royal united hospitals bath nhs foundation trust 2015-20 ...of service users, their carers and...

Digital Informatics Strategy Version 1.0 Sep 2015

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Royal United Hospitals Bath NHS Foundation Trust

2015-20 Digital Informatics Strategy

September, 2015 (Version 1.0)

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Contents

Executive Summary ............................................................................................................ 3 Background and Context .................................................................................................... 4

Vision .................................................................................................................................... 6

Patient Impact ...................................................................................................................... 7

Health Informatics Services ............................................................................................... 8

1. Information Technology (I.T) Department .......................................................... 8

2. Electronic Patient Records (EPR) and Information Systems ........................... 9

3. Medical Records .................................................................................................. 10

4. Information Governance ...................................................................................... 10

The CCIO’s ........................................................................................................................ 11

Key Priorities ..................................................................................................................... 12

Key Investments ................................................................................................................ 14

Benefits Realisation...........................................................................................................16

Risks and Challenges ....................................................................................................... 17

Conclusion and Next Steps ............................................................................................ 21 Appendices ....................................................................................................................... 22

Appendix 1 – Key Information Systems ............................................................... 24

Appendix 2 – eHealth Programme Roadmap ...................................................... 26

Appendix 3 – eHealth Programme Capital Costs ................................................ 27

Appendix 4 – eHealth Projects Summary and Value ...................................... 28

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Executive Summary

This document is the Digital Informatics Strategy 2015-2020 for the Royal United Hospitals Bath NHS Foundation Trust, hereafter referred to as the RUH Bath. This strategy is being prepared as the Trust commences the delivery its five year informatics programme, aligning with the national NHS information vision while empowering the organisation to deliver the objectives of a high performing Foundation Trust. This operational and national framework places greater demands on Informatics Services to: • Provide the secure and resilient information infrastructure required to facilitate clinical

operations, communications and business processes; • Provide an ever increasing electronic health records framework and ensure that paper and

digital record keeping systems meet clinical and legal, primary and secondary requirements for the processing of clinical information;

• Facilitate the delivery of timely and accurate clinical activity, commissioning, statutory and performance reporting information;

• Support commissioning, contracts and service line reporting; • Ensure the highest standards of data quality and data collection to both improve and to

prove the quality of service provided while maximising service income; • Demonstrating effective clinical, financial and information governance to stakeholders and

devolving governance to staff within the Trust; • Provide information fit for planning, risk and market assessment; • Provide safe and effective Trust wide Informatics solutions and services while facilitating

the achievement of Trust cost improvement and efficiency programs.

In 2011 the Trust commenced the progression to the Cerner Millennium electronic patient record (EPR) system under the National programme for IT model. With the national programme coming to an end this year, the Trust gains the full autonomy and contractual control its major informatics supplier. This marks the beginning of a new era whereby the Trust will have a direct relationship with its primary supplier, Cerner and can forge ahead with the rapid expansion of the EPR platform required and desired by the organisation. While good Millennium development has been achieved by the Trust during the life of the national programme, the Trust must now accelerate its clinical systems and IT infrastructure work programme required to achieve an agile, cross-organisational integrated workforce. The new vision aims to equip the Trust with both the modern clinical records; corporate systems and technology infrastructure required to process information that both improves and proves the quality of care and patient experience delivered in an increasingly competitive and integrated health and social care economy. Tanya Beale Chief Information Officer

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Background and Context

This document is the Digital Informatics Strategy 2015-2020 for the Royal United Hospitals Bath NHS Foundation Trust (hereafter referred to as the RUH). Its purpose is to: • Align Health Informatics Service plans with local and national NHS strategic objectives; • Identify the Health Informatics work programmes and the funding required to deliver these; • Assess current delivery capability, risks and recommend mitigating actions.

Local Service Drivers Other Service Drivers NHS Service Drivers • Improve the quality of our inpatient, outpatient and community services

• Local Delivery Plans and targets agreed with commissioners and other partner agencies

NHS Operating Framework

• Make the best use of our resources to improve performance and develop the quality of clinical and corporate information

• Patient and Staff Surveys

National Informatics Board (N.I.B) Strategy

• Ensure the meaningful involvement of service users, their carers and families in the shaping, delivery and evaluation of care

• National Service Framework (NSF) targets and implementation

Information Governance Toolkit (IGTK)

• Meet cost improvement, efficiency and recovery programme objectives

• Other key Plans and Strategies (i.e. Clinical Operations, Estates, HR and Workforce etc.)

Care Quality Commission (CQC)

• Maximise learning opportunities for all staff, provide high quality teaching and training

• Communications and engagement with stakeholders, service users and carers

NHS Litigation Authority

• Develop a highly skilled, motivated and culturally capable workforce

• Local Delivery Plans and targets agreed with commissioners and other partner agencies

Monitor

• Develop existing and new partnerships and promote better interagency working to assist the regional NHS and Social Care received by our service users

• Assurance and Research Governance

• Seek new business opportunities consistent with our vision

Table 1 – Strategic Drivers

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In so doing, this strategy: • Establishes a clear role for Health Informatics Services within the Trust as a major enabler and supporter of service transformation and improvement. • Builds on the achievements established under the former IT Strategy and National Programme for IT model. • Meets the planning requirements as set out in the National Informatics Board Strategy. • Provides a framework within which the value and merit of future Health Informatics projects, programmes and business cases can be assessed. The delivery of this Informatics strategy will be principally via a work programme delivered by the multiple teams within Health Informatics. At the core of this work programme is the delivery of the Trust’s ‘eHealth Programme’ which involves the implementation of the systems and technology solutions required to achieve and support a paper light and then paperless organisation over the coming years in line with national strategy. This strategy and its delivery will be overseen by the Trust’s Clinical Informatics Board. The EPR Deployment and Development Board, IT Infrastructure Programme Board, ESR and Corporate Systems Board, Medical Records User Group (MRUG) and Information Governance Committee (IGC) groups will provide reports and updates to the Clinical Informatics Board to ensure ongoing alignment of Informatics modernisation and system deployments with the Trust’s improvement and transformation activities. They will also escalate to the Clinical Informatics Board and Trust’s Management Board as required or should risks or issues in delivery materialise. The Trust’s recurrent revenue investment in Health Informatics is approximately £4.5 million per annum. Pay revenue costs are approximately £m to cover the employment of 103 whole time equivalent (w.t.e.) Health Informatics staff. Investment in Health Informatics Services (including eHealth Projects) is planned as follows:

Year Capital Investment (£) Revenue Investment (£)

2015/16 7,580,246 4,570,963

2016/17 5,525,987

2017/18 2,499,900

2018/19 2,378,900

2019/20 1,974,900

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Vision The core vision of this Strategy is summarised below:

The Trust’s investment in Health Informatics Services must deliver and support the modern clinical records; corporate systems and technology infrastructure required to facilitate information processing that improves and proves the quality of care and patient experience delivered in an increasingly competitive and integrated health and social care economy.

Health Informatics Services must therefore be delivered in ways that best provide information to clinical and corporate staff and service users. Underpinning this vision are the following central principles: • All key clinical event data should be captured and used electronically and as contemporaneously as possible; • Data should be entered into health records once only and to agreed standards of timeliness and quality; • Greater use of technologies to view and record information – new systems and technology will enable clinical and other staff to capture key patient information more quickly, more accurately and closer to the point of care; • Information should be collected and reported at the level of detail required to support management of patients through the Trust’s agreed Care Pathways; • Information should be treated as a valuable organisational asset - easily accessed but a securely shared resource that supports delivery of services and allows effectiveness of services to be measured and compared; • Clear, robust and secure librarianship, storage and archiving arrangements should be in place for all record types; • Improved access to clinical and other performance information leading to more visible and user friendly presentation and analysis of key information; • Appropriate system security arrangements and nationally required checks/controls will be in place before staff are allowed to access and write to electronic records;

• Staff and others will have the necessary training and competence to use the services and systems – supported by provision of relevant Informatics training for clinicians, managers, Informatics staff and other users; • Collaboration with health, social care, patients and other partners will be actively pursued to ensure Health Informatics services and tools are developed, shared and used effectively to support and improve delivery and management of care; • Information technology will be applied to support the Trust’s other infrastructure strategies e.g. enabling best use of the Trust’s Estate and accommodation through flexible and remote working technologies and appropriate use of electronic learning tools to support staff development.

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Patient Impact This Digital Informatics Strategy aims to support the Trust to deliver the highest quality of care to the populations the Trust serves while also achieving the best possible patient experience. It will do this by meeting national drivers such as the Power of Information and National Information Board Strategies and by helping to address local drivers such as improving regional data quality, acting on patient feedback and improving patient experience. For our patient population, this Strategy will:

Enable patients to make the right choices and make the quality of our care transparent, by providing clear evidence on outcomes and performance, for use by patients, commissioners and quality bodies, as well as for service improvement.

Give health and care professionals, carers and patient’s access to the information they need, through access to information held by our internal systems.

Assure best value for taxpayers by ensuring a high performing and cost effective Health Informatics Service, by building on existing relationships with our incumbent suppliers, and by leveraging the benefits of becoming a paperless NHS.

Our eHealth Programme will deliver an improved patient experience by helping ensure that information is collected from the patient only once; it is shared with the right person(s), team(s) and service(s); via secure and compliant governance arrangements; used so that patients are treated according to the best pathway to meet their needs. We will also ensure that our patients have better digital access to clinical data and RUH services in ways that help enable them to take more effective management of their health by introducing digital information sharing opportunities. We will develop our patient digital information sharing solutions while working in collaboration with our patients and patient representatives. The delivery of this strategy will assist the RUH to respond to patient issues, such as those raised in recent patient surveys. By giving clinicians and allied health staff more time and information so they can better involve patients in decisions, and provide more information about treatment. More efficient working can also mean more time for doctors and nurses to talk to patients about worries and fears, how they feel after an operation, or give advice after leaving hospital. The technology can also inform how the trust provides the resources patients need to get help when they need it, and provide ready access to information for example, about medication side effects. Just as we are listening to patients in person for example, through listening events, we can use data on our activity to inform how we might best match our resources to patient needs. Also, as we are doing in maternity with our birthing centres and with external systems such as SystmOne, we can share information across health and social care boundaries to help deliver the patient-centred care vision that will only be realised through a sound technology platform. We are also looking to a future in which apps will play a central part in health management and in health and care delivery.

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Health Informatics Services

At the RUH the organisations clinical and corporate EPR and Information Systems, Information Technology (I.T.), Medical Records and Information Governance functions are delivered by the Trust’s internal Health Informatics Service (HIS). The Health Informatics Service (HIS) currently has 103 whole time equivalent (wte) staff and an annual revenue budget of £4.5 million. These services are provided during office hours (0800- 1700 Monday to Friday) and are supplemented by an on-call, out-of-hours service. The HIS function is divided into five professional specialities as set out in figure 1 below. The HIS delivers all functions with Trust Board approved Governance Arrangements in place to monitor and control the delivery of services and development programmes while ensuring optimal, efficient and cross organisational collaboration and support is achieved at all times. The top tier governing group for the service is the Clinical Informatics Board which is Chaired by the Trust’s Deputy Chief Executive.

Figure 1 – Health Informatics Service Functions

Information Technology (I.T) Department The IT service remit is complex and broad. The IT Service Desk, Desktop Support, Servers and Network Support, Application Support and Application Development which are committed to continual service improvement using aspects of the ITIL methodology where appropriate including Incident, Problem, Change and Release Management. By early 2016/17 the HIS will have absorbed the Trust’s Telecommunications function into the wider IT remit. In doing so all core and peripherals telecommunications infrastructure (inclusive of mobile phones, bleeps and faxes) will transfer from the Estates and Facilities Directorate to the responsibility and operational management of I.T. (This service transfer excludes the Switchboard function). In addition to this telecoms service transfer, by mid 2017 the eHealth PMO will have completed the project work required to modernise the Trust’s telecommunications infrastructure.

Information Governance

Information

Technology (I.T.)

EPR & Information Systems

eHealth PMO

Medical Records

C.I.O

Deputy C.E.O

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Electronic Patient Record (EPR) and Information Systems Department The HIS has the responsibility for the procurement and provision and associated technical delivery for the majority Trust clinical systems both on and off site. The HIS therefore ensures all such systems fully operate within their procured specification and have optimal service availability. The Trust depends upon a vast number of key clinical systems to deliver and manage patient information. The majority of these systems are housed on-site where the HIS provide all necessary hardware and network connectivity. Some key systems however have externally awarded contracts but the Trust also has a range of in-house developed systems that continue to have service, security and functionality development supported by the in- house systems development team. The HIS ensures that all third party suppliers deliver against contract and provide the best value and service to the Trust. Any incidents that constitute a breach of a contract are escalated and resolved. One such example of an externally provided service is our electronic patient record (EPR), Millennium, which was supplied under the former National Programme for IT Framework by British Telecom (BT) but this contract has since ended and the contract for the provision of this major EPR system service is now directly with Millennium system supplier (Cerner). The Trust’s EPR Team work with the Cerner Team and provide operational administration and support of the system for the Trust’s clinical workforce. The HIS supports the use of the system Adastra for the out of hours service and SystmOne (TPP) solution which is well used by the Trust ‘Front door’ services and Pharmacy alongside the National Summary Care Record. The use of this system has brought real benefits to the speed at which clinicians can view essential GP and community clinical data. The Trust is committed and working with partners in both our local CCG’s and surrounding community partners to support the creation of wider clinical views to provide the best and safest patient care for our patients. Further information about the Trust’s Key Information Systems is available at Appendix 1.

Programme Management Office (PMO) To deliver the Trust’s “eHealth” Programme the HIS has a newly created eHealth PMO (Project Management Office) which consists of a Senior Programme Manager, Project Managers, Business Change / Benefits Analysts and other staff to support our future programme of change. This brings to the HIS all the professional elements and enthusiasm to support a fully integrated electronic patient record and support he Trust in its ambitions to provide high quality safe care for our patients while meeting the national NHS informatics vision of a fully digitally enabled organisation.

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Medical Records The Medical Records Department manages of all of the Trust medical records via the on and off site medical record library facilities. This involves outpatient and inpatient attendances across all clinical specialties at the Royal United Hospitals Foundation Trust Bath (including the Royal National Hospital for Rheumatic Diseases) and satellite community clinics. The Department also provides a range of other administrative, legal and audit functions for the Trust. The Medical Records Department has a team of 34 wte staff which includes a number of experienced staff who have a broad Records Management knowledge base incorporating Data Protection, Subject Access, Medico Legal and Caldicott Guardianship principles. The total number of records distributed (14/15) was 301,347. The total percentage of medical records unavailable (14/15) was 0.10%. The total number of medical records in storage (all sites) is currently 852,884. These records are housed across four storage libraries owned by the Trust, which are supplemented by a large archive store maintained by a contracted third party supplier. The primary information system used alongside medical records service delivery is Millennium which accounts for all movements (tracking) of case notes and stores additional supporting clinical information for outpatient clinics and elective patient admissions. The Medical Records Department is responsible for the delivery of Trust Wide Record Keeping Standards training, compliance is audited via the IG toolkit on an annual basis. The Medical Record Department IG Toolkit Submission (205/406) for 2014/15 was level 3 compliant.

Information Governance The HIS also has a dedicated Information Governance Team which comprises of 3 wte roles including an Information Governance Manager, Information Governance Officer and Freedom of Information (FoI) Co-ordinator. The work of the team is directed to ensuring robust controls and monitoring is in place to ensure that all HIS services and clinical and corporate information processing complies fully with Data Protection Act legislation and Caldicott Guardianship principles. The team also provide assurance to the Trust Board that all IT systems are registered and associated information risks are minimised. The Trust’s annual IG Toolkit submission reflects the efforts made to achieve the highest standards possible with the Trust achieving the required minimum level 2 in all 45 requirements and in most cases the highest level possible, level 3. The overall Trust score for the 2014/15 return was 89% and overall Satisfactory. The Information Governance team is well connected with the wider area health and social care community and participates in a regional information sharing framework. Specific programmes currently being supported are the Wiltshire Single View of the Customer (SVOC) programme as well as the BANES Interoperability Programme. In addition, specific level 2 Information sharing agreements are utilised to support specific information sharing as required.

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The CCIO’s

The Trust has a well established cohort of Chief Clinical Information Officers (CCIO’s) - clinical Informatics enthusiasts and organisational Informatics leaders who have been central to the successful delivery of the eHealth Programme this far. The most digitally advanced clinical discipline is currently the nursing body, who have been successfully led by the Director of Nursing and their nominated CCIO to develop and adopt the use of a range of e-nursing forms and assessments within the Millennium system, work which has been nationally recognised. As however the Trust’s EPR functionality rapidly accelerates from the existing Patient Administration System (PAS), Surginet (Theatres), Maternity modules and develops further forms for use by other clinical disciplines as well as deploying further EPR “clinicals” ( e-prescribing, vital signs, mobile connectivity etc) the role of the CCIO becomes increasingly more vital to assist the delivery of this Informatics strategy and to achieve the maximum value and clinical transformation and improvement through the clinical divisions and disciplines. The current organisational framework of CCIO’s is as follows:

The CCIO’s have a role description which includes a consultative function for informatics initiatives as well as a role in leading the delivery of and the benefits realisation for selected eHealth projects across the organisation or within their own clinical service areas. They attend regular meetings as a group and individually, are key members of the other Informatics Governance Arrangements.

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Key Priorities

Moving to a digital future – delivering the “eHealth Programme” which will first take the Trust to a “paper-light” way of operating and ultimately paperless.

Years 1-3 of this Strategy are focussed predominantly on achieving a digital patient record with the associated technological infrastructure required to achieve a paperless clinical workforce in line with national Informatics Strategy.

In line with the national informatics model, this electronic patient records (EPR) centric work programme can assist facilitate improvements in health outcomes and the patient care experience. Improvements in our patient record keeping system achieved through the acquisition of robust and contemporaneous clinical data can lead to improved professional decision-making, informed service users and an increase in transparency and standardisation across the whole healthcare system’s interactions with patients and clinicians.

The advantages that can be achieved include:

Helping patients to make the right, healthy choices through full access to their care records;

Giving care professionals the data they need through real-time digital access to patient records and improved data on outcomes; and

Making the quality of care transparent by publishing comparative information. As part of this, we will ensure that we would to adopt any nationally approved standards for the clinical structure and content of patient records and we will aim to be one of the best performers in the UK when measured on the international HiMSS model and NHS England, Digital Maturity Index.

We have a number of key priorities which will form the basis of the major work streams for the Health Informatics function over the next couple of years. These are:

1) Deliver the end of national contract data centre transition; 2) Delivery of Millennium 2015 code upgrade to modernise and develop the Millennium

experience for the end user; 3) Migrate the filing of correspondence and discharge summaries from the paper record

and into Millennium EPR (only) and facilitate a patient portal to such information; 4) Expand the use of Millennium to the RNHRD and replace the existing Trakcare solution; 5) Review the order communications model and ensure that e-requesting and e-

authorisation of radiology and pathology orders is best achieved, preferably via the Millennium solution for Trust clinicians;

6) Achieve real time data entry into Millennium inpatient functionality and documentation and see this data represented on the ward e-whiteboard solutions;

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7) Ensure best data storage and rationalisation across the Trust’s data centre and associated computer rooms;

8) Develop a policy for the use and management of bring your own devices (BYOD) so that efficient and optimal use of information with compliance with safety and security is achieved;

9) Implement the new wired and wireless network solution which enables the best use of investment and optimal (fast and resilient) use of information with compliance with safety and security for Trust staff and possibly in time, for others;

10) Rollout additional mobile (tablets, PD’s etc.) and fixed devices so a combination of portable, fixed – fast access and dedicated terminals are in place for clinicians and Trust business staff;

11) Agree the Trust’s e-forms model which will enable the migration of forms from the paper medical record across into the Millennium EPR;

12) Complete the electronic document management (scanning) strategy and deploy the corresponding solution as deemed required;

13) Maintain the improvements achieved in the management of medical records across the Trust and in particular the delivery of notes to outpatients.

14) Delivery of the agreed Information Governance Toolkit (IGTK) standards, achieving level three across the majority of all toolkit requirements.

Once the Millennium Data Centre Transition and 2015 code upgrade are delivered we will endeavour to develop the Millennium system further as our current legacy systems come to require replacement.

Our vision is that Millennium provides the following functionality:

PAS

A&E / Emergency Department

Theatres

Maternity

Bed Management

Cardiology

NICU

ITU

Clinical Notation / eForms

Order Communications (requesting orders and results for Radiology, Pathology, etc)

Observations Recording (vital Signs)

e-Prescribing While Millennium will formulate the majority of the Trust’s EPR, other departmental systems will also integrate with Millennium to form the Trust’s EPR. This EPR functionality will be run from a combination of (locally agreed) mobile and fixed devices over a secure and resilient network with core supporting technical infrastructure.

Our plan is to achieve the Trust’s EPR within the years to 2018 however a process of procurement will be deployed as required when existing systems contracts expire so that the Trust achieves the outcome with the best system balanced with procurement, cost and quality considerations.

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Key Investments The projects within the eHealth Programme are funded from the Trust’s capital programme. The Five year funding has been planned through the Trust’s Capital Prioritisation and Management process but the release of funding remains conditional to business case approval from Committee’s across the Trust as directed by the Trust’s standing orders. The Trust has put into place an eHealth Programme Management Office to lead and manage the delivery of all large value eHealth projects. The Health Informatics PMO model established in early 2015/16 ensures that all projects are deployed with rigorous business case production, procurement and contract management as well as effective planning, project management, benefits realisation facilitation, training, testing and change management. The eHealth programme is made up of the following categories of projects:

The projects within these categories are further broken down in Tables 1, 2 & 3 below: EPR Millennium Projects

2015/16 2016/17 2017/18 2018/19 Data Centre Transition Order Communications

(tbc) e-Prescribing (tbc) e-Prescribing (tbc)

2015 Code Upgrade e-Prescribing (tbc) Millenium eForms 2018 Code Upgrade Digital Dictation &

Voice Recognition Digital Dictation & Voice Recognition

Millennium eForms

MIN Millennium ewhiteboards Kiosks

Maternity Optimisation

Powerchart Touch (Mobile)

Millennium eForms e-whiteboards Care Aware Care Compass (Nursing Tasks)

Care Aware & Connect

Millennium Correspondence

Emergency Department (tbc)

e-Prescribing (planning)

Cardiology (tbc)

Table 1 – Millennium Projects by Year 2015-20

IT Infrastructure

Departmental Specialist Systems / Other

Electronic Patient Record (EPR) Millennium

eHealth Programme

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IT Infrastructure Projects

2015/16 2016/17 2017/18 2018/19 2019/20 RNHRD IT RNHRD IT RNHRD IT RNHRD IT Data Storage Data Storage Data Storage Data Storage Data Storage IT Service Desk Mobile Devices Mobile Devices Firewall Hardware BI Hardware BI Licencing

IT Asset Management

PACS Hardware Refresh

Antivirus & Security

Network Replacement

VOIP / Telecomms

Backup Systems & Hardware


PC Growth / Replacement





Servers Replacement

Servers Replacement

Servers Replacement

Servers Replacement

Servers Replacement

FACNET Devpt. FACNET Devpt. FACNET Devpt. FACNET Devpt. FACNET Devpt. Managed Learning Environment (MLE)

Server Virtualisation

Server Virtualisation

RUH Redevelopment

RUH Redevelopment

RUH Redevelopment

RUH Redevelopment

RUH Redevelopment

Mobile Device & BYOD Management

Mobile Device & BYOD Management

Table 2 – IT Infrastructure Projects by Year 2015-20

Departmental / Specialist Systems & Other 2015/16 2016/17 2017/18 2018/19 2019/20 Paperless Outpatients (Pilot)

Paperless Outpatients


Integration & Apps

Integration & Apps

Integration & Apps

Integration & Apps

Integration & Apps

Interoperability Interoperability LIMS Upgrade Finance System

Emergency Department (tbc)

ESR/MLE

ESR continues

Aria Rad/Chemo Cardiology (tbc) Opthalmology Med Photography e-Prescribing (Planning)

e-Prescribing (tbc)

Prescribing (tbc)

e-Prescribing (tbc)

Table 3 – Departmental / Other Projects by Year 2015-20

The full eHealth Programme is set out in further detail in Appendices 2 and 3. A description of the key eHealth projects with their associated organisational value information is included at Appendix 4.

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Benefits Realisation The Trust is developing an eHealth Benefits Realisation model to agree and then drive the acquisition of benefits linked to projects within the eHealth Programme. The associated benefits model will operate via a Trust and key supplier collaboration, with local Trust benefits realisation, leadership and ownership provided by Trust Divisional CCIO’s with the support of operational management. Typical full EPR benefits expected have been broadly identified as: • Reduction in length of stay (LOS) • Clinical time savings / efficiencies • Reduction in laboratory tests • Improvement in turnaround of tests results • Reduction in adverse drug incidents • Reduction in medications administration costs • Reduction in paper and stationery costs • Improvements in ICD-10 coding and income • Reduction in Medical Records Department and associated operational staffing costs The Trust is also ensuring the eHealth Benefits Realisation Programme links with the Trusts wider Transformation Programme and that this Digital Informatics Strategy is considered as a part of future operational services and strategies redesign. Organisational eHealth project value is set out further within Appendix 4.

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Risks and Challenges There are a number of key risks and challenges associated with the delivery of this ambitious strategy and these are set out as follows:

Funding Risk / Challenge:

Key Risks / Challenge Mitigating Actions

Funding provisions may not be available to support the full range of schemes required to deliver this strategy.

Initial capital planning work done to set out indicative costs and enable provisional capital allocations. Robust and effective business case development via PMO model achieved. Effective Informatics Governance Arrangements in place to assist facilitate development and support of quality business cases that then meet capital planning challenge and requirements. Effective Informatics Governance Arrangements in place to identify and support for any new emerging or changing eHealth priorities.

Operational Risks and Challenges:

Key Risks / Challenges Mitigating Actions

Maintaining active clinical engagement and participation in future projects

Transparent clinical steerage and communications on priorities and direction of travel via the CCIO’s network and through the Medical Records User Group, IT Programme Board, Trust Management Committee and Clinical Advisory Groups.

Ensure appropriate and active clinical leadership and involvement in all eHealth project and EPR Deployment and Development activities.

Formalisation of the CCIO role so that maximum impact and effectiveness from CCIO’s participation is achieved.

Formulation and implementation of an eHealth

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Communications Strategy.

Maintaining optimal operations while introducing the large scale and rapid organisational workforce transformation and changes required.

Effective Communications Strategy in place. Effective CCIO’s framework in place. Informatics PMO established to lead and deliver the eHealth Programme. Effective Operational Management leadership in place to champion and direct the change to expected timescales. Robust Benefits Realisation framework and model within all divisions to identify and facilitate the full acquisition of benefits operationally. Sufficiently experienced and volume of Informatics Change Agent resource in place and aligned to all projects.

Full benefits realisation not achieved in operational areas.

Link benefits framework with Trust Transformation Programme. Effective Operational Management leadership in place to champion and direct the change to expected timescales. Robust Benefits Realisation framework and model within all divisions to identify and facilitate the full acquisition of benefits operationally. Sufficiently experienced and volume of Informatics Change Agent resource in place and aligned to all projects.

Any slippage or seasonal (or other operational) pressures may impact the ability of the organisation to deploy any large scale projects successfully (e.g. 2015 code upgrade).

Trust to ensure strong Executive and middle management liaison and working with Cerner to protect and minimise any potential de-prioritisation of EPR programme timescales or Trust resourcing. Cerner to continue to participate in closed meetings of EPR Board and highlight of any risks, issues with regard to Cerner resourcing of the upgrade. HSCIC to support the Trust for the duration of EPR development programme. Ensure sufficient Health Informatics support in all operational areas pre, during and post upgrade/deployments.

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Clinical and corporate staff may not have the capacity to undertake required Health Informatics and eHealth training (Millennium, IG, ICE, etc).

E-learning packages to be deployed. Review and redevelopment of Health Informatics Training model in consultation with CCIO’s and Operational Managers.

Financial penalties from the Information Commissioner (ICO) or complaints impacting adversely on the reputation of the Trust.

IG Group to become a more operationally focussed group (rather than theoretical). Ensure staffing resource is sufficient to manage IG incidents and to train and educate staff of IG practice. Regular performance monitoring of IG incidents by division by IG Group and Operational Managers.

Health Informatics Service Risks and Challenges:

Key Risks / Challenges Mitigating Actions

Sufficient resources in place (capability and capacity) to deliver the Health Informatics workload.

PMO function and corresponding Team to be established with senior experienced leadership in place. Additional skilled and experienced resource will be brought in where required where traditional NHS recruitment fails. Health Informatics senior managers will ensure resource and deployment plans are in place and the delivery of work programmes will be monitored via the CIB and other Health Informatics led meetings.

Further slippage in the delivery of IT infrastructure programme owing to other IT demands (business as usual and other eHealth schemes) and compromised delivery of other eHealth projects.

PMO to assume delivery of large IT projects. Project Management model in place for delivery of other business as usual IT projects (e.g. IT replacement programme).

Robust programme management with monitoring and escalation via IT Board and Clinical Informatics Board.

The Trust’s data warehouse in its current form is not fit for purpose to best sustain the information reporting framework.

Hardware upgrades planned with data warehouse replacement in 2015/16

Bring your own device (or similar) introduces a risk of potential network penetration / security concern.

Deployment plan with monitoring in place. Antivirus and security software procedural review and change to achieve best practice.

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Medical Records Workforce Management Immediate workforce strategy required which clearly sets out and confirms future opportunities.

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Conclusion and Recommendations This Strategy, if delivered successfully introduces opportunity to migrate away from traditional NHS information management principles to a phased digital and agile working model that facilitates the sharing of digital information across the patient and health and social care boundaries. It is not without significant risks or challenges given the scale and pace required to introduce the transformation required, which impacts on predominantly on clinical service areas of the Trust who are already operating under significant pressures. The delivery of this Strategy if achieved in an integrated Health Informatics Service – CCIO - Trust Management framework should assist to alleviate some of the operational demands and pressures by improving the access to and the quality of information used; by delivering an improved and clinically rich electronic patient record, by delivering a flexible IT infrastructure and by sharing data across the patient – provider and provider – provider (health and social care) continuum. The Trust Board are asked to: Receive and approve: • This Digital Informatics Strategy. • The immediate priorities and associated work programmes. • The recommended investment priorities and funding arrangements. • The Health Informatics service model and governance arrangements required to support the delivery of this Strategy. Note and support: • The risks, challenges and mitigating actions identified. Tanya Beale Chief Information Officer September 2015

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Appendices

Appendix 1 – Key Information Systems ................................................................................ 24

Appendix 2 – eHealth Programme Roadmap ...................................................................... 26

Appendix 3 – eHealth Programme Capital Costs ................................................................ 27

Appendix 4 – eHealth Projects Summary and Value ...................................................... 28

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Appendix 1 - Key Information Systems / Applications

Department/Service Name of System/Application Brief Description Supplier Grade (1 = Highest)

Audiology AuditBase Audiology system Auditdata Ltd 3 - High Priority

BIU

Patient Pathway Manager

(PPM)

Patient management within

RTT timescales RUH 3- High Priority

BIU Data Warehouse

Main database used for Trust

reporting RUH 3 - High Priority

BIU Business Objects (BO) BI reporting toolset SAP CACI 3 - High Priority

Breast Unit Various databases RUH 4 - Medium Priority

Cardiology Spiderflash ECG Sorin Group 2 - Essential

Cardiology Tomcat Cardiology system Phillips 1 - Critical

Cardiology X-Ray database GE 1 - Critical

Diabetes Diamond Diabetes system Hicom 2 - Essential

Finance Agresso Finance system

Unit 4 Business

Software Ltd 3 - High Priority

ED PatientFirst ED system Ideagen plc 1 - Critical

Gastroenterology Endobase Endoscopy system

Olympus

Keymed Ltd 1 - Critical

GUM Lilie GUM system Blithe 3 - High Priority

Gynaecology Various databases RUH 3 - High Priority

Gynaecology ViewPoint Ultrasound Reporting

HealthNet

Connections 3 - High Priority

HR Electronic Staff Record (ESR) Workforce Information System

McKesson -

moving to IBM 4 - Medium Priority

HR NHS Jobs Recruitment system NHS 2 - Essential

HR

Managed Learning Environment

(MLE)

Informatics Interface Engine Interface engine Mirth RUH 1 - Critical

Informatics Cerner Millennium Enterprise PAS/EPR system Cerner 1 - Critical

Informatics MPI2 Back-up PMI RUH 1 - Critical

Informatics Winscribe Digital dictation system Winscribe 3 - High Priority

Informatics Imprivata OneSign Single sign-on system Imprivata 2 - Essential

Informatics Adastra Out of hours service system Adastra 1 - Critical

Informatics SystmOne TPP 2 - Essential

Informatics

National Summary Care Record

(SCR) NHS 2 - Essential

Informatics TrakCare RNHRD PAS InterSystems 1 - Critical

Infection Control ICNet Infection Control System ICNet 3 - High Priority

ITU Critical care clinical database RUH 3 - High Priority

Lablink Microbiology results RUH 3 - High Priority

Central Patient Monitoring

System 1 - Critical

Maternity Cerner Millennium Maternity Enterprise PAS/EPR system Cerner 1 - Critical

MAU ARAMIS

Tracks acute referrals into

hospital RUH 2 - Essential

Medical Records Windip

Electronic scanning/document

management system Civica

OH OPAS Occupational Health system Warwick 4 - Medium Priority

OT & Physio Referrals system RUH 3 - High Priority

Oncology Aria Oncology information system Varian 2 - Essential

Ophthalmology Medisoft Ophthalmology

Ophthalmology Information

system Medisoft 2 - Essential

Oral and Maxillofacial

Surgery &

Orthodontics Various databases RUH 4 - Medium Priority

Paediatrics BadgerNet Neonatal information system Clevermed 2 - Essential

TrakGene Clinical genetics system TrakGene 4 - Medium Priority

Pathology dartOCM Order communications system Ideagen 4 - Medium Priority

Pathology DAWN

Haematology management

system

4s Information

Systems 3 - High Priority

Pathology Ultra

Laboratory Information

Management System CirdanLab 1 - Critical

Pathology Immulink Transfusion medicine Immucor 3 - High Priority

Pathology Sunquest ICE

Requesting and reporting

information system Sunquest 1 - Critical

Pathology Blood Trace Ideagen 3 - High Priority

Pharmacy JAC Pharmacy Medicines management JAC 1 - Critical

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Radiology CRIS Radiology information system HSS 1 - Critical

Radiology Synapse PACS

Picture archiving and

communication system Fuji 1 - Critical

Radiology IEP - Image Exchange Portal

Radiology image

exchange/sharing Sectra 2 - Essential

Radiology Sunquest ICE

Requesting and reporting

information system Sunquest 1 - Critical

Radiotherapy Aria Oncology information system Varian 2 - Essential

Risk Management Datix Risk Register Datix 3 - High Priority

Sterile Services SSDMan

Sterile service management

system Trisoft 2 - Essential

Theatres Cerner Millennium SurgiNet Theatres management system Cerner 1 - Critical


Informatics TeamQ1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4

DC Flip

2015 Code

Upgrade

Paperless Outpatients Pilot

Backups

Comms Rms

Year Totals (£)

5 Year Total £19,749,633

EPR Millennium

Specia l i s t System / Other

IT Infrastructure

Unfunded

Delivered

eHealth PMO

e-Prescribing

RUH Decommission & Re-provision

Data Warehouse

Order Comms

Powerchart Touch

Server virtualisation Server virtualisation

Single Sign-On Single Sign-on

IT Asset Mgt System

PC Growth

MDM & Mobile Devices

Digital Dictation & Voice Recognition

ED system replacement

Cardiology

Wired Network

Wireless Network

VoIP/Telecomms

EDMS (If approved, full rollout)

Medical Photography

ESR/MLE

IT Rolling Replacement

IT Service Desk System

PC Growth

FACNET Development

Millennium Nursing & Medical Forms

Cerner 2018 Code UpgradeCare Aware

Pathway Manager

Electronic W/boards

Anti-virus & Security

Data Storage On Site

PACS Tech Refresh

PACS SW System Upgrade

Firewall hardware

RNHRD IT RNHRD IT

FACNET Development FACNET Development


Electronic W/boards

Care Aware

Connect

Clinical Communications

Appendix 2 - eHealth Programme Roadmap2015/16 2016/17 2017/18 2018/19 2019/20

MIN Millennium

Maternity Post Conversion

Millennium Correspondence

Integration and Apps Solutions


CCG Interoperability

Patient Portal

2,378,900 1,739,900

Cancer Centre Developments

Medical Equipment


Data Storage On Site Data Storage On Site

FACNET Development FACNET Development

PC Growth PC Growth PC Growth

Self Service Kiosks (site redesign dependant)

RNHRD IT RNHRD IT


Vital Signs

Ophthalmology

Finance System

IT Operations

7,513,606 5,522,227

Data Storage On Site Data Storage On Site

RNHRD IT

IT Rolling Replacement IT Rolling Replacement

Aria Radio / Chemo

Ophthalmology

EDMS (Scoping)

Laboratory System

£2,595,000.00


Appendix 3 - eHealth Capital Programme Costs

Category No Project Capital

funded

(Y/N)

Priority for

2015/16

Proposed 2015/16 Proposed 2016/17 Proposed 2017/18 Proposed 2018/19 Proposed 2019/20 Proposed Full-life 5 yr

allocation

Notes

EPR Enablers IMT001 Data Centre Flip Y H 3,406,346 1,606,087 - - - 5,012,433

EPR Enablers IMT002 2015 Code Upgrade Y H - - - - - - Costs included above

EPR Enablers IMT003 Cerner 2018 code upgrade Y N/A - - - 230,000 - 230,000

EPR Enablers IMT004 Care Aware Pathway Manager Y TBC - - - - - - Costs included above

EPR Enablers IMT005 EPR System Enablers Y TBC 90,000 - - - - 90,000 Contribution from this to fund EDMS scoping

EPR Enablers IMT006 White Boards Infrastructure Y M - 199,000 - - 200,000 399,000

EPR Enablers IMT007 Mobile Devices (clinical) Y M 55,000 350,000 370,000 75,000 - 850,000

EPR Enablers IMT008 Digital Dictation & Voice Recognition Y L 120,000 380,000 - - - 500,000

EPR Enablers IMT009 Full Order Communications (Phase 1?) Y L 75,000 - - - - 75,000 Phase 2 in 206/17?

EPR Enablers IMT010 Order Comms - complete Millennium deploymentY N/A - 250,000 300,000 - - 550,000

EPR Enablers IMT011 Full order comms - N Spire Health Respiratory Y N/A - - - 17,000 - 17,000

EPR Enablers IMT012 E-Prescribing Y N/A - 200,000 400,000 400,000 - 1,000,000

EPR Enablers IMT013 Aria Radiotherapy/Chemotherapy Y M 100,000 - - - - 100,000

EPR Enablers IMT014 Ophthalmology System Y M 40,000 - 40,000 - - 80,000

EPR Enablers IMT015 Finance Systems Y M 40,000 - - - - 40,000

EPR Enablers IMT016 Freedom of Information Database Y M 10,000 - - - - 10,000

EPR Enablers IMT017 Network Infrastructure - wired Y H 1,119,690 124,410 - - - 1,244,100 Assuming 90%-10% over 2 yrs

EPR Enablers IMT018 Network Infrastructure - wireless Y H 249,570 27,730 - - - 277,300 Assuming 90%-10% over 2 yrs

EPR Enablers IMT019 EDMS - scoping & business case Y L - - - - - -

EPR Enablers IMT020 BI / Data Warehouse Licences Y H 229,000 - - - - 229,000

EPR Enablers IMT021 ED System Replacement Y N/A - 450,000 - - - 450,000

EPR Enablers IMT022 Cardiology Y N/A - 450,000 - - - 450,000

EPR Enablers IMT023 Cancer Centre Developments Y N/A - - 200,000 - - 200,000

EPR Enablers IMT024 Medical Equipment Database Y N/A - - 40,000 - - 40,000

EPR Enablers IMT025 LAB Systems Y TBC - 370,000 - - - 370,000 To be defined

No capital funding

EPR Enablers IMT026 EDMS - full implementation N L - - - - - - Not defined

EPR Enablers IMT027 Medical Photography N H 70,000 - - - - 70,000 Option currently being assessed (S. Southey)

EPR Enablers IMT028 Clinical & Corporate Comms N M - - - - - - Separate business case for funding;

Possible overlap with Whiteboards (IMT006)

Millennium Devpt. IMT029 Integration Solutions & Apps Y H 80,000 80,000 80,000 100,000 100,000 440,000

Millennium Devpt. IMT030 Patient Portal Y L - 50,000 - - - 50,000

Millennium Devpt. IMT031 CCG Interoperability (BANES) Y H 50,000 - - - - 50,000

BAU Projects:

Millennium Devpt. IMT033 Cerner Concurrency Y H 40,000 - - - - 40,000 Partly covers MIN costs below*

Millennium Devpt. IMT034 Care Aware connect N H - - - - - -

Millennium Devpt. IMT035 Millennium Forms Development (Nursing & Medical)N H - - - - - - Proceeding as BAU*

Millennium Devpt. IMT036 Millennium Other Development (Discharge

Planning, Ward Round etc)

N H - - - - - - Proceeding as BAU - no capital requirement

Millennium Devpt. IMT037 MIN Millennium N H - - - - - - Proceeding as BAU - no capital requirement

Millennium Devpt. IMT038 EMIS and TPP Viewer Extension / Deployment N H - - - - - - TPP funded by Wilts; EMIS new requirement

Millennium Devpt. IMT039 Millennium Clinical Correspondence N H - - - - - -

Millennium Devpt. IMT040 Maternity Optimisation (Post Conversion) N H - - - - - - Secondments funded by Maternity

No capital funding

Millennium Devpt. IMT041 Powerchart Touch (incl. voice) N M - - - - - - New requirement

Millennium Devpt. IMT042 Vital Signs N TBC - - - - - - New requirement

Millennium Devpt. IMT043 Self Check In Kiosks N L - - - - - - Pilot on MIN hardware

Millennium Devpt. IMT043 Paperless outpatients N H - - - - - - No capital requirement

Millennium Devpt. IMT045 Millennium HIE (Banes and Wilts and ? Somerset)N M - - - - - - New requirement

Technology/ Infrastructure IMT046 RNHRD IT Y H 135,000 100,000 100,000 129,900 129,900 594,800

Technology/ Infrastructure IMT047 FACNET Development Y M 10,000 10,000 10,000 10,000 10,000 50,000

Technology/ Infrastructure IMT048 Backup Systems & Hardware Y M 64,000 - 100,000 67,000 - 231,000 Started in 2014/15

Technology/ Infrastructure IMT049 Data Storage Y M 200,000 200,000 200,000 200,000 200,000 1,000,000 Started in 2014/15

Technology/ Infrastructure IMT050 Comms Room(s) Y M 40,000 - - - - 40,000

Technology/ Infrastructure IMT051 BI / Data Warehouse upgrade (hardware) Y H 165,000 - - - - 165,000

Technology/ Infrastructure IMT052 IT Service Desk System Y H 55,000 - - - - 55,000

Technology/ Infrastructure IMT053 SQL Upgrade Y H 100,000 - - - - 100,000

Technology/ Infrastructure IMT054 Mobile Device Management Y M 50,000 - - - 50,000 100,000

Technology/ Infrastructure IMT055 Medical Records Scanners Y L - - - - - 0 Remove

BAU Projects:

Technology/ Infrastructure IMT056 CALS Y H 110,000 100,000 - - - 210,000 Is this needed?

Technology/ Infrastructure IMT057 PC Growth Y M 50,000 40,000 30,000 50,000 50,000 220,000 Started in 2014/15

Technology/ Infrastructure IMT058 IT Rolling Replacement Programme Y M 285,000 300,000 200,000 300,000 300,000 1,385,000

Technology/ Infrastructure IMT059 IT Rolling Replacement Programme - servers Y M 150,000 150,000 100,000 150,000 150,000 700,000

Technology/ Infrastructure IMT060 Single Sign On Y H - 25,000 125,000 - - 150,000 Resolve issues with current system

Technology/ Infrastructure IMT061 PACS Tech Refresh Y N/A - - 200,000 50,000 - 250,000

Technology/ Infrastructure IMT062 PACS Software Upgrade Y N/A - 500,000 - 500,000

Technology/ Infrastructure IMT063 Firewall Hardware Y N/A - - - - 60,000 60,000

Technology/ Infrastructure IMT064 IT Asset Management System Y N/A - 60,000 - - - 60,000

Technology/ Infrastructure IMT065 Server virtualisation Y N/A - - 100,000 100,000 - 200,000

Technology/ Infrastructure IMT066 Anti-virus & Security Y N/A - - - - 60,000 60,000

No capital funding

Technology/ Infrastructure IMT067 Website Hosting and MLE N M - - - - - - Separate business case for funding

Technology/ Infrastructure IMT068 Redevelopment Programme (Decomm and provision)N M - - - - - -

Technology/ Infrastructure IMT069 VOIP/Telecomms N L - - - - - -

Other IMT070 LIMS Y TBC 325,000 - - - - 325,000 Managed by Pathology

IMT071 Audit & Assurance Programme N TBC

Contingency for allocation Y N/A - - - - 430,000 430,000

7,513,606 5,522,227 2,595,000 2,378,900 1,739,900 19,749,633

7,580,246 5,525,987 2,499,900 2,378,900 1,974,900 19,959,933.00

66,640.00 3,760.00 95,100.00 0.00 235,000.00 210,300.00

Proposed 2015/16 Proposed 2016/17 Proposed 2017/18 Proposed 2018/19 Proposed 2019/20 Proposed Full-life 5 yr

allocation

2015-20 Allocation

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Appendix 4 - Summary of Key eHealth Projects with Organisational Value

Project Description Clinical / Corporate Value Millennium Data Centre Transition

Move of the live Millennium service

from BT in Reigate to Cerner in Slough

following exit from the LSP contract.

Urgent requirement to exit the LSP contract

prior to end of October 2015.

Application Management being brought in-

house to give greater flexibility and response

to EPR development needs.

No change to Millennium system but is expected to be faster on new hardware platform.

Millennium 2015 Code Upgrade

To upgrade Millennium from current

version (2010) to latest version

(2015).

Provides an improved look and feel for the

system.

Is a technical upgrade which serves as an enabler for mobile working which in itself is an enabler for the EPR Roadmap

Millennium Maternity Optimisation

Completion of infrastructure

(extension of RUH network into

Trowbridge, establishing direct

connectivity from GP practices).

(in conjunction with EPR enabler)

deploy an electronic white board to

CDS to enable use of Millennium

maternity whiteboard

Business change and process re-

design to support move to paper light

working

Extended champion user training and

community staff retraining

Identification of a longer term plan

for technology changes to support

maternity strategy including mobile

community working, cross community

foetal monitoring, paperless

maternity packs and patient portal.

Improved accessibility of RUH systems

Removal of technical barrier to using new

system and supporting embedding new change

processes

Reduction in time to maintain manual

whiteboard

Single view of patient’s information

Access to whole mother and baby record from

any location at any time

Reduction in lost / mis-filed documents

Millennium e-whiteboards

Replace existing bedboards with

electronic TV screens containing

MPage functionality of Cerner

Millennium. This project also provides

the ability for clinicians to record

One Source Of Truth

Reduction in time to maintain whiteboard and

Millennium

Reduction in the need to look in the patient

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patient information at bedside using

mobile devices.

record/ notes - releasing the time to care

Improvement is Real-time bed board

Improvement in patient flow

Improvement in data quality

Reduction in time for non-ward based staff to

view board

Millennium e-forms Review all forms currently filed in the

paper medical record and devise

plans to move them into Millennium

where appropriate.

This project will cover a number of

topics including:

Agreeing and formalising the

structure of the Electronic

documentation views.

Identifying which documents to

create in electronic format and

support how to roll them out.

This project will be ongoing. Following

the initial document review it will be

assessed to see if it’s possible to

undertake multiple document reviews

simultaneously. Resources will be the

key constraint.

Project has commenced. Initial review of current electronic record structure has taken place. Feedback to MRUG to be planned. Initial document has been identified. Planning underway to create an electronic version of MDT note to review issues identified in meeting

Millennium Powerchart Touch

Powerchart Touch enables clinical

staff to use Ipads and iphones to view

the clinical record within Millennium.

It includes the ability to view the

clinical record including clinician

schedules, patient histories, vital

signs, allergies and alerts, documents,

results, and place orders. As well as

incorporating Voice recognition for

clinical documentation directly into

the device.

There is also message centre

Access to EPR in a quick and intuitive manner using mobile devices from anywhere. Secure with no data stored on device. Improved patient outcomes due to real-time clinical interventions.

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capability including:

Compose messages

Co-sign orders

Endorse Lab results

Refill prescriptions

And a ward round and Handover

capability.

These elements are deemed essential

to allow our clinicians to work

seamlessly within the Trust.

Digital Dictation and Voice Recognition

This project aims to introduce voice

recognition software to expedite the

clinic letter typing process for

clinicians. Requires presence of

Mobile Devices/MDM and presence

of PowerChart Touch.

Substantially improved Clinician experience.

Improved patient care via complete

documentation that is immediately available.

Reduction in time spent documenting care.

Increased per-patient revenue by enabling

clinicians to document a more complete

patient note

Information Duplication is reduced (recording

in paper and then electronically).

Network Replacement This project will provide long term

resilient, integrated and robust

network (wired & wireless) platform

that is both scalable and able to

support the delivery of the Trust’s

Informatics Strategy and enable

future VOIP telecoms. The lifespan of

the new Network is 10 years.

Enable standardisation and uniformity of

network provision across the Trust

Stable and resilient infrastructure to deliver

RUH primary clinical systems such as EPR and

PACS

Faster connection/response times to all clinical

application for end users

Any outages will not impact/affect the entire

Trust

Prioritise use of clinical applications during

peak times

Significantly improves connectivity between

key systems through high availability

Essential enabler for a mobile device at every

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bedside

Enabling the backbone for other patient lead

services such as patient accessible Wi-Fi

Build a scalable environment which can be

used as an enabler for clinical innovation

Fast, Secure Roaming and Identity-based

Security enforced in every access point and

router as a user connects

Centralized Management across multiple sites from a single console or online service.

Mobile Devices & Management

To provide Clinicians with Mobile

Devices for use in different workflows

during patient care

Mobile Device Management software

will also be deployed as part of this

project

Note: Detailed analysis, scope to be

confirmed

Reduction in the need to look in the patient

record/ notes - releasing the time to care

Information is real time

Improvement in patient flow

Improvement in data quality

Remote management of devices and

applications.

Medical Photography Review of process and system

currently used to capture, store and

retrieve medical photographs.

Evaluation of alternative systems.

Production of business case to

support alternative system(s) and

implementation as required.

(Excludes Images captured by

specialist equipment and linked with

bespoke departmental system e.g.

retinal images).

Faster workflow for capture and storage of

images

Improved process for retrieving images

Ensures images are captured in line with

national standards for clinical care

Brings compliance with Data Protection requirement to provide access controls appropriate to the sensitivity of the images held.

Finance Systems The Finance Team use a costing

server to convert data from the SLAM

Server and the Data Warehouse into

patient costing to get a financial

figure for procedures carried out by

the Trust

The Main Finance System (Agresso)

Currently has no Development

infrastructure; this means that all

The Costing Server will be on Warranted

Hardware running on a new version of SQL

Server. This will give improved performance to

the finance dept. costing applications

The Finance and IT Teams will be able to

effectively test upgrades and system patches

to the Agresso System without impacting the

live system

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upgrades are done on the live system.

This is a huge risk if any upgrade were

to fail without prior testing access to

the system would be unavailable until

restoration from the backup is

completed.

The Pay Roll Team needs access to

the HealthPay system as this holds

pay roll data previous to that held in

Agresso. This is running on an aging

server and will need upgrading by

Northgate to run on a modern

operating system.

The Pay Roll Team will be able to continue to

gain access to employee pay records from

before the implementation of Agresso.

Aria Radio/Chemo System

The Trust currently use Aria as its

Oncology management application.

There is a requirement to develop the

existing system.

This will incorporate a general update

of the software plus enhancements to

eprescribing, and integration with

Cerner Millennium.

The upgrade will enable enhancements that

will improve recording of data.

Patient safety will be improved by the

enhancements to the ePrescribing module.

Integration with Millennium will enable Clinicians access to information that was not visible to them from any location at any time

CCG and Patient Interoperability

The Trust currently has the ambition

to work in partnership with our CCG’s

in a more collaborative way and to

share relevant patient information

across multiple systems to support

streamlined patient care.

The Trust is currently working with

BANES and Wiltshire CCG’s to support

the creation portals to fulfil this

purpose. The Trust also would like to

support the creation of a patient

portal(s) to enable patient access to

elements of their electronic patient

record.

Single record for patients across multiple

locations improving patient outcomes.

Potential reduction of admissions

Care planning across multiple stakeholders

Patient inclusion and ownership of care.

FACNET Development Purchase/replace network equipment

on the Facilities LAN to enable their

services to run. These services

include CCTV, Door Access, Meter

Reading and environment control.

To provide central access and management for security and environment systems.

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The budget is solely for the Facilities

Network

Integration Solutions The Trusts intention is where possible

to incorporate small systems within

the EPR Cerner Millennium.

This project is ongoing over four years

and looking at which systems can be

incorporated within Millennium and if

they cannot be establishing an

integration mechanism to support a

single view of the patient within the

EPR.

Some specialist clinical system may

not be able to be incorporated and

these will be identified as part of this

project.

N.B. This project will run over

multiple year phases.

Single record for patients accessible form all

areas in real time.

Time saving for clinicians.

One source of data for reporting purposes.

Reduction in duplication

Decrease in Data Quality issues caused by

duplicate data in disparate systems

Reduction is system support costs

Server Rooms The IT department Existing Server

rooms are in much need of essential

improvement works. This is required

to make sure that the environment

that our essential networking and

Server equipment is located in is

adequate and fits the needs of a 24/

operation.

The Following work will need to be

carried out this Year.

- CAB 73 (Radiology Server

Room)UPS Installation and Air

Conditioning Upgrade

- CAB 01 Additional 6x Power

and Installation of 4x Server

Racks

- CAB 51 (Central Server Room)

Installation of 2x UPS to

maintain Power

- Addition of Swipe access to all

The Trust will see improved uptime on

network and Server Infrastructure and the

disruption caused by power outages will be

minimised

Improved Security to Server Rooms and

security will have audit trails on who has

access to IT Server rooms

PACS equipment will be able to be moved to a

more suitable location meaning improving

uptime on the PACS System

Additional capacity for servers and associated

network hardware in server rooms (in

particular CAB 01)

Server rooms will be adequately cooled by redundant air conditioning units

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Server Rooms

IT Rolling Replacements This is split into two areas, rolling

replacement of servers and rolling

replacement of desktops.

IT Servers are an essential part of the

Infrastructure and as such need to be

running on warranted and modern

hardware, as such a rolling

replacement system has been

established to make sure that the

hardware for all essential servers is

kept up to date and fit for purpose.

The plan for the Trusts’ Server

Infrastructure is to Virtualise as much

of the hardware as possible. This

means that Multiple servers can run

on less Hardware as they will be

running in the virtual hypervisor. The

Trust will need 2x additional ESX

hosts to meet the Memory and CPU

requirements needed to virtualise the

remaining Physical Servers. This will

bring our VMWare Hosts to 10 in

total.

For desktops, we are looking to purchase 500 for the year, based on 50 a month for 10 months, from June 2015 onwards.

Increased performance on virtual servers and

the addition of more memory on ESX C3 and

W3 will allow better performance of SQL

Databases

Increased resilience to server infrastructure

Ability to complete migration of remaining

servers running Windows Server 2003 within a

suitable time frame due to Microsoft ending

support for this product.

The Mirth Appliances will give improvements

in speed and resilience for the HL7 Interfacing

between peripheral applications and Cerner

Millennium.

Replacement desktops will provide better end user computing experience

Data Warehouse Upgrades

Current Data warehouse is running

out of capacity and will run out of

resources by 01/09/15.

Full replacement of current Data

Warehouse infrastructure. Include

Test, Development and production

environments,

Create a separate server for

associated applications.

Provide resilience and DR capability

and future proof for the next 5 years

and replace outdated and fragmented

Provide continuity of service; de-risk losing current data on data warehouse, future proof any capacity requirements. Once commissioned will be able to de-commission legacy and expensive data warehouse.

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hardware.

Excludes Application migration, BO

licences, SQL strategy, MIS.

Millennium Care Aware The Trust has no integrated real-time

capacity management capability. As

part of the Cerner Millennium

Procurement the Cerner Care aware

Pathway manager was bought to fulfil

this purpose. The Capacity

management tool enables the real-

time tracking of patients, staff and

equipment. The solution is comprised

of a number of modules:

Bed management

Domestic services

Transport

Pre-admissions

Transfers

The solution allows you an overall

view of each area associated to

management of capacity. Monitoring

of the solution can be via list of

mobile device enabling efficiency

gains in time to communicate

between areas, and to reduce the

number of visits and calls made to

areas to check current status.

Increases capacity through workflow

automation and streamlined processes

Enables associated tasks to be monitored and

managed more effectively

Improves patient satisfaction by reducing

waiting times

Enables tracking and identification of patients

with infection control risks

Supports the use of real time data to aid workflow improvement.

Millennium Care Aware Connect

The Trust requires a solution to

replace the outdated and

cumbersome Bleep/pager system

within the hospital. Millennium Care

aware connect offers a variety of

functionality including:

Enterprise Communication – Shift

based assignments with patient and

location context, Secure Text

messaging, group messaging & VOIP

Access to clinicians and other staff in a quick,

intuitive and less disruptive manner using

mobile devices from anywhere.

Secure messaging.

Improved patient outcomes due to real-time clinical interventions

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calling

Care Team collaboration – Caregivers

assigned to each patient throughout

their stay, Real-time access to

assigned patient lists with task

indicators that trigger mobile

workflows.

Alerting - Alarms from Millennium,

medical devices and Nurse call

systems delivered with patient

context

Clinical Integration – Real–time

access to critical patient medical

record information, New orders and

abnormal results.

Emergency Department System

The Trust currently has a standalone

ED system (Patient First) which

though interfaced for ATD details

with the EPR does not share any

clinical details. The Trust would like to

look at the ED system being replaced

by the Cerner Millennium ED

application.

One single record for the patient viewable

from anywhere in the Trust.

Real-time whiteboard tracking across the

Trust.

Real-time dashboard information for activity

across the trust.

Improve transition of patient into the trust.

Ability to send GP discharge summaries

electronically.

Improved alerting capabilities.

Data Storage Current Data Storage does not

provide a suitable capacity or

resilience for the subsequent

virtualisation of all remaining Physical

Trust Servers. (Approximately 70).

This will also allow us to upgrade the

remaining 60 Windows 2003 Servers

to 2008 R2 for continued Microsoft

support and updates.

The Procurement of a SAN for the SQL

Infrastructure will allow us to Load

Balance the servers and Increase the

Capacity to move File Servers to CIFS Shares on

the NetApp.

Capacity to Convert all 2003 Servers to 2008

R2 Virtual Servers

Increased Resilience and performance for the

Virtual SQL Infrastructure

QIPP Savings as currently used Replication software will no longer be required and as such no support and maintenance costs will be associated

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amount of SQL Databases that can be

virtualised, reducing operational costs

and increasing performance on these

systems.

Back Ups The IT department has a

responsibility to make sure that

essential services to the trust are

backed up and that those backups are

functionally tested in case of a system

failure.

The trust also has a requirement to send backup data offsite to a secure location.

Essential Patient and Operational Data is

Backed up and multiple copies of this data are

available On site and long term storage

securely stored offsite

SQL Databases are backed up and can be restored in case of failure.

Table 1 – eHealth Key Projects

royal united hospitals bath nhs foundation trust 2015-20 ...of service users, their carers and...

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