strategy for
the Royal Wolverhampton Hospitals NHS Trust (RWT). The strategy is designed to cover the
period 2013 – 2018. Short to medium term goals are more developed while longer term
goals are identified as targets for the Trust to work towards.
ICT is important to the Trust as it is no longer a nice to have; it is essential to improving and
supporting the patient experience and pathway within the hospital and enables us to focus
on patient care rather than administrative processes. ICT is intrinsic to the delivery of the
RWT Overall strategy, including the delivery of service reconfiguration within/across the
local area and the required efficiency and cost savings required year on year without
jeopardising the quality delivered.
This document highlights the intent of direction of travel for ICT across RWT, highlighting
the major outcomes and associated actions required.
This document will be reviewed bi-annually, and a revised version agreed by the Board, but
with an annual update each year. Additionally the Trust should produce an annual ICT
Action Plan that sets-out the activities for the year to deliver the ICT Strategy as agreed with
the recently established ICT Strategy Board. To confirm the plan for 2013-14 it has been
necessary to review all existing projects and agree which should continue, over the next 6
months the intention is that no new projects will be agreed without the approval of the ICT
Strategy Board, this will allow ICT to focus on fewer key transformational projects rather
than the plethora of projects currently within the portfolio. As part of this a portfolio
framework (below) and a prioritisation framework has been agreed using strategic pillars
aligned to the RWT strategy.
Recommendation: The Trust reviews its ICT Strategy bi-annually so that it always has a minimum of a
three year strategy and produces an annual ICT Action Plan to implement the strategy.
Recommendation: The annual plan will be agreed with the ICT Strategy Board and then delivered via
the portfolio framework; any new projects will only be approved once agreed by the ICT Strategy
Board.
2.2
The Role of an ICT Strategy
The ICT Strategy is designed to identify the direction of travel required to provide the
effective use of information technology needed to deliver the Trust's strategic clinical and
business objectives and provide input into the financial annual planning and long term
planning process.
The ICT Strategy looks at the Trust's use and management of technology rather than the
data and information that is held within systems however it is incumbent of the ICT staff to
make sure that systems are up to date, robust and have arrangements in place for
consistent quality, although inevitably there is some cross over particularly in relation to the
consideration of software applications. Data quality remains the responsibility of the
person entering/amending the data held within each application.
It is not the role of an ICT Strategy to set-out specific technical plans, policies and
procedures for the implementation and use of ICT, but to devise a long term framework
with goals and objectives and identify which technical plans, policies and procedures will
need to be developed to deliver the strategic objectives.
2.3
Approach
A first draft of this strategy was written by a consultant who conducted a number of
interviews across the trust, including executives, and external customers i.e.: GP’s and PCT
ICT Representatives. The strategy has since been reviewed and appended by the ICT Senior
Management Team, co-ordinated by the Head of Portfolio and Programme Services, taking
feedback from the newly appointed ICT Strategy Board.
Furthermore external considerations have been taken into account,, these include:
The NHS Commissioning Board Mandate and planning guidance for commissioners
for 2013-14
Digital Strategy (DoH). Published December 2012
Any Local Commissioning contracts/agreements as agreed
Changes to Service Provision resulting from the recent NHS restructuring
Francis Report (February 2013)
2.4
Strategic Background
One of the key priorities for all health care organisations over the last 15 years has been the
development of an integrated Electronic Patient Record (EPR). This vision was set-out in the
NHS IT Strategy (Information for Health) published in 1998. The approach proposed is still
generally accepted globally as the right approach with publications such as the Electronic
Health Record (EHR) Impact Report published by the EU in 20081 supporting this approach.
Very similar approaches have been adopted in the USA and Australia. Most major
healthcare system vendors have aligned their services and products around patient centric
data and the concept of an integrated EPR. The NHS National IT Strategy, published 21st
May 2012 reinforces the strategic objective of delivering an EPR and an Electronic Health
Record (HER), which has recently been further supported by the NHS Commissioning Board
Mandate for 2013-14. The only significant strategic change since 1998 has been in delivery
mechanisms from local responsibility to centrally lead (NPfIT) and now back to local
responsibility again.
Currently progress across the UK in delivering an EPR is mixed with some areas such as
Primary Care being very advanced. The picture in Secondary Care is very mixed with some
Trusts being advanced while others lag behind and Acute Care generally being more
advanced than Community Care.
2.5
Strategic Progress at RWT
The RWT IT vision for all clinical informatics is that the information required can be accessed
within a minimum of 3 clicks. Whilst clearly some way off it is the long term vision we all
aspire too. Significant progress has been made in delivering this, having started some 3-4
years ago with a very poorly maintained base that had experienced significant under
investment for a number of years.
As a result, most recent investment has been in the infrastructure which is the critical
foundation stone required before any capability can be truly delivered to clinicians. This has
seen:
A formal PC replacement programme which runs every year to ensure that the age
of our machines does not inhibit the quality and cost of service
A programme of work to improve and extend the network facilities across RWT
which is now in year 2 of a 3 year programme.
An update and expansion of the wireless facilities across RWT is now 50% complete
with further expansion planned during 2013.
A programme to set up and expand our existing server set-up to ensure flexibility to
expand further as required, to consolidate the infrastructure previously owned by
the PCT and to improve robustness of availability/provide Disaster Recovery (DRS)
opportunities.
A successful iTouch pilot for VITALPACS has been followed with an extensive rollout
to replace all existing PDA’s which were not seen as fit for purpose.
A programme to rollout additional equipment to wards has commenced to ensure
that applications are accessible where-ever and when-ever required within the
inpatient areas of the trust.
Work is in progress to review the future best practice devices for provision across
the Trust. The focus is on clinical inpatient areas, but will support both outpatients
and supporting services. In the meantime the default equipment provided by ICT is
desktops, laptops, C5 tablets and computers on wheels (CoWs).
This investment in the infrastructure will need to continue, particularly in the short term to
ensure that it is both appropriate and flexible enough to deliver future requirements as IT
and strategic drivers change. Core infrastructure will be required whatever the ICT strategy
drives going forward.
Today the Trust is still very heavily reliant on paper records, manual data input and manual
intervention in information transfer, but progress on delivering a clinical web portal (CWP),
providing a single view of the patient has been impressive. This is consistent and
complimentary with the longer term plans to deliver full iEPR functionality. iEPR today is
focusing on scanning existing paperwork for read only access via the clinical web portal,
where possible it is looking to provide the opportunity to capture data entry but the focus
remains removal of the paper records and improved visibility to all of the full record whereever they may be located. The electronic patient record is presented via the CWP; an inhouse developed front-end which presents all available patient information. Access to this
has been provided to GP’s who can now access their specific patient records and plans are
in place to implement in September 2013 a link to the social care applications providing full
patient information, including social care. Any further progress must be supported by
improvements to the overall infrastructure, being the mechanism that delivers this
information to all clinicians, AHP’s and others.
At the same time we have significantly reduced the numbers of systems that are within
departments outside of IT that are unsupported and/or not connected to PAS as the Trusts
master patient index. This now needs to go further particularly with the systems
transferred in from community to make sure all data on a patient is linked together
seamlessly.
As the Trust seeks to transform, reconfigure and develop its services to support the changes
across the NHS, ICT has moved to support these aspirations as can be seen in the recent and
on-going work within pathology. This strategy includes an assumption that more service
reconfiguration will occur, requiring ICT support, over the next 5 years. Further to this there
are changes happening with structures within the NHS, we have seen with the
implementation of TCS a move to provide a shared service centre for ICT across more than
just RWT. ICT currently operates a Shared Service Centre for Infrastructure which services
RWT; WCCCG, Black Country Partnership FT; The Research Network and Compton Hospice.
This comprises of:
– approximately 150 sites which have a network availability of over 99%
– Approximately 450 servers of which over 80% have been virtualised with an
average server up time of more than 99.5%
As we increase the amount of patient and decision support data available we must also look
to ensure that the data is captured in a consistent and useable manner to support decision
making across all areas of the Trust. This has begun with the implementation and pilot of
Patient Level Costing and over the next few years should be extended to deliver a true data
warehouse capability providing information at the point of care (and support) in a timely
and accurate manner.
With increasing reliance on it, IT must be an enabler rather than a blocker, enabling smarter
ways of working, integration with others systems, improving data quality and ultimately
both the clinicians and patients experience It is this clinical and patient focus that MUST BE
maintained, as highlighted in the Power of Information, NHS IT Strategy. Progress has again
been made with the creation of a Clinical Engagement Group, the appointment of a Clinical
Director to IT and the first stages of the IT Portfolio Management framework. This will be
supported by the Portfolio and Programme Services Team which has been developed over
the last 3-4 years from a standing start and now has a clear framework for project delivery.
During this time the team has successfully delivered a number of projects, which include:
MSS/Patient First into A&E; NHS Patient Wristbands and VitalPACS. Significant effort has
been put into the delivery of others which have proved to be more challenging for a variety
of reasons, these include: eDischarge (phase 1), ePrescribing and Safe Hands. Whilst it
should be acknowledged that challenges will always exist in achieving successful project
delivery it is very clear that this will always be aided by a clear and concise view of what is to
be delivered, its relative success factors and most importantly full and active support from
all service areas. On top of this it is clear that we need clinical focus as described in the IT
National Strategy.
There is a general acknowledgement that historically the ICT services provided within the
Trust also lagged behind others and was “playing catch-up”. ICT has “come a long way” and
services have improved in the last 3-4 years however, this change needs to be accelerated
due to the pace of development and change across the NHS and other partnering
organisations, all of which have some level of reliance on ICT delivery. Improvements need
to be made in the people, processes, communications and overall perception of the ICT
service. This is another softer but critical element of our overall foundation stones for the
future. The following are some examples where improvements have been made:
Up skilling of key personnel and teams
Removal of most single points of failure
Consolidation of PCT and RWT services
Phase 1 consolidation of the ICT helpdesk
Improved security protocols and IG compliance
As with infrastructure above we cannot stop here, more is required to transform the service
to ensure that it can continue its journey moving from a ‘blocker’ to an ‘enabler’ that is seen
as critical to all aspects of future Trust Strategy. Specific areas to focus on might be
customer service and service level agreements for service provision and monitoring.
One of the major challenges remaining is cultural change; this includes ICT awareness,
acceptance of change of processes, behaviours and structures/work patterns. This will be a
focus over the next couple of years as more ICT becomes embedded across the Trust.
The ICT Framework below has been produced to summarise the component parts of the ICT
Strategy and the document is structured around this framework.
3 Considerations and Principles
3.1
External Drivers
We have completed a PEST analysis for some of the key external drivers which has been of
key consideration in this strategy. The PEST in shown below together with some of the ever
changing quotes and statements from the DoH and associated bodies/personnel, which
have also been taken into consideration.
Below is a section from the NHS National IT Strategy. The National Strategy concentrates on
firm deliverables in General Practice between 2013 and 2015 and for other areas states:
“The Department of Health will work with relevant parties to identify
and set ambitious but deliverable dates by which we, as users of health
and care services, and our health and care professionals, will be able to
access the different aspects of our own records online – simply, securely
and all in one place (for example via ‘portals’ or other solutions).”
Targets from the National IT Strategy are clear:
• as a health and care professional – Greater and better use
of IT will help me improve the efficiency and
quality of my practice of care, and I will be able to prioritise more of my time for those who need face-to-face
care. I recognise that it is my duty to ensure people can access their records online if they wish and have the
support they need to understand information in their records.
• as a commissioner of care services – I will ensure all patients and service users have the opportunity and
support to benefit from online access to their own health and care records, and from a growing range of other
beneficial online services. I will outline a clear and agreed timetable for providers to deliver this.
• as a service provider – My organisation will outline a plan and timetable for all of our patients and service
users to have online access to their care records and to other beneficial services. Also, we will provide
appropriate support to enable everyone to understand and take proper advantage of all these services.
Other publications, some more recent, include:
3.2
Internal Drivers
To ensure alignment to internal drivers we have confirmed the following to summarise the
key strategic themes for RWT. All outcomes detailed within this document have been
aligned to the Strategic Themes below and in the ICT framework above
3.3
Basic Principles
Continue to move in the direction we have established over the last 2-3 years. We have
delivered the best we can with the money and resources available
Deliver the electronic patient record:
A desire to move from where we are today to an environment where all patient data
is available to those who need it in a timely manner where-ever they need it to
ensure a safe and effective patient experience that our staff would view as an
indispensable asset
Deliver applications that support decision-making using timely and consistent information
ICT systems that are seamless to the user, fit for purpose and efficient to run
As few systems as possible
Robust and secure infrastructure
An ICT department that is appropriately skilled, structured and focused to deliver the
appropriate support and SLA’s
3.4
Standard versus bespoke
It is essential that were ever possible we have standard processes across the Trust so that
consistent processes are in place trust wide meaning that both clinical staff and IT staff can
easily move between areas, as well as making processes and systems less complicated and
more affordable.
This also applies to our purchase of systems that as a Trust we aim to purchase the “best of
breed” systems for each clinical area and integrate them, to give a holist view, currently
there is no one system that would meet the whole Trust’s needs.
4 Integrated Electronic Patient Record
4.1
Elements of an EPR
The diagram below shows the conceptual model of an EPR.
EPR
Clinical Web Portal
Projects feeding into EPR
solution [ i.e. E-Discharge, ePrescribe, Server platforms]
Source Data Systems [PAS / Theatres /
Pathology / Radiology / Prescribing /
Cardiology / Diabetes
Infrastructure Platform Web Servers, Database
Cluster, Network Capability, Scanners, Desktop PC’s
Record Keeping Standards, Retention Policy, Security Policies,
Health Records Policies, Data Protection, Governance
Standards
There are two opposing approaches to delivering an EPR: either a single monolithic system
is procured that delivers all core and departmental systems in a single integrated application
from a single supplier, or a best of breed approach where each element of the EPR is
procured separately and then integrated together. What is generally needed is a hybrid or
pragmatic approach where there is a core system with additional departmental systems.
This model shown above is based on such a pragmatic approach to delivering an EPR system
using a mixture of a central systems and departmental best of breed systems plus in-house
development and integration of systems.
When implementing an EPR it is typical to implement the modules and systems that have
the most impact. These are (and in order of priority) PAS, Order Comms4, Pathology,
Imaging, Notes and Documents, Pharmacy. This is the approach we are following.
Significant progress has been made in the delivery of iEPR and we will continue to develop
the RWT iEPR over the coming years. The key ambitions of an iEPR are to provide secure
information that can be shared both internally and externally to ensure integrated care;
becoming the source of core information used to improve care and deliver cost pressures
where-ever possible
4.2
Patient Admin System (PAS)
Any PAS must be recognised and utilised as the source of all master patient data and as such
is the key foundation stone for any iEPR. Having inherited the community PAS (iPM)
following the transfer of Community Provider services, the trust finds itself utilising two
separate PAS systems for patient data recording. (IPM Community PAS and Acute Silverlink
PAS systems) This is not conducive for alignment of business processes, improvements to
data quality or the effectiveness of a single EPR. It also raises issues and risks concerning full
visibility of the patient pathway across our services.
Current iEPR focus in on development based on the acute PAS however it will be necessary
to consolidate or replace with a single PAS to ensure patient safety, data quality,
consolidated contractual reporting, reduced costs/ICT costs going forward and an EPR which
presents all patient data/information across all trust services.
PAS is the master patient data for the Trust and the back-bone of all other systems and
patient experience. It is critical as we progress that a clear strategy is developed to
consolidate into one single view.
Whilst options for the future are being considered regarding the possible consolidation of
PAS systems or the introduction of any new enterprise system, it’s unlikely that this will
occur in the short term i.e.: prior to 2014. Therefore evolvement of either PAS system
through upgrades or increased connectivity needs to be embraced and progressed
concurrently. Scheduled upgrades of IPM or Silverlink PAS still needs to be accepted and
progression towards an NHS spine enabled Silverlink PAS system should continue (Currently
the Trust is scheduled as an early adopter for this functionality though timescales are yet to
be confirmed by the supplier.
4.3
NHS National Number
The NHS National IT Strategy states:
“All Patient data (in publicly funded health and social care) should be
identified by the NHS number as the primary identifier at the point of care
by 2015.”
This means that every Trust system must contain the NHS number as the primary identifier
at the point of care, not retrospectively. This has been further emphasised in the recent
documentation from NHS England. There is only one way this can be achieved. The PAS
system must contain the NHS number and feed every other system in the Trust. Equally PAS
must be NHS number compliant and be able to directly access the personal demographic
service held on the NHS data spine in real time while patients are on-site.
The PAS review identified above will take into account the requirement to provide NHS data
spine connectivity and real time access to the NHS Personal Demographic Service.
Significant numbers of systems (A&E, Pathology, Radiology etc.) now pull patient
information from PAS; we must continue to connect all systems as appropriate to PAS to
ensure data quality and consistency for all patient demographics.
Recommendation: The Trust carries out a robust business case and option appraisal to move to a single
Master Patient Index and the findings are implemented by 2014.
4.4
Order Communications/Clinical Notes/Referrals
Currently the Trust has implemented electronic ordering for Pathology testing, this was
successfully implemented across all acute services and local (Wolverhampton area) GP
practices. This now provides quick, easy and effective access for Pathology testing requests
negating the previous lengthy paper process which had hand written quality issues.
As part of the overall evolvement of the CWP it has been recognised that the system needed
to change from a presentation of patient information to a more interactive product.
Hence a number of interactive clinical functions have already been offered, which include
the ability for clinicians to enter Clinical Notes or for a number of clinical specialties to have
an electronic solution for Requesting a Test or Internal Referral.
As the EPR progresses then it is envisaged that further electronic requesting functions will
be required from a business perspective. High profile services such as Endoscopy and
Radiology requesting have already been integrated or planned in the near future.
Future requesting/referral functions can also be considered to compliment GP requirements
as the availability of the CWP has been extended to include all GP practices in the local area,
Careful consideration would need to be given in regards to replacing or overlapping Choose
and Book functionality already implemented.
Recommendation: The Trust PAS is made fully spine compliant and able to directly access the personal
demographic service in real-time by 2014.
Recommendation: All systems containing Patient Data are linked to the PAS and Master Patient Index
by 2015.
Recommendation: where-ever possible interfaces must be developed reducing the amount of data
entry duplication and therefore improving data quality. This should commence with a bi-directional
feed from MSS (Patient First – A&E) into Silverlink PAS
Recommendation: The Trust should continue its approach to consolidating order communications and
identify and implement an integrated solution by 2015/16 for all areas across the Trust.
4.5
EPrescribing and Enterprise wide Healthcare Applications
Significant effort on ePrescribing over the last few years has resulted in the conclusion that
no application currently exists which fully delivers the expected ePrescribing scope.
Investigations too have confirmed that whilst there are many applications and suppliers
who offer specific elements of the larger enterprise wide health care scope there is no one
supplier who truly offers the whole solution. Work needs to be re-energised taking a
holistic view of what it is the Trust needs in this whole arena so that a clear roadmap can be
drawn up.
It is the firm belief of the ICT team that it is not appropriate for us to undertake an internal
development approach to this but rather to work with suppliers to ensure successful
implementation over the next few of years. The approach will be to ensure that supplier
offering are fully utilised and the assets purchased sweated to the maximum to achieve as
few applications and therefore operational overheads, as possible, within the Trust. The
challenge here will be ensuring that the suppliers selected can deliver an appropriate
solution that matches the must do’s in terms of clinical process and patient engagement
ideally for both the acute and community services. It is possible that clinical processes may
need to change to be aligned when appropriate.
Recommendation: The Trust should take a holistic view of all clinical applications and pull together a
roadmap for delivery utilising a few key suppliers by mid-2014.
5 Electronic Document Management
5.1
Documents and Notes
The final key building block of the “core EPR” is the ability for clinicians to access electronic
copies of patient paper documents (perhaps from previous episodes, areas of EPR not yet
developed or from external agencies) and to make clinical notes.
Existing paper records are currently being scanned as required for outpatient clinics and
loaded up onto the CWP. This is helping to deliver the electronic patient record and
noteless outpatient clinics whilst reducing the amount of paperwork being moved around
the trust. This is helping to deliver savings but is also putting more pressure on the HR
library as historically up to 30% of patient notes have been ‘out of the library’. Whilst other
scanning and storage options are being investigated to overcome this challenge it is clearly
the right approach when supported by a drive to reduce the creation of the paperwork in
the first place.
This is the approach proposed by RWT and is included in its Clinical Portal. This is in line with
typical NHS practice, with clinical notes being captured by the keyboard, however it is
recognised that this is not ideal for all clinicians and investigations are currently on-going
around the capturing of handwriting directly into the clinical web portal.
Within the community there is often a need to leave a paper copy of the notes/documents
with the patient whatever your location, usually the patient’s home. Whilst still part of the
PCT digitised pens were implemented to capture contact activity information, replacing
administrative iPM data entry and subsequent income generation reporting within some
services in the community. It is planned to utilise this significant investment to capture all
paper documentation as a read only PDF for visibility via the Trust portal and the community
equivalent Clinical Document Suite (CDS).
Recommendation: To rollout digitised documentation to all community services and to integrate CWP
and CDS to provide a full view of patient information across the whole of RWT.
Recommendation: To continue a prioritised and planned approach to scanning for patient record whilst
working alongside to reduce the paper creation by 2015.
5.2
4.6. Clinical Portal
The Trust delivery mechanism for an EPR is its Clinical Portal. Typically a Clinical Portal sits
over the Core EPR and departmental systems and gives a single view of the patient data
held within the feeder systems with links for further data held within other systems should
this be needed to be accessed. The RWT CWP portal is a key element of what is termed the
iEPR project. All scanned patient records are accessible via the portal. Furthermore all new
departmental systems should and must be viewable via this route.
6 Service/Trust Transformation
As the trust moves to support the changes within the NHs for both service and trust
transformation ICT will support providing flexible and efficient solutions. Wherever possible
clinical applications will be updated considering existing supplier options first and foremost
to reduce the number of applications and therefore sign-on’s, interfaces and overhead
costs. Applications will be updated and implemented that allow the most flexibility in terms
of expanding footfall and functionality and to support the overall strategic plans of the
Trust.
The Trust has many clinical applications some of which are already integrated. As
new/replacement applications are required integration with iEPR and the CWP will
continue. Most existing applications have been purchased following the traditional capital
investment approach for both software and supporting infrastructure. There are a number
of smaller in-house developed applications.
Gaps exist in the current applications specifically around trust wide processes, eg: No Live
Bed state. Many processes are still undertaken manually eg: hand hygiene audits and family
& friends surveys.
Continued integration with iEPR and CWP will be essential eg: Maternity due for completion
2014.
Service specific applications will be updated/replaced prioritised in the main by age.
Additional modules with existing suppliers will be considered at all times eg: Patient
First/MSS in 2013/4 and VitalPACS in 2014.
Trust transformational initiatives will be supported with increased flexibility and innovative
thought eg: Pathology from 2013.
Applications will be prioritised based on benefits delivery, patient care and CQUIN
requirements. On-going support and maintenance for exiting applications will remain.
SafeHands will deliver increased patient safety and hand hygiene monitoring by 2014.
Recommendation: ICT will continue to link all new applications with the EPR and CWP as they are
implemented.
Recommendation: ICT will support transformational and reconfiguration needs as required.
7 Business Intelligence
7.1
Data Warehouse
A Data Warehouse is a single repository in which data is taken from operational systems
cleaned, transformed, catalogued, cross-referenced and made available for use by
managers, clinicians and other business professionals for business performance analysis,
research and decision support.
Typically a Data Warehouse takes data from different operational systems to allow the data
to be correlated across systems and data sources in a way that would not be possible in the
operational systems alone.
It would be typical for a NHS Trust with modern ICT to operate a Data Warehouse that
collates data from the PAS and all major systems (as shown in the section in 4.1) to facilitate
performance management and reporting. This must support the needs of managers,
clinicians and other business professionals alike, including where appropriate external
partners.
At present RWT does not have such a Data Warehouse, instead data extracts are provided
to information from many disparate systems that are not fully joined and correlated
resulting in much manual intervention, re-work and duplication of effort.
However the start of this for the Trust is obtaining a Data Warehouse for Patient Level
Costing and Information System (PLICS), in the future this should be expanded to include all
data from other system to create a trust wide data warehouse.
Recommendation: The Trust should implement a corporate data warehouse solution based on best
practice by 2015.
Recommendation: The Trust should have a best practice based implementation of Active Directory by
the end of 2013.
7.2
Data Quality
Data quality is critical as is driven by those entering the data at source following agreed
policies and processes. It is essential that as the amount of data grows in line with this
strategy that data quality too improves.
All new ICT applications will consider data quality as a prerequisite and must ensure that
processes are implemented to support the quality of that entered. Monitoring of data
quality will continue. Data quality should improve as more data is used in a consistent and
joined up manner via the data warehouse.
Recommendation: Data quality must remain a top priority for the Trust and all ICT implementations;
this will need to be supported by process and behavioural changes.
8 Commercial Opportunities
We are recognised as a Trust that is making significant progress with the electronic patient
record amongst other things across the NHS and as the focus on electronic solutions
continues there are opportunities to gain revenue for the Trust as part of this work. We will
at all times, assuming capacity allows, to consider these opportunities and report to the
RWT TMT.
A non-recurring R&D and innovation fund is allocated annually to ICT, recent initiatives
include a proof of concept for mobile tablet devices - Apple iPads and Windows slates
devices.
We currently operate an ICT Shared Service Centre, servicing the WCCCG and Mental Health
which brings in significant revenue to the division.
Opportunities to develop commercially viable offering to external parties are considered
when appropriate an example would be Caseload Allocation for District Nurses which we
are developing jointly with an external consultancy. Further opportunities for commercial
gain will be explored, starting with Glustats and iEPR in 2014.
Outsourcing will be considered as part the overall roadmap.
Opportunities to extend the shared service centre offering will be considered, including
formal benchmarking of our current service with other NHS bodies to establish our baseline
requirements.
Opportunities to support other commercial offerings as part of Service and Trust
Transformation will also be part of the overall prioritisation. Pathology GP Direct Access is
the first example of this.
R&D/Innovation will continue as prioritised year on year.
9 Information Access and ICT Infrastructure
9.1
General
The infrastructure is crucial to the Trust ICT and no ICT projects, application delivery or data
project will be successful if the infrastructure is not robust. The Infrastructure in the Acute
Hospital has historically lagged behind the levels expected of an NHS Acute Hospital in terms
of technology and processes such as standards, security, support and documentation,
however significant progress has been made in this area.
The Trust has been going through a process of integration of two infrastructures post TCS
which is actually achieving two objectives: it is moving the merged Trust onto a single set of
infrastructure platforms that makes support and maintenance easier; and it is adopting the
best systems and infrastructure from each organisation.
9.2
Desktop Systems
The PC platform is designed to have a life of 3-4 years and with advances in applications,
security and technology older PCs become slow, unreliable and unable to run the more
recent application software. The majority of the clinical applications on the market today
have minimum specifications for PCs and it is highly unlikely any PC over 5 years old will be
able to meet such minimum specifications, which in turn means that older applications have
to be run.
Currently the Trust has many old desktop computers some are up to 6 years old, these will
be included in the current replacement programme. There is currently a plan to bring the
age of the PC estate down to 4 years by April 2015
Recommendation: The Trust continues the project to “align to product set” in particular to improve
standardisation and security and this project is suitably resourced. By 2014 the Trust should aim to
have an infrastructure that meets good industry practice.
Recommendation: The maximum age for a Trust PC should be 4 years and this should be achieved
within 2 years.
9.3
Devices
The standard current devices available are Desktop PC’s, C5 tablets, laptops or CoWS
(Computer on Wheels). In addition to this a further device, the iPod Touch, is offered for
the sole collection of VitalPACS observations.
Additional equipment is currently being rolled out following a CBP wards agreed default
model.
As more IT enabled applications are rolled out across the Trust and the personal provision of
mobile devices becomes more and more prevalent it is planned to review all devices and
produce a strategy which details the preferred devices based on the intended use. This
strategy will need to include both mobile and static devices and as importantly define the
link with telephones and bleep devices. It will need to fully support the overall IT strategy,
ensure that suppliers/applications do not drive device usage and fundamentally the iEPR
programme of work which will see data being collected and viewed real-time at the
patient's bedside, in clinic or in the patient's home. While this can be successfully achieved
in clinics with desktop computers, these devices are less suitable in other settings. It is
intended that these devices will all be in the position to run multiple application, supporting
interoperability, as required and that the overall strategy will limit the overall investment
made by the Trust to best practice devices rather than ‘trendy’ fashion accessories.
Recommendation: That the Trust develops an IT device strategy/policy which will support the
replacement and increase of devices as appropriate.
9.4
Wired Network:
A business case submitted in 2011 outlines the network strategy for the next three years. It
recommended replacing the current Nortel hardware and the upgrade of key areas of the
network infrastructure at New Cross Hospital in order to address the current under
performance issues and to provide the necessary future proof bandwidth to support the
optimal performance of current and future IT systems.
Phase one is now complete which included the Server Distribution layer, Edge Distribution
layer , with a plan to complete the strategy by March 2014. This will be supported by a
significant amount of configuration changes including changing the IP address range across
the New Cross campus.
The areas of the network are broken down into several building blocks that form the overall
campus network at New Cross Hospital. These areas are known as the Server Distribution
layer, Edge Distribution layer and edge switches. The edge switches being the outlying
switches that PC’s and other network devices directly connect to (See diagram below).
Once complete it is anticipated that a hardware refresh will be required between 5-7 years.
There are plans to review the cabling infrastructure which has a number of issues including,
outdated cabling technology and non- conformance of standards and increase of capacity in
local areas. This will be completed over the next two financial years.
PC’s, medical
devices, etc.
Edge
Switches
Edge
Distribution
Core
Server
Distribution
Servers and
Applications
Recommendation: The network hardware and cabling is refreshed in 2017 based on a 1 GB desktop
standard.
9.5
Servers and SAN(s)
Today, as a result of TCS, the Trust has four SANs. All the SANs are circa 3 years old.
The Trust is undergoing a programme to consolidate and replace (where required) its server
capacity and is following good practice in using blade servers and virtualisation where
appropriate. The plan is to consolidate all services and data across two redundant
datacentres each capable of supporting the other.
Over the next 12 months hardware from the Community network will be integrated,
replaced or decommissioned where appropriate, whilst working towards this consolidation.
Significant progress has been made here following the decommissioning of Coniston House
and the move to new locations.
During the next financial year the plans for a replacement SAN will be completed to be
submitted in 2014/15. At this point options for cloud storage will be reviewed.
Recommendation: No Server or SAN is older than 5 years meaning that 60% of the existing server base
and all SANs will need to be replaced by 2015.
9.6
Telephony
The Trust currently operates two telephone systems – a Cisco system in Community that
uses Voice Over IP (VoIP) Technology and a Nortel analogue System that uses traditional
telephony at the Acute. The current Nortel analogue system in place is now out of date and
requires replacement.
The strategy is currently being reviewed with a view to consolidate the current phone
systems to a common platform. This will be Cisco Unified Communications based due to the
recent investment within Community which is based on this vendor’s technology. This is
further supported by plans to replace the Choose and Book call centre with this technology.
The Strategy will be completed during 2013 and will outline the plans for the next three
years.
Recommendation: The Trust replaces the Nortel telephony system in use at the Acute Hospital by
extending the Cisco system already in use, and this project is completed by 2016.
9.7
Wi-Fi
The strategy is to consolidate the two current different vendors installed at the New Cross
campus and Community sites to a common platform. It has been decided to expand the
Cisco wireless network to replace the current Aruba wireless network, to support
interoperability between all RWT locations.
In addition the number of transmitters (APs) is being increased to improve coverage across
all areas required by the business subject to capital funding.
As part of the on-going strategy once the hardware has been standardised wireless access
for patients will be reviewed.
Recommendation: On completion of the wireless network upgrade a full coverage study should be
carried out.
9.8
Desktop and Server Licensing
The NHS has stopped its national funding for Microsoft products and Trusts will have to pay
for software licences themselves. This means that all upgrades to products such as
Microsoft office, Windows Operating systems and Microsoft Server applications will have to
be paid for by the Trust.
We are currently fully licensed up to Windows 7, Office 2010 and Windows Server 2008 ,
however as these products are updated (normally on a three year cycle with updates on all
three products likely to happen in the next 12 months) the trust will now incur costs of
these upgrades which are likely to be circa 1 Million pounds.
Recommendation: The Trust must identify and plan when it will be rolling out these new Microsoft
Products so that provision can be made for the software licensing costs.
9.9
Email and Groupware
The Trust has recently consolidated from two email and groupware systems NHSMail.
Email and groupware are the most basic organisation based collaboration tools: using
separate systems is a barrier to collaboration and inefficient. Equally, groupware systems
are the basic foundation of cross-organisation collaboration and in more developed
implementations would typically link to instant messaging, telephony and video, presence,
mobiles etc. Now the Trust has a single email and groupware system more use needs to be
implemented in the use of these collaboration tools across the organisation.
The Trust (along with other NHS organisations) is lobbying hard for additional functionality
to be included in NHS mail to enable greater collaboration, if this isn’t achieved the trust
would need to consider other email systems providers.
Recommendation: The Trust must review its approach to email taking into account (a) the
interrelationship between Groupware systems and other systems.
10 People Governance and Policies
10.1 Portfolio Management
The Trust has made significant progress in IT project management over the last 3-4 years
and now supports around 50 projects with a standard framework for delivery. Portfolio
Governance recognises that there is only a limited amount of resource, both people and
money, to any organisation. As such projects or programmes need to be prioritised and
agreed. IT delivery will always be more successful when the focus is on a smaller number of
significant change initiatives. This ensures that all resource is focused on the agreed big
strategic drivers and resource planning can be undertaken to support its delivery. Planning
for this needs to be done on a 1, 3 and 5 year basis, linked to the overall ICT strategy. A
Trust portfolio framework agreed by the newly formed ICT Strategy Board and will be fully
implemented during 2013-14.
Successful implementation will result in higher visibility of the ICT portfolio of work,
assistance where risks/issues need to be escalated and resolved and an improved
knowledge of ICT work supported by communications on progress and deliverables.
The portfolio management process also aims to formally establish the link/dependencies
with any other change programmes being undertaken across the Trust by groups such as
service improvement and R&D.
Recommendation: The Trust must implement a robust portfolio management framework during 2013
to ensure the focused delivery of the ICT strategy.
10.2 Governance and communication of ICT
In any organisation, ICT must be business directed and mapped onto the business goals of
the organisation. In terms of RWT, ICT should be directed and managed to achieve the
business and clinical priorities of the Trust. In other words ICT should be directed so as to
support the aim of RWT to be “a first class Trust providing top quality care in every way”.
This will be achieved by the new portfolio (governance) framework where IT resources will
be prioritised to achieve the strategic aims and drivers of the Trust.
In summary the framework will initially comprise of 3 layers as identified in the diagram
below. It is expected that the terms of reference and attendees for each group to support
the framework will evolve over the coming years.
The Portfolio Management Office
TMT
The ICT Strategy
Board
CCG
The ICT Portfolio,
Prioritisation &
Programme Board
The Senior IT
Managers Portfolio
Group
Feed information in
Change Advisory Bureau
(Chaired by Tracy Kenny)
Clinical Engagement Group
(Chaired by Dev Singh)
This framework will be supported by the individual programmes and projects who will
report appropriately to each group. Over the coming years the recommendation is that this
will also be further supported by business partners who will engage with key areas of the
Trust, sitting at their table, to fully understand their needs and direction and then represent
them at the IT table
Recommendation: The Trust should immediately implement the Governance structure set out above
and move towards a business partnering role for ICT over the coming years.
10.3 Security
There is an increasing focus on IT Security, Information Governance and associated issues
across the public sector and whilst the Trust has policies and processes in place these need
to be continually kept up to date and defences put in against the latest threats to the trust.
Security must be appropriate in that it ensures the security of our data and staff but also is
designed to ensure that the users gain access required to do their job.
At present within ICT the security area is under resourced and understaffed. This must be
rectified or the Trust risks an information security breach or failure to meet legal
obligations. Additionally the Trust should adopt a structured approach to information
security and it is recommended the Trust adopts the ISO IEC 27002 security standard.
The Trust has regular penetration testing and it is recommended that all new systems or
services before going live are subjected to penetration testing.
Recommendation: The Trust must develop and expand its ICT security function and look to adopt the
ISO IEC 27002 security standard.
Recommendation: The Trust continue undertake and ICT security Audits and repeat these regularly.
10.4 Testing
Testing is an essential element of all ICT implementations and must be undertaken to
ensure that any application is both fit for purpose and complies with IG and NHSLA
mandated requirements.
Historically testing has been undertaken as ‘just another task’ during implementation. A
test manager has now been appointed and is working hard to set up best practice processes
to support implementations going forward. A test strategy will be produced during 2013-14
for consideration and implementation as appropriate.
Recommendation: The Trust must develop and implement a robust and appropriate testing strategy
which ensures standards are maintained.
10.5 6.5. Single sign-on (SSO)
The issue of a single sign-on to access all systems is considered a goal in all NHS
organisations where there are numerous different systems. However, the costs of these are
significant and both the Executive Directors and Clinical Engagement Group have seen
demonstrations of potential software and are keen to progress.
The implementation of a single sign on (SSO) product will streamline the login process for
use by clinicians and their use of multiple clinical systems each requiring separate user
names and passwords. Currently the number of systems a user needs access to on average
is 4, but this figure can be far greater depending on specialty and the number of systems
required to perform patient administration or treatment.
By introducing these technologies the Trust will meet several other requirements in terms
of Information Governance and the Care Records Service.
The Trust is currently reviewing products and plans to submit a business case for review in
the 2013/14 financial year.
10.6 ICT People and Structure
The key elements to delivering the recommendations within this strategy will be to ensure
that the capability and capacity exists within the Trust to meet the strategic developments,
projects and day to day demands.
10.6.1 Resources – Staff
It has already been highlighted in section 6.6 the work in relation to portfolio management.
The need to produce an overall ICT Department resources plan remains. This plan should
include not only projects and day-to-day activity but also the delivery of the
recommendations within this report and be based on providing sufficient resources to
deliver a realistic annual programme of work. Appendix 1 details the current 5 year plan by
project by year and a financial plan will be added once a clinical strategy is completed and
priorities confirmed.
11 Culture, Process Change and Data Quality
These enablers are crucial for all whether transformational or small changes within one area
and are often the element that is missed. Data quality issues are the result of people not
following process whether new process change or existing. It is essential that we ensure
that “our people come with us” and the inevitable changes take place.
Currently, ICT perception across the Trust is not good however service statistics suggest
improvements. Staff across the Trust have little awareness of ICT SLA’s, plans and
achievements and often feel that ICT just adds to their workload when implemented and
have no time for the appropriate training. Staff have a very varied degree of confidence
when it comes to using ICT. GP’s are getting access to more and more RWT patient
electronic information and feedback is very positive. Data quality issues exist due to too
many disparate systems and lack of adherence to process. The helpdesk is located across 2
sites. SLA’s are recorded and reported as part of the SLA Shared Service Centre agreements.
Access to internet sites has been relaxed. Social Media is becoming more and more
prevalent.
The desired future state should see significantly improved perception of ICT via clearer
communications, SLA achievements and prioritisation of plans. Appropriate ICT training
that is both appreciated and ‘welcomed’. ICT awareness plans to include training when
appropriate. Closer communications are required with GP’s both within and outside
WCCCG and focus needs to be on 2-way electronic communications. Improved belief and
trust in data/information and processes to ensure data quality is embedded. Fully
integrated customer service focused helpdesk. Security, which addresses the risks but also
recognises the needs of all users. Social Media available for formal and controlled Trust
Communications
11.1 Training and Skills
Currently ICT training is not universal across the trust and benefits of ICT systems will not be
realised unless users know how to use systems properly. The Trust must address this issue.
It is recommended that the Trust carries out a detailed ICT training and skills audit and on
the back of this produces an ICT training strategy for agreement by the ICT Portfolio Groups.
11.2 7.4. Social Media and Public Interaction
The Trust is currently considering its position regarding all social media. This iniative is
being owned and run by Human resources. ICT will ICT would support the policy but does
see itself as custodians.
–
See attached ICT Strategy 2013-14 Appendices 1 and 2.pptx
–
See attached ICT Strategy 2013-14 Appendices 1 and 2.pptx
Appendix 1
ICT 5 year Roadmap
The following 16 slides summarise the challenges and roadmap for each
outcome and the enablers and foundations required to deliver the ICT
Strategy as described
The roadmaps show all projects that we must do
and need to do
11/07/2013
1
Outcome 1 – Integrated Electronic Patient Record
2013-14
Outcome 1 – Integrated Electronic Patient Record - Roadmap
Noteless
OPD
2014-15
2015-16
In Patient Rollout
Integrated
Patient Pathway
Community Pilot & Rollout
eDischarge 3 – Day
Case & Full Rollout
2017-18
Key:
MUST
DO
NEED
TO DO
Bi-Directional PAS Feeds
In Patient
Trials
eDischarge 2
– Scanning &
Reporting
2016-17
iEPR Consolidation
Clinical Letters and Proformas
Integrated order Communications
Electronic Document Management (see next slide)
Review
PAS NHS Spine
Compliance
PAS
Consolidation
ePrescribing Implementation
Strategic PAS
Enterprise Healthcare
Community/Mobile Patient Flow/Tracking
11/07/2013
2
Outcome 1b– Electronic Document Management
As the single view of the patient the CWP is the Trusts patient document management store for all electronic
paperwork and significant progress has been made in scanning records into it to support iEPR. As this
progresses there will be opportunities to reduce the cost of paper storage and delivery to services. Work will
also continue on how to stop paper being created I the first place.
Today:
The patient record is predominately paper which is
tracked and delivered by staff around the Trust. There
are currently over XXX records held in the library on
site with more being held in community and services
specifically, these records cannot all be seen by the
person facing the patient. As noteless clinics increase
there is less demand for these paper records and as a
result the library stock is growing significantly.
Many paper records are unwieldy, made up of more
than one volume, and significant work is currently
underway to improve the quality and filing of the
paper itself.
Community policy is to leave a paper copy with the
patient so that they have a full record themselves.
Co-ordination of health records across the Community
as a whole has improved in the last year co-ordination
and storage management improves but work is
required here.
11/07/2013
Desired Future State:
• Complete scanning for community and acute,
active and historical patients by 2018
• Complete appropriate shredding and weeding
with patient records ahead of scanning individual
records
• Deliver electronic solutions for all paper records
by end 2016
• Provide on-going developments to support the
overall strategy within CWP eg: extending access
to GP’s; Partner’s and Patients and updates driven
by software upgrades eg: Windows 8
3
Outcome 1b– Electronic Document Management
2013-14
2014-15
2015-16
2016-17
Key:
MUST
DO
NEED
TO DO
In Patient Scanning
Outcome 1b– Electronic Document Management - Roadmap
2017-18
Acute Historical Scanning
Community Scanning
Digital Documentation - Community
Historical Community Scanning
Deceased Patient Scanning
Digital Documentation - Acute
Shredding – Acute & Community
Weeding – Acute & Community
In Patient Electronic Documentation
CWP Enhancements
GP CWP
Access
Partner CWP
Access
Patient CWP Access
Windows 8 CWP Upgrade
11/07/2013
4
Outcome 2 – Service/Trust Transformation
Wherever possible clinical applications will be updated considering existing supplier options first and foremost
to reduce the number of applications and therefore sign-on’s, interfaces and overhead costs. Applications will
be updated and implemented that allow the most flexibility in terms of expanding footfall and functionality
and to support the overall strategic plans of the Trust.
The quality of patient care will remain the main driver at all times.
Today:
The Trust has many clinical applications some of which
are already integrated. As new/replacement
applications are required integration with iEPR and
the CWP will continue.
Most existing applications have been purchased
following the traditional capital investment approach
for both software and supporting infrastructure.
There are a number of smaller in-house developed
applications.
Gaps exist in the current applications specifically
around trust wide processes, eg: No Live Bed state.
Many processes are still undertaken manually eg:
hand hygiene audits and family & friends surveys
11/07/2013
Desired Future State:
Continued integration with iEPR and CWP will be
essential eg: Maternity due for completion 2014
Service specific applications will be updated/replaced
prioritised in the main by age. Additional modules
with existing suppliers will be considered at all times
eg: Patient First/MSS in 2013/4 and VitalPACS in 2014
Trust transformational initiatives will be supported
with increased flexibility and innovative thought eg:
Pathology from 2013
Applications will be prioritised based on benefits
delivery, patient care and CQUIN requirements
On-going support and maintenance for exiting
applications will remain
SafeHands will deliver increased patient safety and
hand hygiene monitoring by 2014
5
Outcome 2 – Service/Trust Transformation
2013-14
2014-15
2015-16
Stroke Hyper Acute
Renal
Infection Prevention
Outcome 2 – Service/Trust Transformation - Roadmap
Maternity
Other Service Provider Bids
Walsall Pathology
Integration
2017-18
Key:
MUST
DO
NEED
TO DO
Coding Automation
GP Pathology
Theatre Asset Tracking
Stock Management
Emergency
Assessment
PAU & A9
Emergency
Assessment
AMU
2016-17
ESR/RA Smartcard
Vital Signs/Observations
Patient
Reminders
Hospital @ Night
Telehealth
Theatre Systems Review
Friends & Family Surveys
SafeHands
Radiology
CQUIN
Comorbidity
OP Redesign/Patient Self Serve
CQIN Demands
Small Projects Enhancements
Applications Support & Maintenance
11/07/2013
6
Outcome 3– Business Intelligence
A data warehouse typically takes data from existing operational systems to allow the data to be
correlated to support performance/management reporting and decision making. This must
support the needs of managers, clinicians and other business professionals alike, including where
appropriate external partners. Improved data quality supports all decision-making and is the a
desired outcome for the Trust.
Today:
SQL data extracts are provided to information from
many disparate systems that are not fully joined and
correlated resulting in much manual intervention, rework and duplication of effort.
Patient Level Costing & Information (PLICS) is the first
initiative which is driving joined up thinking and is
currently in pilot across 2 specialities, this also
includes piloting a new reporting suite for
consideration across the whole Trust.
Quality, accuracy and accessibility of data and
information provided and peoples knowledge and
ability to analyse is variable.
11/07/2013
Desired Future State:
PLICS will be rolled out during 2013-14 and be the
basis of our Trust-wide data warehouse and the future
business intelligence reporting and dashboard
provision. Training for managers and clinicians should
be considered in parallel to this.
Data from new/replaced applications must be made
available for any future data warehouse.
The collection and utilisation of big data should be
considered as part of the overall strategy.
Opportunities to improve data quality must be driven
as a priority across all ICT portfolio initiatives, this will
need to be supported by process and behavioural
changes.
7
Outcome 3 – Business Intelligence
2013-14
PLICS Pilot
2014-15
2015-16
2017-18
2016-17
MUST
DO
NEED
TO DO
PLICS Rollout
Data Warehouse
Outcome 3 – Business Intelligence - Roadmap
Key:
Performance
Reports/Dashboards
Corporate Records
Management
Data Quality
Big Data
Demand Management
Data
Migration
Stock
Mgmt
iEPR/CWP
SafeHands
Renal
Maternity
ePrescribing
Hospital @
Night
Emergency Assessment
Radiology
11/07/2013
PAS
ESR
Coding
VitalPACS
8
Outcome 4 – Commercial Opportunities
We are recognised as a Trust that is making significant progress with the electronic patient record amongst
other things across the NHS and as the focus on electronic solutions continues there are opportunities to gain
revenue for the Trust as part of this work.
We will at all times, assuming capacity allows, consider these opportunities and report to the RWT TMT.
Today:
Desired Future State:
An non recurring R&D and innovation fund is
allocated annually to ICT, recent initiatives include a
proof of concept for mobile tablet devices - Apple
iPads and Windows slates devices
We currently operate an ICT Shared Service Centre,
servicing the WCCCG and Mental Health which brings
in significant revenue to the division
Opportunities to develop commercially viable offering
to external parties are considered when appropriate
an example would be Caseload Allocation for District
Nurses which we are developing jointly with an
external consultancy
Further opportunities for commercial gain will be
explored, starting with Glustats and iEPR in 2014
Outsourcing will be considered as part the overall
roadmap
Opportunities to extend the shared service centre
offering will be considered, including formal
benchmarking of our current service with other NHS
bodies to establish our baseline requirements
Opportunities to support other commercial offerings
as part of Service and Trust Transformation will also
be part of the overall prioritisation. Pathology GP
Direct Access is the first example of this
R&D/Innovation will continue as prioritised year on
year
11/07/2013
9
Outcome 4 – Commercial Opportunities
2013-14
2014-15
2015-16
2016-17
2017-18
Outcome 4 – Commercial Opportunities - Roadmap
iEPR
Glustats
CMT Caseload
Management
Other Commercial Opportunities
Outsourcing Considerations
Formal
Benchmarking
Shared Service Expansion Opportunities
R&D/Innovation
11/07/2013
10
Foundations 1: Information Access & ICT Infrastructure
ICT infrastructure is the key technical foundation stone for all ICT innovation. It has historically lagged behind
the levels expected for a NHS Acute and we will continue to invest in it as appropriate. This will include
consideration for more flexible delivery including use of the cloud. Consideration must be made for
information access both on and off site, for mobile works and staff and patients at home. Device interoperability will be one of the key drivers together with an approach to reduce/minimise the number of devices
provided.
Today:
There are currently 2 data centres providing all ICT
infrastructure and approx. X% of the servers are
virtualised, integration of these services is making
good progress
Recent years have seen significant investment in the
Trust network, including Wi-Fi. As a result
performance has improved but is still too variable.
Desktops, laptops, tablets and COWS (computers on
wheels) are the default devices, of which we have
circa 4,000, these range in age up to 5 years old.
There are significant numbers of personal and single
use printers.
Some IPT telephony exists though the majority is
analogue and 2 switches are utilised by the 2 main
telephony services – switchboard and the patient
help-line
11/07/2013
Desired Future State:
A rolling replacement of existing equipment must be
supported by the appropriate financial investment to
achieve an average age of no more than 3-4 years by
2014-15. This will include consideration for BYOD
(bring your own device) and other mobile devices
together with desktop standardisation
Plans to consolidate core infrastructure must continue
and deliver good industry practice by end 2014 and
financial forecasts built to ensure core refreshes every
3 years
Financial forecasts will be agreed to ensure all
software licensing upgrades, including Microsoft can
be delivered. Together with the NH Mail refresh due
2016
Telephony will continue to be consolidated and
upgraded
11
Outcome 4 – Information Access & ICT Infrastructure
2013-14
2014-15
Outcome 4 – Information Access & ICT Infrastructure - Roadmap
Windows 7
Upgrade
2015-16
Web
Conferencing
2016-17
2017-18
Key:
MUST
DO
NEED
TO DO
Windows 8 Upgrade
Desktop Standardisation
Desktop Virtualisation
PC Replacement
Device
Strategy
In Patient Device Rollout
Single Trusted
Domain
BYOD
Network Edge
Emergency Portal New Build
Personal
Wi-Fi
Wi-Fi Extension
Acute Network Refresh
Cabling
Community
Servers
Community Network
Refresh
Server/SAN Refresh
UPS
Centralisation
Cloud Storage
Data Centre Integration
IP Telephony
Telephone
Switch Upgrade
11/07/2013
Windows Server
Upgrade
NHS Mail Refresh
12
Foundations 2 & 3: People, Governance/Policies
We have made significant improvements in both areas here over recent years and must continue with this
drive.
ICT must remain complaint at all times with NHSLA and IG requirements and has numerous RWT polices in
place which are kept updated at all times to support this. Any new developments always consider governance
implications as a priority.
Up skilling of ICT staff to support the changing requirements of the division has seen good progress but must
remain a focus as ICT and the digital age becomes more and more part of everyday life.
Today:
We have improved security protocols across the Trust
and regular audits are undertaken
Many different passwords are required for staff which
is both time consuming and a risk for access
A test manager has been appointed to help ensure a
standard framework is followed at all times
IG & NHSLA Compliance is a focus at all times
ICT Staff Up skilling must continue to remain a focus
Portfolio Management has been introduced to help
enable prioritisation of the portfolio and alignment to
strategy, however there are still too many projects for
staff to implement and take on board
11/07/2013
Desired Future State:
Continue to ‘align to produce set’ as part of desktop
standardisation and adopt ISO-IEC27002 to ensure
security is maintained by 2015
Testing must continue to follow a standard framework
and consideration taken to set up a full test
environment
IG & NHSLA Compliance to be a focus on an on-going
basis. The implications of Caldicott 2 must be
considered in full, the first briefing is Autumn 2013.
An ICT department with staff skilled to the job
required for the future
Portfolio management must drive ICT delivery and
changes as required by the Trust strategically
13
Foundations 2 & 3: People, Governance/Policies
2013-14
2014-15
2015-16
Security Updates
Foundations 2 & 3: People, Governance/Policies - Roadmap
Adoption ISO-IEC27002
2016-17
2017-18
Key:
MUST
DO
NEED
TO DO
Caldicott 2
Single Sign-On
Standard Testing
Framework
Full Test Environment
Security Audits
Portfolio Management
Staff Up Skilling
Policy Updates/Approvals
IG Compliance
NHSLA Compliance
11/07/2013
14
Enablers 1,2 & 3: Culture, Process Change & Data Quality
These enablers are crucial for all whether transformational or small changes within one area and are often the
element that is missed. Data quality issues are the result of people not following process whether new process
change or existing. It is essential that we ensure that “our people come with us” and the inevitable changes
take place.
Today:
ICT perception across the Trust is not good however
service statistics suggest improvements
Staff across the Trust have little awareness of ICT
SLA’s, plans and achievements and often feel that ICT
just adds to their workload when implemented and
have no time for the appropriate training
Staff have a very varied degree of confidence when it
comes to using ICT
GP’s are getting access to more and more RWT patient
electronic information and feedback is very positive
Data quality issues exist due to too many disparate
systems and lack of adherence to process
The helpdesk is located across 2 sites
SLA’s are recorded and reported as part of the SLA
Shared Service Centre agreements
Access to internet sites has been relaxed
Social Media is becoming more and more prevalent
11/07/2013
Desired Future State:
Significantly improved perception of ICT via clearer
communications, SLA achievements and prioritisation
of plans
Appropriate ICT training that is both appreciated and
‘welcomed’
ICT awareness plans to include training when
appropriate
Closer communications are required with GP’s both
within and outside WCCCG and focus needs to be on
2-way electronic communications
Improved belief and trust in data/information as
processes to ensure data quality are embedded
Fully integrated customer service focused helpdesk
Security which addresses the risks but also recognises
the needs of all users
Social Media available for formal and controlled Trust
Communications
15
Enablers 1,2 & 3: Culture, Process Change & Data Quality
2013-14
2014-15
2015-16
2016-17
2017-18
Enablers 1,2 & 3: Culture, Process Change & Data Quality- Roadmap
ICT Balanced Scorecard
IT Awareness Training
GP/Partner Engagement
ICT Communications
Data Quality Improvements
Integrated Helpdesk
IT Application Training
Social
Media
11/07/2013
16
Appendix 2
Finances 2013-2018
11/07/2013
17
5 year summary
Must Do’s
Row Labels
2013-14
2014-15
2015-16
2016-17
2017-18
Grand Total
Must Do’s and Need to Do’s
Capital
NR Rev Rec Rev
2937
1768
351
4327
1966
1203
4165
968
1576
3150
533
1714
1800
233
1654
16379
5468
6498
Row Labels
2013-14
2014-15
2015-16
2016-17
2017-18
Grand Total
12000
12000
10000
10000
8000
8000
Capital
6000
NR Rev
4000
Rec Rev
Capital
6000
2000
0
0
11/07/2013
NR Rev
4000
2000
2013-14 2014-15 2015-16 2016-17 2017-18
Capital
NR Rev Rec Rev
2937
1768
351
5357
2370
1578
5615
1748
2776
11025
1478
3929
6000
733
4739
30934
8097 13373
Rec Rev
2013-14
2014-15
2015-16
2016-17
2017-18
18
Summary by Outcome
Must Do’s
Must Do (1)/ Should Do (2)
1
2014-15
2015-16
2016-17
2017-18
Row Labels
Capital NR Rev Rec Rev Capital2 NR Rev2 Rec Rev2 Capital3 Rev3 Rec Rev3 Capital4 NR Rev4 Rec Rev4 Capital5 NR Rev5 Rec Rev5
Business Intelligence
35
110
250
125
100 350
245
50
125
125
Culture
20
50
101
44
20
44
20
44
20
44
Doc Mgmt
25
125
10
275 175
45
250
100
70
70
Governance
500
100
50
50
50
50
iEPR
48
232
6
946
789
290
2025 125
395
100
390
390
Info Access/Infrastructure
1715
122
187
2340
100
216
1300
50
197
2600
100
377
1800
150
377
Opportunities
63
63
63
63
63
Trust/Service Transformation
1139
1331
158
356
438
468
465 185
600
300
100
658
598
Grand Total
2937
1768
351
4327
1966
1203
4165 968
1576
3150
533
1714
1800
233
1654
Must Do’s and Need to Do’s
Must Do (1)/ Should Do (2)
(All)
2014-15
2015-16
2016-17
2017-18
Row Labels
Capital NR Rev Rec Rev Capital2 NR Rev2 Rec Rev2 Capital3 Rev3 Rec Rev3 Capital4 NR Rev4 Rec Rev4 Capital5 NR Rev5 Rec Rev5
Business Intelligence
35
110
250
125
100 450
295
325
275
175
100
145
Culture
20
50
101
120
20
195
20
195
20
195
Doc Mgmt
25
125
10
275 175
45
250
100
70
70
Governance
520
100
75
75
75
75
iEPR
48
232
6
996
824
295
2425 375
440
4150
325
1265
4000
200
2065
Info Access/Infrastructure
1715
122
187
2950
210
365
1740
80
851
5600
350
1081
1800
150
1081
Opportunities
63
50
72
63
63
63
Trust/Service Transformation
1139
1331
158
656
688
588
1075 585
875
700
345
1068
200
200
1108
Grand Total
2937
1768
351
5357
2370
1578
5615 1748
2776 11025
1478
3929
6000
733
4739
11/07/2013
19
Detailed by Project and Priority (1)
Outcome
Project
Business Intelligence
PLICS Pilot
Business Intelligence
PLICS Rollout
Business Intelligence
Data Warehouse
Business Intelligence
Performance Reporting/Dashboards
Business Intelligence
Data Quality
Business Intelligence
Data Migration
Business Intelligence
Corporate Records Management
Business Intelligence
Big Data
Business Intelligence
Demand Management
Business Intelligence
Data Migration
Culture
IT Staff Training
Culture
IT Awareness Training
Culture
ICT Accomodation
Culture
GP/Partner Engagement
Culture
7 day Working
Culture
24/7 Working
Doc Mgmt
In Patient Scanning
Doc Mgmt
Acute Historical Scanning
Doc Mgmt
Community Scanning
Doc Mgmt
Shredding/Filing - Acute & Community
Doc Mgmt
Weeding - Acute & Community
Doc Mgmt
In Patient Electronic Documentation
Doc Mgmt
CWP Enahncements
Doc Mgmt
GP CWP Access
Doc Mgmt
Partner CWP Access
Doc Mgmt
Patient CWP Access
Doc Mgmt
Windows 8 CWP Upgrade
Doc Mgmt
Historical Community Scanning
Doc Mgmt
Decreased Patient Scanning
Governance
IT Application Training
Governance
Test Environment Set Up
Governance
Security
Governance
Single Sign On
Governance
IG Compliance
Governance
NHSLA Compliance
Governance
Portfolio Management
Governance
Performance Monitoring & KPI's
11/07/2013
Must Do (1)/
Should Do (2)
2013-14
1
1
1
1
1
1
2
2
2
2
1
1
1
1
2
2
1
1
1
1
1
1
1
1
1
1
1
2
2
1
1
1
1
1
1
2
2
Capital
NR Rev
2014-15
Rec Rev
Capital
NR Rev
2015-16
Rec Rev
Capital
NR Rev
2016-17
Rec Rev
Capital
NR Rev
2017-18
Rec Rev
Capital
NR Rev
Rec Rev
35
110
50
100
100
100
75
50
150
100
100
20
50
75
100
50
75
25
150
150
20
100
20
20
25
50
50
50
100
25
50
20
5
15
30
50
75
100
5
15
20
50
56
10
62.5
62.5
80
25
44
76
130
325
10
62.5
62.5
80
125
10
44
76
75
130
325
10
62.5
62.5
25
250
195
125
50
162.5
195
44
76
75
44
76
75
40
62.5
10
10
25
250
100
162.5
31.25
10
10
50
10
10
50
30
500
100
50
50
50
50
25
25
25
25
20
20
Detailed by Project and Priority (2)
2014-15
2015-16
2016-17
2017-18
Must Do (1)/
Should Do (2)
2013-14
Outcome
Project
Capital NR Rev Rec Rev Capital NR Rev Rec Rev Capital NR Rev Rec Rev Capital NR Rev Rec Rev Capital NR Rev Rec Rev
iEPR
iEPR Phase 2
1
125
6
6
6
6
6
iEPR
iEPR Phase 3
1
214
368
22
22
22
22
iEPR
IPP
1
48
iEPR
eDischarge
1
107
iEPR
iEPR Consolidation
1
25
25
5
iEPR
Digital Documentation - Community
1
62
51
10
10
10
10
iEPR
Bi-Directional PAS Feeds
1
20
2
2
2
2
iEPR
ePrescribing
1
500
300
100
100
100
100
iEPR
PAS Spine Compliance
1
20
iEPR
PAS Consolidation
1
150
50
150
150
150
150
iEPR
Strategic PAS
1
2000
100
100
100
100
100
iEPR
Digital Documentation - Acute
2
50
35
5
400
50
45
45
45
iEPR
Enterprise Healthcare
2
200
4000
200
800
4000
200
1600
iEPR
Community Mobile Patient Flow/Tracking 2
150
25
30
30
Info Access/Infrastructure
Windows 7 Upgrade
1
197
Info Access/Infrastructure
Windows 8 Upgrade
1
1800
100
180
180
Info Access/Infrastructure
PC Replacement
1
800
800
800
800
800
Info Access/Infrastructure
Device Strategy
1
Info Access/Infrastructure
In Patient Device Rollout
1
100
50
200
50
Info Access/Infrastructure
Single Trusted Domain
1
Info Access/Infrastructure
Network Edge
1
42
Info Access/Infrastructure
Emergency Portal New Build
1
100
Info Access/Infrastructure
Wi-Fi Extension
1
200
Info Access/Infrastructure
Acute Network Refresh
1
1000
150
Info Access/Infrastructure
Cabling
1
50
Info Access/Infrastructure
Community Network Refresh
1
43
10
500
50
20
20
20
20
Info Access/Infrastructure
Data Centre Integration
1
533
122
164
164
164
164
164
Info Access/Infrastructure
Server/SAN Refresh
1
300
300
Info Access/Infrastructure
UPS Centralisation
1
50
10
10
10
10
10
Info Access/Infrastructure
Community Servers
1
50
3
190
22
3
3
3
Info Access/Infrastructure
Windows Server Upgrade
1
200
Info Access/Infrastructure
Telephone Switch Upgrade
1
200
Info Access/Infrastructure
NHSMail Refresh
1
Info Access/Infrastructure
Desktop Standardisation
2
250
50
Info Access/Infrastructure
Desktop Virtualisation
2
3000
250
50
50
Info Access/Infrastructure
BYOD
2
50
5
50
10
10
10
Info Access/Infrastructure
Personal Wi-Fi
2
30
30
Info Access/Infrastructure
Cloud Strategy
2
50
100
600
600
600
Info Access/Infrastructure
Web Conferencing
2
10
10
10
10
10
10
Info Access/Infrastructure
IP Telephony
2
300
34
360
34
34
34
11/07/2013
21
Detailed by Project and Priority (3)
2014-15
2015-16
2016-17
2017-18
Must Do (1)/
Should Do (2)
2013-14
Outcome
Project
Capital NR Rev Rec Rev Capital NR Rev Rec Rev Capital NR Rev Rec Rev Capital NR Rev Rec Rev Capital NR Rev Rec Rev
Opportunities Strategy and Innovation
1
63
63
63
63
63
Opportunities Social Media
1
Opportunities Out Sourcing
2
Opportunities Shared Service Centre Extension
2
50
9
Trust/Service Transformation
Renal
1
159
Trust/Service Transformation
Maternity
1
633
9
48
48
48
48
48
Trust/Service Transformation
Walsall Pathology
1
Trust/Service Transformation
GP Direct Access Pathology
1
300
100
100
100
100
100
100
Trust/Service Transformation
CMT Caseload Management
1
Trust/Service Transformation
Emergency Assessment AMU
1
10
13
Trust/Service Transformation
Emergency Assessment PAU & A9
1
37
25
10
10
10
10
10
Trust/Service Transformation
ESR/RA Smartcard
1
15
50
50
50
50
Trust/Service Transformation
Vital Signs/Observations
1
150
25
30
150
25
60
60
60
Trust/Service Transformation
Infection Prevention
1
50
10
2
Trust/Service Transformation
Patient Reminders
1
15
37
Trust/Service Transformation
Telehealth
1
250
100
50
50
50
Trust/Service Transformation
Hospital @ Night
1
191
376
280
280
280
280
Trust/Service Transformation
Theatre Systems Review
1
300
100
60
Trust/Service Transformation
SafeHands
1
1184
Trust/Service Transformation
CQUIN
1
Trust/Service Transformation
Stroke Hyper Acute
2
200
100
100
100
100
100
Trust/Service Transformation
Other Service Provider Bids
2
200
100
100
200
100
200
200
100
300
Trust/Service Transformation
Coding Automation
2
10
50
5
5
5
Trust/Service Transformation
Theatre Asset Tracking
2
75
20
15
15
Trust/Service Transformation
Stock Management
2
100
25
20
20
Trust/Service Transformation
Friends & Family Surveys
2
25
Trust/Service Transformation
Glustats
2
100
50
10
10
10
10
Trust/Service Transformation
Out Patient Reception re-design and Self Serve
2
400
150
50
50
50
Trust/Service Transformation
Small Developments/Enhancements
2
100
10
100
10
100
10
100
10
11/07/2013
22