Digital Maturity Outline Business CaseDraftv1.305.12.2014
Programme / Digital Maturity (DM) / Document Reference / 74.SHSW.DM.BC
ProgrammeLead / Marcos Faquer-Manhaes / Status / Draft
Owner / Dr Paul Rice / Version / 1.3
Author / Heiko Kausch / Version issue date / 05/12/2014
Patients & Information Directorate Outline Business Case
Digital Maturity (DM) Programme
Formerly known as the “Clinical Digital Maturity Index” (CDMI)
Approvals
This document was reviewed and approved by the following people:
Name / Title / Date / VersionDr Paul Rice / Senior Responsible Officer (SRO) / 05/12/2014 / 1.3
Marcos Faquer-Manhaes / Digital Maturity Programme Lead / 05/12/2014 / 1.3
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The controlled copy of this document is maintained by NHS England. Any copies of this document held outside of that area, in whatever format (e.g. paper, email attachment), are considered to have passed out of control and should be checked for currency and validity.
Document management
Revision history
Version / Date / Summary of changes1.1 / Nov 2014 / Pasted from DMM Q1 2014 “OBC” v1.3 (author: Heiko Kausch)
1.2 / Dec 2014 / Refreshed by Marcos Faquer, Digital Maturity Programme Lead
1.3 / Dec 2014 / Costs and text updated by Dr Paul Rice, SRO – version published
Document assurance
This document has been given the following gateway review and endorsements:
Name / Endorsement given / DateSponsorship
This document was approved by the following sponsors:
Name / Role / Approval given / Date / VersionPaul Rice / SRO / I can deliver this business case
Table of Contents
1Strategic Case
1.1Vision statement
1.2The case for change
1.3Intended scope
1.4Overall objectives, capabilities delivered and outcomes
1.5Benefits
1.6Identified risks
1.7Constraints and dependencies
1.8Stakeholder support
2Economic Case
2.1Delivering programme approach
2.2Endorsed approach
2.3Value for money
3Financial Case
3.1Whole life funding requirements
3.2Financial strategy
3.3Financial assurances
3.4Constraints and negating commercial risks
3.5Breakdown of costs
3.6Funding organisation
4Commercial Case
4.1Procurement
4.2Contractual obligations
5Management Case
5.1Generic operating model
5.2Organisation
5.3Governance and assurance
5.4Reporting and monitoring
5.5Implementation plan
5.6Benefits management
5.7Risk management
Appendix A – NIB 2015- 2020 Timeline
Appendix B – High-Level Programme Plan
Appendix C – Estimated Resource Effort Required
1Strategic Case
1.1Vision statement
The Digital Maturity programme will create, provide and administer an audit framework to support the delivery and evidence achievement of digital transformation across health and social care services in England and specifically the delivery of the paperless 2020 vision. The digital maturity framework will establish a set of indicators thatdisplay how far local health and care economies in England (and the provider organisations which they comprise) have progressed in terms of delivering digital capabilities such as electronic patient records, electronic prescribing, integrated digital care anddeployment of other technologies that enable innovative and flexible delivery of care. It will allow progress to be tracked over time by commissioners particularly with respect to the effective interoperability and integration of health and care information captured at the point of care.
A detailed record outlining the digital maturityof local health and care systems willbe built upon open data repositories enabling transparency, analysis and extensibility in innovative and novel ways to increase breadth of organisation’s profiling models to support better health and care choices, commissioning, improvement and sustainability movements.
1.2The case for change
1.2.1Background
In October 2012, the Prime Minister announced the establishment of a Nursing Technology Fund to support nurses, midwives and health visitors to make better use of digital technology in all care settings, in order to deliver safer, more effective and more efficient care.
The first round, for £30m, was for funding to be spent in FY13/14 and attracted 226 applications from 139 organisations representing the full range of geographies and care settings. In the second round launched in November 2014, £35m of Revenue funding is available to be spent across FY14/15 and FY15/16. Organisations eligible to apply include NHS Trusts and Foundation Trusts, Local Authorities and Voluntary, Community and Social Enterprises (VCSEs).
In May 2013, the Secretary of State and Professor Sir Bruce Keogh, Medical Director of NHS England, announced the establishment of the £260m Safer Hospital Safer Wards (SHSW) Technology Fund, increased to £500m in September 2013. The fund has been renamed the ‘Integrated Digital Care Fund’, and it is focused on supporting local NHS Trusts and Foundation Trusts move more rapidly from paper to paper-light to paperless processes, adopt increasing levels of digitisation in clinical business processes and to adopt e-Prescribing more widely and comprehensively.
In its first round, over 200 projects from digital clinical records to electronic prescribing and medicines management were approved, with a financial commitment of over £200m in FY 2013/14 and 2014/15. In round two of the fund, closed on 14 July 2014, awards from the fund will continue to support the move to integrated digital records with the emphasis on supporting information flows across organisational boundaries. Consequently, the eligibility criteria were widened to include local authorities.
1.2.2Purpose of the Programme
NHS England is responsible for the delivery, administration and governance of these funds to facilitate the widespread development and adoption of digital capabilities aimed to benefit patients and clinicians by enabling safer, flexible and more joined up care through timely accessible and comprehensive clinical information. The Digital Maturity Programme is required to support delivery of the Funds and to support the delivery and evidence achievements of a number of policy commitments in ‘The Power of Information’, the NHS Mandate, NHS England Business Plan, the NHS Outcomes Framework are met, and is one of the Secretary of State’s two key priorities for action.
The Acute Trust ‘baseline’ Clinical Digital Maturity Index (CDMI™) was originally designed by e-Health Insider (EHI) Intelligence, with information compiled and validated by a combination of Freedom of Information (FOI) enquiries, self-reporting and “interviews” with IT professionals, and where available, lead clinicians, Chief Clinical Information Officers (CCIOs) or equivalent. The audit design was largely developed by commercial system providers with an interest in supplying added-value solutions to NHS Trusts where the opportunity arises. The architectural reporting design and scoring business rules, therefore, were based on its limited understanding of NHS Acute Trust purchased systemic capability.
1.2.3Case for change
In June 2013, NHS England, in partnership with EHI intelligence, developed the ‘Clinical Digital Maturity Index’ (CDMI™) as a unique benchmarking tool. This initial baseline analysis has been created specifically as a means of putting insight into the hands of clinicians, senior managers and boards, as to the alternative road maps that exist to secure clinical digital maturity at an organisational and systemic level.
Whilst CDMI™ delivers a good level of local ownership and engagement within its existing processes it has not proven to be a comprehensive and robust methodology for sanctioning the conformed technological range of systemic capability and, critically, the scale of meaningful use of that capability across health and social care organisations. For example, current baseline identifies if a Trust is using an electronic prescribing system but fails to ascertain how widely it is used, how well it is utilised and how it has benefitted patient outcomes (in terms of safe prescribing and timely discharge due to legible and approved prescriptions being dispensed by its local pharmacy).
Given the good Digital Maturity Programme development achievements thus far and to provide more meaningful information to inform the clinical effectiveness of digital maturity, there is an immediate requirement to increase the existing scope to cover systemic capability in terms of delivering business intelligence as follows:
- Examine meaningful use of technology capabilities such as e-prescribing;
- Extend to Mental Health Services, Community Care, Social Care and Primary Care Services;
- Evaluate enterprise-wide interoperability (information sharing supporting continuity of care);
- Provide capability of measuring benefits consequential to technological advancements.
Building on its progress to date, existing maturity models applied in health systems in other countries and other industries, and adopting an Agile approach, the Digital Maturity programme actively looks to establish a digital maturity frameworkwhich is being scoped and designed in collaboration with Academic Health Science Networks, health and social care services providers and commissioners, professional bodies, HSCIC, CQC, NHS Choices and others,making it a true partnership and synergy within NHS England.
The complexity of programme will require a number of adept and expert “digital maturity” teams to support design, development, delivery, audit, review and refresh of the framework. While some of the work has already commenced, this Outline Business Case looks to secure funds to deliver the existing projects to plans in the next three years.
1.2.4Five year forward view and aligning to the NIB framework
NHS England’s Five Year Forward View describes how digital and technology strategies will – in the next five years – supportthe delivery of better outcomes; thereby, helping to reduce avoidable harm to patient, use medicines more optimally, reduce waste in prescribing, free up front line staff time, improve citizens’ experience and satisfaction. The Five Year View’s blueprint is further developed by the National Information Board (NIB) Personalised Health and Care 2020 (the NIB framework).
The NIB framework sets digital ambitions and milestones synchronised to which the Digital Maturity framework will be paramount to support organisations to comprehend, assess and plan compliance, as well as to enable evidence achievements at a national level and support identifying areas for prioritisation and targeted support. More detailed alignment of the Digital Maturity programme has been set out in the NIB timeline on Appendix A.
1.2.5Reduction in funding
If no further investments are allocated to give continuity to this programme, assumptions on use of clinical systems and progress against digitisation will have to be drawn from limited information on installed infrastructure and systems. This information is not sufficient to support effective investments, commissioning and citizen’s choice, and not satisfactorily evidence of progress and achievements.
If only half of the required funding is to be allocated to the programme, a comprehensive Digital Maturity framework will be delivered featuring Acute and Mental Health settings only.
1.3Intended scope
A Digital Maturity (DM) programme was established in 2013 to support the understanding of technical capabilities within NHS Acute settings with objectives to support the delivery of a transparent service capable of demonstrating where the NHS investment in technology has achieved the delivery of patient-outcome benefits and thereby providing evidence of value for money. Primary drivers include a number of policy commitments in ‘The Power of Information’, the NHS Mandate, NHS England Business Plan, the NHS Outcomes Framework and one of the Secretary of State’s two key priorities for action.
Clinical Commissioners will be interested in understanding what technology is currently used in supporting the effective and safe service to citizens’ care, how well and widely these are used and how technology supports efficient clinical outcomes. This programme looks to answer these questions by breaking down the audit information requirements, develop an analytical measuring and reporting mechanism and deliver an audit framework that will frequently update its knowledge base as services continuously advance with their digital technology.
To date, e-Health Insider Intelligence developed a Clinical Digital Maturity Index (CDMI™), providing a skeleton baseline digital maturity index covering Acute Trusts only based information obtained directly from NHS Trusts. For more meaningful and informative purposes, this programme is looking to widen its scope to include:
- Comprehensive audits to expose meaningful use of technological capabilities in Acute /Foundation Trusts (focusing on clinical systems such as e-prescribing);
- Extend to Mental Health Trusts, Community, Social Services and Primary Care;
- Develop an enterprise-wide interoperable capability audit to understand how well clinical and administrative systems share critical decision-making information across other settings.
- Establish a sustainable framework capable of measuring and inform benefits to technological advancements.
1.3.1Scope inclusions
The programme will complete its deliverables within 3 years and requires a£6.45m total budget. This business case, therefore, looks to secure funding for the duration of its lifetime based on a ‘2-plus-1 year’ funding plan proposal.
Via advocating and engagement with impacted NHS organisations and influencing key stakeholders (commissioners), this project aims to increase the sensitivity and comprehensiveness of the existing CDMI™ analysis. This will not only extend its scope to include more points of care (in community services and integrated care for example) but also to provide more meaningful quantifiable audit/benefit comparative measures and analytical tools – never achieved before – plusensure that new capabilities (end to end interoperability) are added as the digital landscape develops. It will enable key stakeholders to develop a deeper understanding of the essential elements that combine to deliver not just ‘capability’ and ‘potential’ but demonstrable benefits for citizens’ care and more critically, clinical outcomes.
Initially this is only rating the underlying technical capabilities that an organisation possesses. It does not currentlyreflect, in terms of outcomes for patients, the extent to which any organisation has meaningfully used the full range of capability at its disposal. It does, regardless of starting point, exemplify what the steps to progressively improve capability and execution might look like. It can highlight how organisations have plotted similar or alternative pathways that deliver success. Therefore, current plans include the immediate procurement of a system supplier to:
- Develop a system, recruit and employ health-expert design groups;
- Develop the detailed audit requirement specifications;
- Appoint a proficient and professional academic institute to ensure credibility;
- Commission a skilled Business Intelligence team to support self-assessed audits;
- Conduct national audits on completion.
The programme acknowledges that the complexity of programme will require a number of adept teams to support further development, design of digital maturity datasets and information flows, and establish a sustainable digital maturity framework enterprise-wide. While some of the work has already commenced, continued communication of intentions and progress will remain critical to the programme’s success.
The diagram below illustrates the intended scope inclusions.
1.3.2Scope exclusions
Although the programme will set aspirational digital maturity stages, the data will nottell how individual organisations are planning and by when they will achieve these stages. It is also out of scope to capture how organisationsare managing their clinical business change required to get the best from introducing new technologies.
The programme will not seek to deliver organisation financial analysis or forecast costs and dates required to upturn digital maturity at any level.
1.4Overall objectives, capabilities delivered and outcomes
Going forward, it is proposed the programme will continue to develop thedigital audit framework to support the delivery and evidence achievements of digital initiatives across health and social care services through a combination of self-reporting, local agreed peer review and comprehensivedata quality assessment. The methodology will be developed in conjunction with the Academic Health Science Networks (AHSNs), NHS managerial, commissioners, informatics and clinical (multi-disciplinary) communities in health and social care environments, and experts in digital maturity field across industries and will utilise the best available national and international practices available.
Building on existing work and bringing together ambitions from key partners, NHS England is playing a more active part in steering, leading and bringing together digital maturity silo initiatives that have emerged across England; thereby recruiting subject-matter experts to work together and lead the maturity audit datasets design, piloting and evaluating their usability and usefulness. The adopted approach is based on collaboration rather than centrally driven.
Funding to support the programme and its deliverables is required to primarily:
- Develop and launch a Digital Maturity framework contained by agreed scope and scale to meet the identified wider requirements, particularly understanding systemic clinical digital maturity within acute, mental health, community, primary and social care;
- Support the delivery and evidence achievements of digital initiatives across health and social care services in England.
- Promote and champion the maturity model to all potential interested audiences, including NHS Trusts / Foundation Trusts, Clinical Commissioning Groups, Local Authorities, Commissioning Support Units, Academy Health Science Networks, academic research intermediaries, Industry, Monitor, CQC and Trust Development Authority, Health Education England;
- Provide additional functionality to allowdigital maturity data to be made easily and timely available to relevant stakeholders enabling transparency, analysis and extensibility in innovative and novel ways to increase breadth of organisation’s profiling models to support better health and care choices, commissioning, improvement and sustainability.
- Create knowledge networks to disseminate learning and best practice;
- Support procurement and communication skill-set requirements.
To support the year-on-year programme funding, this programme was been strategically planned as follows:
Stage 1 - Discovery and Design
Employing subject-matter experts, this stage looks to design and develop the business and information requirements, which inform the ‘maturity benefit' dataset specifications and the development of information (data) recording and reporting tools.
Deliverables:
- Literature review of current models of digital maturity used to assess healthcare systems internationally;
- Review digital maturity tools used to assess impact on business processes in other industries to carry out outputs used to inform recommendations for a revised heterogeneous model for England;
- Established Digital Maturity Board, Programme plans, design groups and assurance mechanisms;
- Existing digital maturity indices mapped to understand similarities and differences between models, such as the Clinical Digital Maturity Index (CDMI), Health Information and Management Systems Society (HIMSS) Electronic Medical Record Adoption Model (EMRAM+) and COACH, the Canadian Electronic Medical Record Adoption and Maturity Model;
- Two Digital Maturity workshops to CCIOs, CIOs and equivalent roles in health and care services, alongside other communications activities;
- Acute, Mental Health and Primary Care Digital Maturity Datasets;
- Initiated Social Care, Ambulance Services, and Community Services Dataset design.
Stage 2 - Development and Delivery