implementing carecast: the uclh experience - bcs.org · will be paper light – clinical...

Wednesday, 24 November 2004

Implementing Carecast:The UCLH Experience

Kevin JarroldDirector 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 under-investment 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 & timetableNo

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

December 2005Phase 5 – Electronic Prescribing

October 2005Phase 4 – Clinical applications – the rest

April 2005Move into New Hospital

December 2004Phase 3 – Clinical applications for movers

October 2004Phase 2 – Orders/Results, Theatres, TTOs

July/August 2004Phase 1 – PAS plus Maternity and A&E


IDX Project DirectorIDX Project ManagerPhase leads and stream leads

UCLH Project DirectorUCLH Project ManagerPhase leads and stream leads

EPR Project Team

IDX Project ManagerClinical Boards x3Nurse leadConsultant leadCorporate Services

EPR Implementation Steering Group

MD for IDX UKChief Operating Officer for IDX US

IDX Project Director

Chief Exec (Chair)Finance DirectorMedical DirectorDirector of Cap. InvestHR DirectorSenior ClinicianUCLH Project Director

EPR Project Board

IDXUCLH


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 NPfITapproach 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

Training ManagerUCLH Trainers x10Deverills Trainers x 20Admin support x2

Training

Tailoring LeadTailoring Analysts x 4

TailoringInformation Analysts x2Management Reporting

Process Review LeadProcess Analysts x 5

Process Review

Project Director & ManagerPhase Project Managers

Project Management


UCLH Resource (2)

Clinical Board Implementation LeadKey Users and Super UsersTesters and TrainersLeads on Training and PC roll out

Clinical Board

QACommunicationsPC Roll OutClinical AdvisorInterfacesSecurity x1.5Testing x3Data Quality x4

Other Key Roles


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

implementing carecast: the uclh experience - bcs.org · will be paper light – clinical...

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