Information, Communication,
Technology Strategy
2009 – 2014
1Contents
1Contents
2Executive Summary
3Background
4Strategic Aims and underlying principles
5What is the vision for ICT services in five years time?
6Year One Operational Plan
7The Architectural Vision for the BHR Enterprise
8The Technology Roadmap 2009 to 2014
Document Control:
DOCUMENT NAME: / Slimline ICT Strategy 2009 – 2014 v1.0ABSTRACT:
DOCUMENT ID:
Distribution List
COPY NO. / ISSUED TOMaster
01 / ICT Programme Board
02 / ICT Programme Board
03 / ICT Programme Board
04 / SSIB Member, ICT Programme Board, Trust Board
Version History
VERSION / DATE / AUTHOR / COMMENTS / Reasons for changeDraft 0.1 / 30/01/09 / WG / First draft for review
Draft 0.2 / 09/02/09 / WG / Amendments following comments
Draft 0.3 / 02/06/09 / SV / Add operational elements
Draft 0.4 / 15/07/09 / SV / Updated to include 18 months spend profile
Final 1 / SV / Finalised changes for Trust Board
2Executive Summary
This Strategy Paper broadly articulates a five year programme directed at transforming the Barking, Havering & Redbridge University Hospitals NHS Trust. The starting viewpoint is that the NHS Care Record Service (CRS) implementation might perhaps be the single biggest transforming event and opportunity in BHRT history to date. However delays around the National Programme CRS Acute Solution necessarily influence the Strategy Plan and Roadmap.
The approach taken therefore is use this critical strategic lead time productively to both prepare the ground for CRS and improve and enhance services now. Creating value through continual service improvement and assuring benefit realisation are core objectives from the strategy start point.
Guaranteeing patient safety and constantly improving the patient experience at all Trust service touch-points are main drivers for change and therefore a major consideration when considering solutions and benefits.
Introduction of electronic knowledge systems, resource planning and management, clinical administrative process automation and moving from manual administration and paper based decision support will bring very significant benefits in the areas of cost reduction, improved service quality, patient safety and experience and Information Governance.
Building infrastructure and information systems that support the commissioning and management of clinical services will be key goals. Enabling mobility and collaborative working and extending services interfaces into partner environments will be a critical success factor.
Identifying, extracting and maintaining appropriate levels of revenue from PCT and other acute service commissioners is critical to the efficient operation and evolution of the Trust. Appropriate, timely and accurate service information is required to assure revenues for Trust services.
The proposal is for a stepped staged geometric increase in service capability, infrastructural maturity, and systems’ readiness - all preparing the ground and leading to CRS Rollout in stages from 2009 till 2014. The Strategy describes broad-based and comprehensive architecture-based steps designed to assure full eventual CRS benefit realisation. Capital Investment in year one is proposed for items that prepare the way for CRS – acting as essential building blocks. An operational plan has been included in Chapter 6 which provides greater detail and identifies £7 million spend in the first 18 months of the lifecycle of this strategy
2.1Year One Planned Activity
However from the outset the plan is to deliver a schedule of work aimed at “doing what we do now but better” and making the most of what we have. Much can be achieved through the next financial year. Year 1 activity focuses on achieving benefit in the areas of Trust-wide customer experience improvement, systems upgrade and capability planning. Activities and financial implications are summarised in the table below and greater detail can be found in Chapter 6 on page 10.
Tracks / Project / Cost (000’s)Infrastructure / Desktop PC Rollout * / 750
Virtualisation / 300
Combined Networks and unified Comms / 750
Infrastructure upgrade at King George / 850
Data Management / Data warehouse* / 200
Solutions / PAS Hardware and Software Upgrade* / 200
CRS (PAS, A&E, OCS) / 3000
Electronic Discharge Summary / 250
Mobility / Citrix Access Gateway* / 340
Video Conferencing* / 300
Capability / Service Desk Upgrade* / 100
7,040
Table One – Year One Operational Activity
* denotes approved funding already received.
2.2Year 1 to 5 Activity by Track
All work is organised into tracks for the period. There are project streams that dictate when track related activity is planned.
The Solutions Investment Trackprovides a complete BHRT wide CRS/EPR Solution - A Patient and Clinical Information Management System will automate and record most clinician-patient administrative interaction and provide integration with core hospital sub-systemsThe Data and Information Investment Track is a phased programme of activity to consolidate, centralise and more effectively manage data assets, and, build an information architecture that focuses on patient safety; helps assure compliance and delivers revenue assurance
The Mobility and Collaboration Investment Trackis visualised as a phased programme of activity that extends the reach of Trust systems to Trust members, PCT’s and other external partners, creating a virtual collaboration-enabled local health community
The Infrastructure Investment Trackis a phased programme of technology upgrade and centralisation with the ultimate goal of building an operating environment that guarantees capacity, performance and is virtually managed and automated on a 7/24 basis
The Capability Investment Trackfocuses on assuring achievement of general strategy and roadmap benefits. This involve introduction of strong project governance and planning to assure successful transformations. It also identifies and sources appropriate resources and skills to deliver and support the required change programme
3Background
3.1In common with most trusts BHR has developed a comprehensive and diverse portfolio of information systems over the past few years. These include a Patient Administration System (PAS), A&E System, Picture Archiving Communication System (PACS), Choose and Book (C&B), Radiology Information System (RIS), Pathology (WinPath), Pharmacy Stock Control (JAC), Radiotherapy (Aria) and Theatres (Phoenix) all of which are already being used in the organisation; in addition we have recently implemented a Maternity system (E3). Many of these have added significant clinical and administrative value.
3.2The investment has also included business support systems to better manage the operation of the hospital to provide more efficient delivery of patient care. These include
Electronic Staff Records (ESR), which is an administration system for maintaining a comprehensive and complete employment records of staff.
Shared Business Service (SBS), which provides NHS shared financial, accounting and procurement services.
Choose & Book, which provides direct hospital appointment booking from GP’s surgeries.
3.3BHRT is also currently implementing one new system and two additional PAS modules
Olympus, which simplifies and reduces risks in the tracking and administration of blood and blood products
PAS Bedweb, which improves the management of bed capacity and throughput
PAS Discharge Summary, which improves the communication between the hospital and GPs at time of patient discharge
3.4However, the trust has reached the conclusion that the present portfolio of systems is unsuited to the delivery of the emerging NHS service agenda and more importantly the Trusts emerging vision for the future. The rationale in part is because these systems are not integrated and do not provide a joined up clinical record.
3.5The Trust has moved into a very different healthcare environment in the last few years now aiming to deliver a patient-led service with greater choice and involvement of patients in decisions about their health care. This change requires information to be available across the whole health economy with secure access by community clinicians and patients. Nationally, since 2004 the NHS has made a substantial financial and managerial commitment to the Connecting for Health programme with which we must be compliant.It is therefore timely for a new ICT strategy to be produced.
3.6The timing has even greater significance as currently CCN3 is being negotiated by London SHA to enhance the London CRS product and deliver greater flexibility. Currently the timetable for this activity is July – September the CCN3 will be available for consultation for all London Trusts. It is anticipated that the commercial agreement will be signed in October 2009. It is this product that BHR will deploy using the Method M deployment model.
3.7This strategy sets out a vision for ICT services over the next five years. The strategy was developed from workshops and in interviews with senior members of staff of the organisation from a variety of backgrounds who have contributed their ideas and expertise. The document has been refined through comments from those participants.
3.8Information technology is a rapidly changing field and it is therefore envisaged that this strategy will evolve with time. However, it will provide a solid foundation upon which these developments can take place and will result in a world-class ICT service for the Trust.
4Strategic Aims and underlying principles
4.1The Trust’s Vision Statement is ‘Healing, Caring, Serving’and aims include:
To strive for clinical excellence within a safe and robust clinical governance framework.
To provide the best possible patient experience.
To work with our GPs, Primary and Social Care and voluntary sector partners to improve the healthcare of the residents that we service across organisational boundaries.
To be a healthcare employer of choice such that we recruit, retain and develop high quality staff and build up morale.
4.2The ICT strategy aims to contribute to the creation of this centre of excellence by ‘making it easier to do the right thing’. The strategy sets out six key objectives:
1.To improve patient care through innovation in information technology.
2.To improve patient safety through the use of IT.
3.To provide easy access to information of all types for patients, staff and customers across the health economy.
4.To support the business and commercial objectives of the Trust.
5.To ensure that information systems are reliable, resilient and fully integrated.
6.To ensure legislative requirements are met, including compliance with Connecting for Health and security and data quality standards.
4.3In conjunction with these six objectives are interwoven five underlying ICT themes. These themes enable the objectives and can be found throughout the ICT strategy. These include:
1.Capability which involves introduction of strong project governance and planning to assure successful business transformations. It also identifies and sources appropriate resources and skills to deliver and support the required change programme
2.Dataand Information Resource Management is a phased programme of activity to consolidate, centralise and more effectively manage data assets, and, build an information architecture that focuses on patient safety; helps assure compliance and delivers revenue assurance
3.Infrastructure is a phased programme of technology upgrade and centralisation with the ultimate goal of building an operating environment that guarantees capacity, performance and is virtually managed and automated on a 24/7 basis
- Mobility and Collaboration is visualised as a phased programme of activity that extends the reach of Trust systems to Trust members, PCT’s and other external partners, creating a virtual collaboration-enabled local health community
5.Solutions provides a complete BHRT wide CRS/EPR Solution - A Patient and Clinical Information Management System will automate and record most clinician-patient administrative interaction and provide integration with all hospital sub-systems
5What is the vision for ICT services in five years time?
The six key objectives may be understood better by setting out how they relate to the vision of ICT services.
5.1Objective 1 - To improve patient care through innovation in information technology
The prime function of the Barking Havering & Redbridge University Hospitals NHS Trust is to deliver high quality patient care. As technology and knowledge management advances, new opportunities will appear for patient care to be delivered in better ways. The enthusiasm and skill of clinical and ICT staff to innovate will be fully exploited as the strategy is implemented. Innovation will require research and development if we are to move beyond tried and tested solutions.
Examples of such innovation include:
NHS Care Record Service (CRS) with integrated patient information into one central place.
Telehealth e.g. video conferencing, is collaborative working of multidisciplinary specialties
- Digital dictation of patient discharge summaries and recording episodic outcomes
Patients being given secure access to their own electronic health records to support self care
5.2Objective 2 - To improve patient safety through the use of IT
Making information readily available at the point of care will lead directly to improved clinical decision making and thereby patient safety. However, patient safety can be enhanced more directly through information systems that reduce human error and give users greater control of processes. Examples include:
Patient identification through the use of bar codes or RFID tagging
Order communications system and information access portal
Elimination of illegible handwriting in drug prescriptions and written notes
Data error reduction of duplicate data entry
Provision of alerts, prompts and reminders to support clinical care pathways
Scheduling of clinical encounters directly by clinicians
In future, information systems will provide knowledge and decision support functions which will enable staff to follow guidelines more easily.
Increasingly, programmes of care will be delivered across the whole health economy for groups of patients. These care management programmes will be supported by new IT systems.
5.3Objective 3 - To provide easy access to information of all types for patients, staff and customers across the health economy
Future information systems will require easy but secure access for authorised users via a single user interface that displays information relevant to that user. The interface will be customised by the user to their specific requirements and be available wherever required, within or outside the hospital sites.Examples include:
Remote systems access
Centralisation of data
Universal point-of-care access will be made possible by the use of a variety of hardware devices including desktop computers, wireless-enabled tablet PC’s and personal digital assistants (PDA’s), and mobile phones. Data and text entry will be possible by handwriting and voice recognition, as well as by keyboard and mouse.
Training in the use of this new technology will be reduced by the use of intuitive software and industry standard displays.
5.4Objective 4 - To support the business and commercial objectives of the Trust
As a Trust in financial turnaround and in response to the demands of the NHS, we are a commercial business and to be successful we require efficient business processes and systems which are flexible and can respond quickly to changes in the healthcare market. The information system architecture and software functions must therefore mirror these requirements of flexibility, responsiveness and reliability.
Trust business demands accuracy in data quality and coding so that performance can be effectively managed. The data must also be readily transformed into information so that sound commercial decisions can be made. For example:
Dashboards detailing divisional performance targets
Business information toolkit for service commissioners and performance analysts
5.5Objective 5 - To ensure that information systems are reliable, resilient and fully integrated
The information systems within the Trust are no longer a luxury and healthcare already depends upon their constant availability. The network and hardware infrastructure will therefore be similarly resilient and reliable and have the capacity to deal with increasing demand. Technical and user support functions will also be available as necessary to ensure business continuity
In the event of hardware failure, reliable disaster recovery systems will be in place to avoid loss of clinical and management information.
To maximise the efficiency and benefit of information technology, systems will be fully integrated across the Trust, the local health economy and with the national NHS care record spine.
5.6Objective 6 - To ensure legislative requirements are met, including compliance with Connecting for Health and security and data quality standards.
The national Connecting of Health programme via theInformation Governance Toolkitsets a number of standards and technical requirements with which the Trust’s information systems must comply.The Trust will comply with Legal requirements such as the Data Protection Act and Caldicott Guardian legislation.
Storage of data on Trust activity should facilitate the response to requests for information under the Freedom of Information Act, leading to greater openness and accountability of Trust activity.
Collection of electronic data within the patient record will allow easier defence against litigation about clinical care through the ability to trace activity to individual users and the legibility of text.
Information systems will also facilitate the audit of Trust activity by external organisations such as the Standards for Better Health.
6Year One Operational Plan
From the outset the plan is to deliver a schedule of work aimed at “doing what we do now but better” and making the most of what we have. Much can be achieved through the next financial year. Year 1 activity focuses on achieving benefit in the areas of Trust-wide customer experience improvement, systems upgrade and capability planning. Activities are
Infrastructure:
-Desktop PC Rollout delivering newer replacement PC’s to the desktop. 1000 PC’s will be delivered within the first year. The business case for this has already been approved and PC’s are already being deployed across the Trust.
-Storage Array Networks and Blade Servers for Data CentralisationtheTrust currently buys a server every time that there is a new system or project that comes online. As a result there are now in excess of 170 servers that could gain from economies of scale and virtualisation. This would result in efficiency gains and assist in the Trust meeting its carbon emissions footprint reduction.