SMT APPROVED
eHealth Delivery Plans
[2012-2017]
UPDATED VERSION DEC 2013
1
1. FOREWORD
This strategy is about ensuring NHS Fife makes the best use of the investment in information technology to support our local plans and improvement priorities for the coming years. Our collective goals remain simple. We seek a single electronic patient record that is consistent and accessible by all clinical staff, in multiple clinical settings, and supports the quality principles reflecting the complexity of care provided across health and social communities.
This is particularly important as we develop new service structures, open up avenues greater partnership working and seek alternative ways of working to meet increasing demands, while we seek to use our resources as efficiently as possible and reduce inefficiency within paper-based services. This will provide multiple opportunities to be more efficient and effective.
The changes we seek have a high dependency on the technologies developed from our previous strategy 2008-2011, and in this next period we will be seeking to embed these technologies to support clinical change, be more efficient and measure this in specific outcomes that supports NHS Fife and national delivery plan. eHealth needs to directly support better outcomes for patients, easier ways of working for clinical staff, and improvement in the use of information for managing our service across NHS Fife.
I ask all staff to embrace, engage and make eHealth a key component to help us all deliver the significant challenges and opportunities in this coming period. Without making the best use of available eHealth solutions and embed into our clinical and administrative activity we will not maintain the pace of improvement needed to keep pace with the challenges ahead. This plan sets out the details for delivering our eHealth Strategy between 2011-2014 for review in 2015.
John Wilson
Chief Executive
2. EXECUTIVE SUMMARY
This is the first NHS Fife Delivery Plan covering the period 2012-2017 and replaces the annual strategy, all boards in Scotland now work to a national strategy aligned to the agreed finance strategy of 2011.
This plan is closely aligned with delivering the NHSS Quality Strategy and eHealth Strategy 2011-2017 and builds on our baseline and success from previous eHealth strategies. The plan is focused on those outcomes that directly underpin the National and Local (NHS Fife’s) drive to continually deliver measurable improvements for patients and directly support the safety and efficiency of healthcare delivery.
NHS Fife will continue in the application of using the most efficient IT and clinical innovation in daily working practice and ensure it directly contributes to local service plans and delivering improvement with measurable outcomes. This is an approach that NHS Fife has pursued since our original plan in 2003, delivered in our focus since 2008, the difference in 2011-2017 is that agreed outcomes will be measurable and agreed within the plan.
The diagram at Figure One provides an overview of the key components we will be seeking to deliver through this strategy and implementation plan. These are expanded further in greater detail at Annex B and explained in delivery terms at the service narrative at Annex C.
Figure 1: The Supporting Programmes for this Plan
Key Themes for supporting better outcomes in 2011-2017 this includes a series of common themes linked to programmes and projects that directly support the service across NHS Fife to;
Maximise Efficiency
Support Care Provided in the Community or at Home
Provide Clinicians Better access to information
Support people to better manage their own health and communicate with NHSS
Help Improve medicine management
Deliver quality information to help manage operational services
Information services and IT infrastructure remain fundamental to delivering this plan. The success of the delivery plan 2011-2017 will be measured against its ability to directly support key objectives that deliver solutions embedded in our health services and that can be measured in terms of improvements as ‘outcomes’.
The ‘outcomes based’ approach is new for eHealth across Scotland and last year (2011-2012) was accepted as a “development year “in which to agree appropriate and common measures that are feasible, achievable, pragmatic and can be linked to measurable outcomes.
The principles remain we focus on the following;
· We invest primarily to support the 6 primary themes
· We continue to develop the infrastructure needed for a modern health service, including a more mobile, agile service
· We seek to apply equity across all clinical settings
· We seek to ‘turn off’ those systems that do not provide real patient value/benefit
· We increasingly replace the inefficient paper process with electronic services that directly improve the experience for patients, clinicians and managers of the service, at a pace that the service directs
· We will measure systems in their ability to contribute directly to achieve patient benefits and outcomes rather than just for systems in their own right
· We will communicate and share service improvement and key benefits in terms with clinicians, managers and patients, and refrain from the use of technical jargon where possible and build a service that understands clinical and patient perspectives around the value of eHealth.
· We will maintain a balance of technical and medical expertise that can work as a single entity to best enable opportunities to exploit eHealth for the best advantage of improving care.
3. DELIVERY OF PLAN: ASSESSMENT OF CURRENT POSITION
NHS fife has benefited from a clear strategic direction around eHealth since its first strategy published in 2003. This has enabled a targeted investment programme including Capital and Revenue resources in Information and Informatics, IT infrastructure, a Programme of Work to develop/buy Clinical Systems, deployment of these systems and a training resource.
In early 2009 we shifted our focus toward the importance of ‘project outcomes’ rather than over-proscriptive ‘project methodologies’ that tended to lose direction towards process rather than delivering improvement outcome. This shift in approach continues to provide success and reflects well on the new arrangements proposed at national level using an outcome based results process for both planning and delivery. All new key projects in eHealth are service led, meaning that eHealth remains an enabler rather than the owner of the service change, there are some areas this has proved more successful than others, but is increasing becoming the norm for all eHealth projects across NHS Fife.
There of course remains some cultural challenges in moving from the traditional IT department for staff, clinicians and managers to view eHealth as a multi-disciplinary team of IT, health and management experts, that when combined, can provide critical service and support to help enable and deliver frontline service change.
NHS Fife will continue to embed and expand this approach by seeking further measurable benefits from the significant investments made in 2008/2011 that has provided a mature catalogue of eHealth solutions to help underpin the operational improvements planned for 2011-2015, and review in 2015. eHealth currently support;
· 18WKRTT business transformation around Digital Dictation, Referral Management, UCPN for tracking, electronic recording of clinical outcomes, Unified Patient Tracking and DNA, with plans to support Treatment Time Guarantee in 2013
· Implementation of theatres system OPERA
· Implementation of sexual health NaSH
· Telehealth solutions in COPD/CHD and Rheumatology and Hospital at Home
· OCRR Implementation to Labs and Radiology
· Successful Clinical Portal Implementation (some 1700 clinicians)
· Single Sign On/Password Reset/2 Factor Authentication/Biometric testing
· New Addiction Services System/Needle Exchange (2013)
· Management Dashboard for Information Services, and primary care/prescriptions/ plus new dashboards for quality, nursing and reporting
· Major Infrastructure projects including (OCS, Telepresence, DNA, Comms, GH&MS, and new data centre)
· GH&MS support
· Electronic Patient Alerts/Electronic FEWS
· eForms and Applications including Podiatry and Cataract
· Cancer services
· Maternity System
· MiDIS for AHP
This provides a very strong solution base for NHS Fife to deliver on the 6 strategic outcomes for NHS Scotland and meet the National eHealth Strategy and Quality Plan, the 3 year plan for key systems to support the delivery on the outcomes (See Table One)
Table One: A summary of the key projects to deliver on the 2011-2017 Plans
Notes – This document replaces the approved SMT 3 year plan
a) LIVE means the system has been delivered, tested, accepted by service users and projected as being used in a range of healthcare settings across NHS Fife. (Including Acute, Community and Primary Care) This does not mean that the system is in full use throughout NHS Fife.
b) ‘Amber’ means the system is in design/working in a limited area, or to a different degree of operational capability and is subject to further management decisions relating to policy or approval prior to expanding to the full service.
c) BAU (Business as Usual) means the system is being operated by the service as part of their daily operations and eHealth supports either via application support, service desk support or replacement/upgrade/repair.
4. DELIVERING OUTCOMES 2013-2015 (Phase One)
Our strategy is now based on the National eHealth Strategy released to the service in September 2011. This strategy defines 5 key outcomes and 11 targets which NHS Boards must deliver by 2014. These targets are summarised at Annex A.
As outlined above, previous strategic decisions and investment by NHS Fife have provided a robust baseline from which to deliver the national targets set at Annexe A.
Many of the targets set nationally are already being addressed in our 3 year plan . Our key systems are in a high state of readiness to be rolled-out to underpin the outcomes expected in the next strategic period 2012-2014.
Annex B outlines in detail how NHS Fife will deliver the national targets which are set within 5 key outcomes while Annex C provides a detailed narrative of the NHS Fife projects. The 5 key outcome streams outlined in our eHealth Strategy and summarised here for completeness.
Area 1 Support improvements in Medications management
The purpose of this outcome is for eHealth to directly support the improvement of medication management from admission, transfer and discharge of patients back to their GP, the community nurse and across acute care boundaries. In the short-medium term all health boards will need to approach this incrementally and ensure we make the best use of available and affordable interim solutions that will enable medication management and effective medicines reconciliation via the use of current technologies like the Clinical Portal, Emergency Care Summary and make use of an Electronic Discharge Letter.
Some services will have more urgent demands like H@H with a high dependency on fast transition of care between primary, community and acute, that increases the risk of transcribing errors with currently available systems. The trial of Electronic Discharge Document (EDD) from Tayside in 2011/2012 failed to cover the key aspects needed, specifically around medicine reconciliation and tests. We plan to introduce medicine reconciliation and results reconciliation with an Electronic Discharge Document, launched from within the Clinical Portal V4 in 2013. We will develop this work as a board, a consortium and a national initiative where appropriate. We will seek to find tactical solutions that help deliver improvement outcomes where appropriate including developing primary care solutions to work in acute settings.
NHS Fife will be seeking a full ‘Hospital Electronic Prescription Management & Administration (HEPMA) solution but this option remains unfunded in our current programme while there remains national uncertainty about whether a ‘full solution’ is readily available in the commercial market. Most current HEPMA systems are currently geared towards pharmacy or prescribing, but not both. As the costs are significant, we remain reluctant to procure if only a partial solution is available. We will be seeking to test this in 2013/2014.
This new plan includes a DRAFT PID discussed at the December eHealth Board on a steering group for approving a OBC for HEPMA and subject to funding implementation 2015-2017
It is projected NHS Fife will have an interim solution during 2013 while we review a permanent and funded solution for full ePrescribing during 2013-2014. This procurement would significantly address the safety and quality issues around medication management in and out of Hospitals and for staff in the community..
Area 2 – Help the people of Fife to Manage and Improve their own health and wellbeing
As well as providing patient/citizens with the information they require to be informed about health and wellbeing (such as Keep Well), this extends to the provision of better access to information and services and help monitor/manage chronic conditions in the community
New service channels are opening allowing patient access to services via areas such as Patient Portal and Digital TV services such as "Looking Local." We are currently reviewing the Audit Scotland report on Telehealth and will be seeking ways to further exploit this approach in Fife, including roles for providing services to patients from a patient portal which could enable patients to manage appointments, view results, order medication, view records, and ask advice.
In 2012 we deployed TELEHEATH to the H@H team with some success and would be seeking to deploy similar service on demand as required while we develop our full plan in 2013.
Area 3 –Help NHS Fife Provide better access to Information
At the present time many clinicians spend significant periods of time trying to locate the most relevant information. Phase One of Clinical Portal helps bring key information like referrals, letters, results, medicines via a single system and is viewable whether working in community, an acute ward, a clinic, a nursing home, or in the patient’s home, we currently have 1700 clinicians in Phase One and seeking 2500 clinical users by end of 2013. The early clinical portal also enables clinicians with the option to view scanned case-notes (or continue to use paper) making them available ONLINE if they are unavailable, in a different hospital or absent. In Phase Two we are adding the ability to create forms, discharge letters, see information from other clinical systems /like MiDIS/Patientrack/Nursing Notes and help view assessments and other letters (including social work letters) allowing more mobile working in and /shared information between health and social work.