IT Strategy 2009 – 2014


Introduction

A key element of theoverall strategy for Basingstoke and North Hampshire NHS Foundation Trust (BNHFT) is to exploit technology to transform services and improve efficiency to deliver a modern, fully IT enabled Trust.

The Trust currently has limited technology support to deliver patient care. There is a Patient Administration System providing administrative functionality for scheduling patients. There are limited trust wide clinical systems however some departments such as maternity, A&E, cardiology and Pathology do have IT systems with a one way interface from the PAS limited to providing Patient demographics.

IT Strategy

Electronic Patient Record

The IT strategy is designed to support the transformation of services and improvements in efficiency that are critical to the Trust’s overall strategic imperatives through significantly enhanced IT capability.

The Trust’s IT strategy will deliver a complete electronic patient record where patient information is immediately available 24/7 to all stakeholders relating to a patient’s care whenever and wherever it is needed in a secure way. The strategy is designed in three parts to mirror the execution phases.

Phase One

Phase 1 diagram shows the implementation of new E Prescribing and Order Communications systems and key infrastructure improvements.

Phase 1 of the trust IT strategy is to improve the current technical infrastructure whilst at the same time introducing the core strategic clinical systems. Information such as clinical notes, test results and prescription information will be provided quickly and easily through the ability to update data in real time to support clinical decision making as well as providing reliable, accurate, high quality data for management decisions and audit. The main additions to the existing core strategic clinical systems areOrder Communications and Electronic Prescribing supported by the implementation of a wireless network.

Phase Two

Phase 2 diagram shows the implementation of the single view portal with the information bus middleware to allow bidirectional flows of information between the portal and underlying core systems.

When the core systems are implemented the second phase of the Trust’s IT Strategy can be developed. This consists of a ‘single view’ portal of the full patient record with different sections for results, observations, images, appointments and a full patient history enabling clinicians to find relevant sections quickly and easily. This will be achieved through interfacing laboratory, radiology and pharmacy data into one ‘single view’ portal using interfaces and middleware referred to as an Information Bus to transfer data between systems.

The Electronic Patient Record is provided in the single view portal and will provide the information seamlessly to be incorporated into clinical documentation and clinical coding.New medical records will created electronically in the single view portal while historical records will continue to be retrieved from the Medical Records Library until they atrophy in line with the retention schedule of the records management guidance.The ‘Single View’ Portal interfaces will also be utilised to provide the Data Interrogation Portal. This will enable interrogation of the various databases to provide information and reporting for both managers and clinicians at trust-wide, divisional, specialty, individual service and patient level.

During Phase 2 the Specialist Systems (Cardiology, Cancer) remain linked via a unidirectional interface to the PAS.

Single View Portal Architecture

The Trust ‘Single View Portal’ is a web based user interface (screen) based on an enterprise information portal which is a framework for integrating information from different systems and different processes within the organisation. This enterprise information portal will integrate information from the underlying core systems in the Trust such as patient demographics, e-prescribing, results and PACs images and display them on a screen. An example of where this technology is used would be the BBC website where there are different boxes across one screen which are each taking content from different sources.

Features of the Single View Portal

Enterprise information portals have features that will provide significant benefit to the trust while integrating data from different systems.

  • Allow connection of functions and data from multiple systems into new components which are called portlets.
  • Single sign on capabilities where the users needs to authenticate only once to access multiple systems.
  • Allows the customisation of screens for different professional profiles. Allows user to prioritize most appropriate content based on attributes of the user and available data. This would allow consultants to create a view accessing most important underlying data from different systems that optimally supports clinical decision making.
  • Privacy functionality enables roles based access to restrict certain content from staff not authorised to view it.

Product providers of Enterprise Portal software

  • IBM Websphere, Oracle BEA Weblogic Portal, Microsoft sharepoint 2007 server, SAP Netweaver, Tibco Portal Builder 5.2 are all examples of Portals to be considered.

Information Bus Middleware Architecture

As the different foundation systems are written in different software languages (PMS, JAC) with different definitions for the same data, they can’t communicate with each other or share data or business rules and so it is necessary to have a middleware solution.

  • Enterprise Application Integration is an integration framework composed of a collection of technologies and services which form a middleware to enable integration of systems and applications across the business.
  • The enterprise service bus is a software infrastructure (platform) that allows data to move successfully from one system to another. It is essentially a message broker between applications. There is an enterprise message model which translates between the messages sent and received. The applications connect to the bus through adaptors. For the PMS application, the adaptor will translate the data into a legacy format but for data from PMS to JAC, the adaptor will translate the data to the JAC format.
  • IBM have a product called Websphere message broker and Oracle and Tibco also have an information bus as part of their offering.

Phase Three

Phase 3 diagram shows the further implementation of bidirectional interfaces to specialist systems and medical devices with external access extended to other stakeholders providing care to patients.

Phase 3 of the Trust’s IT Strategy will be the development of interfaces between the patient record ‘single view’ and bespoke clinical systems which are data intensive (cardiology, cancer) to enable clinicians to connect seamlessly to extremely specialist areas.There will be implementation and interfacing with bedside medical devices to enable faster patient monitoring and early warning of changes in patient conditions leading to early intervention of specialist teams.

External interfaces will be developed enabling other stakeholders involved in the care of the patient to access the electronic medical record.

Phase Four Electronic Patient Pathways

The NHS is moving towards providing services through patient pathways. A patient pathway is a clinical process to be followed during a defined period of time to provide a certain treatment for a clinical condition. Clinical pathways require information from multiple systems and require an element of flexibility to accommodate the individual needs of patients.

When the underlying systems and infrastructure are in place, it will be necessary to provide the capability for a process to be followed with information to be recorded or displayed across multiple different systems for a single pathway for an individual patient. Business process management software will provide this capability. This software is a workflow management tool that is part of the middleware suite of applications. It will allow a defined diagnosis and treatment pathway to be followed by clinicians, in addition to providing clinical information not previously available in this context.

Patient Administration

Administration of patients will be seamlessproviding a full, electronic end to end experience from GP referral to acute treatment back to the GP. Patient self service appointment management will be available to patients and the ability to receive automated reminders of appointments through the internet, mobile and landline phoneswill be provided.Patients will only be required to give their information once and Information will flow real-time allowing all areas to have up to date information.

Clinical Documentation

Clinical documentation for all clinicians will be provided and will include the ability to record day to day care as well as specific assessments either at admission or at any other point in the care of the patient. These documents will be available for clinicians to review whenever necessary. Documentation should also have links to Trust policies and protocols such as; use of pressure sore equipment and Malnutrition Universal Screening Tool and use of antibiotics.

Trust Wide Functions/Specialist Functions

IT systems will be supplied to support general trust wide functions such as prescribing and order communications in addition to specialist systems providing specialist functionality such as cardiology and cancer care systems.

Medical devices

The use of technology will expand into providing diagnostic and monitoring information from the introduction of medical devices throughout the Trust taking information directly from the medical device attached to the patient into the IT system and patient record. Clinicians will have real-time access to information regarding a patient’s conditionand be immediately alerted to any change in a patient’s condition.

Community Care

Clinicians supporting patients in the community will be able to manage the patient’s record from referral to discharge with remote, wireless access and a light weight portable device.

Telehealth

Telehealth and other media enabled systems will be introduced to support clinicians in the community, the ambulance service and between Trusts. Images will be sent to clinicians in the Trust from a patient’s home, images will be sent to A&E from ambulances and specialist clinicianswill provide services to each other within and between Acute/Tertiary trusts.

Data Warehouse

The Trust requires a new data warehouse to consolidate, standardize and maximize its use of operational data. The data warehouse will deliver a single place for corporate data to be retrieved from and standard reports defined to enable the organization at all levels to monitor performance and to support operational delivery. An executive dashboard will be built to monitor key metrics.

Data Interrogation Portal

There will be a Data Interrogation Portal to support a large amount of information required by the Trust. More and better data will be retrieved from the increase in system use with a focus on capturing the right activity and clinical data. Management and clinicians will benefit from sophisticated tools to interrogate data that will enable them to understand patterns and trends affecting the patient, the Trust and the population of North Hampshire.

Wireless enablement

Wireless access within the Trust and within the community will facilitate the introduction of many new and sophisticated medical devices for monitoring patients at the bedside to images sent from the community. Speed of response will be significantly improved with clinical staff having handheld devices or lightweight notebooks. Clinicians will be continually receiving data regarding their patients in addition to being given the flexibility for ordering results and prescribing medication.

Clinical professionals willhave the flexibility to access information relating to patients with appropriate, clinically safe equipment for inputting and accessing information, ordering and reviewing information. A variety of equipment will be provided to accommodate the unique needs such as PC/drug trolleys to handheld PDA devices.

Security and Access

Advanced security policies will be embraced by the Trust to ensure the safety of patient information including the use of smart cards. Simplified access however will be given to clinicians through single sign on capability.

IT Plan

The failing underlying infrastructure relating to the network and server infrastructure will need to be addressed to provide a solid foundation for the increase in IT systems and reliability required to support the organisation. Upgrading the existing network, improving the server environment, consolidating of servers and the introduction of a wireless network throughout clinical areas of the Trust will provide a more stable foundation for the new systems.

New clinical and administrative systems will need to be implemented such as an e-prescribing system, order communications system to implement the electronic patient record. Getting the information into one place in a ‘single view’ portal will require new portal software. Bringing the information together will require a new architectural approach which will move information around safely and seamlessly. New middleware technology (Information Bus) will allow the systems to send data between each other and the Single View Portal. Business process modelling software will be implemented to support patient pathways.

There will be a Data Interrogation Portal providing sophisticated tools for detailed data analysis and reporting. Upgrading the environment allows for other entities to access patient data for ongoing treatment in primary care to national research initiatives as information will be more powerful and more accessible.

Remote access from light weight PC’s will be needed to improve clinician’s ability to make decisions while mobile and Telemedicinecapability will enable remote diagnosis when patients are in ambulances or clinicians are on call. Introduction of sophisticated medical devises will populate the patient record with diagnostic information monitoring the patient’s condition within the Trust, in the patient’s home or in an ambulance.

Delivery

Delivering the vision will require significant resource for implementation and adoption. The scale and complexity of delivering the various systems mean that that a phased or staged approach to implementation will need to be embraced. This will enable a realistic but still intensive pace of change for staff within the Trust and provide sufficient scope to cope with cultural and organisational change that will be required to make best use of systems

The trust strategy is achieved through a phased approach and is focus on quickly delivering immediate value to the Trust.

Phase / IT Implementations / Org changes
Phase I
Sept 2009 –end 2010 /
  • Core Network Upgrade
  • Installation of Wireless Network
  • Key infrastructure initiatives (firewall)
  • Server Consolidation
  • Upgrade Server room
  • Implement ADT real-time Admission, Discharge Transfer
  • Implement e-prescribing
  • Implement online order communications
  • Implement community clinicians real-time remote access
  • Single sign on
/
  • Bring IT infrastructure in house from HIS
  • Move Informatics under IT organisation

Phase II
2010 – 2012 /
  • Single view (clinical portal)
  • Data Interrogation Portal
  • Rollout Medical devices
  • Implement Information Bus middleware to facilitate data flows
  • Smartcard introduction

Phase III
2012 /
  • Integrate to GP systems, social services
  • Telemedicine products
  • Medical Devices

Phase IV
2012 /
  • Implement business process modelling for care pathways

While there are three phases in the Strategic Implementation Plan, some initiatives such as the implementation of medical devices and telemedicine products can be brought forward with a parallel implementation. IT capital investment would need to be brought forward to support these initiatives.

IT Strategy 2009-201402-09-2009