The Royal United Hospital NHS Trust IM&T Strategic Plan ... · OBC Outline Business Case OJEU Official Journal of the European Union ... PID Project Initiation Document PRINCE2 Managing

The Royal United Hospital NHS Trust IM&T Strategy 2013 - 2023

The Royal United Hospital NHS Trust

IM&T Strategic Plan

2013 - 2023

Release: Final

Date: 6th March 2013

The Royal United Hospital NHS Trust IM&T Strategy 2013 - 2023

Document History

Document Location This document is only valid on the day it was printed. The source of the document will be found within the Royal United Hospital (Bath) NHS Trust.

Glossary of Terms

The following table presents a glossary of specific terms used in this strategy that are in many cases important with regard to precise definitions of the content of the IM&T programme of work and do not feature in an overall NHS consolidated glossary of terms.

Acronym Term

ANC Authority Notification for Change

BaFO Best and Final Offer

BT British Telecom (Global Services)

CDS Contract Data Set

CSRO Clinical Senior Responsible Owner

CQUIN Commissioning for Quality and Innovation

DICOM Digital Imaging and Communications (data/image exchange standard)

EBITDA Earnings Before Interest, Tax, Depreciation and Amortisation

ED Emergency Department

EPR Electronic Patient Record

EU European Union

FBC Full Business Case

GFH Green Folder Holders

GP General Practitioner

HL7 Health Link 7 (refers to a data exchange standard)

HMRC Her Majesty’s Revenue and Customs

HR Human Resources

LPfIT London Programme for Information Technology

LPP London Procurement Programme

LSP Local Service Provider

LTFM Long Term Financial Model

IM&T Information Management & Technology

ICD International Classification of Diseases

IDX Company name for a Supplier of Health Software

IG Information Governance

IT Information Technology

ITT Invitation to Tender

MSS Company name of supplier of Emergency Department System

NHS National Health Service

NPC(V) Net Present Cost (Value)

NPfIT National Programme for Information Technology

OBC Outline Business Case

OJEU Official Journal of the European Union

OPCS Office of Population Census and Surveys (refers to classification of interventions and procedures)

The Royal United Hospital NHS IM&T Strategy 2013 - 2023

Page 3 of 84

© RUH,Bath. All rights reserved. No part of this document may be reproduced, stored or transmitted in any form witho ut the prior written permission of the Trust or its licensors, as applicable.

ORSOS Proprietary name for Theatres System used at RUH Bath before Cerner Millennium

PALS Patient Advice and Liaison Service

PAS Patient Administration System

PBAC Position Based Access Control

PCT Primary Care Trust

PDS Personal Demographics Service

PID Project Initiation Document

PRINCE2 Managing Projects in a Controlled Environment

PwC Price Waterhouse Coopers

QIPP Quality Innovation Productivity and Prevention

RiO Proprietary name of a Mental Health and Community Services patient system

R&D Research and Development

RBAC Role Based Access Control

RTT Referral to Treatment

SCR Summary Care Record

SECA Stakeholder Engagement and Communications Approach

SHA Strategic Health Authority

SME Subject Matter Expert

Snomed CT Snomed Clinical Terms

SPfIT Southern Programme for Information Technology

SRO Senior Responsible Owner

TAN Transition Assistance Notice

TAP Transition Assistance Period

TCNC Trust Consultative & Negotiation Committee

TDS PAS Proprietary name for Patient Administration System used at RUH Bath before Cerner Millennium

TIE Trust Integration Engine

TUPE Transfer of Undertakings (Protection of Employment)

VAT Value Added Tax

VfM Value for Money

XDS/XDSi Extended Data Services


Page 4 of 84


Contents

1. EXECUTIVE SUMMARY .................................................................................... 6 1.1. BACKGROUND .................................................................................................. 6 1.2. PURPOSE ........................................................................................................ 6 1.3. SCOPE ............................................................................................................ 7 1.4 THE STRATEGIC IM&T ROADMAP............................................................................ 8 1.5. THE IM&T PROGRAMME OF WORK ................................................................... 10 1.6 STAKEHOLDER ENGAGEMENT .......................................................................... 10

1.7. Investment ................................................................................................... 11 1.8. IM&T Strategic Benefits ................................................................................ 12

1.9. IM&T STRATEGIC RISKS ................................................................................. 12 1.10 DELIVERY OF COMPLEX ORGANISATIONAL CHANGE ........................................... 13 1.11.STANDARDS, GOVERNANCE AND PROCESS ....................................................... 13

2. INTRODUCTION....................................................................... ..................... 15

2.1. AMBITION ..................................................................................................... 15 2.2. OBJECTIVES.................................................................................................. 15 2.3 BUSINESS CONTEXT.............................................................................................16 2.4. NATIONAL IM&T CONTEXT.............................................................................. 16 2.5. LOCAL IM&T CONTEXT .................................................................................. 18 2.6. LOCAL IM&T BACKGROUND ............................................................................ 18

2.7. Trust Future Vision ....................................................................................... 20

2.8. Risks to Delivery of Trust Strategic Objectives................................................... 23

3. THE CASE FOR AN ELECTRONIC PATIENT RECORD ............................ 26

3.1. NATIONAL CONTEXT ...................................................................................... 26 3.2. LOCAL CONTEXT ........................................................................................... 27 3.3. EPR PROGRESS TO DATE .............................................................................. 28 3.4. EPR NEXT STEPS ......................................................................................... 29 3.5. SIGNIFICANT OTHER SYSTEMS CONTRIBUTING TO THE EPR ............................... 30

4. GOVERNANCE OF THE IM&T PROGRAMME OF WORK .......................... 32

4.1. APPROACH................................................................................................... 32 4.2. STRATEGIC IM&T ALIGNMENTS FOR A FOUNDATION TRUST ............................... 33 4.3. GOVERNANCE .............................................................................................. 33

4.3.1. Clinical Informatics Board .................................................................... 33 4.3.2. 2015 Procurement and Transition Board .............................................. 34 4.3.3 Senior Information Risk Owner and Chief Information Officer..................34 4.3.4. Advisory Clinical Group ....................................................................... 35 4.3.5. Clinical Chief Information Officer .......................................................... 35 4.3.6. IM&T Programme Board ...................................................................... 36 4.3.7. Information Governance Steering Group .............................................. 38 4.3.8. The Data Quality Steering Group ......................................................... 38 4.3.9. The Medical Records User Group ........................................................ 38

4.4. RISK MANAGEMENT ..................................................................................... 39

5. CURRENT STRUCTURE OF THE IM&T DEPARTMENT ............................ 40

5.12.EXTENSION OF IN-HOUSE CAPABILITIES ........................................................ 43

6. DELIVERY OF THE IM&T PROGRAMME OF WORK .................................. 44

6.1. IM&T PROGRAMME OF WORK POSITION – STAGE 1 ........................................ 44


Page 5 of 84


6.1.1. Audit of Existing Departmental systems* .............................................. 48 6.1.2. Non-clinical Systems ........................................................................... 48 6.1.3. Project in Stage 1 Remaining to be Agreed and Funded ..................... 48 6.1.4. Stage 1 Benefits ................................................................................ 49 6.1.5. Stage 1 Risks .................................................................................... 49

6.2. THE EXIT FROM THE CURRENT BT LSP CONTRACT – STAGE 2 ...................... 49 6.2.1. Stage 2 Benefits ................................................................................ 51 6.2.2. Stage 2 Risks .................................................................................... 51

6.3. THE DELIVERY OF THE FULL EPR – STAGE 3 (2017/18 – 2022/23) ................. 51 6.3.1. Stage 3 Benefits ................................................................................ 52 6.3.2. Stage 3 Risks .................................................................................... 52

6.4. THE PLANNING PROCESS ..........................................................................522 6.5. IM&T PROGRAMME OF WORK ENABLING AND DEPENDENT PLANS..................533

6.5.1. Hardware and Infrastructure Strategic Plan ........................................ 53 6.5.2. Business Intelligence Unit Information Plan ........................................ 54 6.5.3. Information Governance Plan ............................................................ 55

7. IM&T FINANCIAL POSITION ............................................................................ 58

APPENDIX 1..............................................................................................................60

APPENDIX 2.........................................................................................................................62

APPENDIX 3.........................................................................................................................71

APPENDIX 4.........................................................................................................................77

APPENDIX 5.........................................................................................................................81

APPENDIX 6.........................................................................................................................84


Page 6 of 84


1. Executive Summary

This document outlines the ten year combined Information Management and Technology (IM&T) strategic plan for the Royal United Hospital Bath NHS Trust. It is aimed at providing a strategic framework for the future of IM&T management and delivery within the Trust and will act as guidance for Management Board and Trust Board on the current and future state of IM&T infrastructure and developments as well as national and local IM&T agendas. The strategy has been developed to be compatible with the NHS Information Strategy - “The Power of Information: Putting us in control of the health and care information we need” and takes into account the recommendations made by the 2013 Francis report regarding information and its usage. The document will also contribute towards meeting requirement 9-105 of the Information Governance Toolkit.

1.1. Background

The Trust is facing considerable changes in its business environment and the healthcare landscape in which it operates. The drive for Foundation Trust status, coupled with increasing competition from other providers, means that information and performance reporting are critical to the future development of the Trust as a key player in an emerging market. The Trust is also facing challenges in the delivery of core IM&T services as national contracts reach their expiry dates and services are devolved to local ownership and funding. The Trust therefore needs to examine and improve the quality, efficiency and productivity of the IM&T services it provides, whilst meeting requirements and critical deliverables through challenging cost improvement programmes. Historically the Trust has had individual Information Management and IT strategies and this IM&T strategy sets out to combine the current and future plans and ambitions of both IT, Information Management and Information Governance into a consolidated programme of work which will enable the efficient and effective delivery of core services acting as enablers to the Trust’s strategic objectives.

1.2. Purpose

The strategy sets out to detail the technical transformation and cultural changes to existing operational governance structures required to enable the delivery of a future where the Trust can successfully meet its obligations and work effectively as a partner within the health community through integration and development of supporting technology and IM&T arrangements. The strategy aims to link current and future IM&T developments into the Trust’s overall objectives and details the governance structures underpinning further investment required in IM&T. The strategy has been extended to cover a ten year period rather than the usual five due to the magnitude of the expiry of the national contract to supply the Cerner Millennium system to the Trust in 2015 and the impact that the transition from national to local ownership will have on Trust capabilities. The outcome of the current and future actions to exit the national contract have far reaching implications and will shape the future IM&T roadmap which the Trust will take. It is therefore in the interests of IM&T vision and future financial forecasting that plans post expiry of the contract are included in the scope of this strategy.


Page 7 of 84


The core theme throughout the strategy argues that the provision of quality information will underpin the Trust’s future success as a viable business and that the implementation of a Trust wide Electronic Patient Record (EPR) is a critical factor in delivering the information and capabilities to improve efficiency and patient safety, thus enabling the delivery of the overall strategy of the Trust. The foundation of an EPR has been delivered by the deployment of the Cerner Millennium system into the Trust in July 2011. Since this date the Trust IM&T teams together with their Business Intelligence Unit (BIU) and Information Governance (IG) colleagues have strived to continue the building of an integrated clinical solution, delivering real-time information in an accessible and efficient format, factors which are fundamental to the realisation of this strategy.

To deliver a full electronic state the Trust must be in a position to develop and enhance current and future IM&T systems with the full engagement of clinical and operational staff to the vision and ultimate goal of an EPR. The major challenge facing the Trust is the uncertainty which the end of the national contract to supply Cerner Millennium brings (the procurement outcome is as yet unknown and could signal the move to an alternate core platform). This uncertainty means that there is a likelihood that there will be a period of time where development of the EPR may be paused as the Trust focuses on a safe exit and transition to new arrangements. As such the requirements plan for the realisation of the EPR forms the heart of the strategy over the next ten years to provide time for exit, transition and stabilisation into future arrangements before completion of the delivery of a full electronic state.

1.3. Scope

The current economic climate means that the financial situation will be difficult across the whole NHS over the next five years at the very least. Therefore it is vital that the IM&T strategy and programme of work focuses on getting the basics right now, that is the things that must be delivered by the organisation to progress the immediate future of successful IM&T delivery and embedding the foundation of the EPR. Therefore the IM&T programme of work will concentrate on delivering improvements in service delivery and information capability aligned with the Trust’s five ‘pillars’ of improvement:

Quality Improvement Focused transition and programme management activities to ensure safe and

cost effective exit from national contracts to ensure continuity of services, minimal impact on financial balance and delivery of future services that are aligned to meet the emerging needs of the Trust.

Sound and effective project management and procurement to underpin all deliverables within the programme of work.

Demonstrating Performance Developing and building resilience into high quality information management

systems to fulfil the business needs of the Trust.

Workforce Development Training and development of IT skills and change management in all staff to allow

for the implementation of a programme of work which will deliver systems and technology successfully to ensure that the EPR is accepted as the primary source of patient information within the Trust.

Relationship Management Sound governance arrangements including full clinical and operational buy in

from executive to end user level to use Trust systems as defined by best practice.


Page 8 of 84


Collaboration and alliance with other NHS organisations and suppliers to the healthcare sector to share knowledge, best practice and learn from others experiences.

Physical Environment Robust, resilient and scalable IT Infrastructure that delivers information where

staff need it.

1.4. The Strategic IM&T Roadmap

The ten year IM&T programme of work has been divided into three clear stages:

Stage 1 (2013/14 - 2014/15) - The key priority in the next two years is the development of further clinical functionality, predominately within the Cerner Millennium system, to support the move towards a paper light environment and to embed the core of the EPR through sustained clinical and operational usage of IM&T systems. Delivery of further clinical capabilities will enable the IM&T department to support the changes required to mitigate the clinical and safety risks posed by the existing paper based Medical Record and to contribute to the fulfilment of the Facilities strategic direction in releasing capacity within the current on-site and proposed off-site Trust libraries. As the Trust progresses the use of electronic recording and viewing of patient information, the repository of clinical and administrative data will grow leading to further benefits in the use of information for business management purposes and for communication with other Health Care Providers to support patient pathways across the community. Development of clinical IM&T functionality must be supported by further investment in modern and robust infrastructure to enable the optimisation of workflow and efficient delivery of care, giving staff the ability to embrace the benefits that modern technology can offer (wireless connectivity, mobile devices, remote working etc) and thus driving benefits from increased productivity as well as engaging staff further in new ways of working.

Over the Stage 1 period it is critical that new functionality and ways of working are accepted and utilised by all clinicians and operational staff in order to realise the return on investment. To enable this, the IM&T strategy must be recognised by the Trust executive team, operational leads and senior management and integrated into Trust delivery plans as a core enabler to the achievement of the Trust’s strategic objectives. This will take a change of mindset in many areas compared to the way in which IM&T has been perceived by the Trust previously and will require robust governance arrangements and executive direction to support and deliver.

Further development of the Trust data warehouse will ensure that the current performance-reporting framework is enhanced to support increased core reporting functions and service line management requirements. The overarching need for the Trust to continue to co-ordinate, standardise and maximise its use of operational data is articulated throughout this strategy. The data warehouse has been designed to be a single repository for clinical and administrative data to be managed, thus enabling the organisation at all levels to monitor performance and support operational service delivery from a single source of truth. Over the Stage 1 period data from all activity systems including finance, commissioning and other sources will be linked to enable a consistent view of service delivery, including comprehensive modelling against planned activity. Where


Page 9 of 84


appropriate and in conjunction with the research community, options for secondary anonymised use of operational information for research purposes will be explored and progressed. Stage 1 will also see the progression of procurement activities within the Trust to support the expiry of the nationally owned contract which supplies the Cerner Millennium system to a number of Trusts across London and the South. Clinical and operational engagement in procurement activities is critical to ensure the Trust derives the best outcome to meet the current and future needs of patients, staff and the Trust’s business ambitions. The IM&T strategy examines the procurement process and the risks around transition and aims to deliver a direction that supports Trust objectives and overall strategy but which also minimises the risks surrounding any upheaval that may result from procurement outcomes and the volume of Trusts wishing to exit the national contract in a short period of time. Stage 2 (2015/16 – 2016/17) – This period of the IM&T programme of work will concentrate on the safe transition from the nationally owned contract to supply Cerner Millennium which expires in October 2015. The period will be a time of uncertainty for all Trusts who have deployed under the Southern and London arm of National Programme for IT (NPfIT), as services transition from central to locally led ownership. The focus of the IM&T department over this period of time will be to ensure the continuity of quality technical and information services to the Trust supporting the delivery of safe patient care whilst minimising the risks of exiting the contract and entering into new supplier arrangements. The strategic direction of IM&T will ultimately be linked to the outcome of the procurement which will have been conducted in Stage 1 and as such Stage 2 focuses on the fulfilment of the exit plans and formation and embedding of new supplier relationships, which will be the outcome of such procurement activity. There will be limited ability for development of the EPR across this stage as the core system is ‘locked down’ in preparation for exit. However, where possible, disparate departmental systems will continue to be rationalised and the development of emerging requirements standardised in line with future core services. Stage 3 (2017/18 – 2022/23) - Following transition activities, the strategy then examines a period dedicated to achieving a full EPR, in essence a Trust where the use of paper is at a minimum and both clinicians, management and administrative staff are provided with the capability to use modern and efficient technology to support their roles in delivering safe and effective care, anytime, anyplace and anywhere. In this environment it is important that the Trust fully maximises its use of the EPR and ensures that any remaining legacy systems are replaced with integrated, modern equivalents as the EPR gains additional momentum. Success of this stage will be defined as an EPR which is accepted as the primary source of patient information and for managing patient care within the Trust and replaces use of the paper based Medical Record for business as usual activity. Functionality to be delivered to support the EPR will include medications management/e-prescribing capabilities and clinical decision support tools to assist in the management of patient care.


Page 10 of 84


1.5. The IM&T Programme of Work

It can be seen that the above stages are defined according to their purpose (develop paper light and procure future services; exit/transition; develop full EPR) and in the first two stages there are critical timeline dependencies linked in to core Trust objectives and national contract expiry dates. The stages may well overlap as preparation for some later developments may commence before earlier components have been fully deployed. The IM&T department will ensure to provide a properly constructed framework (the IM&T programme of work) into which existing solutions and technologies, information management requirements, procurement activities, transition planning and delivery can be integrated with enterprise-wide IM&T improvement plans under the governance of the Clinical Informatics Board and the 2015 Procurement and Transition Programme Board (focusing specifically on the contract exit and associated activities). Delivery of the IM&T programme of work will be managed in line with PRINCE 2 guidelines and in conjunction with the Trust’s Transformation agenda. Both Boards will support the progression of IM&T business cases at Management Board level. Operational management of the IM&T programme of work will be overseen by the IM&T Programme Board. Details regarding the governance of the strategy and the IM&T programme of work can be found in section 4. of this strategy.

1.6. Stakeholder Engagement

Engagement with key stakeholders will be led by divisional and clinical representation on the above mentioned Boards and through an Advisory Clinical Group, both of which will ensure that operational and clinical needs of the Trust are prioritised according to Trust objectives. Whilst each stage will be self-contained in terms of its business cases, benefits and change agenda, the vision of the ultimate goal of achieving a full EPR needs to be maintained and promoted by all stakeholders. Without full operational and clinical support from the executive team through to end user level, the delivery of the strategy will be compromised, leading to loss of benefit to patient care and impact on financial efficiency through inability to achieve the efficiencies that will be introduced by electronic ways of working. As the delivery of the strategy progresses, new models of care advocated through commissioning channels will need to be supported by greater levels of collaborative working and the Trust will need to develop and maintain robust project management structures to ensure that all IM&T current and new projects are carefully prioritiesd and risk assessed to ensure that they deliver on time and budget to meet the needs to the business objectives of the Trust and thus promote the Trust as a leader in the delivery of services to the emerging market. Section 4 of the IM&T strategy examines in greater detail how revised governance structures will prioritise projects as part of an ongoing plan of work to enable the Trust to move forward coherently in support of its overall business objectives whilst effectively delivering business as usual requirements. The IM&T programme of work will identify key milestones in line with the three stages over the ten year period and these will be used on monitor performance against strategic direction and will mark revision points for the IM&T strategy itself.


Page 11 of 84


1.7. Investment

Information Technology and service delivery are developing on an exponential scale worldwide and it is abundantly clear that the current infrastructure and technology developments within the NHS as a whole fall short of the advances seen within other industry sectors and the home environment. Understandably IM&T is increasing in importance for the Trust as an enabler to realise core clinical and operational strategies and information will be a critical driver for the Trust to position itself as a key player in the emerging healthcare environment. Staff and patients are increasingly exposed to technology in their home environments and thus expectations of what Trust IM&T can and should deliver are increasingly unable to be met within current resource and infrastructure arrangements. As the IM&T programme of work to deliver the EPR progresses, patient care will become increasingly dependent on having network and IT facilities which are in line with modern and emergent technologies and it is therefore critical to ensure that investment in IM&T is significantly increased and protected, together with the development of efficiency projects within the IM&T departments to drive greater value for money from current IM&T services and delivery. Comparisons with other Acute Trusts in the South have shown that current revenue investment by the Trust into IM&T is proportionally lower than that of similar sized organisations and capital allocations are believed to be in a similar position. The Trust’s Long Term Financial Model (LTFM) allows for capital investment across a five year period, predominately to support the delivery of the EPR and to underpin the activities to exit the national contract. Such provision will need to be supported by significant revenue investment to ensure that infrastructure outlay is underpinned by sound delivery and support mechanisms. As development of the IM&T programme of work is progressed, the IM&T strategy will be revised to include the anticipated full costs of delivery of the strategy in-line with the Trust’s current and future Long Term Financial Model and additional revenue requirements.

It is anticipated that capacity for future financial support for delivery of the IM&T strategy will be based on :

The elimination of legacy debt by 2015/16

Delivery of QIPP savings where IM&T is an enabler over the 10 year period to

support maintenance of financial balance and offset cost pressures

The achievement of a Trust wide target surplus of 2%

Surpluses to be underpinned by cash reserves which will be used to finance the

Trust’s capital programme.

The financial implications of the expiry of the national contract to supply the Cerner Millennium system to the Trust and the activities to transition out of the current data centre will require revisions to the Trust’s financial plans from 2013/14 onwards in line with financial strategy. To mitigate the significant costs expected for exit, the Trust will actively seek alternative ways of funding and minimising the expense of the replacement systems and service as part of the procurement process. Opportunities for such may include:

Seeking national and/or commissioner support


Page 12 of 84


Exploring alternative solutions within the existing options, for example through

joining an existing framework to reduce procurement and implementation costs

Ensuring negotiations with suppliers optimise both revenue and capital funding

available, for example, by spreading up-front implementation costs over the

contract period.

1.8. IM&T Strategic Benefits

Identifying and delivering cashable savings has always proved problematic for many IT deployments and initiatives. Lack of delivery of expected benefits is a widely communicated criticism of the NPfIT and it has become the norm for anticipated savings to be listed and claimed in business cases but rarely delivered in practice, even when a structured benefits realisations plan have been put in place. Fluid communication through IM&T governance arrangements (The Clinical Informatics Board, IM&T Programme Board and 2015 Procurement and Transition Board) will support a transformation agenda to assist the IM&T programme of work in identifying practical and realistic ways to exploit the opportunities available from the developments and systems delivered in each of the Stages and to do so in a co-ordinated manner to avoid double-counting savings from multiple initiatives. Divisional representation on the above Boards is key to ensuring that all stakeholders are aware of the benefits to be delivered via IM&T and are active in their support to deliver.

1.9. IM&T Strategic Risks

There are four fundamental risks which will impact the ability of the Trust to deliver the IM&T programme of work as set out in this strategy:

Engagement – The vision of the EPR and steps to its successful delivery must be owned by clinical and operational stakeholders. Committed stakeholder support to use IM&T systems and capabilities is vital to the realisation of the plan. This needs to be underpinned by a joined up thought process of what is the best direction for the Trust as a whole and not just for individual departments.

Investment – Historic lack of investment into IM&T means that the future investment needed to deliver an optimised platform to enable the best care to patients and support business needs will not show quick returns. Lack of appreciation of the reasoning for investment and application of savings targets which impact delivery of an optimised future platform will have significant impact on the ability of IM&T teams to deliver a quality service.

Competing priorities – Information and technology will play a pivotal role in shaping the future success of the Trust. It must not be overlooked. Executive promotion of the IM&T strategy and programme of work is crucial to delivery.

Dependencies outside the control of the Trust – the changing healthcare landscape and increasing pressures on the Trust from commissioners and national bodies must all be taken into account as the IM&T programme of work progresses. Therefore strong management of the programme to adapt in an ever changing climate will be essential.

The risks which lack of successful delivery of the IM&T programme of work place on the achievement of Trust strategic objectives are outlined in section 2.8 of this document.


Page 13 of 84


1.10. Delivery of Complex Organisational Change

The delivery of quality information enabled by the progress towards the full EPR will support the Trust in improving the clinical management of care and the efficiency of care processes. Delivery of such will involve complex changes in organisational culture and workflow, clinical practice and the application of information system, technologies, staff and data. To develop, sustain, and advance the EPR, a transformation agenda (as identified above) must be present to help establish organisational precursors, such as clinical and operational staff engagement, buy in to quality improvement and the communication of the IM&T programme of work, projecting the IM&T strategic vision in an understandable and easy to digest format. Interaction between IM&T and clinical and operational staff across both Divisions is vitally important to the success of the delivery of the EPR and must not be overlooked. A key risk to delivery of the IM&T strategy will be a lack of Trust engagement in the overall IM&T vision and buy in to supporting the IM&T programme of work. If the core systems are not used in the manner for which they are designed (particularly for clinical information capture) then the benefits which the systems are intended to deliver will not be realised. It is evident that the impact of introducing electronic methods of recording clinical information by clinicians will lead in many cases to the requirement for a revision of the way in which operational services are delivered and fluid communication between business planning, operational delivery and IM&T teams is essential to ensuring that staff are given the opportunity and capacity to use systems in the most beneficial way and are managed accordingly if they resist. Therefore engagement and support from all operational managers, clinical leads, Divisional Managers and the Executive team is crucial to ensuring that the vision to achieve the full EPR is realistic and that IM&T is a forefront enabler to achieving Trust objectives.

1.11. Standards, Governance and Process

In order to deliver the IM&T programme of work, there is therefore a direct dependency on the Trust recognising the importance of adhering to IM&T governance standards and ensuring that IM&T is a key component and influencer of decision-making via stakeholder support. This means the recognition by operational leaders of those systems chosen by the Trust to support the delivery of patient care and the management of the staff who use such systems to ensure that recommended process and best practice is adhered to in a timely and efficient way.

Overall governance for IM&T will be achieved via the support of a Senior Responsible Owner (the Director of Finance), by Chief Information Officer presence on the


Page 14 of 84


Management Board and regular updates to both Management Board and Trust Board via the 2015 Procurement and Transition Programme Board, Clinical Informatics Board and the Advisory Clinical Group. IM&T senior management will also attend operational user groups and committees to support a Trust wide communications approach. Details of the IM&T governance structure are contained in section 4.


Page 15 of 84


2. Introduction

The RUH’s strategic IM&T direction is to provide the best possible care for its patients through the provision of modern, integrated, appropriate, useable and well supported information systems in line with the Trust’s overall vision and strategy.

2.1. Ambition

The Trust has a clear ambition to increase its market share, collaborating with local providers and working effectively as a partner within the health community through integration, development and contractual arrangements. Investment in IM&T to support optimisation of working practice and fluidity of communication across the care setting will support the Trust’s ambitions and position it as an effective business partner within the emerging market. A single integrated electronic patient record, the EPR, will enable the Trust to communicate patient data more effectively to its health community partners and will also enable the capacity to further integrate information from those partners. A centralised repository from which to manage quality data from a single source of truth will allow the Trust to run an effective business underpinned by the power of information. The IM&T strategy therefore aims to support and improve the Trust’s position as a valued service provider, a viable business partner and a key player in a competitive market place. The thesis underpinning this is that the majority of the service improvements, new developments and efficiency gains proposed by the Trust business plan and overall clinical and strategic objectives rely on a modern and robust technology infrastructure and good quality, relevant information systems.

2.2. Objectives

The objectives of IM&T strategy are to:

Combine IT, Information Management and Information Governance plans into a consolidated programme of work, aligned to supporting the Trust strategic objectives.

Enable the provision of practical, usable technology platforms supported by viable business cases which will provide a robust environment to support service innovation and transformation.

Develop the implementation of the Trust’s vision to become a paper light hospital where IM&T systems integrate to form a single Electronic Patient Record (EPR), providing clinical and administrative staff with information about their patient in a usable and effective way, wherever and whenever they need it.

Implement systems designed to support the continuity of patient care across all settings, including community, thus enabling Trust clinicians to ensure that the patient needs are met in the most appropriate, safe and efficient way.

Provide a robust, reliable and resilient information management infrastructure to support a diverse range of integrated functionality as part of the strategic plan to improve communication both within the Trust and across the health care system.

Maximise opportunities and efficiencies to be gained from emerging technologies including cloud based technology, interoperability/health information exchanges and mobile/remote working.


Page 16 of 84


Ensure that information and technology are used to support staff in giving patients the best possible care within the Trust by enabling Trust professionals to have access to appropriate information necessary to support them in making the right decisions at the right time.

Minimise the risk posed by the expiry of national contracts and the devolution of services to local ownership

Support the strategic and business aims of the Trust in terms of its future status as a Foundation Trust, its service development strategy and its long-term research and development agenda.

This current version of the IM&T strategy builds on the previous 2011 IM&T strategy which was developed by the Head of IT and approved by the IM&T Steering group in July 2012. This current version will be circulated widely to stakeholders before being submitted for formal approval at the Management and Trust Boards in early 2013.

2.3. Business Context The Royal United Hospital Bath NHS Trust (RUH) provides general acute and emergency treatment and care for a catchment area of Bath and north East Somerset, Wiltshire (West and North) and Somerset (Mendip). The catchment population of the RUH is 410,000 people for emergency care and 320,000 people for planned care. The Trust occupies a 52 acres site about one and a half miles from Bath city centre and became a National Health Service Trust in 1992. All acute services are provided on the RUH site with over 24 clinical specialties provided. The Trust also provides a range of outpatient and diagnostic services to a number of community sites. The Trust’s lead commissioner is the Primary care Trust (PCT) cluster of NHS Wiltshire and NHS Bath and North East Somerset (BaNES), which commissions on behalf of seven other PCTs and one specialised Commissioning group. Trust performance and patient ratings are consistently high and there are significant on-going service improvement programmes on bed capacity, theatre utilisation, emergency care, outpatient care and administrative services. All these programmes aim to contribute to the Trusts priorities of patient safety, patient experience and overall efficiency. Key metrics for the Trust in the 2011/12 financial year were:

Annual budget £224m 70,052 ED attendances

3,466 whole time equivalents permanent staff

18,722 Surgical Admissions

572 beds, with an intention to reduce bed numbers over time

300,548 Outpatient attendances

Population served in region of 320,000 for planned care, up to 410,000 for emergency care

207,339 Inpatient days

34,500 emergency admissions 24,083 Day cases

2.4. National IM&T Context

At a national level IM&T strategy has been dominated over the past decade by the contractual framework established within NHS Connecting for Health (CfH) and delivered


Page 17 of 84


through the Southern and London Programmes for IT (SPfIT/LPfIT). CfH’s vision was to procure Electronic Patient Record and PACS systems centrally with each health economy being responsible for implementation. However the model has failed to deliver its expected results, bringing unprecedented levels of disruption and cost to many Trusts who sought to benefit from its concept. Subsequently the model has been redesigned in later years to provide more choice at a Trust level and less of a one size fits all approach. This is evidenced by the Greenfields model which saw the final delivery of Cerner Millennium into the Trust in 2011, using a more localised level of delivery allowing for greater flexibility in design and configuration to meet the specific needs of the Trust. Central contracts themselves are due to run out by June 2013 for PACS and October 2015 for Cerner Millennium. The central information strategy, the “Power of Information,” is focussed on providers having to deliver an EPR which supports the “clinical 5” (referenced below, section 2.6) with additional emphasis in the future on patients having more control over their own records. The national strategy sets out a ten-year framework for transforming information for health and care with a patient visibility focus. It aims to harness information and new technologies to achieve higher quality care and improve outcomes for patients and service users. Underpinned by the Health and Social Care Act 2012, it covers public health, healthcare and social care in adult and children’s services in England. The strategy examines the use of information to support patients, service users, carers, clinicians and other care professionals, managers, commissioners, councillors, researchers, and many others. Its lays emphasis is on the availability of relevant, quality information at the point of care and transparency between organisation which will drive up standards, leading to safer, more integrated care and more effective prevention of ill health. The detail of patient access has yet to be fully defined but this is likely in the first instance to be more focussed on access to the patient‘s longitudinal record held within primary care, which means all correspondence about a patient is likely to be seen by the patient. In addition to the national strategy, the Francis report, published in February 2013 following the independent enquiry conducted by Robert Francis QC regarding concerns about the standards of care at Mid Staffordshire NHS Foundation Trust, has made a series of national recommendations regarding Trust standards, governance and performance with 29 specific recommendations relating to information and its management. The findings of report make very difficult reading for all involved in healthcare and though it is clear that there were very particular circumstances at Mid Staffordshire, the fact that services can be poor for such a period of time highlights the need for effective reporting arrangements and information management to underpin the quality of care delivery.

The report makes reference to the realisation that better information “does not require a vast computer system applied throughout the country” and that “efforts in that direction have not succeeded.” Instead, recommending that “there is a need for all to accept common information practices, and to feed performance information into shared databases for monitoring purposes.” The report argues that new indicators and monitoring systems should be based on information “collected about individual patients and recorded by those clinically responsible for their care” in such a form that it can be aggregated and analysed and that Trust Boards should be given the responsibility for making sure there are “effective systems of recording, analysis and publication of local performance indication” and that this should be monitored by the regulator. It also calls


Page 18 of 84


for boards to take more responsibility for the publication of quality accounts, and for there to be new legal offences of giving out misleading information.

Regarding visibility of information, the report recommends that patients should have access to both their own records and other data sources, “From the patient’s point of view, swift, online access to their records, with a facility to note their own comments, can only serve to enhance their involvement in their own treatment and to improve its accuracy and completeness.” The report also calls for public access to published information via “a user-friendly information gateway” and says that “access to raw, anonymised information should be available to any organisation or individual intending in good faith to undertake their own analysis and having the competence to do so.”

It is therefore the primary ambition of the IM&T strategy to integrate all such recommendations into an achievable and affordable programme of work that is delivered by a combined approach between operational, clinical and technical teams. Ownership and accountability for effective and timely usage of the systems and services provided by IM&T must be the responsibility of operational and clinical leads and therefore all such individuals must be an integral part of the design, planning and implementation of future IM&T delivery.

2.5. Local IM&T Context

The IM&T Strategy outlines the approach and the programme of work to deliver a service which will act as an enabler and facilitator to support the Trust’s achievement of its strategic objectives. This will extend from consolidation and rationalisation of service delivery to delivery of technology and information which will underpin the Trust’s ambition to become a leading healthcare provider. The strategy provides a simple roadmap of activities, aligned to three core Stages and defining developments delivered in the context of:

Ensuring patient safety and information governance is at the forefront of all IM&T initiatives

Providing clinicians with an intuitive, robust systems to access an emerging electronic patient record

Ensuring that data is translated into useful information to fully support patient flow, capacity planning, service line reporting and enabling staff to optimize their performance at work.

Achieving value for money and delivering efficiencies where possible As the NHS market becomes more competitive, IM&T provision must be agile and innovative in enabling the Trust to respond rapidly to commissioning groups and national guidelines and to excel as a qualified provider of high quality, safe and effective services. The strategy aims to realise this responsiveness to change.

2.6. Local IM&T Background

In July 2011 the Trust successfully deployed the Cerner Millennium system under the terms of the ‘Greenfields’ arm of the national programme. This programme of work resulted in the delivery of a modern PAS, Theatre system, integration with the established ED system and the introduction of clinical functionality including the capability for electronic recording of patient risk assessments and the compilation and transmission of integrated discharge summaries.


Page 19 of 84


The original national business case supporting the Southern Trusts deployment of Cerner Millennium was approved by the Treasury in 2005 and outlined an implementation programme and benefits realisation period of over 10 years. This was originally designed to take all Trusts to full deployment of the “Clinical 5” functionality, as outlined in the Health Informatics Review, July 2008. The “Clinical 5” were detailed in a whitepaper published in response to the growing requirement for high quality information to effectively manage and deliver NHS services and were built on Lord Darzi’s Next Stage Review of the NHS which described how informatics could support the delivery of better, safer care for patients, improve the health service through better research, planning and management, and empower patients to make more informed choices about their health and care. In particular, the whitepaper identified a pressing requirement for secondary care systems that met the information needs of clinicians. The five key elements termed the “Clinical 5” which were identified as required to “create a “tipping point” in the acceptability and demand for strategic IT systems” were:

A patient administration system (PAS) with integration to other systems and

sophisticated reporting

Order communications and diagnostics reporting (including all pathology and

radiology tests and tests ordered in primary care)

Discharge letters with coding (discharge summaries, clinic and Accident and

Emergency letters)

Scheduling (for beds, tests, theatres and so on)

E-prescribing (including ‘To Take Out’ medicines).

By the time the national contract ends in October 2015, the Trust will have obtained little more than 4 years’ benefit from the Millennium system and is unlikely to have achieved the final e-Prescribing element of the “Clinical 5.” Order Communications has been delivered outside of the national contract and is integrated with the Cerner system to provide the capability of viewing results inside Millennium. However, core elements of an integrated clinical record have been achieved, alongside a mitigation of the risks posed by the previous PAS and Theatre systems deployed by the Trust. Achievements which can wholly or partially be attributed to the delivery of the national system into the Trust include:

The Trust has a relatively technology literate workforce with a well defined

learning path for core IT systems.

A significant proportion of operational processes and workflows have been standardised with the advent of the new system, underpinning improvements in data quality, accurate performance management and reporting and enabling the detailed auditing of core system usage through the use of Smartcards.

The Trust’s IT Infrastructure is subject to an ongoing renewal programme, supporting the core business functions and gradually introducing flexibility and cost effectiveness to support innovation

Clinicians have access to an integrated, real time, multidisciplinary, proven patient based system from multiple locations in the care environment including off site locations

There are elements of the patient record that are electronic and the Trust is recognising that a path must be established to develop an electronic record to support the eventual removal of conventional paper records


Page 20 of 84


A data warehouse has been developed into which there is efficient and flexible data mining functionality to support the evolving business environment, accessed from common dashboards and available to managers to support the effective running of their business units. Via the warehouse, the Trust delivers activity information to Commissioners using the Secondary Uses Service (SUS).

There is fully resilient disaster recovery for core PAS and Theatres systems and clinical functionality deployed within Millennium.

Connectivity to the National Data Spine (PDS) has enabled the roll out of Choose and Book direct booking capability placing the Trust in a stronger position amongst its competitors.

Therefore, although by no means a full EPR at this stage, the deployment of the Cerner Millennium system has provided the Trust with the opportunity to create the core of an integrated electronic record which can be built upon to move the Trust first to a paper light state and then to a full electronic state post national contract end and transition. The following sections of the IM&T strategy examine the concept of the EPR and what it means to the Trust, outlining the IM&T programme of work to enable the EPR and investment required to achieve its delivery. However it is vital to overlay two critical factors at this stage upon which the delivery of an EPR will be entirely dependent:

Clinical and Operational stakeholder buy-in to use the Trust IM&T systems in line with best practice guidelines and standard operating procedures, including the alignment of operational strategies to enable clinical and administrative staff to have the capacity to effectively use the systems underpinning the EPR.

Adequate and timely investment in IM&T to ensure the effective delivery of the systems and services to achieve the EPR and to support its effective usage.

Many Trusts have attempted to realise the ideal of an EPR and have expended large sums of public money in failed attempts to achieve delivery. Enterprise Document Management systems (EDM) have been hailed as the way forward to achieve the electronic state but in many instances have added an additional financial and management burden to Trusts as paper has not been stopped but rather transferred into a parallel medium which has often been unusable from a clinical and management information perspective. The use of scanning functionality plays a core part in the move to a paper light state but the creation and use of the electronic record within core, integrated systems must be the primary focus of an EPR delivery programme with scanning as a secondary enabler where recording of data has minimal benefit. The Trust must take a united approach between strategists, clinicians, technologists and operational leads to understand the lessons learned by other Trusts and to jointly strive to achieve the EPR goal with minimal risk to patient care and the financial and stability of the Trust.

2.7. Trust Future Vision

Over the next ten years the Trust will continue to be a major provider of hospital and specialist care for the local populations of Bath and North East Somerset, Wiltshire (West and North) and Somerset (Mendip). It will maintain and strengthen its position through diversification of services to include integration with community providers and others. As a consequence of the changing market environment, the RUH of the future is likely to have fewer beds as services move into community settings, demand management


Page 21 of 84


initiatives to reduce the number of patients accessing acute services, and what was once complex elective work delivered through day surgery. At the same time, an expanding and ageing population is adding pressure to the wider health system and competition is rising as providers strive to maintain economic scale in a low tariff-high fixed cost environment but also to acquire share of higher margin business e.g. less complex elective activity. To deliver the above vision the Trust has developed a series of strategic objectives and the following table identifies how the IM&T strategy and programme of work will support the overall strategic direction of the Trust:

Trust Strategic Objective How IM&T will assist in the delivery of

this Objective

Improve the quality, efficiency and

productivity of the services it provides for

patients.

Through investment in the provision of

modern, integrated IT systems which

support clinical best practice, advanced

record keeping and clinical decision

support through the deployment of a full

Electronic Patient Record (EPR).

Reduce the overall bed base at the RUH,

releasing direct and indirect costs to

deliver to cost improvement

programmes.

Through the use of robust and accessible information and support services to underpin business modelling and service management by operational teams.

Increase market share, collaborating with

local providers and partners to secure

the flexibility of additional capacity when

required.

Through appropriate data sharing and communication across the healthcare community to support rapid diagnosis, utilising systems and networking, with clinical decision support that promotes best practice.

Work effectively as a partner within the

health community through integration

and development of working and

contractual arrangements.

Positioning the Trust as a market leader through investing in modern, efficient technology and information systems, enabling the Trust delivery of a patient-centred Electronic Patient Record with tasks and assessments supporting clinical best practice and care delivery.

Developing its acute offering and

research and development (R&D) to be

best in class, meet commissioner

expectations and support a strong

positive image of RUH in the local

community.

Through the use of quality information collected through the development of the EPR and supported by joint working between Trust IM&T teams and Academic colleagues to support the research agenda.


Page 22 of 84


Specific Trust Ambitions How IM&T will assist in the delivery of the Ambition

Ensure delivery of better or,

as a minimum, equal

performance standards as

local competitors (for quality

and waiting times).

Robust information management systems supporting the use of anonymised data for continuous comparison analysis with competitors to support proactive business management.

Maintain and strengthen its

community presence.

Visibility as a leading player in IM&T enabled change to support better delivery of care and communication between providers and commissioners.

Ensure that staff

demonstrate compassion,

professionalism and

continuity.

Enable staff to focus on patient care by providing modern, usable and efficient technology that becomes a desired part of care delivery rather than an encumbrance or distraction.

Deliver affordable services.

Investing early in the ten year IM&T plan to drive a paper light Trust will mean that efficiencies and affordability will be delivered in the medium to long term through the reduction of paper and the accessibility of information to support care.

Build strong relationships

with commissioners, drive

forward its public reputation

and collaborate with other

providers.

Improvements in communication with commissioners, healthcare providers and third parties to position the Trust as a leader for innovative use of IM&T to deliver the needs of patients and staff.


Page 23 of 84



Page 24 of 84



Page 25 of 84



Page 26 of 84


3. The Case for an Electronic Patient Record

3.1. National Context

There have been a number of studies looking at the opportunities for health organisations from the advancements in technology. This has naturally led to looking at how moving to a more paper light (or even paper free) scenario could be have benefit to a health provider and perhaps more importantly, the patient. The outcome of these studies has resulted in a distillation of the expected benefits in to a number of common areas supported by the experiences of those having taken steps in this direction already and have been summarised by the House of Commons Health Committee in their white paper on the EPR:

“Electronic patient record (EPR) systems have the potential to bring huge benefits to patients and are being implemented in health systems across the developed world. Storing and sharing health information electronically can speed up clinical communication, reduce the number of errors, and assist doctors in diagnosis and treatment. Patients can have more control of their own healthcare. Electronic data also have vast potential to improve the quality of healthcare audit and research”. “An important aim of most developed health systems is the creation, expansion and linkage of electronic patient record (EPR) systems. The introduction of EPR technology offers numerous and significant benefits. Storing and transferring patient information electronically has the potential to significantly reduce clinical errors and improve patient safety as well as allowing clinicians to communicate more quickly and accurately and to identify relevant information more easily. Good EPR systems can increase efficiency, reduce duplication and waste, and improve the cost-effectiveness of health services. EPR systems can also make information much more readily accessible to patients, allowing them to assume more control over their health records and thereby become more active in their own care. In addition, electronic databases of health information can be used for a range of purposes other than direct care provision, for example clinical audit and research. It is right to describe EPR as a potentially a transformative technology”

The national strategy recognises that the NHS as a whole remains a long way from exploiting the full potential of information and new technologies to transform care and support better outcomes. Developments in the consumer and private sector IT market place have long overtaken the majority of developments in the healthcare sector. The advent of capabilities such as cloud computing and smartphones, making information more flexible, portable and cheaper – quite literally enabling anyone to carry the most sophisticated information in their pockets, has served to highlight the gulf between what the health sector can offer its patients now compared to what the majority of those patients expect. The pace of technological change has outstripped the old approach of centrally and regionally commissioned systems, and points to a new approach that is more adaptable and local. The thought processes that the Trust must use to develop its EPR must allow for both present and future requirements and delivery mechanisms and deliver a solution that is adaptable to a rapidly changing environment. Both the House of Commons Health Committee whitepaper and the Power of Information offer the following advice when looking to embark upon the EPR journey:

The installation of a comprehensive EPR is a long journey best managed by a staged and piloted development not a big bang approach.


Page 27 of 84


The input of end-users is vital in planning, design and implementation.

Local flexibility is essential to allowing continued use of effective systems already in place, as is interoperability if local systems are to communicate with one another.

As EPR systems make more personal health data accessible to more people, breaches of security and confidentiality must be regarded as serious matters.

The support of the public must be obtained. The fact that EPR systems are essential for the delivery of modern health care and can improve communication between different health care staff and between staff and patients must be adequately publicised to users of the NHS. In doing so it is believed that this will help to convince people of the necessity and benefits of the EPR and reduce resistance where it exists.

The Power of Information follows with direct guidance on delivering the change necessary for successful adoption of the EPR:

Professional and managerial staff need to embrace a culture change, improve

leadership and promote staff education to maximise the potential of information and informatics services to transform the way in which services are delivered

Clinical and professional staff should be supported to develop the necessary skills and capability to support informatics agendas, including encouraging accreditation of informatics professionals such as Chief Clinical Information Officers (CCIOs)

There should be a move away from centralised management of IT programmes to allow for innovation and services offered by those best placed to provide them.

There is huge potential for health and care and support to make better use of modern technology in delivering high quality services that are both convenient for the people using them and efficient for those providing them.

3.2. Local Context

Although at an early stage in the development of an EPR, the Trust has already recognised the value of a paper light state in contributing to the delivery of overall strategic objectives, including the mitigation of the risk posed by the current paper based Medical Record and the fulfilment of the Facilities plan for re-locating of the Medical Records building. A single, integrated electronic patient record is recognised as fundamental to supporting further relationship building with commissioners and other health care providers, enabling the sharing of secure data to support regional management of patient care across both public and private setting. Work has commenced in looking at the local impact an EPR would have at the Trust in a specific specialty (Urology) but a wider approach to jointly deciding what constitutes the EPR and scoping its delivery programme is a necessity and urgently needs investment to commence. The new governance arrangements introduced into the IM&T department (as set out in section 4) enable the sharing of IT decision making processes with clinical and operational leads under the direction of the IM&T SRO. The engagement of clinicians and Divisional Managers in particular via the Clinical Informatics Board (CIB) and the Advisory Clinical Group (ACG) has been designed to provide improved communication channels leading to more operational engagement in IM&T as a whole. Both the CIB and the ACG are tasked with identifying the structure of the EPR, with guidance and support from IM&T and also with championing its progression at Management and Trust Boards and its usage with clinical and operational colleagues. The IM&T programme of work is directly


Page 28 of 84


dependent of the engagement of these stakeholders in clarifying the EPR and its future use. As an aid to developing what constitutes the EPR the Trust recognises that:

A ‘good’ electronic patient record will provide an electronic record that contains

the same information as the paper record with the information being available to

anyone at any time.

A ‘better’ electronic patient record would also provide additional specialist

information; increased information that may support complex cases and long term

conditions, as well as information that can’t be printed (e.g. images, ultrasounds).

The ‘best’ electronic patient record would also provide intelligence and decision

support that would allow the Trust to provide the best clinical and non-clinical care

to patients with automatic alerts and pathway/best practice guidance.

However key to note is the fact that it should not be the expectation that implementing an EPR is in all cases a direct way of reducing costs to such an extent that it pays for itself as an investment. Much like with other critical “equipment” involved in delivering care, the EPR should be seen as another component that needs to be invested in as technology moves forward. Notwithstanding, there will be efficiency gains and potential for cash releasing opportunities as an EPR programme develops but such opportunities should not impact on the focus of delivering quality in the technical solution and associated transformation activities.

3.3. EPR Progress to Date

As part of the initial move towards an EPR and as an integral part of the deployment of the Cerner Millennium system, the Trust has introduced the capability for clinicians to record patient outcomes and supplementary information in both the inpatient and outpatient setting over and above the administrative capabilities provided by the PAS. In the inpatient setting this has enabled the creation of integrated discharge summaries which are now electronically transmitted to GPs. In addition electronic nursing risk assessments have been deployed providing immediate access to data supporting improved delivery of patient care. Such assessments will be enhanced within Millennium throughout 2013/14 to encompass further elements of the care pathway. In the outpatient setting the recording of procedures, diagnosis and problems has engaged clinicians in the initial electronic documentation of their patients’ care and has enabled instantaneous views of data to support the introduction of service line management initiatives. GP referral letters are scanned and attached to the patient record and forward plans include the creation and management of clinic outcome letters in Millennium and their transmission to GPs and other healthcare organisation. Further 2013/14 planned activity in both the outpatient and inpatient setting includes the introduction of MPages (clinical summary views within Millennium) supporting greater efficiency in using the system, clinical noting (giving the ability to record further patient information in specific format) and the incorporation of an integration with order communications capability to allow for the viewing and endorsing of results by doctors. External to Cerner Millennium there has been the roll out of the Summary Care Record viewer in the emergency care setting to support authorised views of key patient information (medications, allergies and conditions) held by GPs both across the region


Page 29 of 84


and nationally. Further investigations are progressing into greater interoperability with community systems to enable the Trust to deliver more effective care to patients, particularly in the emergency care setting, and to assist in the reduction of waiting times and productivity of such environments. To further support the creation of the EPR and to ensure that high quality information is available to be shared by the Trust’s clinicians, a number of initiatives are also in progress to underpin the Trust’s drive to deliver equal or better performance standards as/than local competitors. Although such initiatives use IM&T as their enabler, they require to be operationally/clinically led and emphasise the importance of strong communication and relationships between IM&T, clinical and operational staff (a good example being the electronic transmission of all discharge summaries and outgoing GP correspondence to community locations within 24 hours in alignment with national requirements, which needs a robust IM&T solution and monitoring capability to be driven by Clinical Leads through their departments).

3.4. EPR Next Steps

The above initiatives are creating the basis of the core integrated patient record, however the Trust is still to define the full EPR, as adhered to in section 3.2 above, the task being the core responsibility of the ACG and CIB. Once fully defined, the EPR can then be scoped in detail across all care settings and translated into the IM&T programme of work which will provide overall management for the delivery of an appropriate single-view access to an up to date, unified patient record that is available anywhere, at any time. Stakeholder engagement from across the Trust and visibility of the IM&T strategy on corporate agendas (with demonstrable executive support), is a critical part of building towards a trust-worthy EPR that clinicians and colleagues can use to support the delivery of high quality patient care and reap the benefits which can be gained from a more cohesive and comprehensive record. Therefore for 2013/14 and potentially 2014/15, and to fulfil Stage 1 of the IM&T programme of work, attention will focus on developing Cerner Millennium as the core of the EPR but in a structured and pragmatic way, mindful of 2015 procurement activities and an outcome which many require the migration to an alternate platform. Existing departmental information systems will be the subject of a systematic review which will examine where efficiencies can be made by amalgamating their functionality into Millennium or by creating further systems integration in line with the requirements of the EPR. In all cases IM&T, wherever possible, will work with their departmental system owners to ensure that they are all systems are secure, resilient and provide the right levels of service. Digital dictation capabilities, stronger links to GP systems and a secure, refreshed medical and general imaging capability will all be developed in parallel and combined into the core system where possible (financially or technically). New system/functionality requirements will be managed in terms of their criticality according to Trust strategic objectives and realistic capabilities for their creation in the core systems in the Stage 1 period.

The outcome of the 2015 procurement is expected to be known in May/June 2014 and progress of EPR development will be dependent on whether the Trust will move to an alternate platform. Should an alternate platform be the outcome, a change freeze will commence on any further developments of Cerner Millennium in June 2014 in order that


Page 30 of 84


IM&T teams can commence detailed planning and implementation activities for the migration to the new platform. Should the outcome of the procurement be the continuation of usage of the Cerner Millennium system, then EPR development will continue until a change freeze in April 2015 at which point IM&T teams will be fully committed to data centre exit planning. Once exit, transition and stabilisation activities are completed (estimated 2017/18), work to develop the EPR further can recommence, as summarised in Stage 3 of the IM&T programme of work. At this point in time the uncertainty of future system(s) and platform mean that there cannot be a detailed plan of how a full EPR will be achieved but it is recognised that core functionality must be deployed to achieve the paperless environment. This will include, at the very least, medications management, advanced imaging techniques and the availability of rules-based pathways management to support the Trust’s drive for clinical efficiency and future benefits to patients as well as financial balance. The remit of IM&T should expand in this period to combine the amalgamation of resource management, electronic coding and full capacity planning capabilities as well as the remainder of paper case note management

3.5. Significant Other Systems Contributing to the EPR

A number of other national solutions contribute to the core foundation of the Trust’s EPR. In many cases such national solutions are reaching the end of their current contracts and services are being transitioned to a local ownership model, meaning that the Trust requires to procure its own future services either individually or as part of a collaboration.

Picture Archiving and Communications System (PACS) One of the other core components of the National Programme has been the delivery of PACS (Picture Archiving and Communications System) via CSC. This was implemented into the Trust in 2005/6, with the current contract ending in June 2013. A project is currently under way to manage the exit from the current contract with a new supplier appointed in February 2013. The initial scope of the new services will encompass Radiology imaging but will not include other imaging services (Cardiac Echos, Ultrasound etc) and the IM&T strategy seeks to ensure that the scope of all imaging requirements is encompassed as part of the development of the EPR. The current position will see deployment of the new solution commencing in March 2013 with final modalities coming off CSC PACS by Jun 2013.

Choose and Book Central funding to support the delivery of this service has been extended until 2014. As a continuation of the Millennium post go live stabilisation plan, the Trust has rolled out direct booking capability to the majority of specialties thus positioning itself in a competitive position in terms of the service across the region.

NHS Mail NHS mail has provided the Trust with a secure and recognised method for the transmission of sensitive data and migration to NHS Mail continues across the Trust with all doctors provided with an NHS Mail account as well as a significant number of operational staff. The national contract for central provision of NHS Mail will be devolved in 2014 however the Trust will continue to fund this valuable service.

National NHS Network (N3)


Page 31 of 84


Central funding to support the continuation of provision of N3 has been extended until at least 2014

Enterprise Wide Agreements (EWAs) The National Enterprise Wide Agreements with Microsoft, McAfee and Novell were not renewed in 2010, which led to unplanned expenditure to maintain the correct and fully licensed software estate. The Oracle EWA remains in place until June 2014.

Interoperability The original vision of the National Programme was for an all encompassing set of linked systems that can deliver an integrated, patient centric solution. The reality is that many information silos have been introduced with little linkage between systems. At a local level and as part of the scope of the EPR, the Trust will be instrumental in publishing and making data available in a safe and open way when it is needed in line with Data Protection Act guidelines. The IM&T department will seek to work with Commissioners and other healthcare providers to embrace national interoperability standards to share records for specific healthcare pathways. It is critical that as a tertiary centre that the Trust, as part of its business objectives, promotes itself as easy to work with in an information capacity, with a proven record to be open in the assisting and sharing of information using common standards in a secure fashion.


Page 32 of 84


4. Governance of the IM&T Programme of Work

4.1. Approach

The core approach of the IM&T department over the next ten years will be to deliver a systematic programme of activities to deliver a robust set of clinically-focused, integrated software applications and technologies which will constitute the EPR and will fulfil the information requirements of a Trust who wishes to operate as a successful competitor in an increasingly diverse market. The EPR and the organisational change processes which will support its usage, will underpin Trust strategic objectives and provide clinicians and operational staff with the practical means to derive tangible benefits from improving patient care and making better use of Trust assets and resources. Therefore Information Management and Technology will increasingly underpin clinical service delivery and support the Trust’s success as competitive player in emerging markets. At the very least, IM&T will be required to provide fast, accessible and reliable services to make the capture, processing and display of information as relevant, quick and easy as possible for users. Building on existing strengths achieved from the successes of the Millennium deployment, the IM&T department will develop within itself to become more responsive to changing service and user needs, and will aim to be recognised as a centre of technology excellence, promoting the delivery of leading-edge information services delivered to a high standard. The IM&T programme of work will follow a core set of fundamental principles:

Utilising proven methodologies (PRINCE) and Government recommendations to underpin all project management and business case development (including the development of delivery milestones, gateway reviews and internal/external audits).

Putting in place robust change control and configuration management methodologies to manage development lifecycles and ensure focus of delivery to Trust strategic objectives.

Putting in place an appropriate infrastructure and modernising the way the Trust stores and communicates information

Investing in stakeholders through education, exposure to regional and national initiatives and through regular appraisals and review for IM&T staff to ensure that the IM&T department leads on researching new technology and innovation to support changing patterns of working, making better use of existing technologies and ways of accessing and presenting information

Ensuring that quality is maintained through all IM&T delivery cycles and that internal and external workflows/processes/suppliers/relationships are underpinned by explicitly defined quality standards and criteria.

Following a structured management response to risk with mitigation plans being drawn up in a proactive manner, addressing threats prior to them materialising and not simply being reactive after the event.

Adopting financial care and discretion, communicating programme delivery plans to all key stakeholders in a legible and accessible manner and ensuring that plans are developed with focus on efficiency and achievability and can be directly traced back to Trust strategic objectives.


Page 33 of 84


Developing existing IM&T resources to deploy significant in–house developed capabilities thus avoiding the need to spend large sums of money on purchasing external resources.

4.2. Strategic IM&T Alignments for a Foundation Trust

In addition to the above principles, there are also specific information technology requirements that a Foundation Trust must meet:

Demonstrate governance of information technology within the Foundation Trust committee structure.

Provide an overview of information technology systems including readiness for national initiatives such as the National Programme exit, delivery of choose and book, connectivity to National Data Spine etc.

Provide a summary of key risks for information technology that may impact the Trust’s strategic plans, assessing likelihood, describing mitigation actions and detailing potential financial and non-financial impact, including describing the worst case scenario.

Demonstrate that the information technology systems covering financial reporting and procedures are fit for purpose.

Such principles and requirements have been managed to date by previous IM&T strategies and will continue to be governed the implementation of the new IM&T Strategy.

4.3. Governance

4.3.1. Clinical Informatics Board

To ensure that the Trust’s information and technology systems are properly managed to deliver quality and safe solutions to Trust strategic objectives, a Clinical Informatics Board, chaired by the Chief Information Officer, operates with representative membership from Executive Directors, General Management, Heads of Division and the IM&T Department. The Board reports to the Trust Management Board on a quarterly basis and undertakes the following core functions:

To provide overall control, leadership and direction for all aspects of

Information Management and Technology within the Trust

To approve strategies, projects and implementation plans and monitor progress against plans

To approve business cases within delegated limits or refer to the Management Board for approval at, as defined in Trust Standing Financial Instructions and Standing Order

To maintain oversight on projects authorized by the Board, including achievement of project objectives and deliverables, realisation of identified and agreed benefits and assure adequate funding is available for projects, and to monitor expenditure against budget allocation

To ensure integration with the Trust's strategic objectives, Transformation Agenda and Efficiency Programme


Page 34 of 84


To oversee Risk Management including regular review of the high residual risks relating to IM&T issues

4.3.2. 2015 Procurement and Transition Board

In parallel, a 2015 Procurement and Transition Programme Board is authorised by the Management Board to be responsible for the overall direction of procurement, transition, exit and stabilisation activities over the period of expiry of the national contract and beyond. The Board’s remit is to ensure that Trust strategic, clinical and economic requirements are met and risks mitigated at all stages of the procurement and exit processes and within the new contractual arrangements. The Board will be chaired by the Director of Finance and made up of senior representatives from across the Trust, representing clinical, operational and corporate functions including Human Resources. The Board will receive advice and guidance from the Clinical Informatics Board with fluid communications supported by the presence of senior roles on both Boards (Chief Information Officer, Medical Director, Director of Finance, Head of IT, Head of Information). The 2015 Procurement and Transition Programme Board’s main objectives are to:

Agree the procurement strategy and approach in full support of the Trust’s

electronic patient record vision

Ensure the programme reflects the user and business requirements

Agree the delivery mechanism/s to achieve the Trust’s immediate and future objectives and ratify all programme controls and deliverables

Recommend the budget to be allocated

Agree and oversee the detailed implementation programme plan (to include procurement, implementation, transition, deployment, stabilisation and future delivery/enhancement)

Ensure the key milestones are met on time and to budget and within quality expectations

Understand the benefits programme and ensure that the processes recommended will deliver the expected benefits

Receive, understand and support the management of any risks and issues

Agree and ensure compliance to action plans.

4.3.3. Senior Information Risk Officer (SIRO) and Chief Information

Officer (CIO)

Senior Information Risk Officer (SIRO): The Director of Finance is the senior manager responsible for Information Governance and in the capacity of SIRO Senior Information Risk Owner works closely with the Chief Operating Officer and Chief Information Officer to lead on information security issues. The SIRO is assisted by both the Information Governance Manager and Information Asset Owners (IAO’s) and will provide a focal point for managing information risks and incidents. The SIRO will take ownership of the Trust's information risk policy, act as an advocate for information risk on the Board and provide written advice to Accounting Officers on the content of their Statement of Internal Control in regard to information risk. The Chief Information Officer (CIO): The Chief Information Officer


Page 35 of 84


provides leadership and management to the Finance Director and Chief Operating Officer, advising them on new business systems, ensuring provision of business critical IM&T hardware and software support, ensuring effective IM&T Programme management and development of information systems. The CIO also assures the delivery of information governance requirements in line with statutory and regulatory guidance across the Trust. The CIO furthermore ensures that the Trust has systems and procedures in place that provide the required levels of IM&T security, including Data Protection and assures that the Trust maintains a position of information integrity with its systems and operations in line with NHS standards

4.3.4. Advisory Clinical Group

Supporting both the Clinical Informatics Board and the 2015 Procurement and Transition Programme Board is the Advisory Clinical Group (ACG), a group of clinical stakeholders (including representatives from the Nursing community) who will provide advice and guidance on clinical IM&T and Health Records Management initiatives and implementations as directed by the Clinical Informatics Board. This group will assure that clinical IM&T benefits are deliverable and achievable and will be the advocates of best practice for IM&T usage throughout the Trust. They will also be a conduit for the communication between clinicians and technical leads. Key priorities for the ACG are as follows:

To provide clinical informatics advice to support the creation and delivery of

the Trust’s IM&T and Health Records Management strategy.

To assist in securing clinical commitment and engagement to approved Trust wide IM&T projects and initiatives.

To assist in the review of new clinical systems, hardware and support requirements.

To act as a core liaison between IM&T and clinicians across all Specialties.

To communicate with fellow, like-minded clinicians across the healthcare community to review IM&T initiatives and to advise the Clinical Informatics Board accordingly on a regular basis.

To review existing operational IM&T and Health Records Management clinical service delivery, providing feedback to the IM&T Programme Board on a regular basis to assist in the provision of an efficient and effective programme of work to support clinical use.

The group will be chaired by the Medical Director with the Chief Information Officer and Head of IT providing continuity to the Clinical Informatics Board.

4.3.5. Clinical Chief Information Officer

The Trust is recommended to support the creation of a Chief Clinical Information Officer/Clinical Safety Officer role, appointing a consultant who will play a pivotal role in the formation and implementation of clinical information systems to derive the EPR. A CCIO would be responsible for leading medical staff involvement in IM&T through the Advisory Clinical Group, working with senior operational and medical leadership to assure that the development of the EPR meets emerging clinical requirements and patient safety standards. The role would support from a clinician’s perspective the complex changes in organisational culture, processes and medical practice which will be required to support the delivery of the EPR.


Page 36 of 84


4.3.6. IM&T Programme Board

Operational management of the IM&T programme of work delivery will be fulfilled by the IM&T Programme Board (IMTPB) who will oversee the development and implementation of a robust and effective plan to deliver functionality and service in line with Trust strategic objectives. The objectives of the IMTPB include:

Formulating, reviewing and updating policies relating to IM&T and its usage

across the Trust.

Providing a forum through which consultation and communication on IM&T matters can take place.

Overseeing the standardisation, wherever possible, of IT applications and equipment across the Trust.

Monitoring compliance with NHS and any other relevant standards.

The following diagram illustrates the core IM&T governance arrangements and how these link in to other Trust operational and strategic groups. Operational groups focusing on specific areas of IM&T, such as the Information Governance Steering Group, Data Quality Steering Group and the Medical Records User Group will communicate directly with the IMTPB. IM&T internal governance functions managing service delivery and development (the IM&T Change Board and Delivery Board) will provide progress reports to the IMTPB on a monthly basis. The chair of the IMTPB will be the Head of IT with continuity of communication to the Clinical Informatics Board via the chair and the Chief Information Officer.


Page 37 of 84


Trust IM&T Governance Structure

Trust Board

Management

Board

Clinical

Informatics Board

IM&T Programme

Board

IM&T

Development

Board

IM&T Change

Board

Project Board 4... Project Board 3 Project Board 2 Project Board 1

Human Resources

Education

Facilities

SPfIT / SHA

Business Planning

Finance / Procurement

Commissioners

Patients

Medical Records Steering

Group

Information Governance Steering Group

Data Quality Steering Group

Advisory Clinical

Group

2015 Procurement and Transition

Board


Page 38 of 84


The purpose and remit of operational IM&T supporting groups are summarised as follows:

4.3.7. Information Governance Steering Group

The purpose of the Information Governance Steering Group (IGSG) is to:

To ensure that an appropriate comprehensive information governance

framework and systems are in place throughout the organisation in line with national standards

To monitor the organisation’s information handling activities to ensure compliance with legislation, codes of practice and other NHS Directives

To review compliance with the above requirements through the formal use of the DH Information Governance Toolkit on an annual basis.

To develop the organisation’s information governance work programme and oversee the production and delivery of action plans put in place to meet any gaps

To develop and monitor the implementation of an information governance policy framework and associated guidance.

To provide a focal point for the resolution and /or discussion of information governance issues.

To ensure that the organisation’s approach to information handling is communicated to staff and made available to the public.

To provide assurance on this area to the Trust Board through the IM&T Programme Board.

To provide assurance that the Trust is meeting its legislative requirements under the Freedom of Information Act 2000.

4.3.8. The Data Quality Steering Group

The remit of the Data Quality Steering Group is to engage Divisional leads and senior operational managers in the following objectives:

Identification and recording data quality Issues

Development and review of data quality action plans

Review and action audits in relation to data quality

Identify and highlight any potential training issues regarding the collection and timely recording of data

Identify issues and action arising from ISN’s. (Information Service Notices)

Monitor data quality contract penalties

Effective performance of the Millennium Data Quality team

Staff take responsibility for the data they record

Clinical and Divisional departments are engaged with Trust data quality

Raised awareness and ownership of data quality across the Trust

Improved confidence in Trust data

4.3.9. The Medical Records User Group

The Medical Records User group engages clinicians, operational staff and IM&T to support the following:

Health Record Content - To monitor the continued and expanded delivery of Trust wide training and audits related to Health Record Keeping standards in


Page 39 of 84


order to achieve compliance set out by the NHSLA , Care Quality Commission and IG Toolkit

Delivery of the Medical Records Department Health and Safety Action plan

To support the development of the Electronic Patient Record and a rationale for the continued storage of paper records including:

The reduction of oversized records The migration of the service from paper to paper light (incorporating

the functionality of the new IM&T / Medical Records Building) Scanning of Nursing Documentation Cessation of archive record retrieval from off-site storage The Retention and Destruction of expired records notably in John

Apley Development of the Storage facility at Peasedown St John The Management and escalation of Risks Associated with the above

4.4. Risk Management

The Trust has a structure in place to identify and mitigate IM&T risks, which is headed by the Director of Finance in the role as Senior Information Risk Owner (SIRO). All risks are recorded using the Trust Risk Management system, Datix, and are reviewed on a regular basis by IM&T senior Managers. The SIRO is supported in their role by the Chief Information Officer, Heads of IT and BIU, Divisional Managers and Clinical Heads of Divisions. Departmental system risks are the responsibility of Clinical Leads in their roles of Information Asset Owners with System Managers (where present) acting as Information Asset Administrators, each of whom are responsible for identifying risks and escalating them as necessary via Datix. Other controls are achieved through staff training at induction and annual refresh training. The management of Trust Policies is a shared remit between the Information Governance Manager and the Trust Board Secretary, meaning that key procedures and guidelines have visibility within IM&T to ensure that all aspects of information management and technology can be taken into consideration in the processes of policy creation. Specific IM&T system controls (e.g. encryption of USB sticks and Laptops, standardised timeout of applications, use of SmartCards etc) are used to protect confidentiality. Smartcards also provide an audit trail of system usage which is monitored by the Care Records Service team as part of the business as usual function. Identification and investigation of specific information governance incidents are published on the Trust intranet and are widely promoted.


Page 40 of 84



Page 41 of 84


development requirements. The team will be a critical factor in supporting the development requirements identified in the IM&T programme of work and already work closely with each of the Divisions to evaluate functionality requirements and assist in business case development and scheduling within the IM&T development plan. The key driver for this team is to consider Millennium as the first choice for new functionality requirements and to encourage its use wherever possible.

5.4. Care Records System Team – The CRS team are responsible for the ongoing maintenance and business as usual (BAU) back office functions to support the Millennium system as well as supporting data quality initiatives and working with the Business Systems Team to manage requests for change, enhancements and optimisation and rationalisation of all other Trust systems. This team are also planned to take responsibility for technical Business Intelligence Unit developments from April 2013. Key resources from both this team and the Business Systems Team will be required to develop the technical elements of the EPR strategy and to support the 2015 Procurement and Transition activities.

The CRS team actively build on the knowledge gained of Millennium through their role as principle development team in the recent deployment and will be the primary technical architects of the EPR, building upon existing relationships with clinical and operational leads to underpin development with their background knowledge of the Trust and its systems.

Business as usual activities included within this team’s remit include:

Maintaining levels of user support via Phone and Service Desk

Support Choose and Book roll out

Re-establishing levels of recording of NHS Numbers, Deceased, and Babies

Improve the process for recording and maintaining staff in the Millennium role based access model and the Spine.

Improving the commissioning challenges process.

Continuing with Data Quality Tasks

Support the Testing team with system changes (Maintenance release and developments)

Support Training to ensure content appropriate and relevant

Working with BIU to ensure all Data Quality issues are dealt with

Supporting Millennium developments with advanced changes.

5.5. Testing Team – The Testing team provide a critical support function to all IM&T developments and are expert system users, working with change and development teams to assurance that functional developments and maintenance releases have been fully tested before release into the live environment. The team are significantly underfunded to support the increasing demands for functionality across the Trust, particularly in light of the advancements which will occur as part of the EPR development.

5.6. Business Continuity – This small team support the back end Trust databases which provide the backbone of all core systems and functionality. The team also support the virtualisation of Trust servers, enhancing the governance framework alongside the Information Asset Owners, making the existing hardware more efficient in a difficult financial climate and ensuring the Trust has robust and resilient environments from which to support the delivery of patient care. Work in this team significantly underfunded team continues throughout 2013/14 to build further


Page 42 of 84


resilience into the Trust database platform, making the current databases more scalable and providing supporting development and test environments to minimise risk to live service.

5.7. Information Governance - The Information Governance team manage the following requirements:

Freedom of Information Requests (FOIs) - The statutory requirement for the Trust to comply with requests for information and to maintain an up to date publication scheme.

Information Governance Toolkit – The Department of Heath requires that each acute hospital works to deliver improved information governance performance across a wide range of separate requirements which are measured through the information governance toolkit. The action plan to deliver compliance is monitored by the Non Clinical Governance Committee on a year by year basis and continuously seeks to deliver further improvement of the Trusts compliance and performance.

Information Risk Management - A rolling programme of information governance audits of controls on local department managed systems to ensure effective access management and user management is in place along with Business Continuity and Disaster Recovery Planning. The information Governance Manager actively visits departments and operational systems managers to ensure all information governance requirements and resulting action plans are satisfactorily completed. In addition, all reported incidents of information governance breaches are investigated and briefed to the Information Governance Steering group.

Severe Untoward Incidents - Should an Information Governance Serious Untoward Incident (SUI) occur, this is managed according to the Trust’s Incident Reporting and Management Policy. Any incident that is classified as a ‘high’ risk or ‘extreme’ risk within the Trust’s risk evaluation matrix will be identified as a serious untoward incident.

Privacy Impact Assessment and New Systems - In line with Information Governance toolkit requirements, the IG team manages a screening questionnaire which is required to be completed for all new systems to assess the need for a full or small scale Privacy Impact Assessment. In addition new NHS PASA information assurance clauses have been entered into the contracts the Trust signs with any new supplier. Monitoring by the IG team takes place to ensure these are completed and effective.

The Information Governance team remit is covered in more detail in section 6.5.3 and in Appendix 1.

5.8. IM&T Change Management and Training – The IM&T Change management and training teams work in conjunction with development, back office and testing resources to ensure that the technical delivery of all functionality is supported by business process support for the end user. Both teams work closely with operational staff in both administrative and clinical environments to support the embedding of IM&T systems and to ensure that data quality is not compromised through deviation from recommended workflow and best practice. Both teams will be significant in the development of the EPR strategy and the communication of the IM&T vision and objectives to the Trust stakeholders.


Page 43 of 84


5.9. Interfacing – The emphasis in the first part of 2013/14 for this team will be the deployment of the future PACs solution. Business as usual activities include the redevelopment and testing of the interfaces required to support the rebuilt MPI2 and the transfer of Trust interfaces to an open source interface engine, the MIRTH product, a cost effective solution which is already in use in a number of Trusts and will be core to future information sharing. This team is significantly under resourced to support the future integration needs of the Trust (both internal and community) in a timely manner.

5.10. Internet/Intranet – The work of the Web Team remains fully committed with a plan of work extending into 2014 and priorities may need to be adjusted to avoid over-commitment. Ongoing developments include open source content management systems (that allow individual users and groups to publish directly to Intranet microsites) and wikis which are starting to be introduced for group information exchange. Continued improvements to the GP website will be progressed together with the development of additional patient facing information in line with emerging national requirements.

5.11. Business Intelligence Unit – The Business Intelligence Unit has recently come

under the remit of IM&T, which will enable the merging of technology and information programmes of work to be realised by the single IM&T strategy. The primary objective of the BIU is to support the management of the delivery of information for the Trust in terms of performance reporting, national reporting requirements, financial billing and to support service level initiatives. Over the last three years BIU have constructed an effective in-house data warehouse to manage information for multiple Trust systems, creating a ‘single point of truth’ from which to manage Trust business. The IM&T strategy sets out to ensure that the forward plan of work encompasses information management and its uses as an integral part of the development of the EPR and that the objectives for BIU are consolidated with IM&T and Trust overall strategic objectives. Further information on the role of BIU and consolidation of its strategic plan into the IM&T strategy is included in section 6.5.2. The BIU Information strategy, which pre-dates this IM&T strategy, is contained in Appendix 2.

5.12. Extension of In-house Capabilities

As a result of previous investment in training during the recent Millennium deployment, the Trust has developed a small but strong and diverse team of professionals who form the foundation of the development hub required to deliver the Stages identified by the IM&T strategy. Further (limited) funding remains within the national contract to train more staff in Millennium development skills and this will be called upon to support the EPR initiatives contained in Stage 1 and to ensure continued support for in-house solutions. The development and implementation of in-house functionality and solutions will be managed in a more formal way than has previously been the case, to avoid disjointed application design, bottlenecks of critical requirements and poor uptake and control of usage through lack of change management support. Governance of the programme of work will be via the IM&T Programme Board, reporting to the Clinical Informatics Board and ultimately Management Board. Quality will be managed via a series of milestones and gateways which will also provide for the opportunity to update the IM&T strategy.


Page 44 of 84


6. Delivery of the IM&T Programme of Work

6.1. The Current IM&T Programme of Work Position – Stage 1 (2013/14 – 2014/15)

The following table examines the commitments that define the IM&T Stage 1 programme of work over and above the business as usual (BAU) function. The Outline IM&T Roadmap is illustrated in Appendix 6:

Stage 1 Priorities Committed Projects (unless otherwise indicated) Expected Timeline

Maintaining the currency, safety and availability of core clinical and corporate systems (including Millennium, clinical departmental systems, order communications and the data warehouse)

1. Audit of all departmental systems* 2013/14

2. Audit/Rebuild of MPI2 to underpin the continuation of management of patient demographic data outside of the Millennium environment

2013/14

3. Data Warehouse audit review (including all reporting) and introduction of further resilience to the data warehouse platform

2013/14

4. Server and System upgrades or replacements including TOMCAT, Pathology, Laboratory Information Management System (LIMS)

2013 - 2015

Development of Millennium and integrated systems as the core of an EPR and the enabler for Trust strategic objectives

1. Continuation of the embedding of the use of Millennium as the primary source of patient information throughout the Trust

2013 - 2015

2. Electronic discharge summary transmission (switch off paper)

March 2013

3. Introduction of scanning of inpatient nursing documentation held within Medical Records library

April 2013

4. Enhanced electronic Nursing Assessments and documentation

November 2013


Page 45 of 84


5. Clinic outcome letter creation in Millennium and electronic transmission to GPs

March 2013 – March 2014

6. Outpatient self check in kiosks pilot August 2013 - March 2014

7. Consolidation of the EPR into a single integrated view (a clinical portal)

August 2013 - March 2014

8. Integrated Medical Image/Photography capability April 2013 – March 2014

9. Integration of Millennium with existing digital dictation capabilities to extend the benefits of clinical use of the system

March 2014

Promote the use of Information as a Strategic Asset by building upon the strengths of the Trust data warehouse

1. Increase the information user base utilising the Trust Business Objects capabilities

2013/14

2. Improved Data quality, managed by the Data Quality Steering group (focus on capture of OP procedures, ucodes etc)

Ongoing

3. Fix at Source project to promote better end user recording of information

Ongoing

4. Millennium replacements for Qulturm systems 2013/14

5. Medium and long term information planning in conjunction with IM&T teams to further combined strategy

2013/14

6. Creation of a clinical MPI to support delivery of the EPR 2013/14

7. Further enhancement of SLM dashboards to support clinical business management

2013/14


Page 46 of 84


PACs/RIS system replacement PACs/RIS transition Project June 2013 – Sept 2013

Order Communications

1. Results viewing in Millennium June 2013 (Radiology)

September 2013 (Pathology)

2. Results authentication in Millennium through the use of Message Centre

Sept 2013 - Sept 2014

3. Enhancements to the ICE/ Millennium integration to support demand management

Sept 2013 – Sept 2014

4. ICE interface with Cardiology system for requesting and results

Funding and timeline to be confirmed

2015 BT LSP contract end 2015 Procurement and Transition Programme March 2013 – March 2016 Funding to be confirmed

Corporate records management

1. Cloud storage capabilities and use of mobile devices

2. Mobile meeting functionality

Ongoing 2013/2014

Pilots in Q3 2013

More efficient IT Service Support Stemming the tide project to reduce the demand on IT service support, encouraging self service for issue logging and use of online support for resolution

Ongoing across 2013/14

Maintaining performance and reliability of the Trust network

Upgrade of wireless connectivity to support future innovations in mobile working

2013/14 – 2014/15

Review of IT infrastructure and move to a virtual desktop platform

1. Server virtualisation project (in parallel with the IM&T age replacement schedule)

2013 – 2015

2. Microsoft Product Migrations (including Office 2007, Windows 7 and Server 2008)



Page 47 of 84


Review and rationalisation of the governance of IT systems

1. Review of Application Development Tools and Environment – use of Team Foundation Server as a standard software set

2. Audit and improvement of development and test environments in line with current best practice models



3. Single Sign On to promote easier access to the desk top for clinicians

2013/14

4. Oracle Apex – allowing for the further rationalisation of departmental systems to support movement to a centralised IM&T solution

2013 – 2015 (dependent on availability of developer

resource)

5. Snow Asset Management – the Snow tool will enable greater control over IM&T system management

Ongoing usage as part of development practice

Provide support for Trust initiatives including QIPP, CQUIN

Integral to delivery of the EPR ‘paper light state’ in Stage 1 2013 - 2015

Delivery of Information Governance compliance with national standards

1. Information Governance Toolkit completion

Ongoing each year with work commencing as early as possible to gain maximum benefit from introduced improvements

2. Management of Freedom of Information Requests

3. Information Risk Management rolling programme of governance

4. Management of Severe Untoward Incidents

5. Privacy Impact Assessment and New Systems evaluation in conjunction with development team

6.


Page 48 of 84


6. 6.1.1. Audit of Existing Departmental systems*

The IM&T department is aware of at least 90 departmental systems (and many more that have not been ‘discovered’) used around the Trust that are being used for a wide variety of purposes and will be contributing to operational benefits but also introduce risk to data quality and information management. The Trust Integration Engine (TIE) currently provides interface-based data via a master patient index (MPI2) to feed many of these systems with patient registration and activity data from Millennium. The IM&T team will embark on an audit of as many of these systems as possible in 2013/14 to establish the level of supplier and local support used, compliance with information governance, technical resilience and other factors according to the application involved. It is envisaged that some of these systems may, with the agreement of their owners, be good candidates for replacement within Millennium. Other departments may choose to take advantage of IM&T’s capabilities so that the systems can be ‘adopted’ and managed centrally to ensure compliance to governance requirements (subject to resource availability and funding). Appendix 4 contains a table of existing Trust systems known to the IM&T department.

6.1.2. Non-clinical Systems

The Trust operates a wide range of business systems that do not have a direct impact on clinical practice, yet are nonetheless critical to the Trust’s business operations. It is suggested that these systems should also be reviewed and support arrangements reviewed as part of Stage 3 of the IM&T programme of work.

6.1.3. Project in Stage 1 Remaining to be Agreed and Funded

Merger with the Royal Hospital for Rheumatic Diseases (RNHRD) Progress of this project will be dependent on Foundation Status application and contractual discussions and is expected to commence mid 2013. There are undoubtedly efficiencies to be gained from the merger of the two services but it must be noted that at the present time the technology and change project is unfunded.

Funding to support the 2015 Procurement and Transition

Workstream The Trust will require to run a full procurement for the future systems and services required to support business continuity and IM&T operational delivery post 2015. At the current time the team who will be required to support the procurement activities (Project Manager, technical and change analysts and subject matter experts) remain unfunded.

Delivery of ‘Paper Light State’ As part of the committed plan of work the existing IM&T team will strive to deliver the areas of functionality described in the table above which support the foundation of the EPR. However there is no allocation of funding to support a detailed scoping exercise to ensure that the clinical developments supporting an EPR are fully aligned to business requirements and future needs, nor is there a team dedicated to the delivery of further technical initiatives that may be identified as part of the scoping exercise as critical too progressing a paper light environment. An outline business case for the scoping and planning work required to deliver an EPR is contained in Appendix 5.


Page 49 of 84


6.1.4. Stage 1 Benefits

The benefits of the delivery of the programme of work set out in Stage 1 include:

Further embedding of a core clinical system functionality to enable the EPR, promoting further clinical use of the Cerner Millennium system and improving information governance, data quality and performance management

Driving further efficiencies through the audit of existing departmental systems and rationalising where possible

Developing and reforming the IM&T department with integration with BIU providing the capability for an integrated, single information strategy

Building upon the successes of the Millennium deployment and the delivery of the Trust data warehouse to use enhanced reporting capabilities to model business requirements

Developing an integrated platform from which information can be shared with other healthcare organisation to promote the delivery of effective, safe continuation of care.

6.1.5. Stage 1 Risks

The risks to delivery of the programme of work set out in Stage 1 include:

Funding to support the recruitment and retention of skilled resource to deliver programme objectives and to mitigate areas of risk in development practice (ie single points of failure, lack of effective project management and change governance)

Funding to support the infrastructure required to deliver robust, modern platforms and devices from which clinical functionality can be used efficiently and effectively to deliver quality patient care.

Engagement from clinical and operational stakeholders to support the effective and timely use of Trust systems

Lack of operational ‘buy in’ from executive to end user level to the overall IM&T strategy and vision with focus diverted by other critical priorities

Limitations of the development opportunities of the Millennium system due to the uncertainty of the outcome of the 2015 procurement exercise

6.2. The Exit from the Current BT LSP Contract and Transition to New Service

Arrangements – Stage 2 (2015/16 – 2016/17)

The vision and eventual achievement of an Electronic Patient Record is central to

national objectives and the Trust’s own IM&T strategy. Previously NPfIT has been central

to achieving this with limited success. Nonetheless, the Trust currently receives critical

operational service delivery from systems and services provided and funded under a

contract managed centrally by the Department of Health. The end of this national

contract in 2015 places the Trust in a position of considerable risk for the continuity of

current IM&T services and for the achievement of its longer term strategy and objectives.

The number of Trusts in a similar position means that the Trust must act quickly to ensure

supplier resources are available to support service transition and re-provision.


Page 50 of 84


The Trust must therefore plan for both the system and service replacement and the loss

of the Treasury funding source for its current IM&T provision. The failure to act speedily

and to recognise the need for significant local IM&T funding will place the Trust at critical

risk in the areas of business continuity, patient safety, financial stability and delivery of

strategic objectives.

Therefore the Trust has developed an outline business case to support the procurement and funding of future replacement systems and services which has been agreed by both Management and Trust Boards. The procurement outcome will advise the series of exit and transition events which will need to be delivered as the Trust moves from the central contract provision into the new arrangements. Procurement activities will run as a parallel to the Stage 1 programme of work, the outcome of the procurement exercise will be the dependency for the Stage 1 timeline and Stage 2 timeframe. The table below indicate the key milestones expected in the procurement and exit/transition activities:

Phase Key Tasks Dates

Approval to Proceed

Management and Trust Board approval to proceed

January 2013

Procurement Commences End March 2013

Procurement

OJEU Notice March – August 2013

Tender submission and evaluation September 2013 – May 2014

Procurement Concludes with Preferred Supplier Appointed, contract agreement and signoff

June 2014

Deploy and Exit

Transition Assistance Period Notice to BT June 2014

New Supplier(s) and Trust stand up of Deployment Teams

July / August 2014

Commence Deployment with Preferred Supplier

September 2014

Transition Assistance Period Commences November 2014

Technical Exit and Migration Commences November 2015 Completion of Migration and Exit from BT Data Centre, Live Service Commences

End March 2016

Over the period of exit and transition the IM&T teams will focus on ensuring the safe and effective move to the new supplier(s) arrangement. Although business as usual activities will continue as normal with regard to Trust service delivery, there will be a change freeze instigated in the lead up to exit from the BT data centre. Dependent on the procurement outcome, the programme of work to be delivered over the Stage 2 period may mean that activities to deliver an EPR and paper light state and to further rationalise departmental systems are minimised until the future systems and services procured are stabilised. Major transformational projects or new system deployments will be restricted during this stage.

The Trust will also need to prepare itself for a new relationship structure with future suppliers developing partnerships, alliances and commitments to support the delivery of service provision and the future strategic roadmap, functions which have previously been managed by central entities such as SPfIT and CfH. The Trust will need to support an account management function to enable the understanding of supplier strategies and


Page 51 of 84


delivery practices to ensure that strong technical and business integration is featured in the final stage 3 delivery of the EPR, the fundamentals of which will have been laid out in the procurement specification and contractual agreements.


The strategic benefits which will be sought from the investment in the procurement of future IM&T systems and services can be summarised as:

Continuity of Service - by procuring and implementing future systems and

supporting services in a timely way to minimise disruption to staff and patients

Supporting Trust Strategic Objectives - by exploiting the functionality of future

solutions to underpin information needs and support future programmes of

work to deliver cash releasing and efficiency savings

Minimising Financial Risk - by providing readiness for exit and transition

activities in a timely manner and securing a future solution that enables the

Trust to achieve value for money across contract lifetime and beyond


The risks to delivery of the Stage 2 programme of work can be set out as follows:

Capabilities of the future solution to deliver business continuity

Disruption to clinical services

Capacity and capability to support the technical change and exit activities

Organisational readiness for change

Solutions and service adaptability to changing models of healthcare

Stakeholder support

Delays in approval to proceed with key milestones

Commercial risks associated with operation and management of new

contracts

6.3. The Delivery of the Full EPR – Stage 3 (2017/18 – 2022/23)

The aim in Stage 3 will be to further harness advanced technology and informatics to provide clinicians with the tools they need to make better, more informed decisions about patient care. To do this it will be necessary to invest further in Trust-wide systems which will deliver advanced clinical benefits across both the Trust and the community, building upon the foundations of the EPR which have been delivered as part of Stage 1 and utilising the opportunities realised from the newly procured systems and services resulting from the exit from the national contract in Stage 2. The primary example of functionality to be deployed in Stage 3 is the use of Electronic Prescribing and Medicines Administration (EPMA), the benefits of which may help the Trust to significantly reduce the number of Adverse Drug Effects recorded which in turn will improve patient safety and contain the cost of litigation. There is also evidence that the introduction of EPMA will, over time, reduce drug spend and support clinicians in achieving prescribing best practice. Detailed business cases and benefit realisation plans will be delivered for such developments with outline planning commencing following


Page 52 of 84


transition from the national contract and potentially as part of the end of the Stage 2 timeframe. The systems procured as a result of the actions in Stage 2 will have the capabilities to enable localised development to further move the Trust to an electronic state through introduction of additional clinical functionality, supplemented by clinical decision support tools and the ambition to reduce the use of paper to a minimum. Opportunities for the merging of the Medical Records and Coding Departments into IM&T as the paper diminishes and more clinical information is available electronically mean that greater efficiencies can not only be gained from reduction of physical material but also from streamlining of delivery processes across the Trust. The value and practicality of mobile access technologies will be explored as part of the procurement in Stage 2 and will be exploited in Stage 3 to transform the way clinicians work across the Trust. Therefore delivery in Stage 3 will be underpinned by the engagement generated with the clinical community in Stages 1 and 2 and both clinical and operational ‘buy-in’ to the whole vision across the Stages is a key factor in the success of achieving the whole IM&T strategy.


The Trust will be delivering further clinical functionality onto an environment which will be consistent for the next seven years as a minimum

Opportunities to deliver the full EPR can be tailored within the Trust’s procurement specification in Stage 2, utilising lessons learned from those Trusts who are currently delivering to EPR strategies and are not constrained in their activities by the national contract expiry

Understanding the vision of the EPR enables stakeholders to buy-in to the wider picture of short to medium term IM&T plans in the attainment of the ultimate goal.


Lack of investment in procurement supporting activities may compromise the future ability of the Trust to deploy the additional capabilities to realise the full EPR

The complexities and uncertainties of the exit from the national contract may lead to impact on the Trust’s ability to fulfil Stage 3 ambitions both financ ially and operationally

Lack of engagement from clinical and operational stakeholders for the IM&T strategic vision may mean that focus is detracted from the IM&T programme of work and direction for the end goal is lost

6.4. The Planning Process

The IM&T department is currently working on refining the Stage 1 programme of work, taking into account prioritisation of outstanding requests for change and business as usual requirements and aligning their delivery to Trust strategic objectives. Those initiatives and requirements which have not yet been allocated funding will be supported by the creation of separate business cases which will ensure alignment to the rest of the Stages and be supported by realistic and achievable benefit realisation plans (business cases will be self-sustainable where possible).


Page 53 of 84


Stage 2 will require complex planning and is still subject to a significant number of unknown factors which could potentially contain competing priorities for the stage 1 programme of work. Early alignment of Stage 2 expected outcomes to the Stage 1 programme of work will be instigated to determine relative priorities, inter-dependencies and sequencing. The resource plans to enable the delivery of Stage 1 and the procurement project in Stage 2 will be contained in section 7 in later revisions of the strategy and are currently the subject of review by Finance as part of 2013/14 budget setting. The Millennium deployment project has given the IM&T department some experience in the level of output and resourcing required to deliver critical deployment projects and whilst none of the projects to be delivered as part of the Stage 1 programme of work will be of the same scale as the Millennium deployment, the sheer variety of the projects and their inter-dependencies is likely to be of a comparable level but with more ‘go-lives’ over a longer period. As such the programme of work will need to maintain access to a strong resource pool and good working relationships with the respective suppliers if applicable. The resource required to support the delivery of the outcome of the procurement in Stage 2 and the corresponding exit and transition activities can only be estimated at this stage. Such estimates will be contained in section 7 in later revisions of the strategy and are the subject of Finance review at this time. Resourcing requirements for Stage 3 will be examined as part of the preparatory planning work carried out towards the end of Stage 2.

6.5. IM&T Programme of Work Enabling and Dependent Plans

6.5.1. Hardware and Infrastructure Strategic Plan

The full IT operations plan is contained in Appendix 3 and is summarised in the contents of this strategy to provide an overview of the critical infrastructure and hardware deliverables and initiatives which will underpin the delivery of the IM&T programme of work. In the short term (2013/14), the replacement Single Sign-On system will be procured and implemented enabling for more efficient log on capabilities for all end users, specifically in the clinical setting. There is also further significant investment planned in online storage and backup and the rationalisation of data into logical clinical and administrative ‘vaults’. The team will also work towards better integration of mobile devices into the day to day usage of the Trust, within the constraints that SmartCard authentication place upon this. The medium term (2014/15 – 2015/16) will see the Trust network further developed to meet future needs and in particular support increased usage of mobile devices and IP telephony. The Infrastructure team will work towards ensuring data is no longer held locally on PC’s, and decreasing the reliance on particular physical PCs by moving towards a virtualised desktop infrastructure with software provisioned remotely. The gradual investment in virtual desktop technology will be progressed over the ten year IM&T strategy and will steadily decrease reliance on specific PC’s and allow a faster, less complex, more responsive breakdown service which is more efficient and minimises inconvenience and downtime experienced by end users. Users will have a more seamless experience as their desktop profile follows them wherever they work (either on a PC, a tablet or slate device, or at a remote location) resulting in IT becoming a better integrated tool at the point of healthcare delivery to support efficient the delivery of patient care.


Page 54 of 84


Overall, greater scrutiny and control of the usage and development of software applications will be applied to ensure that the most efficient and effective usage of existing assets is made, and that purchases and developments are better aligned to Trust objectives and initiatives. Upgrades will be better assessed to understand the financial implications versus benefits derived, and control of software assets will be strictly enforced to ensure legal compliance is maintained.

The Future of User Access and Mobile Devices Across all stages of the IM&T programme of work the IM&T department will seek to roll out more complex clinically-orientated systems and functionality which will increase the demands on clinical and operational staff to deliver their remit using electronic devices. System users will be able to see an increasingly unified view of the patient record, including clinical, administrative and management information, all of which needs to be captured and viewed from easy to use, portable devices. In essence, the end users need to be able to use whatever technology is the best for them to tackle the task in hand. Over time the IM&T teams plan to make use of the best of proven technologies including wireless networks, laptops, hand-held devices, voice recognition systems, barcodes and conventional desktop computing. Whatever devices are deployed they must be fast, relevant, flexible and easy to use. Clinical stakeholders in many departments are often the first to identify new ways of using new technology and the IM&T department will strive to work in conjunction with clinical colleagues to assist in making the best of emergent technologies by bringing the knowledge of data and information security and integration to bear where it can be of use to support business cases for further capital investment in hardware. This will be particularly relevant in Stage 3 of the IM&T programme of work with the final push to deliver the full EPR.

6.5.2. Business Intelligence Unit Information Plan

Within the Trust there has historically been no single strategy that defines a vision for Information underpinned by technology, which has an adverse impact on supporting teams such as BIU where priorities have not clearly been defined in relation to Trust requirements and objectives and underlying IT strategy. Focus has been on short term goals and ‘quick wins’ which have often diverted resources to requirements which have not been prioritised in line with Trust strategic objectives. It is perceived that BIU are the source of most information, however there are areas where this is not clear and leads to confusion and multiple versions of the truth, particularly in the light of the multiple departmental systems which still exist across the Trust and the historical practice of using MS Access, Excel and other mediums for storing information. Therefore information within the Trust is currently driven by short term business needs and even though there is some support for managing Information centrally, senior sponsorship, direction and budget has been limited. The introduction of the Chief Information Officer role has given the Trust the opportunity to have a single point of ownership for both management information, IT and Information Governance and with this has come the opportunity to merge the


Page 55 of 84


information strategy, IG strategy and IT strategy into one consolidated IM&T strategy and an associated programme of work. The benefits of a combined strategy mean that the ‘bigger picture’ can be seen in terms of how information can and will be used to underpin the Trusts current and future business requirements and direction. The introduction of the Millennium system in 2011 and the creation of the Trust data warehouse enabled the Trust for the first time to see the wider picture of its true performance and capability in near real time. Since go live the BIU team have built upon this capability to introduce critical initiatives (such as Service Line Management) which will support Trust business managers (both operational and clinical) to deliver efficient and effective service in the future. The power of information as an enabler cannot be underestimated but also the risk of misinformation can be equally as destructive. The future of a combined IM&T strategy, where BIU, IT and IG work as a combined team will mean:

A combined IM&T programme of work, aligned to Trust strategic objectives - allowing for the identification of dependencies, risks and efficiencies which may be gained and enabling overall governance and assurance by a single Board (Clinical Informatics Board).

Delivery of enabling functionality, the EPR, will be underpinned by enhanced information capabilities - The greater the move to the electronic state, the quicker the access to information to manage patient care. Operational business managers will be able to accurately and quickly view the performance of their departments and base key decisions accordingly

Improvements in Data Quality – the move to the electronic state must be underpinned by activities which consistently monitor quality of information and move the Trust forwards with principles of system usage and ownership of data entered

Advanced integration with other healthcare organisations – The combined working between technical and information teams to promote the delivery of safe and quality patient care across the community and the region, positioning the Trust as a leader in interoperability and information sharing

The challenge for the Trust and BIU team is that there is an ever increasing demand for Information. The CIO and Head of BIU have started the process of combining the IT and Information objectives and this first circulation of the combined IM&T strategy will be revised as planning develops, particularly for the medium and long terms ambitions of the Trust. The 2011/12 Information plan is included in Appendix 2.

6.5.3. Information Governance Plan

The Information Governance plan for 2012/13 has been to move gradually from an emphasis on both information security and information governance to one of Information Assurance. The aim has been to provide an even more robust assurance to the Trust Board that all steps are being taken to suitably protect patient confidential information and ensure compliance with statutory requirements. Three measures of the work undertaken and the standards to be achieved are:

The IG Toolkit Score

The number of serious breaches reported in the Trust Annual report


Page 56 of 84


The performance in responding to Freedom of Information (FOI) requests

IG Toolkit Score The progress made in previous years, measured by the IG Toolkit, saw an improvement in the Trust’s overall score from 81% for 2010/11, to 90% for 2011/12 and marked a move from an overall grading of unsatisfactory to satisfactory as defined in the table below:

Overall IG Toolkit Assessment

Assessment Overall Score

Grade

Version 9 (2011 – 2012) 90% Satisfactory

Version 8 (2010 – 2011) 81% Not Satisfactory There were two areas from the 2010/11 IG toolkit that needed to be improved to ensure that the Trust achieved level 2, which is the minimum level to be graded as satisfactory. These two requirements were to be able to pseudonymise patient information when it is being used for a secondary or business purpose and secondly to ensure that a minimum of 95% staff receive annual mandatory information governance training. Both of these areas were closely managed throughout 2010/11 and level 2 adjudged to have been reached. Both requirements will be applicable in 2012/13 with compliance with IG training being seen as the most at risk of no delivery due to reluctance to release staff due to operational pressures. Serious Breaches of Patient Confidentiality An additional critical measure of the success of the work which goes into the IG toolkit is the number of serious breaches of patient confidentiality. Such serious breaches have to be reported as part of the statement of Internal Control in the Trusts Annual Report. In 2011/12 there were no level 3 Serious Untoward Incidents and therefore no entry required in the annual report. Freedom of Information Requests A large proportion of the Information Governance team’s time (and key operational and executive leads) is also dedicated to responding to Freedom of Information (FOI) requests received by the Trust. There were 226 requests received in 2011/12, an increase of 10% on the number received in 2010//11 and 27% up on 2009/10. 2011/12 saw just 5 breaches of the 20 working days statutory timescale allowed to respond, which represents 2% of the total. The longest delay was an additional 3 days. The forward plan which will be combined into the IM&T programme of work will focus on the improvement of the three key areas identified above and will encompass:

IG Toolkit: Driving improvements in the Trusts embedded IG processes by

delivering an improvement in the Trusts Information Governance Toolkit assessment

Patient Confidentiality Breaches: Further reduction in the risks of confidentiality breaches by delivering a revised Information Risk Management Action Plan linked to ISO/IEC 27002 and engaging IAO’s more fully in the process


Page 57 of 84


Freedom of Information Requests: Further strengthening the culture that ensures that our staff consider Information Governance requirements whenever they process personally identifiable Information, by delivering face to face training as part of Induction, and Core Skills as well as reviewing the possibility of a workbook that would allow hard pressed ward staff to complete the training more easily.

As part of the combined IM&T strategy progression, the Information Governance Manager, Chief Information Officer and Head of BIU will work together to combine the IG plan into the IM&T programme of work to ensure that the current and future objectives for IG are fully understood by all stakeholders and underpinned by technical and information reporting capabilities. Detail of the objectives of the IG plan are contained in Appendix 1.


Page 58 of 84


7. IM&T Financial Position


Page 59 of 84


Page 60 of 84

© RUH,Bath. All rights reserved. No part of this document may be reproduced, stored or transmitted in any form without the prior

written permission of the Trust or its licensors, as applicable.

Appendix 1 – Information Governance Strategic Objectives

The forward Information Governance plan, which will be combined into the IM&T programme of work, will focus on the improvement of the three key areas identified above and will encompass:

IG Toolkit: Driving improvements in the Trusts embedded IG processes by delivering an

improvement in the Trusts Information Governance Toolkit assessment

Patient Confidentiality Breaches: Further reduction in the risks of confidentiality breaches

by delivering a revised Information Risk Management Action Plan linked to ISO/IEC 27002

and engaging IAO’s more fully in the process

Freedom of Information Requests: Further strengthening the culture that ensures that

our staff consider Information Governance requirements whenever they process personally

identifiable Information, by delivering face to face training as part of Induction, and Core

Skills as well as reviewing the possibility of a workbook that would allow hard pressed ward

staff to complete the training more easily.

As part of the combined IM&T strategy progression, the Information Governance Manager, Chief Information Officer and Head of BIU will work together to combine the IG plan into the IM&T programme of work to ensure that the current and future objectives for IG are fully understood by all stakeholders and underpinned by technical and information reporting capabilities.

IG Toolkit

The intention is to initiate work as early as possible on completing the IG Toolkit thus gaining maximum benefit from introduced improvements. 3 key work streams will deliver an improvement in the assurance provided by the IG toolkit:

o To review the few remaining areas where the Trust is only at level 2, such as our NHS numbers programme and risk management follow up to Incidents

o To challenge ourselves to provide more comprehensive assurance against existing requirements such as Business Continuity planning

o By ensuring a strong link between the IG toolkit and ISO/IEC 27002 code of practice for information security

Information Risk Management Action Plan

In order to progress more fully to becoming an information assurance rather than an information governance function, it is imperative that Information Asset owners are engaged more fully and become integral to the review of the rolling audits of information risk management. A number of actions will drive this strategy forward

All key information assets to have a robust risk assessment including business

continuity arrangements and a system handbook

The IRM plan to engage directly with IAO’s

IAO’s to receive regular IRM updates


Page 61 of 84



Audit programme to avoid delays of circulating ‘agreed’ reports and to go to Head of

Divisional for review

IG group to receive regular reports from the audit programme as part of assurance

processes

Strengthening the Culture

Whilst the culture at the RUH is acknowledged to be strong around the need to ensure correct handling and sharing of patient and staff information, the ‘noise’ level around IG can still be increased and imaginative ways of keeping Information security and information governance front of mind need to be pursued. Actions for 2012/13 include

Face to face training will be a core activity as part of the core skills programme and

also to provide an option to staff who are not IT literate and cannot therefore

complete the e learning modules.

Liaison with HR and the education department to ensure clear and regular reporting

on staff’s status for mandatory training in Information Governance

Review of the potential to offer staff an Information Governance Workbook

alternative to e-learning which may assist with staff who find it extremely difficult to

be released to attend scheduled sessions.

Incident follow up is robust but the use of Datix to record the follow up needs to be

improved. The FOI administrator to be fully trained to help administration of IG

incidents

Articles to be planned to appear at regular intervals in corporate magazines and via

IntheWeek

Freedom of information requests will continue to be managed so as to comply with statutory timescales and to avoid and if possible reduce further any breaches.

Page 62 of 84



Appendix 2 – The Business Intelligence Unit Information Strategy 11/12

This Information Strategy document aims to set out an approach that allows the Trust to manage information as a strategic asset, the provision of a trust wide reporting capability and the implementation of a performance management framework out to 2013/2014. The strategy is based on the findings of the Business Intelligence Unit who have over the past two years managed the delivery of Information for the trust. The team and its service have grown organically, and the successes over the past two years have increased the user base and demands for more information and improved capabilities are driving this strategy.

1.1 Background

Within the trust, there has historically been no single strategy that defines a vision for Information, which in turn has an adverse impact on supporting teams such as the BIU where the priorities are not clear, and the focus is on short term goals. It is perceived that BIU are the source of most information, however there are areas where this is not clear and leads to confusion and multiple versions of the truth. Information within the Trust is currently driven by short term business needs and even though there is some support for managing Information centrally, senior sponsorship, direction and budget is limited to business as usual. The challenge for the Trust and BIU team is that there is an ever increasing demand for Information. The Trust has started an approach to deliver this service however there is the need for a clear vision, roadmap and the right skills to ensure the Information Strategy supports the future direction of the organisation.

1.2 Trust Priorities

The RUH vision and strategy as set out in the Integrated Business Plan will be delivered through five ‘pillars’ of Improvement: These are Quality Improvement, Demonstrating Performance, Workforce Development, Relationship Management and the Physical Environment. Each of these objectives is supported by enabling strategies, of which this Information strategy will be an enabling functionality in particular for Quality Improvement, Demonstrating Trust Performance and Workforce Development.


Page 63 of 84



1.3 Business Drivers

It is clear that within the RUH there are remain a number departments delivering Information with the support of end users tools such as excel and access. This needs to be addressed as part of the overarching IM&T strategy and actions put in place to deliver the changes required to rationalise information into a single source of truth. Ensuring the Trust has the right level of insight and standards will not only improve the quality of information but drive out inefficiencies as effort is consolidated.

1.4 Progress to date

As the BIU team has organically grown and matured, existing resources and technology have been utilised to deliver Information to the Trust. During 2011/12 the Information Strategy set out the approach to supporting the implementation of the Millennium system including the following key deliverables:

Reporting on previous 24 hours, rather than lag.

SUS / SLAM reconciliation issues been reduced to a minimum, now activity provided on 1st of month compared to 15th.

Consistent, timely and accurate reporting.

Daily automated reporting

Wider reporting improvements including Clinic Utilisation, Coding reporting, notes tracking that was previously not available

Significant RTT improvements, enabling in month validation and monitoring of performance.

Data Quality improvements, Working Group set up, which has generated a number of examples of real improvements in terms of reporting and data capture.

All SUS mandatory and non mandatory submissions provided.

This has led to a resource reduction in the Business intelligence Team of 2 x FTE in 2011/12.

Improved efficiencies within BIU have enabled the creation of a quality analyst post, extra support to RTT and an extra analyst to support the divisions.


Page 64 of 84



The department has now reached the point where focus is needed to improve the management of information for specific specialty, local and national reporting requirements and supporting the organisation to build a culture of change through education and training. The challenges BAU faces in delivering the above are:

• Lack of dedicated resources for information education and training • The skills of BIU staff to address gaps in roles and responsibilities • Sustained funding to deliver the required capabilities.

Excellent progress has been made during the past 18 months post Millennium go live and the department will seek to build upon the successful approach to the Millennium project with the following vision, approach, benefits plan and roadmap integrated into the overall IM&T strategy to ensure the Trust has a cohesive and integrated MI function supported by technical, clinical and operation stakeholder engagement.

1.5 Vision

To create an agile service that will manage Information as an asset for the Trust, delivering a single source of data and capabilities that will provide the necessary insight to manage and improve patient care and Trust performance. The goal is to deliver Information to key enablers within the Trust and this should include staff at ward level to ensure improvements in the quality of patient care. The intent is to increase the current Information user community to 400 active users in the next 24 months.

1.5.1 Objectives

To create one central version of the Truth that is used to support all Trust wide performance reporting.

Consolidation of existing reporting streams including Clinical, Operational and back office systems such as HR, Finance and Quality (e.g. patient experience) into the Trust data warehouse.

Ensure that the data warehouse is “System Neutral” enabling a flexible methodology capable of future proofing any changes in IT Systems or Strategy.

The improved delivery of reporting Trust information using a variety of different processes such as e-mail, web based reporting, self-service, dashboards and mobile devices.

Empowerment of Business Units and operational staff access to all centralised data, through an Information Portal available to all staff containing all relevant information.

The creation of Information Champions who are non BIU staff capable of supporting the Trust’s ever expanding requirements for information.

The execution of a comprehensive change management plan to deliver education and awareness of the Information function, tool and capabilities within the hospital


Page 65 of 84



The reduction in resource needed to support Trust Information Management while improving the access and availability of this information to front line staff.

Improved information governance, as access to patient level data will be more robustly managed and ensure the new system is compliant with DH guidance.

Data Quality to be driven by a culture of data being “Get it right First Time Every Time” with ownership and responsibility at all levels within the organisation.

Centralisation of dispersed information analysts within the Hospital to deliver further efficiency savings and optimisation of resources and systems.

Resource within BIU focused and prioritised towards support of the specialties.

1.6 Approach

To enable the BIU vision a flexible structure is required to enable an approach that has low risk and requires minimal investment. The approach will re-use current resources and identify where there are gaps.

Who What How Centralised Information team supported by IM&T and empowered by the Trust to deliver Management Information and Performance. Active Support from critical sponsors from each Division, Speciality and IT functions (Information Champions) and goverenance provided by Clinical Informatics Board and IM&T Programme Board Managed by Chief Information Officer and lead by Head of Business Intelligence, empowered to drive priority and resolve business definition discrepancies, integrating functions/process into the IM&T programme of work

Force the single source of Trust information consolidated in the data warehouse Use the single source of Truth to see the WHOLE PICTURE, activity, workforce, finance and quality. Short-term deliverables and Long-term strategy & Roadmap combined into IM&T programme of work Information organisation design in line with delivery of the EPR Focused involvement with 2015 procurement activities to ensure continuity of information reporting and performance management capabilities

Data Definitions and processes supported by Standard Operating Procedures

Agreed service level agreement for management of capability Development of skills and functions available across the Trust Analyst User Community. Define and implement desired MI Capabilities as a consolidated part of the IM&T Programme of work Provide a project roadmap reflective of the IM&T programme of work and deliver in line with the Trust strategic Objectives


Page 66 of 84



1.7 Method

BIU will enhance its existing processes and provide an agreed Information and performance delivery programme, aligned with the IM&T programme of work, through a Service Level Agreement. The development of a 24 month roadmap (set out below) of projects covering all aspects of Information and performance reporting will be integrated with the IM&T programme of work Stage 1 activities which will enable a robust process and platform from which the Trust can manage and review Information requests and projects into the future. The Business Intelligence Unit will act as this lead to the management of tactical, strategic and ad-hoc requests for information. There are anticipated to be many future information projects which will need to initiated to ensure that BIU can manage information in response to changing requirements from Commissioners and the Trust and the IM&T programme of work, as it develops, will have information requirements such as data quality management/monitoring, changes to source systems etc. Emerging projects will need to be balanced against the capacity of the team, the IM&T programme of work and the strategic requirements of the Trust. To this end BIU will work in conjunction with their colleagues within IM&T and will hold responsibility for the information roadmap and ensuring it is aligned with the IM&T programme of work. The outline plan for BIU capability improvements is to enhance the information user community and growth in response in line with developments delivered by the IM&T programme of work.

1.7.1 Roadmap

Below is the current roadmap for the implementation of the BIU plan, delivering improved service and capability over the next 12 – 18 months.


Page 67 of 84



1.8 Integration

In addition to a closer working relationship with IM&T teams and the progression of a combined IM&T strategy, it is recognised that BUI and the data warehouse will need to progress closer technical integration and working relationships across the Trust in the following areas:

Finance both income and expenditure teams

PLICS project team

Closer integration with the CRS and Millennium Data quality team

HR work force analysts

Theatres Analyst

Closer integration with dispersed systems managers within Specialties. (Radiology etc)

1.9 Data Quality

The Trust needs to ensure that data quality consistently meets information standard expectations and at a minimum BIU need to effectively manage the following attributes for Trust data:

Attributes Description

Accuracy Does the data accurately represent reality or a verifiable source?

Integrity Do broken links exist between data that should be related?

Consistency Are data elements consistently defined and understood?


Page 68 of 84



Completeness Is any key information missing?

Cohesiveness Is seemingly related information incompatible due to different formats or business meanings?

Accessibility Is the data easily accessible, understandable, and usable?

Timeliness Is information recorded and made available to systems as rapidly as is required?

There is no technology process to support these requirements, the fundamental aspects need to be driven by focused management of the end users to ensure quality information is entered into Trust systems in a timely way and in line with required workflow. A specific data quality policy and approach, owned by the Data Quality Steering Group, will be used to manage the above but the success or failure of such is ultimately the responsibility of the Divisions and outcomes will directly impact the benefits which will be gained through the IM&T strategy and delivery of the EPR. The Data Quality Steering Group is led by the Head of BIU and works with both Trust Divisions to progress the following objectives:

Identification and recording data quality Issues.

Development and review of data quality action plans.

Review and action audits in relation to data quality.

Identify and highlight any potential training issues regarding the collection and timely recording of data.

Identify issues and action arising from ISN’s. (Information Standards Notices).

Monitor data quality contract penalties.

Effective performance of the Millennium Data Quality team

Staff take responsibility for the data they record.

Clinical and Divisional departments are engaged with trust data quality

Raised awareness and ownership of data quality across the Trust Improved confidence in Trust data

1.10 Recommendations and Benefits

There are many perceived benefits to the hospital in adopting a mid to long term combined IM&T strategy where information is a primary driver for technology developments. Benefits are not limited to technology and cost alone but will drive significant improvements in Trust culture and process. The key recommendations from the BIU perspective are defined below and work is in progress to ensure these are combined in all stages of the IM&T strategy and programme of work.

Recommendations Benefits

Agree IM&T Strategy, programme of work and ensure aligned with

Agree a set of common, business key performance indicators (KPIs), against which MI solutions are to be built in line with IM&T programme of work

Provides clear Information message for the Trust

Aligns information needs across the Trust

Drives the requirements for a management information service


Page 69 of 84



Information requirements

delivering to Trust current and future strategic objectives

Enables effective cascade/roll-up of Trust priorities and objectives via governance structures

Enhance your Management Information Environment

Agree a set of common standards (technology, architecture & data management) and a governance structure in conjunction with IM&T teams and Divisions to ensure adherence to standards and approve deviations – communicate to Trust via IM&T strategy

Increased value from Information investment from reduced development costs

More rapid development

Reduced operating costs from economies of scale in software licences, support etc.

Single source of trusted information

Reduced operational risk from reduced reliance on key individuals’ systems’ knowledge.

Increased longevity of solutions One organisation to manage MI,

Quality and Governance for the trust

Deliver Through a collaborative programme

Use IM&T programme of work to drive process in collaboration with all key stakeholders Agree milestones and mechanisms by which all projects will align to agreed MI standards

Involvement of all stakeholders ensures all needs are addressed, creating an improved, more sustainable solution

A “roadmap” of milestones and key steps sets the pace and scale of change

Increased awareness of data and capabilities

Governance from Clinical Informatics Board and IM&T programme Board

1.11 Information Risks and Issues

Below are the key risks associated with delivery of the information plan as part of the IM&T strategy:

Risk Mitigation Owner Current Trust Risk Score

Resources to support the implementation

Agreement to support the information plan from the organisation should enable prioritisation of resource within the Information Teams.

Trust Likelihood = 3, Consequence = 2 Total Risk Score = 6


Page 70 of 84



Identify a Trust SRO and Heads to support the Info plan

Early identification and engagement with relevant sponsors to ensure support to project and engagement. This can be delivered through BIU business as normal and with the support of the CIO role but also needs engagement from key operational and clinical stakeholders to ensure a consistent message across the Trust

CIO Likelihood = 3, Consequence = 2 Total Risk Score = 6

Short term Priorities

Alignment with the IM&T programme of work to support delivery, give clarity of requirements and support the understanding of the impact of short term issues.

Head of BIU

Likelihood = 3, Consequence = 3 Total Risk Score = 9

Skills within existing resources

Individuals PDPs to be developed in line with the information plan to ensure skills gaps are identified and addressed.

Head of BIU


Technical Solution to meet business requirements within available resource

On-going benchmarking of tools and capability to deliver the vision ensuring value for money for the Trust

Head of BIU and Chief Information Officer


Data Quality

Robust Data quality policy, engagement with operational staff through service line management and reporting.

CIO / Head of BIU and SRO



Page 76 of 84

© RUH,Bath. All rights reserved. No part of this document may be reproduced, stored or transmitted in any form without

the prior written permission of the Trust or its licensors, as applicable.


Page 81 of 84



Appendix 5 – Outline Case to Scope the EPR

The Electronic Patient Record Pilot Project (prepared for February 2013 Management Board and remains to be approved) The Advisory Clinical Group (ACG) will be tasked with defining the Trust Electronic Patient Record (EPR) and will play a leading role in the creation of the EPR strategy and delivery of such within the Trust. The ACG members will also play a critical role as subject matter experts in the forthcoming 2015 procurement for systems and services post expiry of the current nationally funded BT contract to provide the Millennium system to the Trust. The Clinical Informatics Board members discussed concerns regarding consultants completing outpatient procedures, diagnosis and problems in Millennium. A number of Specialties have delegated the recording of such activity to administrative staff due to operational pressures and the requirement to secure income. The Board agreed that consultants entering information directly into Millennium was a core requisite of progressing the EPR and that to allow for this process to be delegated to administrative staff (either already in post or requiring to be recruited) would be a step backwards regarding the progression to a streamlined paper light state and the efficiencies to be gained from such. The Head of Medicine asked for data to be shared identifying those consultants not recording their own activity and for an investigation to be progressed to examine key issues. The Head of Surgery expressed concerns following the Board that although the stance of mandating clinical recording of such activity was understood, a pragmatic approach needed to be taken to ensure that income was secured. The matter of clinical recording of outpatient activity was discussed again at the Efficiency Board on 28 January 2013, where the Divisional Manager for Surgery echoed the concern regarding clinical recording and reiterated the need for administrative support. The Efficiency Board took the decision that clinicians should record activity as part of their role.

The Francis report, published on 7 February 2013, made almost thirty recommendations about how information should be used to transform the NHS. Of the core recommendations, the move to ensure that ‘all professionals, individually and collectively, should be obliged to take part in the development, use and publication of more sophisticated measurements of the effectiveness of what they do, and of their compliance with fundamental standards,’ should actively support the Trust in moving forward with clinical usage of IT systems, including where clinicians are required to record outcomes relating to their delivery of care. This clinical recording of outcomes is fundamental to the start of developing the electronic state and is already widely practiced by GPs.

The report also states that ‘it is crucial that the information that is collected is appropriate, accurate and verifiable, and it can be interpreted and used correctly by NHS staff, managers, regulators and patients.’ In terms of the accuracy and auditability of recorded information, the Trust needs to ensure that clinicians are fully supported in their usage of IT so that their performance is not impacted by the systems they are required to use. The efficiency and quality gains which the progression of an EPR is expected to deliver will not be achievable if there is no clinical buy-in to use IT and administrative staff are tasked with supporting entry of clinical information.

In light of the above and in response to the outcomes and recommendations of the Francis report, the Management Board are requested to reconsider their approach to funding the progression of a scoping exercise and proof of concept to develop a plan to deliver the initial stages of an EPR (a paper light state). This exercise will help support the current issues seen


Page 82 of 84



with clinical usage of IT and examine where further efficiencies can be made. The requirements for a scoping pilot were identified in the July 2012 Management Board paper and are summarised below:

The Hybrid Approach to Clinical Document Management

A forward facing approach which focuses on utilising existing IT systems to build the electronic patient record, with Millennium as the core, whilst reducing the reliance on the paper record over time. The approach would rely upon an extensive amount of clinical engagement and would be dependent on the following:

EPR Scoping - Outpatient Research Stage (April – June 2013)

A scoping exercise in conjunction with clinical and operational leads to examine the current use of paper records within each Outpatient setting. This would ensure that an integrated IT solution would not only provide sufficient information to allow clinicians to deliver a quality and timely service to their patients but would also assure that any such system was resilient in design and governance to support patient safety across all care settings, usable by clinicians and structured to support the future use of information for clinical decision making.

The Outpatient Research stage would be conducted over a three month period and would cumulate in a detailed business case, PID, technical plan and outline benefits case supporting the delivery of a transformation programme to move Outpatients to a ‘paper light’ state. A group of consultants, led by the chair of the Medical Records User Group, have previously met and formed an advisory group to support the delivery of such an approach. This group would combine with the Advisory Clinical Group to steer the direction of the EPR.

Outpatients Proof of Concept Stage (July 2013 – December 2013)

The next step would be to translate the findings of the Outpatients Research Stage into a technical proof of concept to develop system functionality across a sample set of Specialties, involving clinicians and administrative staff at all stages to ensure that the system supports workflow and requirements and does not impact on patient flow. The proof of concept would be assessed against critical success factors (set within the Research stage). Based on a successful outcome of the proof of concept, the plan would be to roll out the paper light initiative to the whole of Outpatients by December 2014.

In parallel to the Outpatient proof of concept, a Research stage for Inpatients would be progressed using the lessons learned from the Outpatient stage. Based on the success of the Outpatient proof of concept, the Inpatient Research stage would cumulate in a detailed business case, PID, technical plan and outline benefits case supporting the delivery of a transformation programme to move Inpatients to a ‘paper light’ state.

Timeline Summary

Task Completed By

Agreement from February Management board to proceed with Research Stage (inc funding allocation)

February 2013

Research Stage commences with resource in place to support

April 2013

Business Case, PID, outline plan and benefits case for OP approach. Approval required to commence OP Proof of Concept Stage and IP Research Stage

June 2013 Management Board

Commence OP Proof of Concept and IP Research Stage

July 2013


Page 83 of 84



Outcome of OP Proof of Concept and approval to roll out to all OP

December 2013 Management Board

Business Case, PID, outline plan and benefits case for IP approach. Approval required to commence IP Proof of Concept Stage

December 2013 Management Board

Outcome of IP Proof of Concept and approval to roll out to all IP

June 2014 Management Board

Paper light state in OP Expected before December 2014

Paper light state in IP Expected before June 2014

Subject to approval by Management Board in February 2013, a robust set of Trust wide policies would require to be created and introduced to support electronic capture and viewing of information, the retrieval of records from the live or off-site libraries and the creation of any further paper records (such as temporary folders).

Outpatients Research Stage Financial Requirements

Research Stage Resource Band *Gross Cost (3 months) £,000

Project Manager 7 12 Business Change Analyst 6 10

Technical Analyst 7 12 Total over 3 months 34

The above figures do not include time from clinical, operational or administrative resource, nor do they include management overhead.

Outpatients Proof of Concept Stage and Inpatients Research Stage Financial Requirements

Proof of Concept Stage Resource

Band *Gross Cost (6 months) £,000

Project Manager (continuation of above)

7 24

Business Change Analyst 6 20 Technical Analyst/Developer x 2

7 48

Technical Tester 4 13 Total over 6 months 105

*based on mid point of band

The above figures do not include time from clinical, operational or administrative resources. Neither do the figures take into account any capital costs for additional hardware that may be required to support roll out. Such requirements will be outlined within the Research Stage and determined from the outcome of the proof of concepts.

The programme will not work with the level of clinical and operational engagement seen within the Millennium Project. Clinicians and operational leads will need to own the vision of the programme and be held responsible for the delivery of the programme. The Trust Executive team must be visible in their support of the programme and ensure that all internal stakeholders recognise the business imperative of adopting the new ways of working.


Page 84 of 84

© RUH,Bath. All rights reserved. No part of this document may be reproduced, stored or transmitted in any form without the prior writ ten permission of the Trust or its licensors, as

applicable.

Appendix 6 – The Outline IM&T Programme of Work

April 201

3

April 2014

April 201

5

April 201

6

April 201

7

April 201

8

April 201

9

April 2020

April 2021

April 2022

Paper Light Initiative (EPR)

PACs Replacement

Rationalise IM&T Systems

e-Prescribing

RUH and RNHRD

Maternity System?

2015 Procurement BT Data Centre Exit

Delivery of QIPP via IM&T Initiatives / Robust governance and financial management / Further benefit identification and realisation programmes

IM&T Business as usual activities including infrastructure upgrades, maintenance releases, back office support, training, data quality, IG and service delivery management

Stabilise

Full EPR Initiative (electronic document management)

Rationalise IM&T Systems

Labs Information System

Replacement

Further Integration with Community

Deploy New Service Benefit Delivery

e-Prescribing Benefits

Documents

The Royal United Hospital NHS Trust IM&T Strategic Plan ... · OBC Outline Business Case OJEU Official Journal of the European Union ... PID Project Initiation Document PRINCE2 Managing