WHICTS County ICT Programme Board

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Worcestershire Health ICT Services ICT Planning
Workshop Presentation (15th Dec 08) John
Thornbury Director Worcestershire ICT
Services john.thornbury_at_nhs.net (planning_081215_
0910_pres_v01.ppt)
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Content

• SHA Meeting (16th Dec 08) Agenda.
• Planning Outline (Worcestershire LHC).
• Lorenzo Outline Implementation Plan (OIP)
• Current OIP - practicalities.
• Recommended LRC Initial deployments PCT MH).
• Operating Framework
• Service Plans
• PCT (Commissioning)
• Acute
• MHP PCT (Provider) - awaited.
• Local Deployments
• Project
• Current (extending into 2009-10).
• New.
• Departmental (where available).
• Next Steps
• Remaining HoD Plans.
• Priorities.
• Resources.

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SHA Meeting 16th Dec 08 (Agenda)

• Update on contractual negotiations with CSCA
• Process.
• Outcomes.
• Current Position.
• Impact on Plans (OIP DIP)
• LHC / PCT Strategic Planning
• Informatics Planning integral to strategic
  planning.
• The strategic alignment tool.
• Operating Framework national informatics
  expectations.
• DH performance monitoring in 2009/10.
• Confirming DIP to Mar 2010 / Deployment
• Deployment approach (start early ramp up
  reduce risk).
• LHC risk sharing approach (response to MJ paper).
• Risks Issues approach.
• Single instance ramifications.
• Clinical documentation need for very early
  discussions.

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Planning Outline (Worcestershire LHC)

• Service Plans made available between Dec 08 and
  Feb 09
• Acute available.
• PCT (commissioning) - available.
• PCT (provider) awaited (end Jan 09).
• MHP awaited (end Jan 09).
• National Operating Framework 2009-10 now
  available.
• Health Informatics Review now available.
• Planning meeting with SHA (16th Dec 08).
• Intended Process (dependent on SHA meeting) will
  be
• Summary Draft Plan to County ICT Programme Board
  (29th Jan 09).
• Priorities.
• Resources.
• Further Drafts.

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Lorenzo Outline Implementation Plan (OIP)

• Full plan last submitted in Mar 08.
• Contract reset has been taking place since Feb
  08
• Previous OIP
• Full OIP in Attachment 1 (xls) and Attachment 2.
• 2009-10
• For 2009-10, only covers Community Mental
  Health
• Care Management (replacement PAS for ipm).
• Clinical Documentation.
• Current Go Live dates (generally 2009-10 Q2F)
  when worked back to include planning and
  engagement would need to have already started at
  beginning of 2008-9 financial year, but
• No system available.
• Contract reset discussions until end of Autumn
  08.
• Functional reconfigurations require better
  groupings
• Care Managt Daycare Managt (MH Care
  Managt) administrative processes.
• Clinical Documentation Care Plans (after care
  management etc to gain clinical benefits).

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Lorenzo Outline Implementation Plan (OIP)

• New Release Strategy.

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Lorenzo Outline Implementation Plan (OIP)

• Recommend Attachment 3 for initial deployments
• Takes a range of LRC1, LRC1.9 and LRC2 modules
• Takes into account
• General Availability dates for deployment units.
• significant local service priority deployments.
• likely availability delays ironing out of
  functional issues Worcs does not want to deploy
  systems that do not work.
• Wish to have demos asap - BUT only demos that
  reflect the actual finished product.
• Standard deployment timescales taken into
  account
• Phase 1 (8.6w) Creation of Brief.
• Phase 2 (6.4w) Brief to PID.
• Phase 3 (variable) PID to Go Live.
• BUT require significant pre planning work with
  the service to understand functionality in a
  service setting and what approach to using the
  system is best for Worcestershire this would
  need to take place before Phase 1 as not taken
  into account yet.
• Clinical functionality follows administrative
  (PAS type) deployments (also because replacing
  ipm).
• Conclusion
• Projects may start over 2009/10 BUT...
• Main deployments will take place over 2010/11
  and..
• Conclude 2010/11 Q3/4

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Operating Framework Service Plans

• Operating Framework 2009-10 Headlines
• Existing 2008-9 priorities remain
• Improving cleanliness And reducing HCAIs
• improving access through achievement of the
  18week referral to treatment pledge, and
  improving access (including at evenings and
  weekends) to GP services
• keeping adults and children well, improving their
  health and reducing health inequalities
• Links with Social Care / Local Authority
• Prevention packages for Older People
• Supporting those with Long Term Conditions
  particularly with the provision of individualised
  care packages
• Supporting carers
• Cancer Reform Strategy
• National Stroke Strategy
• Access to maternity neonatal services
• Childrens health and mental well being
• improving patient experience, staff satisfaction
  and engagement
• preparing to respond in a state of emergency,
  such as an outbreak of pandemic influenza.

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Operating Framework Service Plans (Contd.)

• Operating Framework 2009-10 Headlines (contd.)
• Developments to be Addressed
• National Alcohol strategy
• National Dementia Strategy
• End of Life Care
• Access to psychological therapies
• Military personnel, their dependants and
  veterans
• Reduction in mixed sex accommodation
• People living in vulnerable circumstances
• People with learning disabilities.

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Operating Framework Service Plans (Contd.)

• Operating Framework 2009-10 Headlines (contd.)
• Specific reference to technology - priorities
• Deployment of Summary Care Record.
• Data Quality especially use of NHS Number
  correct patient demographics.
• Secondary Uses Services (incl use of HRG4 for
  PbR).
• Information Governance - especially secure
  storage of Patient Identifiable Information.
• Programme management arrangements especially
  those to identify and realise business benefits.
• Guidance and more detailed expectations are
  provided in Informatics Planning Guidance
  2009/10, published alongside Operating Framework
  ltto be obtainedgt.
• Supported by evidence of robust local technical
  infrastructure, plans will identify the roadmap
  that achieves the five key elements for secondary
  care determined in the Health Informatics Review
  ltDarzi Informatics Rreview?gt as soon as possible
  and demonstrate how community services will be
  supported in a more integrated way with primary
  care and other local services.

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Operating Framework Service Plans (Contd.)

• PCT (commissioning) Headlines
• Reflects Operating Framework.
• 10 local strategic priorities
• Staying Healthy - improve health and well-being
  overall, and close the gap between the health of
  the worst-off and best-off in Worcestershire.
• Maternity Services - transform services to
  improve choice, quality of care and the range of
  services for women and infants to improve health
  outcomes.
• Child and Adolescent Mental Health - improve the
  emotional and mental health and well-being of
  Children and Young People aged 0-19 years through
  development of Child and Adolescent Mental Health
  (CAMHS) services.
• Adult Mental Health and Well-being - promote
  mental health and wellbeing through timely access
  to talking therapies, development of
  comprehensive dementia services and improvements
  to existing services.
• Intermediate Care - minimise unnecessary hospital
  admissions and excess lengths of stay through
  development of intermediate care services which
  ensure people have access to appropriate care
  closer to home.
• Diabetes - redesign services to provide care
  closer to home.
• Falls Prevention - reduce deaths and disability
  related to falls, adding life to years, and
  reducing emergency admissions in older people.
• Stroke Care - provide high quality stroke care
  across whole pathway to people at risk of TIA and
  stroke, all patients and families and carers of
  stroke survivors with improved access to
  scanning and community rehabilitation.
• End of Life Care - give people a choice of end of
  life care and improve the quality of care for of
  adult patients with less than one year to live,
  including allowing more people to die in their
  own homes.
• Protecting Excellence - maintain or improve
  performance in other key areas of health service
  delivery where necessary.

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Operating Framework Service Plans (Contd.)

• PCT (commissioning) Headlines
• Includes specific reference to ICT
• Staying Healthy
• Performance monitoring for Healthy Lifestyle
  services will require providers to have
  appropriate data collection and collation systems
  in place - eg. Health Trainers.
• New screening programmes will require IMT
  solutions to extract lists of eligible people,
  record the outcome of screening and refer screen
  positive individuals for ongoing management.
• Maternity
• Maternity Information System is being
  implemented.
• ??IMT Badger Lite neonatal information system is
  being implemented.
• Children Adolescent Services
• Increased workforce of 21 will require IT
  support.
• Intermediate Care
• develop an integrated IT system that allows
  collection of a common data set and facilitates
  sharing of information across organisations.
• IT systems will need to be developed to meet the
  needs of a mobile workforce so that info can be
  shared instantly through mobile IT systems.
• Health social care staff will need to use a
  single IT system so that information can be
  easily shared and collected.

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Operating Framework Service Plans (Contd.)

• PCT (commissioning) Headlines
• Includes specific reference to ICT (contd.)
• Diabetes
• establish a single patient register for diabetes
  communication and patient transition across the
  care pathway.
• utilisation of Map of Medicine as a tool to both
  develop and publicise the new care pathways which
  reflect the proposed model of care.
• Falls Prevention care pathway, information
  prescription, public health information ,
  telehealth.
• Stroke
• Care pathway, information prescription, public
  health information , telehealth.
• Potential link with several other counties to
  support rota for 24/7 access to thrombolysis -
  compatibility of local PACS system with others on
  rota.
• General IT equipment for developing community
  stroke service.
• Design of system to collect and analyse data to
  support performance management.
• End of Life Care
• Support patients by helping them to know their
  disease and the services available, and to feel
  confident to remain at home, offering local
  support groups, day hospice access and carer
  respite
• centralising of Hospice IT - coordination of
  palliative care services joining up
  acute/community IMT /OOH/ambulance service
  providers.

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Operating Framework Service Plans (Contd.)

• PCT (commissioning) Headlines
• Includes specific reference to ICT (contd.)
• Information Management - need for accurate,
  consistent and timely information to support
  commissioning decisions performance management.
  This requires systems to capture, collate and
  analyse data.
• Care Records Service Healthspace The
  development of Health Space and the continuing
  development of the National Care Record Systems
  will be pivotal in the delivery of care in the
  21st Century. Healthspace will enable patients
  and the public to be more proactively involved in
  improving their health and partnering with health
  and care professionals to improve both their
  experience of care and the associated outcomes.

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Operating Framework Service Plans (Contd.)

• Acute Headlines
• Reflect Operating Framework.
• Heavy emphasis on gaining Foundation status.
• Additional local focus in the following
• Urgent Care - to increase capacity for urgent
  care outside of the AE and reduce the time spent
  being assessed in AE, whilst consolidating and
  potentially growing catchment area
• those not requiring urgent care will be assisted
  back into a planned care or chronic disease
  management pathway
• those requiring minor injury services will be
  streamed directly into the minor injuries unit
• those requiring an appointment with a specialist
  but who need not be seen immediately will be
  directed to rapid access outpatient clinics
• those requiring observation outside the AE or
  assessment over a period longer than 4 hours will
  be streamed to the observation, medical, surgical
  and paediatric assessment units
• those requiring resuscitation will bypass triage
  and proceed immediately to the resuscitation area
• those requiring more complex urgent intervention
  through to emergency specialist support and
  diagnosis will be streamed to AE.

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Operating Framework Service Plans (Contd.)

• Acute Headlines
• Additional local focus in the following
• Planned Care to be the provider of choice for
  Worcestershire residents and neighbouring
  counties through
• Developing additional capacity eliminating
  waiting times for treatment diagnosis -
  currently deliver a significant proportion of
  planned care through waiting list initiatives
• Additional capacity will delivered through
  improved productivity and efficiency, but
  additional
• theatre capacity is required and programmed
  within plan
• Improving communication with patients 89 of
  our patients would recommend Trust to their
  family and friends - capture this opportunity for
  positive marketing through tailoring the
  information we provide to patients, making that
  information more accessible and timely, and
  engaging membership in promoting the Trust
• Improving performance against key Healthcare
  Commission operational standards need to
  improve on cancelled operations, and working to
  drive down DNA rates and increase day surgery
  rates
• Grasping the opportunities presented by new
  technologies and practice, and developing
  specialist treatments locally.

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Operating Framework Service Plans (Contd.)

• Acute Headlines
• Additional local focus in the following
• Children Maternity Services expectation that
  by expanding the range of services offered, Trust
  will also increase catchment population with the
  support of commissioners
• Worcestershire PCT and Acute Trust have jointly
  agreed a strategy for maternity and childrens
  services. Addresses potential vulnerability of
  the services at both the Worcestershire Royal and
  the Alexandra Hospitals due to their size, volume
  of activity and recruitment of specialist staff.
• Trust will investment in additional posts to
  bring existing rosters into compliance with
  national standards, and by extending the range of
  our services on each site, so that they provide
  care for local people who currently are referred
  outside of the county, and are also attractive to
  specialists when recruiting.

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Local Deployments

• Projects
• Current project expected to extend into 2009-10
• GPSoC
• EPS.
• GP2GP.
• Equitable Access to Primary Care Services.
• OOH.
• Order Communications (Anglia).
• Acute Medical Records (Procurement).
• Maternity (Clinicals).
• Theatres
• WRH.
• Community (Evesham Tenbury).
• GP Data Extraction.
• PCTi Docman (EDT module).
• NSTS.
• NHAIS.
• Portfolio Management (EPM).
• VoIP.

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Local Deployments (Contd.)

• Projects
• Extend into 2009-10 as operational rollouts (post
  project)
• Digital Dictation (new depts, existing product).
• Map of Medicine (new pathways, existing product).
• Order Communications (Anglia) (new wards,
  existing services).
• Oasis V7.
• Acute Risk Register (Datix) (new depts, existing
  product).
• E-consent (new depts, existing product).
• EPM (new depts, existing product).
• VoIP. (new locations, existing product)

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Local Deployments (Contd.)

• Projects
• Potential new projects
• Acute Medical Records (Deployment).
• Lorenzo.
• CRIS Upgrade.
• NHS Number / Duplicates.
• EDS (in house Bluespier).
• NCRS Instance Consolidation (dependent upon
  business case).
• Child Health (health visitor school nurses to
  NCRS?).
• Summary Care Record (have indicated 2010/11
  but).
• Healthspace (have indicated 2010/11 but).
• NHS Staff Record?
• New services in Order Communications (Anglia).
• E-health assistive technologies.

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Local Deployments (Contd.)

• Other Departmental
• Network Servers
• Pharmacy migrate Ascribe onto virtual machine
• CCU upgrade to virtual machine
• Rhapsody upgrade information reporting and
  interface system
• NCRS Reporting Ardentia replacement, separate
  nodes for PCT (Comm)(Provider) MHP.
• Project Management Server to manage reporting.
• Intranet replacement of PUNCH with Folding
  Space system for all intra and extranets.
• New Cardiology system to replace current Phillips
  ECG system.
• Oasis hardware redesign and replacement to
  provide resilience and upgrade to version 7.10.
• UPS large single UPS devices to be installed in
  each Hub room to provide continual uptime for all
  systems.
• Second Virtual Server farm hosted at ALX.
• Sleep database migrate laptop hosted Access db
  to SQL.
• Pharmacy drugs refrigeration temperature
  monitoring system.
• SCCM Microsoft system, providing proactive
  monitoring and reporting on key systems.
• Wi-Fi rollout to Community sites.
• OCS Integrating voice presence into outlook.

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Local Deployments (Contd.)

• Other Departmental
• Knowledge Management
• promoting the knowledge and info managt approach
  to business.
• project managing the development of the Knowledge
  and Information Strategy to comply with the
  National Service Framework for Quality
  Improvement.
• facilitating the establishment of team knowledge
  officers through contacts developed by the
  Clinical Librarian
• encouraging the development of a learning culture
  for all staff by providing knowledge skills
  training, including providing access to and
  assistance in the use of e-learning materials.
  Training will be offered in a variety of formats
  to ensure the widest possible availability.
  Training will available to teams of staff, on a
  one-to-one basis and in regular workshops. A
  critical appraisal module will be added to the
  programme.
• develop links with Trust research departments
  providing literature search services in the
  initial stages of research and information skills
  training to staff.
• Develop links with audit departments, providing
  literature search services in the initial stages
  of the audit process and information skills
  training to staff.
• Increase the use of new technologies blogs, RSS
  feeds etc to promote WHL services keep staff
  up-to-date in areas of interest.

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Local Deployments (Contd.)

• Other Departmental
• Knowledge Management (contd)
• upgrading and rationalising the current network
  of Internet Study Points to form bases for
  personal e-learning and facilities for small
  group knowledge and information skills training
  and IT training.
• providing better access to internal knowledge via
  the development of the Worcestershire Knowledge
  Portal hosted by Folding Space.
• investigating the knowledge needs of service
  non-users and determining how these can be met.
• contact each GP practice in GP roadshows
  promoting electronic resources and remote library
  services
• organise a conference with education and public
  sector librarians to promote working ties
• support of GP practices with the Books On
  Prescriptions project, working closely with WPCT
  and WCC
• developing the proposed project to support the
  provision of public health information, including
  the employment of a fixed term contract Clinical
  Librarian
• editing the Map of Medicine in conjunction with
  clinical teams (current involvement is with the
  Diabetes Teams)
• supporting the development of Information
  Prescriptions in cancer clinics as part of the 3
  Counties Cancer Network IP Project working
  closely with the Macmillan Information Pods.

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Local Deployments (Contd.)

• Other Departmental
• Clinical Informatics Application Support (based
  on previous HoD note ongoing elements)
• Unisoft GI Reporting.
• Bar Code scanners.
• LSD Accreditation.
• Bluespier clinical datasets.
• NCRS mini projects (10 services).
• SMS text messaging.
• Tablets.

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Next Steps

• Remaining HoD Achievements (2008-9) / Draft
  Objectives (2009-10).
• Close of 19th Dec 08.
• Priorities based on.
• Workshop discussion.
• HoD plans.
• Iterations with alignment to
• Operating Framework
• Trust service plans
• Resources
• Identify specific new resources for HoD plans and
  outcome of workshop discussion.
• Realign to Operating Framework Trust Financial
  Plan.
• Drafts
• Summary to County ICT Programme Board (29th Jan
  09).
• Priorities.
• Resources.
• Drafts.