IM&T Strategy 2010 – 2015 Wrightington Wigan & Leigh

NHS Foundation Trust

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Document Control:

DOCUMENT NAME: IM&T Strategy 2010

DEPARTMENT/FUNCTION: IM&T

Authorisation:

Reviewed by SignatureKeith GriffithsMartyn Smith

Security Classification: Internal Confidential

Version History

VERSION DATE AUTHOR COMMENTS / Reasons for changeDraft 0.5 8th

DecemberStephen Dobson

Approved V1.0

15th December

Stephen Dobson Approved at the Trust Board on 15th December 2010

Supporting documentationAshton, Leigh and Wigan (ALW) Clinical services delivery strategy

2009/2011Service Catalogue v 1.2.doc

WWL Webinar. A future proof trust wide Electronic Patient Record

2010/11 three year capital plan (November 2010) Confidential

IM&T Strategy Board Terms of Reference

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CONTENTS

1 EXECUTIVE SUMMARY.........................................................................................5

2 IM&T VISION...........................................................................................................7

3 INTRODUCTION.....................................................................................................7

3.1 Drivers for change.............................................................................................................................................7

3.2 A patients story now..........................................................................................................................................8

3.3 High Level Strategic aims...............................................................................................................................103.3.1 Infrastructure............................................................................................................................................103.3.2 Information capture, integration and workflow.......................................................................................103.3.3 Reporting.................................................................................................................................................11

3.4 Technology principles.....................................................................................................................................113.4.1 Open Standards........................................................................................................................................113.4.2 Community Driven..................................................................................................................................123.4.3 Best Practices...........................................................................................................................................123.4.4 Integrated.................................................................................................................................................123.4.5 Automated................................................................................................................................................123.4.6 Foundational............................................................................................................................................12

3.5 High Level Current IM&T capabilities........................................................................................................12

3.6 High Level IM&T objectives..........................................................................................................................143.6.1 Integrated Clinical Solutions objective....................................................................................................143.6.2 Unified Communications objective.........................................................................................................173.6.3 Records Modernisation objective............................................................................................................183.6.4 Reporting/Information Management objective........................................................................................183.6.5 Infrastructure objective............................................................................................................................19

3.7 A patients story for the future........................................................................................................................19

4 ORGANISATION...................................................................................................20

4.1 Business Analysis.............................................................................................................................................20

4.2 Business Intelligence.......................................................................................................................................21

4.3 Data Quality.....................................................................................................................................................23

4.4 Production and Modernisation......................................................................................................................26

4.5 IT services........................................................................................................................................................27

5 PROJECTS...........................................................................................................28

5.1 Capital Projects...............................................................................................................................................285.1.1 Health Information system (HIS)............................................................................................................345.1.2 IT Relocation Project...............................................................................................................................35

5.2 Ad-Hoc projects...............................................................................................................................................37

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5.3 Revenue projects.............................................................................................................................................37

6 GOVERNANCE AND REGULATION...................................................................37

6.1 IM&T Strategy Board....................................................................................................................................37

6.2 Data Quality Committee.................................................................................................................................39

6.3 Information Governance................................................................................................................................406.3.1 Information governance Main Requirements..........................................................................................42

6.4 Risk Register....................................................................................................................................................43

6.5 IM&T Leadership team..................................................................................................................................436.5.1 Knowledge management.........................................................................................................................44

6.6 Local Implementation Strategy (LIS) Board................................................................................................44

6.7 QIPP.................................................................................................................................................................44

7 ROADMAP............................................................................................................47

8 LONG TERM VISION............................................................................................49

9 Appendix A............................................................................................................51

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1 Executive SummaryWith the release of the Governments white paper “Equity and excellence: Liberating the NHS”, the NHS is facing a large re-organisation with the removal of SHA’s and PCTs and an increase in autonomy for Foundation Trusts. There is a significant emphasis on the role of patient experience, outcomes and quality standards and new libraries of quality indicators are being developed for patient pathways. Trusts will be expected to show faster discharge rates, increased number of day care operations and decreased delays prior to operations. They will also be required to improve the communication with partners such as GPs and community care, speeding up the admission and discharge rates and transfers of patients between these partners. IM&T is expected to be a critical enabler.

IM&T has an excellent track record of delivery for innovative solutions and is recognised for developing a world class best of breed electronic patient record. IM&T has ambitious goals for an integrated health information system to provide a solid founding platform and support the future model of health care within our local health community. The overall vision is for an intuitive suite of clinical and administrative functionality tied together seamlessly and intimately into a health information system.(HIS) using a hybrid strategy (hybrid between best of breed and single solution). This will enable end to end patient care, improved safety, quality and patient experience with a significant emphasis on real time clinical information and data quality. The HIS will allow WWL FT the autonomy to rapidly develop its own clinical processes in partnership with other providers and with the potential to allow seamless access and flow of information across primary and secondary care. Most of the systems that IM&T support and introduce are clinical as opposed to admin systems and over the next 2 to 3 years these include an integrated PAS/A&E system, E-prescribing, trust/GP wide order communications, trust wide bed management, a new CCU and ICU system and several other clinical systems. This goal of an integrated health information system is consistent with the goals of the National program for IT (NPfIT), though IM&T are operating outside the Lorenzo NPfIT framework. The primary reason for this is that Lorenzo is not delivering and has been scaled back to such an extent that it would no longer provide any benefits to WWL FT (E-Prescribing, a critical trust requirement for instance , is no longer included in NPfIT).

Enhanced communication will be key to speeding up services, whether it is guided workflow through clinical systems, automated reminders for patients, single touch consultant to consultant dialling through to telehealth or telecare. Integrated communication technology will be considered during development of all clinical and administrative systems and pathway re-designs.

We need to become a paper light organisation. This will require digitisation of workflows that are currently paper. It will require a move towards real time/near real time data capture and all the changes in behaviour this will bring. It will also require new technologies for data entry such as light weight tablets. However, once achieved, it will generate huge savings through reduced paper output and processes for moving and storing paper. We also expect numerous reporting and data/clinical/patient quality improvements.

The government white papers are introducing greater demands on reporting requirements and information generation. Through a combination of real time data collection, together with

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integrated clinical systems a robust data warehouse and advanced reporting tools such as QlikView and SQL Server reporting services we will be in a good position to report on the vast amounts of data required. This will give us much greater capability to understand our organisation in real time at the click of a link and to reach government information objectives. We will be able to more clearly understand our profitability, our performance and bottle necks. Information generation will become more accurate and less of a manual task.

The current Bryan House location for IM&T represents a significant risk due to fire, due to lack of recovery suites, due to lack of generator support and due to lack of power capacity. In addition IM&T has been served notice to relocate from its current premises and has no option but to look for a new facility. Smooth running of the IT Suite is critical to the continuous operation of the many clinical systems supported by IM&T and patient safety is at risk in the event of a significant failure or downtime. To reduce this risk and to enable the relocation IM&T has to introduce new technology (e.g. virtualisation) to enable maximum continuous service during the relocation and to minimise downtime once at the new location. However, this will allow us to provide a fully secure scalable IT infrastructure that will ultimately enable the robust 24/7/365 support of the clinical environment and be a critical enabler for extending services beyond secondary care or horizontally to other hospitals. It will also enable a shared service strategy for IM&T with other primary and secondary care IM&T organisations. This will be a necessary requirement if we are to deliver on QIPP targets. Partnership with public and private sector is considered critical to achieving shared service goals.

As a professional organisation IM&T must comply with external and internal standards and be governed appropriately. This requires adherence to standards such as the IT infrastructure library (ITIL), rigorous risk management and adoption of Data Quality and Information Governance requirements.

The entire IM&T strategy alluded to above can be summarised into 5 strategic objectives supported by standards and governance. These objectives are

Integrated Clinical Solutions Unified Communications Records Modernisation Reporting/Information management Infrastructure.

According to Bill Gates “The first rule of any technology is that automation applied to an efficient operation will magnify the efficiency. The second rule is that automation applied to an inefficient operation will magnify the inefficiency”. Hence, the introduction of any new technology will require a great deal of process mapping, re-design and change management. To support this and to support the overall strategy, IM&T are requesting (and aim to facilitate) a culture of clinical engagement with IM&T, clinical data ownership, contemporaneous data entry and a focus on data quality.

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2 IM&T VisionTo provide a suite of fully connected clinical and operational applications providing end to end clinical care, using integrated clinical pathways. To maximise the efficiency, capability, compliance and productivity of the WWL FT. To automate interactions between Primary, Secondary, Tertiary and Social Health Care and to increase the safety, comfort and convenience of patients passing through our hospital.

3 Introduction

3.1 Drivers for changeThe NHS and indeed the entire country are going through a period of economic austerity and change that has a direct impact on all NHS trusts. The 2010 comprehensive spending review (http://cdn.hm-treasury.gov.uk/sr2010_completereport.pdf) shows that the total amount the government spends on the NHS is increasing in real terms in each year of the Parliament and that the NHS is very well protected compared to most other public services. However, the NHS will need to make efficiencies to deal with rising demand from an ageing population and the increased costs of new technology. The NHS has already committed to make up to £20 billion of annual efficiency savings by the end of the Spending Review period (2011 – 2015) through the Quality, Innovation, Productivity and Prevention (QIPP) Program, including a reduction of management costs by 45%. This will have a large impact on IM&T which already has annual CIP costs of 12% for non-pay and 7% for pay. It is possible that these CIP targets will continue for at least the length of the Spending Review unless IM&T is in someway protected as a strategic service within the organisation.

Since coming to power the government has produced two white papers that directly impact on IM&T. Firstly “Liberating the NHS: Regulating Healthcare Providers”. This sets out the following broad requirements;

Responsive to patientso No decision about me without meo Increased access to informationo Choice of providers, consultants, GP’s.o Rating of hospital services.o Patient centered approach.o Focus on Personal Care.

Better outcomeso Outcome measureso Removal of targets with no clinical justificationo Paid according to performanceo Reduction in outcome equalities

Removal of SHA and PCTs Devolvement of commissioning to GPs and Local consortia.

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All of these will have a bearing on the type and functionality of software introduced by IM&T and emphasise an emerging theme of increased access to information. It also increases the emphasis on patient experience and changes the relationship of the hospital to the GP.

Secondly “Liberating the NHS: An information revolution”. This sets out the following broad requirements;

The right person having the right information at the right time. Information as a health and care service in its own right, freely available for all who

need it. Information as a basis for genuine shared decision making (no decision about me

without me). Patients and service users in clear control of their care Openness of information, transparency and comparability Away from an approach where we expect every organisation to use the same system

to one where we connect and join up systems. Information captured accurately at the point of care in the user’s record. Patients able to keep a copy of their care record. Patients encouraged to communicate with GP’s and other care providers and to

access services online.

A major impact of this paper is the ability for organisations to work freely outside of the national program for IT (NPfIT) which will greatly increase the speed at which they can deliver the above requirements. Trusts will require a large change in the culture of their organisations with the accurate capture of more data closer to the point of care (contemporaneous data collection) and a move to a paper light organisation. Connections across the health care economy will have to be strengthened with information flowing seamlessly from GP to hospital and community health.

In addition to the white papers, IM&T has to comply with the trusts 2010 (and future) corporate objects (Appendix A) of “high quality patient experience”, and to “Develop and implement integrated clinical care pathways backed up by Information Technology systems which guide compliance”. In other words IM&T is moving more to information/knowledge/process based systems that guide clinical staff simply and easily through agreed workflows.

In summary, IM&T is facing a large pressure to reduce IM&T costs. At the same time it has unprecedented demands to move towards a paperless environment where increasing amounts of information are digitised and reported on. IM&T is expected to aid in maximising the efficiency and quality while minimising the costs of the hospital as a whole. It will be a fine balance for IM&T to achieve the correct middle ground between cutting services and maximising efficiencies/capabilities across the organisation.

3.2 A patients story now

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As part of the Ashton, Leigh and Wigan (ALW) Clinical services delivery strategy 2009/2011 (see supporting documents) pictures of current services have been described as patient stories. These are powerful in highlighting areas for service improvement and are directly relevant to WWL’s IM&T strategy. We have replicated them in this document, much of them taken verbatim from ALW’s strategy. These patient stories include development opportunities within our current service delivery. They are not representative of our services as a whole but highlight areas of challenge we want to address to achieve excellence in everything we do. The picture will assist staff to identify the key areas of improvement we must make to achieve our vision of having excellent services which fully support health and well being through quality.

A patient’s story now.

“As an out patient, I need lots of referrals to get to your services. If I have more than one problem, I have to tell my story again and again and no- one seems to talk to each other. I have to wait days or weeks to get the referral and then weeks to be seen. I am not given any choices or offered any explanation about why there may not be a choice. My GP doesn’t know when I have been seen. When I do get seen I only get a bit of assessment and then I am told I have to wait again for help. I don’t get information about how long I might have to wait and what to expect when I get seen. When I arrive at the hospital I can’t find my way to the right department and the signs are confusing. I am often left waiting for some time before being asked what I want. Then, everyone in the waiting room can hear what I say and which service I am seeing. The work you do is usually very good but my other problems are not looked at and you don’t tell my Doctor about my treatment for weeks. When I ask questions, I can feel like a nuisance. When I have a test I have to wait ages for the results to come back. When I used to see my doctor he seemed prepared for me. My paper clinical notes were on the table when I walked in and my X-rays were already on the light box. The doctor faced me and we had an informative chat while he made brief notes into a tape recorder. It felt personal and efficient. Things seem to have changed with IT. Now when I arrive the doctor often has his back to me trying to enter information into the computer. He seems uncomfortable with the technology and keeps flicking between screens to different applications and between the computer and paper record. He also has to keep re-entering usernames and password. He seems to spend less time actually dealing with me than he did before and I’m not confident he is capturing information efficiently or accurately”.

“As an inpatient I feel vulnerable and lost in your hospital. I’m often left on my own with little to do. Little information is displayed and I am not able to access any information about myself, the hospital, how long I have to wait, what is likely to happen to me or even what has happened. I use wireless internet all the time at home but can barely get a 3G signal inside your building so feel cut off. Although I can get access to tv programs and internet devices in your wards, it is limited and expensive. I have to pay per day or part of and as I don’t know how long I’m staying it can be frustrating to be charged. As I’m transferred from ward to ward and consultant to consultant I feel there is no unified view of my data and feel like I’m getting different sometimes conflicting advice. I have to tell my story again and again and no- one seems to talk to each other or able to find what other information I’ve been told or where I’ve been. Your consultants and managers seem very busy always rushing about but don’t seem to have the information they need at their fingertips and are forever generating scrappy badly written pieces of paper that I’m sure must get lost. When my treatment medication is written down I can’t read or understand the information. I’m worried that the pharmacy will prescribe me the wrong medicine or dose. When a consultant has my case notes it’s a huge pile of badly

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ordered tattered paper. I have to remind him what has happened to me. He can’t find any information about me beyond the top two pages in the 10 minutes he can afford to spend with me. I don’t feel people have time to really understand my condition and I’m sure a lot of repetition and mistakes are happening because of this”

3.3 High Level Strategic aims

There are several key requirements that immediately come to light from these stories and the preceding drivers for change. Firstly we need to be patient centred, with the patient acting as the prime hospital customer. Information should be readily available for the patient care and we must strive to improve the patient experience. Secondly we need to make sure data is captured effectively, easily and accurately across the organisation and can be readily used to support clinical staff throughout their processes and interactions with the patients. Finally we need to make sure we have the infrastructure in place to provide the high performance required to allow real time information capture and usage. With these in mind WWL IM&T has 3 high level strategic aims and objectives, surrounding its infrastructure, data capture, data handling, data reporting and analysis.

3.3.1 Infrastructure. IM&T aims to provide WWL with a robust future proof value for money IT and telecommunications infrastructure capable of supporting current and anticipated business load. IT infrastructure will;

Be stable and secure. Have minimal downtime. Be resilient to external threats (power outages, virus attacks, terrorist attacks) Be able to support future wireless, mobile computing and collaboration technologies. Be readily scalable to support increasing demand. Provide standards based environments for application development and maintenance. Provide sufficient access devices. Provide 24/7 service desk support. Be high performance for critical systems.

3.3.2 Information capture, integration and workflowIM & T aims to provide integrated clinical systems that provide single comprehensive views of patient data, including real time reporting of admissions discharge and transfers. It will streamline the WWL business and maximise patient safety. IT will;

Capture data digitally, minimise the use of paper, reduce or remove current paper archives and reduce the WWL carbon footprint.

Provide environments that simplify data capture, whether from automated data capture devices (e.g. ECG recording) or from easy to use bedside applications.

Provide tools and workflows that minimise the entry of duplicate data, minimise missing data, maximise data quality, and automate wherever possible.

Provide integrated clinical applications allowing information to flow seamlessly and in real time across the business without the need for re-entry in different departments. E.g.

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a patient admitted into the hospital would be entered via an admission screen, depending on the user the screen will send data to PAS, bed Management, A&E etc.

Implement applications capable of using state of the art decision trees and processes for improving care. For instance, ordering systems that ensure the most appropriate medicines for a condition are ordered.

Implement technology that allows treatments and conditions to be coded as close to the time of capture as possible.

Provide technology capable of capturing all required data points simply and efficiently. E.g. RFID technology capable of tracking beds, patients, supplies other assets allowing instant inventory and real time tracking of assets and their interactions.

Integrate applications and information flows with partners in primary and social medicine to improve efficiency of our partner interactions.

Utilise communication technologies to maximise communication efficiencies across the hospital and healthcare economies.

Be patient centric.

3.3.3 ReportingIM&T aims to make relevant information available to those who need it simply and efficiently and in real time wherever possible or practical. IT will;

Provide integrated applications allowing authorised users to hop from one application to another unconsciously or with little effort and that present the most relevant data to the user given the context. E.g. a comprehensive electronic patient record system, E.g. patient call centres that can recognise patient telephone numbers and immediately present relevant patient information to the user. E.g. an automated system that can locate and call the most relevant and closest people to respond to a 2222 crash call.

Provide a comprehensive warehouse reporting environment allowing authorised users access to high quality operational metrics.

Provide a self service environment that allows users to easily drill down to real time information necessary for their purposes.

Enable the capture and reporting of data that may be useful for discovering new processes or procedures that if adopted will improve health care.

Provide patients with on demand access to information or broadcast information directly to patients wherever useful. E.g. access to their specific electronic medical records or broad communications through waiting room digital displays.

Provide public access to health information allowing personalised wellness support for patients and public.

3.4 Technology principles

To implement the above aims IM&T will try to adopt (where appropriate and practical) the following principles.

3.4.1 Open Standards We use technology that follows proven, open standards with multiple interoperable implementations. We avoid technology that locks us into a single vendor, that prevents easy conversion of data, or that does not allow easy integration with other commercial and open source products.

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3.4.2 Community Driven We strive to be an active participant in technological development rather than a passive consumer. We partner with vendors and the technology community to steer the future direction of technology to meet our needs

3.4.3 Best Practices We follow the best practices of the industry and our peer institutions, recognizing the unique challenges faced by healthcare institutions. We avoid reinventing wheels, and instead seek existing solutions and work cooperatively with other institutions.

3.4.4 Integrated We choose technologies that can reuse and build on the existing infrastructure. We consistently encourage vendors to make their products integrate with existing infrastructure, choose products and technologies based on their ability to do so, and refuse to be lured into isolated solutions

3.4.5 Automated We cannot afford to have people doing work that computers can do. We cannot scale to support the entire hospital if routine tasks must be done manually. Unattended operation, automation of all routine tasks, and automation of deployment and provisioning are top priorities in any technological decision.

3.4.6 Foundational We must focus our efforts; we cannot deploy every useful technology. We will focus on deploying technology that is useful across the largest possible set of users (or resolves regulatory requirements), that can serve as the foundation and building blocks for more specialized services, and that is secure, stable, reliable, robust, well-documented, and easy to integrate with.

3.5 High Level Current IM&T capabilities

As of December 2010 WWL IM&T supports the following (see supporting document Service Catalogues v1.2.doc);

Approximately 5000 users across 6 major sites and 4 organisations including;o WWL FTo ALW PCTo 5 Boroughs Partnershipo Salford NHS FT

9 major network circuits between the sites including full network and telecommunications infrastructure.

2500 desktop/laptop computers. 58 Clinical Applications. 9 National Applications. 59 Non-Clinical Applications. 87 Desktop applications.

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16 classes of hardware (phones, monitors, PDA’s, PACs mobile devices etc). Up to 26,000 combined service requests and incidents and up to 250 change requests

per year.

IT services provides a 24/7 on-call service to the organisation for infrastructure support (not applications) and is fully IT Infrastructure compliant for the following processes

Service Desk Incident Management Problem Management Change Management Configuration Management Release Management.

As of 2010 IM&T bases most of its technology on the Microsoft infrastructure. The standard for desktop/laptop computers is Microsoft office 2003 on Windows XP operating system. Most database servers are Microsoft SQL Servers and clinical systems are usually exposed via Intranet explorer version 6.

The trust implemented wireless networking throughout its sites during 2008-2009 and in November 2009 replaced its old analogue telephony system with a full digital voice over IP system. By June 2010 it is starting to reap the reward with the introduction of a popular voice enabled directory calling system removing the need for a large number of calls to go via switchboard or for people to remember long lists of phone numbers.

The trust adopted an integrated best of breed policy for its clinical/administrative applications in 1999 and in 2007 adopted Orion Rhapsody (a highly capable integration engine) and Orion Concerto (a portal system) for development of its current electronic patient record system (EPR). As of 2010 WWL FT’s EPR is highly regarded and thought to be one of the best examples of an integrated EPR in the UK. A comprehensive webinar discussing the trusts EPR can be found at http://ehealthinsider.webseminars.co.uk/futureproof/ and in the supporting document “WWL Webinarv5.ppt”. The EPR provides a single look and feel together with context sensitive navigation across several applications such as PAS, PACS, A&E, Pathology and Order Communications.

The trust started the implementation of its data warehouse in 2007 using the Ardentia data warehouse product. The warehouse supports the overlay of various business intelligence tools for reporting purposes and is linked to several systems (e.g. PACs, A&E, Radiology, Pathology). Currently the Ardentia Cassius reporting tool and SQL Server reporting services are utilised directly by clinical staff and for the generation of Board reports and statutory reporting services. The data warehouse also supports financial reporting and intelligence via the Qlikview reporting tools. The warehouse is under continual development as more data sources are added and reporting capabilities are increased.

A full set of applications currently supported by WWL IM&T can be seen in supporting document Service Catalogues v1.2.doc.

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3.6 High Level IM&T objectives

The three high level strategic aims described earlier have been broken down to 5 strategic objectives presented to and approved by the Trust Board in November 2009. A tabular summary representation of the relationships between IM&T strategic Aims, Objectives, Goals and Solutions is represented in Chapter 5 (Projects).

3.6.1 Integrated Clinical Solutions objective.The goal of the integrated clinical solutions objective is to provide a set of clinical and administrative applications tied together in a way that maximises their ease of use and value to the clinical staff and patients. The aims of section 3.2.2 need to be fulfilled such that end to end clinical care is optimised, with workflows/pathways aiding clinical decisions and information capture. A future proof framework for incorporating new functionality and workflows needs to be created. Historically divisions have been free to evaluate and implement whatever application they feel best meets their immediate needs (a best of breed approach). As a result WWL FT now has over 100 disparate supported systems and several hundred unsupported ones. There is no map of information assets across or unified flow of data through these systems and multiple entry points occur for identical pieces of information causing duplicates and requiring reconciliation. The EPR system has been a very effective attempt to improve this situation, resulting in consolidated records from multiple systems. Several custom integrations now allow information to flow more or less seamlessly from the PAS to pathology, radiology, and theatres or onto the warehouse. However, integrating multiple disparate systems in a complex web of connectivity can be tricky, error prone and lead to unstable applications and delays or errors that could affect patient safety. For example, integration of the WWL bed management system required 5 different application integration points together with over 96 classes of message being transferred. On top of this are all the issues of screen navigation integration. This complexity will only get worse as more and more systems are integrated using one off custom integration solutions. In addition most applications installed at WWL will have one or more maintenance upgrades every year. Each of these need to go through a change control process and can result in numerous upgrades every month. Each upgrade takes considerable resource and has the potential to impact on integration.

The best of breed approach currently used by the trust is only as good as the underlying systems. WWL currently has a 20 year old clinicom PAS system. This causes significant difficulties with implementation of bi-directional interfaces making it difficult to update information within the PAS from clinical systems such as maternity or order communications. This has a large impact on the capability of the overall EPR system.

Therefore a major part of our strategy is to work with a small number of preferred providers that service multiple areas of the business, are tightly integrated and have purpose built mechanisms for interoperability with other systems.

There are two extremes of model for implementing clinical systems. The first is the best of breed where the best clinical functionality is chosen for the particular area and the solution is integrated into the hospital suite of applications via an integration engine. This is the model the trust has worked with for over 10 years leading to the issues described above. The other

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extreme is the Single Solution model where a single vendor provides all clinical functionality in a modular approach. This solution tends to be extremely expensive, can result in reduced functionality in specific areas , reduced adaptability and vendor lock in. However, it greatly reduces the maintenance costs and can provide greater end to end control of clinical care. WWL has chosen the middle route between these two models, which we call a hybrid model, and we suspect provides the greatest flexibility and opportunity for future development. Figure 1. describes and compares these models.

With this hybrid model in mind, the trust has gone out to a full OJEU procurement process for a single system that can integrate the most critical pieces of functionality for the trust. The most critical functionality required currently is;

A new modern PAS to form the backbone of WWL’s clinical systems. An integrated A&E system. An E-Prescribing system.

WWL has chosen Cambio as the provider of these three systems. Existing and future clinical systems will be bolted to the Cambio/EPR hybrid solution as dictated by the operational needs of the hospital. The Cambio PAS/A&E/E-Prescribing system is known as the WWL health information system (HIS). Together with the trust integration engine WWL are now free to choose whether additional clinical functionality is obtained from Cambio giving very tight integration with the other Cambio products, or whether functionality is obtained from other vendors and integrated to the Cambio solution using the trust integration engine. WWL IM&T believes this gives the best of both worlds allowing us to choose the appropriate balance between functionality, cost, and maintenance.

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FIGURE 1. Clinical System Implementation models

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3.6.2 Unified Communications objective

Unified Communications (UC) is the convergence of real-time communication services such as chat, presence, IP telephony, Conferencing and Speech Engines with non real time services such as email & system applications together with the processes involved in administrative and clinical settings. As most activities within a hospital are highly dependent on effective communication, the objective of unified communications is to maximise the ease and speed with which staff and patients can interact. Since November 2009 WWL has voice over IP installed throughout most of the trust, supported by analogue phone lines in critical areas to provide additional resilience to services such as the 2222 crash calls. WWL is therefore in a good position to extend its current capabilities into areas highlighted in figure 2.

FIGURE 2. Benefits of Unified Communications Objective.

UC will allow voice mail (on Phone or PC), creation of a digital telephone directory, the ability to take an extension number wherever you go, remote working, presence (the ability to see if someone is at their computer and if they are busy or free), instant messaging or doctor calling with a single touch direct from an e-prescribing or pathology application to allow discussion of service requests. With UC it will be possible to communicate directly with patients and their carers via email, text or voice mail. Hospital staff could be 'pulled' to support the most important patients or directed to respond to specific emerging issues before incidences become critical. Telemedicine could also be delivered via this approach. Call centres could be developed capable of automatically routing patient requests or filling doctor schedules. Assets (e.g. patient beds) could be tracked electronically and instantly. Patient notes and sample orders could be made directly onto wireless devices. Together with the integrated clinical solutions described above, processes could be made quicker, more efficient and safer.

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3.6.3 Records Modernisation objective

Currently WWL FT relies heavily on paper. As a result patient notes can balloon to a huge unwieldy pile of papers that is physically moved from storage to consultant on a regular basis. The opportunities for losing information, for delays and for inaccurate human transcribing are enormous. In addition the space required for the paper and the environmental impact are not insignificant. The records modernisation objective is to minimise the amount of paper produced on a daily basis and to reduce the amount of paper stored in its patient vaults. Eventually the trust aims to become paper light or even paper free.

The combination of integrated clinical systems together with the unified communications strategy will enable our ability to move to a paperless (or nearly paperless environment). Bedside access devices will enable real time collection of digital patient information. Order communications systems will minimise flow of paper within the hospital and between hospital and GPs. An integrated HIS will eventually allow us to greatly reduce the amount of paper as we move to a fully integrated care record across primary and secondary care.

The Cambio HIS comes with comprehensive clinical noting capabilities. It is expected that this can be used to create electronic forms that replace nursing notes and other paper records. Eventually once most records are generated digitally, instead of via paper, a scanning solution may need to be put in place to prevent the need to store further paper. This may also be required to digitise nationally important case notes from Wrightington, required for research. The size/scope of the scanning solution will depend on the residual paper requirements.

Currently the timeline for going paper light has not been determined and is dependent on the clinical noting capabilities of Cambio. As such it is unlikely that WWL will move to a paper light organisation until at least 2013.

3.6.4 Reporting/Information Management objective.

The government white paper Liberating the NHS: An information revolution shows clearly that information generation is going to be critical for the NHS. There is increased demand for reporting all across the hospital to ensure quality of care, quality of data capture and productivity. The reporting/information management objective is to reach a point where key information is available across the organisation via simple self service interfaces, in real time where new accurate reports can be generated simply and easily with minimal manual effort.

Using data warehouse capabilities and analysis tools such as SQL server reporting services or Ardentia’s Cassius, IM&T often has a comprehensive view of the data that no other part of the organisation has, this puts IM&T in a unique position for reporting and managing information (e.g. key performance indicators, capacity planning, statutory/financial reporting and data quality checking and data cleaning). At first hand IM&T see the issues created by multiple disparate systems and poorly integrated solutions. A great deal of progress has been made by introducing an integration engine, building a reporting data warehouse and introducing an integrated Electronic Patient Records system. As the above strategies move forward reporting and information management are critical to ensure that appropriate information flows are implemented, that appropriate high quality information is displayed to the appropriate user in the appropriate context and that report generation is simplified to a state where users can generate them on demand rather than relying on specialist groups. No new IT system should

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be put in place without a consideration of its reporting requirements and the ability to integrate information generated from the system with the warehouse.

3.6.5 Infrastructure objective

IT services currently has an impressive infrastructure providing much of the stability, bandwidth, security and business continuity required. It is one of the few NHS IT service organisations with a nationally recognised accreditation with NHS Connecting for Health and has a standardised service desk providing advice to the entire WWL FT. In addition it has made some great steps to modernise WWL’s infrastructure, for example, introducing comprehensive wireless coverage, introducing bedside mobile client access devices and modern stable redundant data storage systems for secure data backup. However there are several places where IT infrastructure needs to be improved if it is to keep up with increasing demand on its services.

The infrastructure objective is ultimately to create an environment that meets the infrastructure strategic aims described in 3.3.1 and meets requirements/standards such as Information Governance and IT infrastructure library. As of November 2009 WWL FT has been served notice by their landlord that they will need to vacate their current premises at Bryan house by October 2011. There is no option to extend the lease, to create a new lease or to purchase the current building. Hence, in the short term, the major objective is to move IM&T into a secure long term facility where it can expand its capabilities to meet the infrastructure strategic aims. This location will be at the soon to be vacated sterile services unit at Leigh. To enable this move IM&T must quickly introduce new technologies such as server virtualisation and improved disaster recovery capabilities. This has the added benefit of modernising IM&T and creating a capable facility with the physical room to expand and the potential to provide hosting support for other organisations leading to income generation. These new technologies also reduce IM&T’s carbon footprint and maintenance costs and have important relevance for future CIP savings.

The Leigh facility will also allow WWL IM&T to operate as a shared service with the PCT IM&T division and will allow it to provide services for GP’s and Community health, as well as services such as disaster recovery and others for Bolton and Salford hospitals. IM&T are starting discussions with these other organisations to understand the possibilities for sharing services. This will be essential if large savings are to be realised. This is discussed later in this document and a wider shared service discussion can also be found at (http://www.nhsconfed.org/Documents/QIPP%20Back%20office%20FINAL%20REPORT_pb181110.pdf)

3.7 A patients story for the future

Part of the strategic vision is expressed in a patient story which is set in the future.

“As an out patient I find your services very responsive. As soon as I have been referred to you I can check my appointments and question all your services using one single telephone number or the internet. I can learn of open slots and re-book at a time convenient to me at any point. My GP can look directly at my patient record and knows instantly when I will and have been seen. I can see maps of the hospital on the

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internet and find see exactly where I have to go for my appointment. I can even see what the current waiting times are in the areas I have to go to and if really busy I can re-book for a different time. When I arrive I can check myself in at the front with a quick swipe of a barcoded letter before I move on to my waiting area. When the consultant sees me he has all my information in front of him electronically on a device that the two of us can both look at at the same time. It is ordered and complete and he can quickly find everything that has happened to me. When he prescribes me medication he does this straight into my electronic record and the system checks to make sure he hasn’t over prescribed and that the medication is correct for my condition. A record is made of our visit straight away together with all clinical decisions. By the time I reach the pharmacy my medication is already prepared and waiting for me to pick it up”

“As an in patient I have my own personal laptop with me and can browse the internet whenever I like. Using this I am in regular contact with family members, can use it for entertainment, can browse the days menu (and make choices) and can easily see a summary of my medical record including my medications, allergies and adverse drug reactions. I regularly use this to try and understand the medications I’ve been given and the implications they have for my health. My doctors and consultants are very happy to discuss any of this information with me.

As I’m transferred from ward to ward and consultant to consultant I’m impressed with the unified view they have of my health. Everyone knows exactly where I’ve been and what has happened to me, not just at the hospital but with my GP. I have a clear management plan, that I can see is being followed and it even gives me an expected day that I will be discharged. Usually this day seems to be correct and if it changes this is clearly recorded and any adjustments to the plan available for me or my GP to see. Your consultants and managers seem relaxed and willing to provide time for me. They seem to have plenty of information right at their fingertips and seem at ease with the technology. They capture data about me electronically and instantly using hand held devices that they operate with speed. I’m confident that the hospital is providing me with excellent health care and I feel I’m in good hands”

4 Organisation

As of 2010 IM&T is comprised of approximately 90 staff split across the five separate departments of Business Analysis, Business Intelligence, Data Quality, Production and Modernisation and IT services. The major functions of these five departments and their goals to support the IM&T strategy are highlighted below.

4.1 Business Analysis

The divisional analysis department has been re-focussed and re-named to Business Analysis to better support the IM&T strategy. Their role has been moved away from one of providing ad-hoc divisional informatics analysis requests to providing more strategic business analysis. This

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change happened early in 2010 and Business analysis is currently focussed primarily on supporting the capital and ad hoc program through 2010/11. As it matures it will start to focus more on its business change and performance management role to ensure the big five IM&T objectives are met.

Business analysis supports business change and performance management through organisational, divisional and departmental analysis. They have an important role in driving forward and managing the capital programme and ensuring demands from ad hoc requests to the IM&T department are appropriately met. They align their support across the clinical and non-clinical divisions.

Supporting information describing Business Analysis (as of July 2010) can be found at the following link http://159.170.244.72/pub/Main/InformationManagementAndTechnology/Business_Analysis_IMT_Presentation.ppt

The Business Analysis major roles are indicated below.

Role Summary Detailed RolesCapital Program:- Ground work Completion of Project Mandates.

Completion of Project Briefs (including stakeholder maps).Completion of Business Cases (including Risks/Benefits)

Capital Program:- Project Requirements Business Requirements SpecificationsCapital Program:- Post Projects Benefits Analysis

Post Project ReviewLessons Learnt

Business Change/Performance Management:- Benefits Realisation

Post implementation review(Have the benefits been realised? How can the benefits be realised?)

Business Change/Performance Management:- Processes

Business Process analysisIM&T Processes within the hospital. Process automation through IM&T

Business Change/Performance Management:- Performance Reporting

Assist in Tracking Divisional activity v Plan Service Modelling and Recommendations for changeCapacity and Demand analysis

4.2 Business Intelligence

Split into 3 groups (Analysis, Data Warehouse and Information Governance) Business Intelligence (BI) is closely aligned with the reporting/information management objectives. It is responsible for the organisations Performance, Statutory, Ad hoc and Commissioning reporting and analysis. It maintains and develops WWL’s central data warehouse on top of which all business intelligence activities are built and finally, BI co-ordinates the Information governance (IG) and freedom of information (FOI) requirements to ensure WWL is compliant with IG Law and meets its IG Monitor requirements.

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A summary break down of the roles of the three different groups is indicated below.

Role Summary Detailed RolesAnalysis Performance Monitoring

Key Performance Indicators & trend analysis Statutory, Routine & Ad-hoc reporting for Executives and Divisions Commissioning and marketing analysis Benchmarking Advice , Guidance and investigation of adverse variances

Data Warehouse Maintain the sourcing of key datasets within the warehouse.Develop reporting dataset structures.Maintain front end reporting tools. Ascertain reporting requirements and develop data warehouse reporting strategy.Co-ordinate the inclusion of additional data sources. Implement requests for change.

Information Governance Advice and Guidance on IG requirements IG Toolkit Requirements IG Audits Action plans to achieve IG compliance IG Training and awareness Freedom of Information Requirements and Requests

The above high level list of roles can not do justice to the output provided by BI. The performance reports and compliance frameworks require a team of more than 10 people on a daily basis to extract and configure large volumes of data. Ad hoc requests from the directorate that at face value sound simple enough may require several days worth of data transformation together with the generation of a narrative explaining outputs.

Using the data warehouse, BI is planning to automate or facilitate the automation of reporting capabilities as much as possible. Ultimately to support the reporting/information objective, many of these reports will become self service. BI has recently set up a BI board to ensure that the data warehouse pulls information from all critical sources, that key reports are prioritised through its business intelligence reporting tools or that key datasets are sourced to reporting customers such as finance for financial reporting. It has a goal of ensuring all appropriate data throughout the organisation can be integrated and accessed via the data warehouse. Information governance will ensure that all appropriate laws are adhered to as information is disseminated around the organisation. For many of the statutory reporting requirements data may have to be collected manually then re-keyed together with a narrative explanation from different parts of the divisions. BI is looking at ways to automate the capture of this information or to speed up the process of review using technology.

A key to providing high quality reports with less effort is to ensure data is entered into systems in a timely manner, preferably as close as possible if not at the time at which that data was

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collected. Collection of information such as CQUIN indicators (e.g. Stroke pathway) as close as possible to the time of collection reduces errors and helps move the organisation towards its goal of becoming paper light.

Supporting information describing Business Intelligence (as of July 2010) can be found at the following link http://159.170.244.72/pub/Main/InformationManagementAndTechnology/Business_Intelligence_Presentation_KF_130710.ppt

4.3 Data Quality

The Data Quality department is split into three groups (Clinical Systems administration, Data Quality, IT Training and Clinical Coding. It has roles that impact on all of the IM&T Key objectives from ensuring high quality information is captured and reported (via appropriate training) through validating and correcting information recorded on systems (such as NHS number) .

A summary break down of the roles of the three different groups is indicated below.

Role Summary Detailed RolesSystem Administration Team System Admin of

Choose & Book PAS /SAM A&E System (MSS) Digital Dictation Bed Management

Undertake system configuration e.g. maintain Consultant masterfile, ward masterfile, add or remove data field values Liaise with system suppliers to resolve any system issuesUndertake system testing for new releases of software and manage the system upgrades though the approval processWork with IT Services to ensure data backups are completed regularly to prevent the loss of dataCommunicate system changes to all end usersAdvise users of appropriate use of systems taking into consideration confidentiality and privacy and where this has been breached to support the investigation of system misuseGenerate user accounts and undertake password resets.

IT Training Provide training across PAS/SAM CAB EPR Care Pathways

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Bed Management Digital Dictation A&E Maternity Order Comms Microsoft office packages

Provide classroom and 1-1 training on how to use IT Systems including the requirements for capturing contemporaneous quality information Develop training materials for users to access – These are available on the IT Training intranetDevelop online training packagesUndertake system testing for new systems and upgrades to existing systemsMan the user help desk and provide support to end users on system usage

Data Quality Provide advice on how data should be captured according to Connecting for Health Data Standards – this supports all data submissions to the PCTs for payment according to the agreed contracts. Any changes in activity recording must meet the data standards criteria and be already included or re-negotiated with the relevant PCTUndertake regular audits to ensure data captured is timely and accurateInvestigate data issues raised by staff across the organisation and also those raised as part of the PCT payment challengesCreate and maintain GPs/Contracts on the PAS system and ensure all patient activity is contracted accordingly to secure payment by the PCTUndertake NHS number tracing for all patient records via the National Spine to ensure a high trace rate is achieved and maintained - This also support payment for patient activity undertakenMonitor all new patient registrations and verify for completeness and possible duplicate registrations – where the duplicates are confirmed undertake patient merging or where casenotes exist against both records co-ordinate the merging of both electronic and paper recordsReview all returned clinical correspondence to the Trust and ensure the correct GP receives

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the correspondenceInput the monthly bed status information provided by the wards – This information supports the extraction of bed utilisationOutput reports to the departments where data is incomplete e.g. clinic outcomesProvides support for the administration of the Summary Care Record and it’s users in conjunction with the Registration Authority Manager

Clinical Coding The Clinical Coding Team are responsible for undertaking all clinical coding for inpatient activity to support Payment by Results (PBR) Their key tasks as part of their roles are:

Complete clinical coding for all inpatient activity by the Advancing Quality and PBR deadlines

Provide clinical codes required to support extraction of data as required by the Divisions or mandatory data submissions

Clinical Coding leads provide support to the Divisions in ensuring that clinical documentation supports the allocation of the correct ICD10 and OPCS4 codes to obtain payment for patient care

Audit all patient unexpected deaths to ensure they have been accurately coded

Data quality goals to support the 5 IM&T objectives are as follows.

Role Summary GoalSystem Administration Team Build on the centralised trust systems

approach (hybrid model) to ensure data integrity across systems. Implement the HIS system

IT Training Move to E-Learning Packages to reduce the face to face demand for training and allow a self service modelImplement refresher training. Provide Microsoft office training to increase the IT literature of WWL staffImplement training for all new systems.

Data Quality Pro-actively monitor data quality.

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Work with divisions to drive real time data capture. Increase the use of the NHS Number as the patients primary ID.

Clinical Coding Deliver coding completeness within 5 days post dischargeCode without notes directly from the clinical systemsIncrease the clinical understanding and participation in coding.

Supporting information describing Data Quality (as of July 2010) can be found at the following link http://159.170.244.72/pub/Main/InformationManagementAndTechnology/DQ_Team__presentation_for_IMT_Away_Days_July_2010.ppt

4.4 Production and Modernisation

A startling amount of the software requirements for UK hospitals cannot be obtained off the shelf and any hospital wanting robust applications capable of supporting the business must have access to a group capable of configuring, developing and modifying software. Production and Modernisation (P&M) perform that role at WWL FT. As the demand for development flexes depending on the needs of the organisation, P&M scales up or down using temporary staff to meet these needs while keeping a core base of developers and project/program management experience to maintain standards and knowledge across the group.

A summary break down of the roles PM is indicated below.

Strategy and Capital Programme Design Programme/Project Management Requirements Analysis Input into Business Case Development Detailed specifications of need Systems Procurement/Tendering Contract Negotiation Software Development Interface Development Software Systems Support and Database Administration.

A core component of P&M is management of the capital program. Hence, P&M are critical to delivering all the software systems that support the five high level IM&T objectives (more information of these projects is shown in chapter 5).

As well as their delivery on the Capital program, P&M are continuously improving program and project governance, developing their standards and increasingly focusing on commercial opportunities for any in-house developed software.

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Supporting information describing Production and Modernisation (as of July 2010) can be found at the following link http://159.170.244.72/pub/Main/InformationManagementAndTechnology/Pod_n_Mod_IMT_Strategy_Presentation_-_Final.ppt.

4.5 IT services

Comprised of Service Delivery and Service Support, IT services is responsible for maintaining and supporting the current systems and infrastructure outlined in Error: Reference source not found, High Level IM&T Capabilities, and the supporting document Service Catalogues v1.2.doc. Service support comprises of a service desk capable of logging calls 24/7/365. The desk is operated by WWL staff between the hours of 8.00am and 5.30pm Monday to Friday and by the third party ‘Ansaback’ outside of these hours. Technical support is available from WWL FT staff during office hours and infrastructure support (not application support) is provided as an on-call service for priority 1 and 2 calls.

The mission of Service Desk Support is “To enhance the productivity of the Foundation Trust and to empower our users by making information technology accessible. We achieve this by providing a customer focused single point of contact for quality IT services and technical support”

The following standard IT Infrastructure Library processes are in operation

Service Desk Incident Management Problem Management Change Management Configuration Management Release Management Availability Management Capacity Management

Service Delivery consists of the infrastructure, network, change management, release, telecoms and registration authority teams.

To support the five high strategic objectives of IM&T IT Services has four workstreams developing the projects described below.

Workstream ProjectsIT Suite Relocation To agree a site, design, layout and technology

for moving the entire IT suite from Bryan house to a suitable location such as Leigh HSDU building. To implement the Move from Bryan house to the new location with minimal impact on the organisation, but at reasonable cost.

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Infrastructure Upgrades Server VirtualisationDeployment of Storage Area Network SolutionsRemote TeleworkingPatch Management Virtual Desktop Infrastructure.

Service Desk Implement a 24 hour support service (in partnership with other departments (e.g. Radiology/Pathology). This is application support in addition to the currently provided infrastructure supportImplement an online support service.

Network and Telecommunications Wi-Fi for Patients and VisitorsReal time network monitoringNetwork Security (Device lockdown)Overhaul of Wrightington cabling.

More information regarding these projects is shown in chapter 5. Supporting information describing IT Services (as of July 2010) can be found at the following link http://159.170.244.72/pub/Main/InformationManagementAndTechnology/IT_Services_Technology_Strategy.ppt

5 Projects

The three categories of projects managed by IM&T are capital, ad-hoc and revenue projects.

5.1 Capital Projects

Capital projects are determined by factors such patient needs, business demands, software refresh cycles and their importance to the IM&T strategy and by extension the entire trust. They are agreed with the IM&T strategy board and set at the beginning of each financial year. A rolling three year program of capital projects is developed and reported annually to Monitor. This becomes the Monitor 3 year plan. Spend against this plan and deviations from it are monitored weekly by production and modernisation. The table below indicates the current 30 capital projects and their planned three year capital expenditure as of July 2010. Note the costs below are indicative and not set in stone.

For each capital project a business case is developed by business analysis. This will typically include the reasons for the project, case for change, benefits, options appraisal, a full cost/benefit analysis of all options and a project implementation timetable. Once this business case is approved at Meeting point and the trust board (depending on the cost), spending against the business case can move ahead.

Project # Project Name Year 1 CapEx Year 2 CapEx Year 3 CapEx

1Infection Control Bed Management Phase IV Confidential £0 £0

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2 Hospital Integrated System (HIS) Confidential Confidential Confidential

3Unified Communications (Phase IV Telecoms)

ConfidentialConfidential Confidential

4 Data Warehouse Confidential £0 £05 ICU/HDU £0 Confidential £06 Order Communications Confidential Confidential Confidential7 Clinical and Patient Quality £0 Confidential Confidential8 Electronic Information Boards Confidential £0 £09 CareFX £0 £0 £0

10 EPR Confidential Confidential Confidential11 Medical Records £0 £0 £012 Integrated Cardiology System Confidential £0 £013 Stroke System Confidential £0 £014 Map of Medicine £0 £0 £015 Process Automation (Workflow) £0 £0 £016 Flexible Working £0 £0 £017 Single Sign On Confidential £0 £018 MCAP £0 £0 £019 IG Toolkit Confidential Confidential Confidential20 IT Relocation Confidential Confidential £021 Pharmacy System Upgrade Confidential £0 £022 Printer Rationalisation Confidential Confidential Confidential23 Desktop Replacements Confidential Confidential Confidential24 Server Replacements/Virtualisation £0 £0 £025 Wireless Networking £0 £0 £026 Network Replacements £0 Confidential Confidential27 Patient Self Service £0 Confidential £028 Summary Care Record Service £0 £0 £029 SLR Confidential Confidential Confidential30 Treasury Management Confidential £0 £0

       

         Totals   Confidential Confidential Confidential

Table 1. 2010/11 Capital projects. Indicative costs for three year monitor plan.

All projects are mapped against the Aims, Objectives and Goals of the IM&T Strategy. A summary of the IM&T Strategy Aims, Objectives and Goals together with their associated 2010/11 projects (solutions) are shown in Table 2.

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Aim Objective Goals SolutionsInfrastructure: IM&T aims to provide WWL with a robust future proof IT and telecommunications infrastructure capable of supporting current and anticipated business load

Infrastructure:To re-locate into a secure long term facility with expansion capability. To modernise IT technologies to enable relocation, to reduce maintenance and to reduce the carbon footprint. To be compliant with standards/requirements such as ITIL and Information governance. To share services with other organisations.

Be stable and secure. Have minimal downtime. Be resilient to external threats (power

outages, virus attacks, terrorist attacks) Be able to support future wireless,

mobile computing and collaboration technologies.

Be readily scalable to support increasing demand.

Provide standards based environments for application development and maintenance.

Provide sufficient access devices. Provide 24/7 service desk support. Be high performance for critical systems. Provide one IT Access Device to 2 beds. Have a maximum 3 second screen

refresh on all applications Manage all IT developments via robust

Change Management procedures

Server Virtualisation VMware Desktop Virtualisation Active-Active disaster recovery Dual site resiliance Information governance requirements

o Sanctuaryo Web Filtrationo E-mail encryptiono other

San migration to Net apps Patch Management (servers/desktops) Anti-Virus upgrades External remote access via home PC’s Operating system upgrades (windows 7

evaluation) Internet explorer 7 upgrade. Network review and upgrades

Information capture, Integration and workflow: IM & T aims to provide integrated clinical systems that provide single comprehensive views of patient data, including real time reporting of admissions discharge and transfers. It will streamline the WWL

Integrated Clinical Solutions:Hybrid strategy (between best of breed and single solution for creating a suite of clinical functionality.

Capture data digitally Provide environments that simplify data

capture Provide tools and workflows that

minimise the entry of duplicate data, minimise missing data, maximise data quality, and automate wherever possible.

Provide integrated clinical applications allowing information to flow seamlessly and in real time across the business without the need for re-entry in different departments.

Cambio HIS. PAS A&E E-Prescribing Orion Rhapsody Integration engine Orion Concerto Portal Electronic Patient Record (EPR) Single Sign On. Map of Medicine Other clinical solutions ICU CCU

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business and maximise patient safety

Implement technology that allows treatments and conditions to be coded as close to the time of capture as possible.

Implement applications capable of using state of the art decision trees and pathways for improving care.

Provide technology capable of capturing all required data points simply and efficiently

Integrate applications and information flows with partners in primary care.

Infection control/bed management system Pharmacy system upgrade A&E/PAS integration Maternity Order Communications (GP and Trust) GP access to EPR CareFx EPR Pathways database (e.g. stroke system) Process Automation Workflow tools (E.g.

SharePoint) Medical care appropriateness protocol (MCAP) Senior review of patients tracking system. Patient self service. ScanTrack

Unified Communications: the convergence of real-time communication services such as chat, presence, IP telephony, Conferencing and Speech Engines with non real time services such as email & system applications together with the processes involved in administrative and clinical settings

Utilise communication technologies to maximise communication efficiencies across the hospital and healthcare economies

Remove communications Latency. Improve Patient Contact capability. Improve staff availability. Improve staff security. Improve patient care.

o Automate patient follow upo Share information across skillso Rapidly locate

equipment/resources

Voice over IP. Microsoft communications server (instant

messaging) Single touch instant messaging or calling from

clinical applications (e.g. to a doctor). Email/text or voice mail communication to

patients. Call centre optimisation.

o Automated routing of patient requests.o Automated completion of appointments.

Business process analysis and adoption of UC technology for process improvement.

Home/Flexible Working IG Toolkit Printer Rationalisation Fax Servers Asset Tracking

Records Modernisation : Minimise the amount of paper produced on a daily

Minimise the use of paper Reduce or remove current paper archives Reduce the WWL carbon footprint

Automated communication with GP’s (e.g. electronic discharge letter)

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basis and to reduce the amount of paper stored in its patient vaults. Eventually the trust aims to become paper light or even paper free.

Increase data accuracy associated with contemporaneous data entry.

Cambio clinical noting to replace paper documentation (e.g. Nursing notes).

Light weight hand held devices for contemporaneous data entry (e.g. Galaxy tablets, IPADs).

EPR pathways tool. Document management and scanning solution

for remaining paper documentation.Reporting: IM&T aims to make relevant information available to those who need it simply and efficiently and in real time wherever possible or practical.

Reporting: Key information is available across the organisation via simple self service interfaces, in real time where new accurate reports can be generated simply and easily with minimal effort.

Provide integrated applications allowing authorised users to hop from one application to another unconsciously or with little effort and that present the most relevant data to the user given the context.

Provide a comprehensive warehouse reporting environment allowing authorised users access to high quality operational metrics.

Provide a self service environment that allows users to easily drill down to real time information necessary for their purposes

Enable the capture and reporting of data that may be useful for discovering new processes or procedures that if adopted will improve health care.

Provide patients with on demand access to information or broadcast information directly to patients wherever useful

Provide public access to health information allowing personalised wellness support for patients and public.

To provide feedback on quality of information contained within systems.

Cambio HIS. PAS A&E E-Prescribing Data warehouse Business intelligence tools QlikView SQL Reporting Services Single Sign On. Electronic information boards CareFx IG Toolkit Summary Care Record

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Table 2. IM&T Strategy Summary

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Further information describing each of the projects (solutions) can be found in the supporting document Portfollio_detailed_review_v1.6.xls.

The two largest projects are the Health information system and the IT Relocation project both of which deserve their own mention in the following sections.

5.1.1 Health Information system (HIS)

With the release of the Governments white paper “Equity and excellence: Liberating the NHS”, the NHS is facing a large re-organisation with the removal of SHA’s and PCTs and an increase in autonomy for Foundation Trusts. There is a significant emphasis on the role of patient experience, outcomes and quality standards and new libraries of quality indicators being developed for patient pathways. Trusts will be expected to show faster discharge rates, increased number of day care operations and decreased delays prior to operations. They will also be required to improve the communication with partners such as GPs and community care, speeding up the admission and discharge rates and transfers of patients between these partners.

We have ambitious goals for an integrated health information system to provide a solid founding platform and support the future model of health care within our local health community. Our overall vision is for an intuitive suite of clinical and administrative functionality tied together seamlessly and intimately into a single application. It will enable end to end patient care, improved safety, quality and patient experience with a significant emphasis on real time clinical information. The HIS will allow WWL FT the autonomy to rapidly develop our own clinical processes in partnership with other providers.

5.1.1.1 Summary of HIS benefits

It will provide a modern easy to use PAS, allowing robust real time admissions discharges and transfers, simple data extraction and reporting together with integrated A&E functionality.   It will provide complex ePrescribing functionality such as knowledge/decision support, computerised management of prescriptions and drug history. It will utilise unified communications technology to automate patient and information flows throughout the hospital and to support data sharing and integration with partner organisations across the health economy. The HIS will be a critical enabler of moving to a paperless office and will allow decision trees and pathways to be incorporated into our clinical workflow. Specific benefits include:

Real time capture of data providing a single accurate record for each patient that can be read by clinical staff and accessed by partner organisations.

Reduced time to admission. Removal of risk of duplicate case notes. Reduced length of stay. Reduced re-admission rates. Reduced pharmacy delays. Increased quality in prescribing and administration. Reduced medication errors. Early discharge. Automated warnings to ensure proper patient pathways are followed.

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Reduced administration costs. Paper medical records will cease to be the key mechanism for capturing the patient’s

history allowing a massive reduction in administrative, storage and transport costs.

Ultimately, real time knowledge of the patient’s condition, experience and context should facilitate senior review leading to reduction in length of stay and safe removal of bed capacity.

5.1.1.2 Supplier considerations.

To achieve the expected increases in Safety, Quality and efficiency, the HIS will lead to a significant change in culture at WWL with extensive and contemporaneous electronic capture of information and an increased dependency on information technology. To achieve this the HIS must be:

High performance (fast screen refreshes) Reliable (high uptime) and error free Intuitive (simple, quick and easy to use) Time saving Helpful (containing decision support) Simple to maintain Flexible Adaptable Liked and adopted by our clinical teams as their own (culture changing).

Using a full open journal of the European union tender process, we have chosen Cambio as the supplier that we believe is the most likely to provide the required functionality while at the same time providing a system with the capability to enable the above culture change at WWL.

5.1.2 IT Relocation Project. WWL’s IT Services department and IT Suite is currently located at Level 3, Bryan House, 61 Standishgate, Wigan. It contains the core servers, switches, racks and other infrastructure critical to the operation of WWL’s clinical systems, intranet and telecommunications and to the 24/7 running of the Trust. Currently the Bryan house location is a risk to WWL due to the following;

Bryan house is above a nightclub and a restaurant and next to a pub all representing fire risks.

Bryan house does not have generator backup. In the event of a power failure the battery backup provides 15 minutes of power (enough to safely shut down systems if it occurs within core hours). Uncontrolled shut down results in long system downtime and potential data loss.

There is no recovery suite. If systems go down there is no backup and systems will be out until they can be fixed. A recovery suite would allow back up systems to switch on if the main system fails.

Bryan house has reached its limits in power capacity for introducing new services.

These risks have resulted in a risk assessment (IMT005) being represented on the corporate risk register with a score of 20. “IMT005: The Trust is unable to restore major services in the event of a major incident harming the facilities at Bryan House. It is dependent on a single IT suite; there is no

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immediate recoverability in the event of a major incident. Certain services may be out for days to months”.

The accommodation is sub leased from Ashton, Wigan and Leigh Primary Care Trust who also occupy offices within the building. The current lease agreement the PCT holds with the landlord at Bryan House expires on 1st December 2010. Discussions have taken place with the Trust Solicitor in attempt to extend the lease agreement, but these have proved to be unsuccessful. The solicitor recommends that occupation cannot go beyond 31 December 2011. Therefore the IT Suite must be relocated.

5.1.2.1 Strategic context

Information Management and Technology at Wrightington, Wigan and Leigh NHS Foundation Trust is centric to the patient’s journey. IM&T’s vision is to provide a fully integrated suite of clinical and operational applications providing end to end clinical care. IM&T aims to maximise the efficiency, capability, compliance and competitiveness of the WWL business and automate interactions between Primary, Secondary, Tertiary and Social Health Care to increase the safety, comfort and convenience of patients passing through the Healthcare system. Smooth running of the IT Suite is critical to the continuous operation of the many clinical systems supported by IM&T and patient safety is at risk in the event of a significant failure.

It is not possible to simply pick up the equipment within the IT suite and move it to its new location with out the risk that most if not all IT services will be out of action for several weeks if not months. This could result in a massive reduction in trust capability, leading to a large loss of income and is an unacceptable risk to the trust. To avoid this risk IM&T aims to introduce virtualisation as a technology. This allows services to be safely replicated, and then moved, prior to turning services off at the original location. This would minimise disruption to the trust. Virtualisation technologies also provide many additional benefits. We have ambitious goals for our IT suite to utilise virtualisation technologies, provide a full recovery suite and also contain the scalability to provide for future growth and host / provide IT services for external organisations. The current IT facility in Bryan House will not allow for services to be hosted, however preliminary discussions regarding hosting IT Services are taking place in response to recent changes due to the White Paper, the search for efficiencies in the NHS and the QIPP agenda. WWL could be in an ideal position to offer its services in a new IT Suite that contains a recovery suite.

5.1.2.2 Summary of IT Relocation benefits

IT Relocation will provide revenue savings through virtualisation (virtualisation is a way of consolidating server resource; theory states that you can reduce the number of servers required up to 12:1 dependant on the physical use of the individual servers). Relocation will also mitigate the risk IMT005 on the Corporate Risk Register using a recovery suite makes provision for restoration of services quickly and effectively during system outages. The greatest additional benefit relocation would provide is to enable IT Services to host external applications, therefore increasing the ability for IM&T to generate income.

Specific benefits include:

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- Reduction of electricity costs- Reduction of carbon emissions - Consolidation of Data Storage - Ability to meet future demand - Ability to host IM&T systems for other providers- Provision of generator facilities currently unavailable at Bryan House

Ultimately, stable, secure and robust infrastructure at WWL will provide a robust future proof IT and Telecommunications system capable of supporting 24/7/365 the current and anticipated business load.

5.2 Ad-Hoc projects

Several new requests for project support reach IM&T every month. These are requests outside the current capital program and range from simple spreadsheet or database development all the way through to those requiring a full European tender. The ad-hoc request process is managed by business analysis. A standard set of information is collected for any request and the ad-hoc project is aligned to the IM&T strategy and the capital plan. If the new project aligns closely with the capital plan it may be possible to subsume it within a current capital project. If not then a funding source will be required or, if possible and demand dictates the project may be developed using current revenue resources. Examples of ad-hoc reports include the procurement of a new CCU system using charitable funds. EPR functionality for emailing community matrons once three admissions in a single month have been met. Requests for reports may be subsumed into the existing role of the data warehouse team as they continually develop their reports.

5.3 Revenue projects. These are projects managed by existing staff within the IM&T teams on top of their normal workload. For instance data warehouse report development, development of the board reports and compliance framework functionality within the Business Intelligence team.Within IT Services these projects include those related to information governance such as email encryption, web filtering and USB encryption (sanctuary).

6 Governance and Regulation

IM&T is a professional organisation within WWL FT and must conform to a host of internal and external regulations, and as such must be appropriately governed. The major governance boards and their relationships are shown in Figure 3.

6.1 IM&T Strategy Board.

The principle board relating to IM&T is the IM&T strategy board, the terms of reference of which are included in the supporting documentation. This board reports to the full Trust Board

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and as required to the Audit Sub Committee. The key responsibilities of the IM&T Strategy board are;

To keep directors informed of the design, content and implementation of the Trust’s IM & T Strategy.

To review the clinical and business benefits and risks associated with the strategy. To provide assurances into how the IM & T Strategy supports the Trust Board’s

Corporate Objectives in both business and clinical advances. To formally endorse all IM & T business cases that relate to major areas of investment. To advise upon, as required, the scope, delivery and performance of all key, critical

relationships with external stakeholders.

Reporting to the IM&T strategy board is the Business Intelligence Committee. This Committees purpose is to regulate the use of the data warehouse’s business intelligence. To ensure that information from the data warehouse is rolled out through appropriate business intelligence tools, to prevent the duplication of data and to prevent the creation of inappropriate data silos and associated inconsistencies in interpretation that can result. The Business Intelligence Committee is directly aligned with the reporting/information management objective.

Also reporting to the IM&T strategy board is the health records modernisation board. This plays a central role in determining how the trust moves forward to a paper light/free organisation and fulfils its IM&T Records Modernisation Objective.

Figure 3. Summary of Governance structures impacting on or impacted by IM&T.your hospitals, your health, our priority

6.2 Data Quality Committee.

All trusts need to produce an annual Quality Account Report (e.g. . http://www.nhs.uk/Services/Trusts/Overview/DefaultView.aspx?id=901) to provide public accountability for the quality of their services. In a similar vein to Financial accounts and the scrutiny that these receive to ensure accurate data is reported, the department of health (via Monitor) is starting to scrutinise the Quality Account Report to ensure it’s data quality. The data quality committee has been set up to ensure data is of appropriate quality. This is achieved by performing actions such as;

Creating data assurance documents for all targets and indicators Commissioning policies for maintaining data quality for staff working on data Generating system charts/procedure documents for reporting performance.

The overall responsibility for data quality for the Quality Report lies with the Director of Nursing and Performance and is overseen by the Quality Improvement Committee. Ultimately, overall scrutiny is provided by the Audit committee.

Figure 4. The incentives and relationships involved in generating high quality data.

Effective data quality is obtained through a combination of training, pressure from senior management, real time (contemporaneous) data entry, reporting and feedback together with auditing of captured data against source materials and policies. IM&T’s roll in this lies with designing systems that ease data entry, together with efficient reporting mechanisms that

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highlight areas for improvement. IM&T has little influence on the content of data in its systems. Instead, responsibility for the content of systems should lie with the individuals most able to influence this content. For the most part this will be clinical staff or general managers. Many of these staff will be designated information asset owners (IAO’s) for their respective system and will have an important role to play in information governance.

6.3 Information Governance

Information Governance is to do with the way organisations ‘process’ or handle information. It covers personal information, i.e. that relating to patients/service users and employees, and corporate information, e.g. financial and accounting records. Information governance applies to all staff and is not just a requirement of IM&T. However, there are significant components (e.g. information security) where IM&T has strong responsibilities.

Information Governance (IG) provides a way for employees to deal consistently with the many different rules about how information is handled, including those set out in:

The Data Protection Act 1998. The common law duty of confidentiality. The Confidentiality NHS Code of Practice. The NHS Care Record Guarantee for England. The international information security standard: ISO/IEC 27002: 2005. The Information Security NHS Code of Practice. The Records Management NHS Code of Practice. The Freedom of Information Act 2000.

Elements of information governance also relate to data quality and dictate a roll for information asset owners in the quality of their information.

The information governance toolkit is an online system which allows NHS organisations and partners to assess themselves against Department of Health Information Governance policies and standards. The IG Toolkit has 45 requirements. 22 of these are key requirements for which Foundation Trusts must attain a level 2 or above. A web site describing the toolkit and all of its requirements can be found at https://nww.igt.connectingforhealth.nhs.uk/ (or https://www.igt.connectingforhealth.nhs.uk/ if outside the N3 network).

WWL FT has to submit evidence for IG Toolkit requirements on an annual basis and is regularly audited against the requirements. The purpose of the assessment is to enable organisations to measure their compliance against the law and central guidance and to see whether information is handled correctly and protected from unauthorised access, loss, damage and destruction..Where partial or non-compliance is revealed, organisations must take appropriate measures, (e.g. assign responsibility, put in place policies, procedures, processes and guidance for staff), with the aim of making cultural changes and raising information governance standards through year on year improvements.The ultimate aim is to demonstrate that the organisation can be trusted to maintain the confidentiality and security of personal information. This in-turn increases public confidence that ‘the NHS’ and its partners can be trusted with personal data.

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CEO

Senior Information Risk

Owner (SIRO)

Information Asset Owner (IAO)

Information Asset Administrator (IAA)

Trust Employees

There are four attainment levels, 0,1,2,3. WWL FT are required to reach a Level 2 in 2010/11 for 22 of the IG toolkit requirements and are recommended to reach level 2 for all 45. It is a Monitor target to reach level 2 on the 45 IG Toolkit requirements and it is a Trust corporate objective to “Consistently deliver every element of Monitor/CQC targets” (see appendix 1)

Currently it is not clear what the implications are of receiving a non satisfactory status for the IG Toolkit. It is felt that most Trusts will fail in 2010/11, however this is not certain. There will clearly be an impact on Trust reputation. If the Trust suffers a data breach (e.g. loss of a USB stick containing patient names) the information commissioner’s office (ICO) could subject the trust to a fine of up to £500,000. If the trust is not compliant to Level 2 then the ICO may look at its case unfavourably and allocate increased fines.

6.3.1 Information governance Main Requirements. All 45 requirements can be found in https://nww.igt.connectingforhealth.nhs.uk/RequirementsList.aspx?tk=404333619696791&lnv=4&cb=10%3a21%3a52&sViewOrgType=2&sDesc=Acute%20Trust

Among other things these 45 requirements cover:

Data loss incidents Information risk to be managed in robust way Mandated IG training Culture change – e.g. introduction of privacy impact assessments Encryption for all media Clear and strong accountability & responsibility Identify assets and information risks Assigned ownership of information assets Audit trails & monitoring of user activity

In addition there is a requirement for defined roles across the organisation with the reporting hierarchy described in Figure 5

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Figure 5. Reporting hierarchy for information governance.

The SIRO must be a trust board member and has been identified as Keith Griffiths. Information Asset Owners (IAO’s) must provide assurance that information risk is being managed effectively for the asset(s) they own. They report directly to the SIRO and have the following responsibilities.

Knowing what information comprises or is associated with the asset. Understanding the nature and justification of information flows to and

from the asset. Knowing who has access to the asset and why. Ensuring access is monitored and compliant with policy. Understanding and addressing risks to the asset and providing assurance

to the SIRO. Responsible for the quality of data in the asset (e.g. by running monthly

error reports or using data quality reporting tools). Leading a culture that values, protects and uses information for the

success of the organisation.

Information asset owners are typically people responsible for the content of a database rather than the database itself. They include people such as consultants, general managers and IM&T staff. Information asset owners (IAO’s) are different from the Information Asset Administrators (IAA). IAA’s are responsible for day to day management of information on behalf of the IAO’s.

6.4 Risk Register

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Managing risk is a fundamental requirement for all areas of the trust and IM&T is no exception. Project risks are managed following standard Prince Project Management techniques on a daily basis by the project managers of each of the capital/ad-hoc or revenue projects. However, risks that have a safety, financial, organisational or clinical risk are managed via the standard risk process outlined in the IM&T risk procedure found on the trust intranet at http://intranet.xwwl.nhs.uk/Library/Policy_Library/Trust_Wide/2012/TW10-082_SOP_%20IMT_risk_mgt_procedure_jun_12.pdf

All IM&T risks are risk assessed and logged in the IM&T risk register. A consistency panel comprising the senior leaders of each IM&T department meets on a monthly basis to ensure risk ratings are consistent and to review the actions associated with the individual risks. Risks are raised as appropriate to the Risk and Environmental monitoring committee (REMC) and IM&T representatives attend the REMC meeting on a monthly basis.

6.5 IM&T Leadership teamThe senior leaders of the 5 IM&T departments manage IM&T on a day to day basis. They meet regularly (usually weekly) to discuss current issues, to review capital programs, to prioritise resources and tasks across IM&T and to set strategy. Separate capital and prioritisation meetings are held at regular intervals to ensure financial and project targets are met. In addition regular CIP meetings take place with Finance to ensure that the stringent CIP targets applying to IM&T are met (see drivers for change for more commentary on CIP).

The leadership team are responsible for making sure regulations are met and for developing and maintaining appropriate policies and procedures to support e.g. Information governance, risk or data quality. All policies and procedures can be found on the trust intranet.

6.5.1 Knowledge management.

According to wikipedia “Knowledge Management (KM) comprises a range of strategies and practices used in an organization to identify, create, represent, distribute, and enable adoption of insights and experiences. Such insights and experiences comprise knowledge, either embodied in individuals or embedded in organizational processes or practice”.

A great deal of information and knowledge is generated within IM&T and elsewhere and IM&T are keen to ensure this is captured in ways that make it discoverable, re-usable and more effective. Also IM&T needs to improve its ability to engage, enthuse and involve the entire organisation in the changes that are required and facilitated by increased IT adoption. As such IM&T are experimenting with a variety of knowledge management tools such as Wiki’s, blogs and forums. As our experience with these tools grows, we expect to develop a knowledge management strategy over 2011.

6.6 Local Implementation Strategy (LIS) Board WWL FT IM&T participate in the Wigan health economy LIS with membership from NHS Ashton, Leigh and Wigan PCT, WWL FT, ALW Community Healthcare, Wigan Council, 5 Boroughs Partnership NHS FT and Wigan Health and Social Care. Its core roles and responsibilities are:

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To support the development of the Wigan Quality, Innovation, Productivity and Prevention programme (QIPP)

To develop, implement and monitor an IM&T strategy for the local health economy

To provide strategic oversight of the implementation of economy-wide IM&T QIPP projects through the QIPP IM&T Work-Stream

To ensure that IM&T is developed to support and improve the patient journey

To ensure benefit realisation plans are developed across organisational boundaries

Responsible for managing risks and issues that span the economy-wide programme

To represent the views of the local health economy at Greater Manchester, North West and wider levels

To hold delegated responsibility for agreed local Health and Social Care Informatics resources

To ensure that a suitable local implementation structure is developed with appropriate clinical, patient and public representation

Creation and maintenance of an effective communications strategy to promote and raise awareness of Wigan's plans to all partner organisations and the public

6.7 QIPP

The Quality, Innovation, Productivity and Prevention program is the NHS vehicle for achieving the £20 billion of efficiency savings required by 2015. In the North West the top 10 ways (initiatives) for informatics to contribute to QIPP have been identified. These are described in Table 3 and are available online at http://www.bcs.org/upload/pdf/informaticsframework-021209.pdf

QIPP Initiative QIPP initiative Description Mapping to WWL IM&T strategic objective/solutions

Map of Medicine

An electronic source of best practice evidence. Enables discussion, planning and delivery best practice care

Integrated Clinical Solutions Objective. We are aiming to integrate the map intuitively within the Cambio HIS project. However, this depends on the map providing an interface to allow this. All relevant clinical staff will be given NHS Smart card access to the map.

Care Records Essentially end to end clinical care within the hospital and vertical integration between primary and secondary care.

Integrated Clinical Solutions Objective.

Qipp talks in detail about the national solution (specifically

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Lorenzo). Unfortunately Lorenzo has not delivered and as a result of the recent government white papers trusts are free to implement their own systems. The trust is well ahead on this score with our current EPR system.

Mobile Working

Patients are demanding services in or close to their homes. Mobile links to electronic patient records and corporate systems such as email and intranets are required. Leads to a reduction in travel time and the time it takes to retrieve capture and enter data into systems.

Unified Communications and Integrated Clinical solutions objectives.

E.g. Email/text or voice mail communications to patients. Call center optimisation (automated routing of patient requests).

Working with Partners

Links with partner organisations and the NHS leads to reduced admissions into hospital and reduced patient stays. Reduces the administrative costs of repeatedly capturing and transferring information

Integrated Clinical Solutions and Infrastructure objectives.

E.g. WWL FT is already going through the process of enabling clinician access to EPR and is introducing ordercommunications to GPs and the hospital allowing trusts and GPs to see laboratory tests ordered by each other. In addition WWL FT was recently one of the first trusts in the country to implement electronic discharge letters direct to the GPs.

The new infrastructure suite should allow WWL FT to start sharing services with other organisations (e.g. disaster recovery or storage solutions), and the new Cambio His would allow full GP/Acute hospital sharing of a patient record.

Voice to text

Converts spoken word to computerised text. Can be applied to medical secretaries correspondence and radiology.

Integrated Clinical Solutions.

WWL FT already has digital dictation. We are exploring the possibility of moving to a voice to text model to add further efficiencies.

Collaboration Tools

Telephone and videoconferencing and computer systems that aid collaboration. Reduces travel for

Unified Communications objective;

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meetings, mileage costs and time saved.

WWL FT already has Voice over IP throughout the trust and has completed an instant messaging pilot using its unified communications server. This will be rolled out shortly. In addition we are exploring wikis, blogs and electronic forums as aids for collaboration and knowledge sharing.

Patient Services

Systems for citizens/customers to access directly to help themselves to services and to enquire about progress.

Integrated clinical systems and unified communications objectives;

WWL FT is looking at patient self service machines (for automated registration), automated text/voice message reminders. Single points of contact to update WWL about appointments and web forms for patients to edit their details or change appointments.

Telehealth/Telecare

Remotely treating or monitoring a patient. Allowing access to the right knowledge more quickly leading to better less expensive care.

Unified communications objective;

This is currently not high on the trusts objectives, however we do have the underlying infrastructure necessary to make this possible. If the priorities for this increase it may be possible to add this to the capital program and increase the focus on telehealth/care

Data to Intelligence

The ability to analyse data from the different sectors of the NHS (and partners) along the whole patient pathway. Discovering which health care is effective and which is not. Rationalising the analysis services across the various observatories and services.

Reporting/Information Management objective;

WWL FT are well placed to take advantage of this. We have a mature data warehouse solution with 2 major business intelligence tools (QlikView and SQL Server Reporting services) providing reporting dashboards. Analysis of data from different sectors is possible providing access to that information can be made.

Technology Management

Consolidation of services and management at scale could produce a

Infrastructure Objective:

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30% increase in productivity. IM&T are very keen to share services with partner organisations. Once the IT relocation is complete it is expected WWL will be in a very good position to share services at several levels. Trusted access to shared networks will become more important as site strategy

Table 3. QIPP informatics initiatives and their mappings to WWL’s 5 strategic objectives.

7 Roadmap

A roadmap for the majority of the capital program can be inferred from the 3 year capital plan a summary of which is shown in chapter 5. This provides an indication of what functionality is likely to be introduced over the next three years.

For the two largest IM&T projects (the Health care information system and the IT relocation project) road maps are shown below.

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Figure 6. Road map for implementation of the healthcare information system (HIS)

Figure 7. Road map for Relocation of IT services out of Bryan House

8 Long term vision.

The IM&T strategy described in this document is a living strategy. As new external pressures are applied we expect this strategy to flex and as such it already has a built in capacity to adapt to external pressures. If we follow this strategy we will have a foundation of clinical systems that is both robust, low maintenance and can be adapted to rapidly respond to new processes or clinical demands. We will have a low maintenance highly capable infrastructure that can respond rapidly to demands put onto it and the expected increases (due to site and service strategies) in the need to share information and networking capability across the health community and beyond. Site and service strategies are expected to be developed over 2010 and early 2011. These, together with changes in QIPP, Government white papers, financial constraints or political pressures will all lead to changes in the delivery or components of this strategy. This will be reflected in annual updates to this strategy document as needed.

Baring all of the above the long term (five year vision) is one where;

The elements of the patient story for the future are true. IM&T has a robust suite of clinical systems providing intuitive navigation and

guidance through the care pathway. Allowing rapid communication at the touch of a button or link.

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These robust clinical systems extend throughout the Wigan health economy (providing seamless access to GP’s, social services, community health and hospital staff to the same underlying data and services.

IM&T is acting as a shared service, providing clinical and infrastructure services to Bolton and Salford.

IM&T provides an excellent service and value for money when benchmarked against its peers in other trusts.

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9 Appendix A

Corporate Objectives 2010/11Preface: Our overarching strategy is Quality, defined as Safety, Clinical Outcomes and Patient Experience. In the event of a conflict with any of the objectives listed below, patient safety must always take precedence.

1. The Board to approve a new overall service and site strategy by September 2010 in light of the impact of the economic downturn and service line reporting.

2. Consistently deliver every element of Monitor/CQC targets.

3. Agree and begin to implement an Organisational Development plan by September 2010 to create an organisational culture of high quality patient experience.

4. Achieve an annual Financial Risk Rating of 4 by consistently scoring above 3 and averaging above 3.5.

5. Develop and implement integrated clinical care pathways backed up by Information Technology systems which guide compliance.

6. Implement the transformation of unscheduled care.

7. Agree a revised three year plan by May 2010 and a further version to Integrated Business Plan standards by December 2010 to reflect any changes in government policy. Both are to incorporate integrated service, workforce and financial plans.

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