Programme:GP Clinical System Migration
(Hosted Solution)
Project:Hardwicke House Group Practice – Clinical System Migration
Project ID:TBA
Document:Project Brief
Authors:Clive Crane & David Cripps
Revision History
Revision Date / Version No / Summary of Changes / Changed by / Comments20/10/2010 / 1.0 / Document for Consideration of Business Case by Project Board.
04/11/2010 / 1.1 / Updated Project Engineering and Training resources. / Clive Crane
Approvals
Name / Title / Signature / Revision Approved / DateDavid McKinnon / Head of IM&T,
NHS Suffolk
Dr Rakesh Raja / Senior Partner, Hardwicke House
Phil Baker / Programme Lead, NHS Suffolk
David Cripps / Practice Manager, Hardwicke House
Document Distribution
Name / Role / Distribution Method / Revision / DateDavid McKinnon / Head of IM&T, NHS Suffolk / Email / V1.1 / 04/11/2010
Dr Rakesh Raja / Senior Partner,
Hardwicke House / TBA / V.1.1 / 04/11/2010
Phil Baker / Programme Lead, NHS Suffolk / Email / V1.1 / 04/11/2010
David Cripps / Practice Manager, Hardwicke House / Email / V1.1 / 04/11/2010
Linda Bocking / IT Lead,
Hardwicke House Practice / Email / V1.1 / 04/11/2010
Lois Wreathall / Senior Primary Care Manager, NHS Suffolk / Email / V1.1 / 04/11/2010
Justin Murr / EMIS Regional Operations Director - Eastern Region / Email / V1.1 / 04/11/2010
Glossary
Abbreviation / DescriptionGPSoC / GP System of Choice
Table of Contents
Table of Contents
Project Brief
Background
Project Governance and Management
Project Sponsor
Project Scope & Deliverables
Exclusions, Constraints & Assumptions
Risks, Issues & Dependencies
Project Timescales, Milestones and Project Plan
Strategic Compliance
Fit with National Strategy
Fit with East of England Strategy
Fit with Suffolk PCT Strategy
Fit with Integrated Patient Care Strategy
Practice Business Strategy
Impact of System and Data Migration
Assessment of Available Systems
Revenue and Resource Implications
Estimated Overall Project Costs – EMIS Web
Estimated Overall Project Costs – SystmOne
Business Benefits
Benefits Summary
Clinical Benefits
Non Clinical Benefits
Dis-Benefits
Technical Strategic Fit
Business Strategic Fit
Comparison of Available Systems against EMIS LV
Appendices
Business Case Approval Process
Business Case in CfH format
EMIS Web Hardware Requirements
GPSoC Funding Explained
Supplier Charges
Supplier Plans
Capital & Revenue Implications
Minutes of Meeting to Consider the Project Brief & Business Case…………………….…16
Project Brief
The purpose of this document is to provide a firm foundation for the initiation of the project. This document outlines the overall project giving the current status, expectations and estimates. All estimates are based upon the best information currently available although it must be understood that they are just estimates.
The costs and timescales required to move to project forward to the production of a Project Initiation Document (PID) are detailed and must be approved by the project sponsor before work can start.
This document forms part of the Project Initiation process and will used to assist the project make the decision to proceed and which approach to select (e.g. product).
Background
Hardwicke House Group Practice currently uses EMIS LV as its chosen clinical system. The EMIS LV system is now at the end of life and while it continues to be supported there will be no further development of the system. A decision is now required on how best to proceed.
There are several national drivers for change which EMIS LV does not support:
- Requirement to utilise a “Hosted” solution by 2014.
- Electronic Prescription System R2
Hardwicke House Group Practice first engaged the PCT regarding migrating their clinical system to a hosted solutionon the 11th June 2010 and there have been several subsequent telephone discussions.
The formal evaluation of clinical systems should include a wide selection of systems on the GPSoC framework; there are four clinical systems operating in Suffolk which offer a hosted solution:
- CSC/TPP SystmOne
- EMIS Web
- iSOFT Synergy
- INPS Vision
After early consideration iSOFT Synergy and INPS Vision are not to be pursued further as other systems better meet the practice’s required functionality.
The offering from CSC/TPP has been selected by the East of England SHA as the regional strategic system for primary and community care. Should the Project Board choose an alternative system the clinical and business benefits will need to be clearly documented in case of future scrutiny.
There is some uncertainty about the future strategy regarding IT and clinical systems within the NHS, currently the PCT authorises such developments compared against local and regional IT strategies, until there is clear guidance from central government these strategies will continue to influence the PCT.
For the purpose of this project brief the LSP product, SystmOne and the new offering from EMIS, EMIS Web, are to be considered the options available to the Project Board.
Project Governance and Management
The PCT will require that a sufficient standard of project governance will be undertaken by the practice to ensure the appropriate use of the public funds being committed to the project.
Project Sponsor
A Project Board is anticipated upon which the PCT, Hardwicke House GroupPractice and EMIS as the supplier, will be represented.
The project sponsor will be the Senior Partner at the practice or his/her nominated representative.
The frequency of meetings has yet to be determined although there are currently weekly conference calls in place between the PCT and the practice.
Project Scope & Deliverables
The scope of the project is to migrate the HardwickeHouse practice from EMIS LV toa hosted clinical system.
The deliverables will be enhanced technical infrastructure, new business processes and training of staff to use the new system.
The Hardwicke House Group Practice will be responsible for identifing the resource to undertake Project Manager, Business Change Manager and Training Co-Coordinator.
Exclusions, Constraints & Assumptions
Allexpenditure to be incurred by the PCT must receive prior approval from the PCT and specifically relate to the migration to a hosted solution for Hardwicke House Group Practice.
A 10% tolerance of the estimates contained in this document, has been granted to the project by NHS Suffolk, exceeding this tolerance may trigger a review of the project at the request of either NHS Suffolk or Hardwicke House Group Practice.
The project will not include any other practice systems, training of Suffolk Community Health staff or staff from other practices, N3 or branch connection upgrades, or any other indirect costs.
Should EMIS Web be selected: It is assumed thatProject and Business Change Management will be limited to the resources and skills contained within the practice. The project board will need to be satisfied that these resources exist and are available to the project. (This will not apply to the LSP solution – TPP/SystmOne as SystmOne skilled resources within the PCT team will be made available to the practice free of charge).
PCT funded training and engineering resources will be limited to the estimatesagreed in this document.
Should EMIS Web be selected then any reference to sharing data with other practices assumes that other practices within the local practice based commissioning group will also choose to decide against the Suffolk PCT/East of England strategic direction for GP practice systems and will adopt EMIS Web as their practice system rather than SystmOne.
As EMIS Web is a new system with 30 installations currently progressing nationally, it is assumed that the migration of data from the existing practice system to EMIS Web will carry little risk, or require very little support although this has not yet developed a fully proven process.
It should be noted that the practice has been streaming live data for over two years without any error being detected
The PCT is not supporting the deployment of modules which are not fully accredited and assumes that all deployed modules will have achieved such accreditation.
Risks, Issues & Dependencies
Both EMIS Web and SystmOne are a departure from the EMIS LV character based system and may not be easily accepted by users. However, most PC literate users will be familiar with a modern GUI system.
As EMIS Web is in the early stages of being delivered to GP practices there is a risk that the technical solution may not perform as anticipated, and this is likely to be mitigated by the level of support on offer from EMIS to this high profile migration (the third dispensing practice). It should be noted that through three months use of the FS no areas of concern have been raised.
At this stage there is no accredited Dispensary Module for EMIS Web (planned date November 2010); While the current accreditation plan is progressing,the delivery date and fitness for purpose of such functionality is not guaranteed.
Funding for migrating practices to EMIS is dependent upon available resources and finance residing within the participating organisations.
A migration to EMIS Web is likely to increase both capital and revenue costs over the existing LV system. This increase will arise from the provision of ‘spokes’, UPS units and maintenance costs of the equipment.
The implication of EMIS Web at Hardwicke House Group Practice is in contradiction to the stated strategies of both the PCT and theEast of England SHA to support the implementation of SystmOne at GP practices.
EMIS Web presents an issue around uncertainty of interoperation with future hospital solutions such as Lorenzo, which is to be deployed at IpswichHospital, Suffolk Mental Health Partnership Trust and a strong possibility for deployment at West Suffolk Hospitals Trust.
Community Health Staff use SystmOne as their clinical system for which there is no current data sharing interface with EMIS Web but is fully integrated with the SystmOne GP practice system.
There is risk of loss of data migrating to SystemOne arising from the threedays of manual or alternative recording of data prior to migration and from the attachment of this data to the patient record post migration.
Project Timescales, Milestones and Project Plan
The current target delivery date is January 2011.
A migration to TPP SystmOne will be completed within 12 weeks of the practice and PCT making a formal commitment to proceed.
A migration to EMIS is likely to take around 13 weeks following the practice and PCT making a formal commitment to proceed.
Strategic Compliance
Fit with National Strategy
The systems available for a practice to migrate to are TPP SystmOne; EMIS Web; INPS Vision 360; iSOFT Synergy & Premiere; Microtest Evolution & PM2; Healthysoft Crosscare.
EMIS LV is will no longer be developed by EMIS, therefore practices using EMIS LV and wishing to follow the GPSoC clinical system upgrade path to a hosted solution would select EMIS Web as their future system. Those practices wishing to follow the LSP option would select TPP SystmOne.
Fit with East of England Strategy
The East of England Strategy is to support the implementation of iSOFT Lorenzo at Acute health care providers and SystmOne in Primary Care settings.
There are 795 practices in the East of England; the current take up is as follows:
SystmOne 337
EMIS LV264
The East of England Strategy is to support the deployment of SystmOne. Community Care providers on the Suffolk borders (Norfolk, Cambridgeshire and Essex) all use SystmOne as their clinical information system.
Fit with Suffolk PCT Strategy
Of the available systems only TPP SystmOne; EMIS; INPS and iSOFT have a presence in Suffolk.
Current take-up of Clinical System
EMIS LV32
TPP SystmOne15
iSOFT Synergy12
INPS Vision4
EMIS PCS5
The Suffolk PCT Strategy is to support the deployment of SystmOne.
Fit with Integrated Patient Care Strategy
EMIS Web is designed to enable access to shared patient records across healthcare specialisms and is currently collaborating with INPS and iSOFT. However, there are no current interfaces with IT systems used by acute or community healthcare providers in Suffolk or surrounding Local Health Communities.
EMIS Web is developing a Medical Interoperable Gateway which conforms to the NHS Interoperability Toolkit and this will allow the sharing of data with any other clinical system wishing to participate.
EMIS Web will contain GP2GP functionality and be SCR enabled in the module to be released in December 2010.
The strategy adopted for sharing patient data in the East of England is via the LSP solutions of TPP SystmOne for primary/community health care providers and iSOFT Lorenzo for acute care providers.
SystmOne is fully integrated with IT systems used by community healthcare providers in Suffolk or surrounding Local Health Communities and integrates with the stated strategic direction of acute and mental health providers.
SystmOne is in use with the diabetic team at WestSuffolkHospital and also with a number of voluntary sector organisations in and around the Suffolk LHC.
SystemOne is used for child health provision in Suffolk, Norfolk, Essex and Cambridgeshire.
TPP are involved with the development of the Interoperability Toolkit.
TPP SystmOne is SCR enabled and will incorporate GP2GP functionality in Release 6, due December 2010.
Practice Business Strategy
The practice wishes to share data with:
i)OtherPractices
This will be possible where practices use the same system. However, there are a greater number of EMIS practices in the West of Suffolk.
EMIS Web will share data with INPS and iSOFT practices via the EMIS MIG, which conforms to the NHS Interoperability Toolkit standards.
ii)Community Systems
The practice wishes to share data with the community system - this is currently only possible by migrating to SystmOne.
iii)Secondary Care Systems
The Acute care providers in Suffolk are widely expected to migrate to iSOFT Lorenzo. SystmOne and Lorenzo have contractual arrangements to share data. EMIS are in discussion to share data using the processes required by the NHS Interoperability Toolkit.
Impact of System and Data Migration
Assessment of Available Systems
EMIS Web
EMIS Web is the upgrade path for EMIS LV/PCS. EMIS has a long track record of producing clinical systems for the NHS. EMIS Web will also incorporate CfH modules including GP2GP, C&B, EPS and SCR within a CfH accredited hosted environment which will be secure and resilient. GP2GP and SCR functionality will be available in December 2010.
Not all of the modules are currently available (e.g. dispensary module).
EMIS Web allows the practice to fully examine the solution via the EMIS Web Familiarisation Service. This allows the practice to understand the functionality on offer and to prepare for migration using read-only access to live data for up to 6-months prior to migration.
SystmOne
The LSP solution is the strategic upgrade path from TPP and has a long track record of producing clinical solutions for the NHS. SystmOne will also incorporate CfH modules including GP2GP, C&B, EPS and SCR within a CfH accredited hosted environment which will be secure and resilient.
TPP offers on-line demonstrations and extended on-site demonstrations (e.g. three days) whereby hands on-training and familiarisation can take place. For practices undergoing migration an evaluation database is provided giving the practice access to their data using the SystmOne client.
SystmOne does require three days of downtime prior to migration requiring an alternativemethod of recording consultations,although there are processes to mitigate the impact of this.
There is anecdotal evidence that the SystemOne dispensing module is difficult to use.
Both systems offer very similar functionality in terms of national requirements; both offer familiarisation opportunities prior to migration.
Revenue and Resource Implications
Estimated Overall Project Costs – EMIS Web
One-Off Charges:
Spoke+ UPS / Infrastructure / Project Engineer / EMIS Web one-off / Training / Misc / Total
Hardwicke House / 3,632 / 9,400 / 650 / 2,170 / 3,716 / 5,950 / 25,518
Bures / 1,500 / 1,600 / 388 / 0 / 0 / 500 / 3,988
Clare / 1,500 / 3,600 / 388 / 0 / 0 / 450 / 5,938
Gt Cornard / 1,500 / 3,800 / 387 / 0 / 0 / 600 / 6,287
Meadow Lane / 1,500 / 2,150 / 387 / 0 / 0 / 450 / 4,487
Total / 9,632 / 20,550 / 2,200 / 2,170 / 3,716 / 7,950 / 46,218
To be incurred by the Practice / 0 / 0 / 350 / 0 / 0 / 0 / 350
To be incurred by the PCT / 9,632 / 20,550 / 1,850 / 2,170 / 3,716 / 7,950 / 45,868
Assumptions:
HP 7100 PCs will be replaced
All PCs will receive a memory upgrade at £50 per PC (Crucial Memory: 7900 2Gb £35.24; 7800 2Gb £39.94; £7600 2Gb £35.25)
All monitors attached to a HP7100 will be replaced; Half of the remaining monitors will be replaced.
All Netgear switches will be replaced
£100 for each site to cover cabinets and additional network points
Spoke at Hardwicke House is indicative cost for an HP Rack Mounted Server
Spoke at branches are assumed to use small rack mounted server with 3yr on-site warranty.
Two days total EMIS project engineering at branches to configure Jayex boards and other equipment. £350 per day
Five days total SSS project engineering at branches to install spoke/replace or upgrade PCs £300 per day
The PCT will support 10 days additional training for Hardwicke House at a charge of £371.55 per day
£4,000 has been included to support Local backfill for training of GPs
Estimated Overall Project Costs – SystmOne
One-Off Charges:
Spoke+ UPS / Infrastructure / Project Engineer / SystmOne one-off / Training / Misc / Total
Hardwicke House / 0 / 9,400 / 0 / 0 / 0 / 4,100 / 13,500
Bures / 0 / 1,600 / 0 / 0 / 0 / 100 / 1,700
Clare / 0 / 3,600 / 0 / 0 / 0 / 100 / 3,700
Gt Cornard / 0 / 3,800 / 0 / 0 / 0 / 100 / 3,900
Meadow Lane / 0 / 2,150 / 0 / 0 / 0 / 100 / 2,250
Total / 0 / 20,550 / 0 / 0 / 0 / 4,500 / 25,050
To be incurred by the Practice / 0 / 0 / 0 / 0 / 0 / 0 / 0
To be incurred by the PCT / 0 / 20550 / 0 / 0 / 0 / 4,500 / 25,050
Assumptions:
The project will use internal resource from the BAU pool as defined in the SLA agreement with SSS.
£4,000 has been included to support Local backfill for training of GPs
EMIS Web / SystmOneItem / Additional Cost / Additional Cost
External Resources / £6,586 / £ 0
Internal Resources / £5,500 / £ 4,000
Hardware / £34,132 / £21,050
Software / £ / £
Additional Items / £ / £
Project Governance / £ / £
Total: / £46,218.00 / £25,050.00
Business Benefits
Benefits Summary