2020 Digital Roadmap: ‘One Person, One Digital Record’ Devon IMT Strategic Vision Statement...

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‘One Person, One Digital Record’

2020 Digital Roadmap

Kernow CCG

South Devon & Torbay CCG Northern, Eastern and Western Devon CCG

Footprints

Final v1.0 May 2016

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Table of Contents

1 Review and Approval .................................................................................................................. 5

1.1 Reviewers .................................................................................................................................... 5

1.2 Approvals .................................................................................................................................... 5

1.3 Document Status ......................................................................................................................... 7

1.4 Relevant Documentation ............................................................................................................ 7

2 Executive Summary ..................................................................................................................... 8

3 Scope ......................................................................................................................................... 11

4 General ...................................................................................................................................... 12

4.1 Identify who has endorsed the roadmap (Section 6.2) ............................................................ 12

4.2 Identify which organisations have made significant contributions in the development process (Section 6.2) ................................................................................................................. 12

4.3 Summarise the process through which the roadmap has been developed (Section 6.3)........ 13

5 Vision ......................................................................................................................................... 16

5.1 Vision for digitally enabled transformation (Section 6.4 – 6.7) ................................................ 16

5.1.1 Background ...................................................................................................................... 16

5.2 Our Vision .................................................................................................................................. 17

5.3 Our Principles ............................................................................................................................ 18

6 Baseline Position ....................................................................................................................... 19

6.1 Overview of digital maturity of key primary, secondary and social care providers (Section 6.8) ............................................................................................................................................ 19

Figure 1 - Secondary Care Current Capabilities in Relation to National Average ..................... 21

Figure 2- Secondary Care Provider Capability Projection for 2020 .......................................... 22

7. Identification of rate limiting factors (Section 6.9) ................................................................... 23

8. Readiness .................................................................................................................................. 25

8.1 Set out leadership, clinical engagement and governance arrangements (Section 6.10) ......... 25

Figure 3 – Governance Arrangements ...................................................................................... 26

8.2 Cornwall .................................................................................................................................... 27

8.3 Devon ........................................................................................................................................ 27

8.4 Identification of change management approach(es) / model(s) to be followed (Section 6.11) .......................................................................................................................................... 28

8.5 Identification of approach to benefits management and measurement (Section 6.12) ......... 30

8.6 Identification of known, anticipated and target sources of investment (Section 6.13) ........... 31

8.7 Overview of programme / project structure for 16/17 (Section 6.14) ..................................... 32

8.8 Outline of how resources can be utilised more effectively (Section 6.15) ............................... 32

Figure 4 – Key Principles for our Peninsula Approach .............................................................. 33

9 Capability Deployment .............................................................................................................. 34

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9.1 Identification of current maturity for each of the 7 Paper Free at the Point of Care (PF@PoC capabilities) (Section 6.16) ........................................................................................ 34

9.2 Capability deployment schedule (Sections 6.17- 6.18)............................................................. 34

9.3 Capability deployment trajectory (secondary care) (Section 6.23) .......................................... 38

Figure 5 – The Roadmap and Information Sharing and Standards Trajectory ......................... 40

10 Universal Priorities Delivery Plan .............................................................................................. 41

Figure 6 – Current Assessment of Progress towards Universal Priorities ................................ 41

11 Information Sharing .................................................................................................................. 43

11.1 Information Sharing Approach (Section 6.32) .......................................................................... 43

11.2 Plans for a common information sharing agreement with all providers signed up (Section 6.34) .......................................................................................................................................... 44

11.3 Current status of adoption of NHS number / steps to address gaps / gaps that will persist into 17/18 (Section 6.35) .......................................................................................................... 44

11.4 Plans and milestones for adoption of information sharing standards (Section 6.36) .............. 45

12 Infrastructure ............................................................................................................................ 46

12.1 Current status of the mobile working infrastructure (Section 6.39) ........................................ 46

12.2 Confirmation that individual providers have plans to develop their mobile working infrastructure (Section 6.40) ..................................................................................................... 46

12.3 Description of system- wide initiatives to develop the mobile working infrastructure (Section 6.40) ............................................................................................................................ 47

12.4 Current status and future plans to improve collaboration between professionals from different organisations (Section 6.42) ...................................................................................... 47

12.5 Summary of current or planned initiatives to share infrastructure (Section 6.43) .................. 48

13 Minimising risks arising from technology ................................................................................. 50

13.1 Confirmation that robust plans, policies and procedures in place across the system to minimise risks / steps to address gaps (Section 6.45) .............................................................. 50

13.2 Confirmation that individual providers are moving forward with GS1 adoption (Section 6.46) .......................................................................................................................................... 51

Appendix A - Detailed Gap Analysis and Local Provider Plans .................................................................... 52

Appendix B - Annex 2 Capability Deployment Schedule Illustration ........................................................... 52

Appendix C - Ready to Deliver Change Feedback ........................................................................................ 52

Appendix D - New Projects Details .............................................................................................................. 52

Appendix E - DMA Trajectory Results .......................................................................................................... 52

Appendix F - Universal Priorities Forms for each CCG ................................................................................. 52

Appendix G - SNOMED-CT / DM+D / NHS Numbers / Mobile Working Infrastructure / GS1 Standards (Barcode) Survey Results .......................................................................................................... 52

Appendix H – J2 Interoperability Architecture Specification ....................................................................... 53

Appendix I – HSCIC Feedback on J2 Interoperability Architecture Specification ........................................ 53

Appendix J - Roadmap Process Meeting Representation Details ................................................................ 53

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Appendix K - Patient Safety and Reputational Risk Survey ......................................................................... 53

Appendix L - Achievements.......................................................................................................................... 53

Appendix M – Current Initiatives ................................................................................................................. 53

Appendix N – Outcome to Project Mapping ................................................................................................ 53

Glossary ................................................................................................................................................... 54

** Please note the Sections in brackets refer to the Roadmap Guidance Sections

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1 Review and Approval

1.1 Reviewers

This document must be reviewed by the following:

Name Title / Responsibility Date Version

Annette Benny CCG Lead - NEW Devon 9/5/2016 11/5/2016

Draft v0.1 Draft v0.2

Vanessa Dunn CCG Lead - Torbay 9/5/2016 11/5/2016


Paul Hayes CCG Lead and IT Lead - Cornwall/Kernow 9/5/2016 11/5/2016


Matthew Boulter Clinical Lead - Cornwall/Kernow 9/5/2016 11/5/2016


John McCormick Clinical Lead - Torbay 9/5/2016 11/5/2016


Paul Hardy Clinical Lead - NEW Devon 9/5/2016 11/5/2016


Jim Goodwin IT Lead – NEW Devon 9/5/2016 11/5/2016


1.2 Approvals

This document must be approved by the following:

Name Title / Responsibility Date Version

Annette Benny CCG Lead – NEW Devon 25/05/2016 v1.0

Andrew Abbott CCG Lead - Cornwall/Kernow 28/06/2016 v1.0

Vanessa Dunn CCG Lead - South Devon and Torbay 31/05/2016 v1.0

Nick Roberts Chief Clinical Officer - NHS South Devon and Torbay CCG

28/06/2016 v1.0

Jackie Pendleton Interim Managing Director - NHS Kernow CCG 28/06/2016 v1.0

Rebecca Harriott Chief Officer - NEW Devon CCG 28/06/2016 v1.0

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Partners Governance Approval Boards Date of

Approval Version

South Western Ambulance Service NHS Foundation Trust (SWAST) 15/06/2016 1.0

South Devon and Torbay CCG Governing Body 31/05/2016 1.0

Torbay & South Devon NHS Foundation Trust Executive Directors Board 10/06/2016 1.0

Torbay Council Approval – held at Children’s and Adults Directors Meeting 01/06/2016 1.0

Devon Partnership NHS Trust Senior Management Board 16/06/2016 1.0

Devon County Council Delivery Board Meeting 24/06/2016 1.0

Devon Doctors Board Meeting 16/06/2016 1.0

Virgin Care - Children’s Services Approvals Board 10/06/2016 1.0

Ramsay Health Care (Mount Stuart, Duchy and Bodmin Hospitals) Approvals Board

15/06/2016 1.0

Rowcroft Hospice Approvals Board 08/06/2016 1.0

Plymouth City Council IHWB Programme Board 15/06 2016 1.0

Royal Devon & Exeter NHS Foundation Trust Approvals - Trust Executive Group

14/06/2016 1.0

Plymouth Hospitals NHS Trust Digital Care Record Portfolio Meeting 22/02/2016 1.0

Livewell Southwest (CIC) ET Board 02/06/2016 1.0

Northern Devon Healthcare NHS Trust- Exec Committee 01/06/2016 1.0

Northern Devon Healthcare NHS Trust- Trust Board Meeting 07/06/2016 1.0

Devon Doctors Board Meeting 16/6/2016 1.0

Devon County Council People’s Leadership Team 07/06/2016 1.0

Health & Wellbeing Board - Devon 09/06/2016 1.0

Health & Wellbeing Board - Plymouth 30/06/2016 1.0

Cornwall STP Transformation Board 29/06/2016 1.0

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Our approval process and associated dates is summarised below:

29 April 2016 – New Roadmap Guidelines Published (Final Version) 9 May 2016 – 1st Draft Roadmap Published to CIOs for engagement with their Organisations 11-17 May 2016 – CIOs to Review for accuracy, omissions, and completeness for funding requirements 17 May 2016 – 1st Draft Feedback must be submitted 24 May 2016 – Final Draft Published and Start Governance Process for CIOs 15 June 2016 – Sign Off by All Partner Organisations Required 21 June 2016 – Cornwall STP Transformation Board Sign off 30 June 2016 – Roadmap Submission to NHS England

1.3 Document Status

This is a controlled document.

Whilst this document may be printed, the electronic version maintained in SharePoint is the controlled copy. Any printed copies of the document are not controlled.

1.4 Relevant Documentation

These documents provide additional information.

Title Version

Digital Maturity Assessments N/A

Sustainability & Transformation Plans Devon v3.0

Sustainability & Transformation Plans - Cornwall/Kernow April Submission

South West Region - Integration of IT Systems Strategy v2

NHS England Roadmap Guidelines (FINAL) 1.0

Cornwall CCG Information Technology Strategy and Implementation Plan v1.7

SD&T CCG Information Technology Strategy v1.0

NEW Devon IMT Strategic Vision Statement Draft v10

https://www.england.nhs.uk/digitaltechnology/info-revolution/digital-roadmaps

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‘One Person, One Digital Record’

2 Executive Summary Data and digital technology has the power to support people to live healthier lives and be less reliant on care services, as well as ensuring the provision of health and care is both high quality and sustainable.

In September 2015 a Government initiative was launched requiring local health and care systems to produce Digital Roadmaps setting out the ambition of being paper-free at the point of care by 2020.

This document is the response to that initiative and has been developed through the collaboration of the three clinical commissioning groups, local authorities and providers covering the Devon and Cornwall Peninsula. The collaboration on the journey towards developing this Roadmap marks a sea of change in our organisational attitudes towards the delivery of Information Technology (IT) in health and care and as such this document sets out the shared vision, goals and plan required to deliver integrated Health and Social Care IT solutions across the Peninsula. These solutions will be driven by the appetite for transformation in our services as we deepen the level of integration to provide a more seamless and person centred experience for people using health and care services. The resulting IT solutions will in turn facilitate and accelerate the cultural changes which will be necessary in delivering these reforms.

This roadmap builds upon the progress of our local work and identifies how the three CCGs (South Devon and Torbay, Kernow and NEW Devon) in the Peninsula will work together to make best effect of skills and resources for the population we serve.

Every local health and care system will be expected to make early progress on 10 Universal Priorities between now and March 2017.

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In order to achieve this ambition locally there are four key areas of focus namely:

Build the foundations: Health and care organisations need to reach digital maturity

Leverage the capability: Connect all the digitally mature organisations

Leverage existing capabilities: Identify what can be achieved ahead of the 2020

Exploit the opportunities: Enable citizen access

These are illustrated and mapped in the diagram below:

This roadmap outlines how digital technology will support the delivery of the Sustainability and Transformation Plans for Devon and Cornwall, addressing solutions to close the care and quality gap, finance and efficiency gap and the health and wellbeing gap. Whilst further work is required to clarify the costs of delivering the digital vision during the summer 2016, it is clear that the overall capital programme, across 22 organisations, and across five years will be at least £150m, with ongoing revenue consequences of £15m. At this stage not all providers provided information so the costs are likely to increase. This excludes specific Peninsula wide projects, which would cost between £12m and £22m depending on clarification of a number of issues. Furthermore, response from most organisations for the initial costing

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for the implementation of digital related patient safety initiatives has revealed at least a further £5.9m cost. There is a clear piece of work required to ensure that there is a consistent data collection and to identify where funding is already sourced.

And in addition we take into account a number of the 10 Sustainability and Transformation Plan big questions which include:

Q2 How are you engaging patients, communities and NHS staff?

Q3 How will you support, invest in and improve general practice?

Q4 How will you implement new care models that address local challenges?

Q8 How will you deploy technology to accelerate change?

This roadmap should be considered as a living document; it is both aspirational and ambitious and is expected to evolve over the coming months and years.

By supporting this document organisations are signing up to the following commitments:

Our vision for ‘One Person, One Digital Record’

That all organisations within the Peninsula work to common standards for data structures,

technology and information sharing

That we commence a period of scoping to produce project mandates for the programme of work

identified

That an updated and more detailed roadmap is produced in September 2016.

Optimise and make best use of any funding sources to ensure that we maximise income within this

programme of work

Work collaboratively and apply our “Do it Once” methodology across the Peninsula

Make the best use of national systems

Make best use of our combined procurement power to ensure financial sustainability

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3 Scope

The scope of this Roadmap includes our population of 1.7 million patients, supported by 3 CCGs (Kernow, South Devon & Torbay and Northern, Eastern & Western Devon), 9 NHS Trusts, 4 Local Authorities, 245 GP Practices, and private providers.

The scope of this Roadmap encompasses how we will enable: (i) Paper-free at the Point of Care (ii) Digitally enabled self-care (iii) Real-time data analytics at the point of care (iv) Whole systems intelligence to support population health and social care management and effective

commissioning, clinical surveillance and research (v) Sustainability and Transformation Plans across Cornwall and Devon (vi) 5 Year Forward View objectives We recognise that there are a number of NHS funded care providers who (due to their small size and localised nature) have not been actively involved to date i.e. RISE (Drug and Alcohol Services) and CHIME (Audiology). We recognise their importance and will engage with these colleagues at a future point in the programme.

The Peninsula

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4 General

4.1 Identify who has endorsed the roadmap (Section 6.2)

There are a total of 22 Partners within the combined footprint declared by the three CCGs all of which have input and supported the Roadmap, they are detailed as follows:

Kernow /Cornwall CCG

Cornwall Council Cornwall Health Out of Hours Cornwall Partnership Foundation Trust Council of the Isles of Scilly Kernow Health CIC (GP Consortium) Kernow Primary Care

Northern Devon Healthcare NHS Trust Plymouth Hospitals NHS Trust Ramsay Health Care approvals board (Duchy and Bodmin hospitals) Royal Cornwall Hospitals NHS Trust South Western Ambulance Service NHS Foundation Trust

NEW Devon CCG

Devon County Council Devon Doctors Devon Partnership NHS Trust Livewell Southwest (CIC) Northern Devon Healthcare NHS Trust

Plymouth City Council Plymouth Hospitals NHS Trust Royal Devon and Exeter NHS Foundation Trust South Western Ambulance Service NHS Foundation Trust Virgin Care – Devon Children’s Services

South Devon & Torbay CCG

Devon County Council Devon Doctors Devon Partnership NHS Trust Haytor Health GP Consortium (for 34 practices) Ramsay Health Care UK (Mount Stuart Hospital)

Rowcroft Hospice Torbay Council Torbay and South Devon NHS Foundation Trust South Western Ambulance Service NHS Foundation Trust Virgin Care – Devon Children’s Services

4.2 Identify which organisations have made significant contributions in the development process (Section 6.2)

The majority of the organisations (detailed in Section 4.1) have made significant contributions to the development process and are acknowledged for their support and contribution. We also acknowledge the South West Academic Health Science Network (SWAHSN) for their contribution and support. Our early work included organisations within the Somerset CCG Footprint. As work progressed Somerset made the decision on the 15th March 2016 to work separately, but are still engaged at CCG level to ensure we share progress as required.

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4.3 Summarise the process through which the roadmap has been developed (Section 6.3)

Since the inception of Clinical Commissioning Groups in 2013, each CCG has either had a clear or evolving Information and Communications Strategy (“Living Well” - Kernow, “Joined Up” - South Devon and Torbay “IM&T Strategic Vision” - NEW Devon). During 2014/2015, the South West Academic Health Science Network (SW AHSN) surveyed the Health and Social Care Organisations across the South West in terms of digital capability and opportunities to work together were identified. In order to move forward from this position and create an environment where organisations could work together and co-ordinate their efforts in achieving a joined up approach, a number of Senior Executives across the Cornwall and Devon (and Somerset initially) agreed that an IM&T Strategy group should be established, to build upon the work already underway at individual CCG levels This IM&T Strategy Group has been meeting on a regular basis since June 2015 – membership of this group is made up of many of the organisations listed in Section 4.1. The IM&T Strategy Group along with all of its members has focused efforts on the development and creation of a joined up and co-ordinated Digital Roadmap Plan for our population. A small sub group of this meeting / project team has been established, to work with all partner organisations. The initial remit was to produce a single roadmap plan for the area that incorporates all organisations’ individual IT strategies and plans, show where collaborative working could be achieved (such as joint procurements), and help organisations prioritise and cost out the how much investment would be required. A significant amount of discussion and collaboration took place during 2015, this included a level of partnership working and all organisations agreeing that a single approach to an Integrated Digital Care Record should be the recommended way forward as part of approving the Digital Roadmap. All partners co-funded a technical piece of work to identify the shared standards for adoption across the Peninsula. In order to pull a project of this complexity and size together, and produce a meaningful digital roadmap plan that all organisations could sign up to, (as well as meeting all the NHS England requirements) the project team set out the following programme of work commencing in January 2016. January 2016 o Clinical and Professional Stakeholder Event, which provided feedback on the vision and outcomes

that would add value to clinical practice.

o Presentation to the NEW Devon CCG Executive Committee

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February 2016 o Initial 1-2-1 meetings with each CCG Leads were arranged by the Roadmap Programme Lead to

discuss data gathering and each CCG’s requirements. o A consultancy firm (J2) were appointed to produce a technical architecture document, with the aim

of setting out a technical piece of work to identify the shared standards for adoption across the Peninsula. A workshop attended by IT technical leads was organised to start this work

o The IM&T Strategy Group met monthly to discuss the roadmap guidance context and approach, fielding questions and clarifying current status within the landscape

o Work was started to ascertain the baseline position of all organisations (gap analysis) with the aim of giving us a clear and accurate picture of the current state, above and beyond the information contained within the Digital Maturity Assessment.

March 2016 A number of meetings and workshops were held to: o Gain greater understanding of the CCG environment o Provide feedback to the IM&T Strategy Group on the Roadmap and discuss what’s next, information

requirements and timescales o Presentation given at the South Devon & Torbay Joined Up IT Group to provide an update on the

Roadmap and discuss what’s next, information requirements and timescales o Presentation to private meeting of the NEW Devon CCG Governing Body April 2016 o Attendance at the NHS England South Regional Digital Strategy - "Working Together" Event –

presented South West approach o LMC Liaison Meeting for Cornwall and NEW Devon CCGs to update on the Roadmap and discuss

next steps and timescales o First 2020 Digital Roadmap Priorities Workshop with key service providers to discuss priority

outcomes in addition to the Universal Priorities (62 outcomes identified) o The IM&T Strategy Group to provide an update on the Roadmap and discuss what’s next,

information requirements and timescales o Second 2020 Digital Roadmap Priorities Workshop with key service providers to plan the projects

required to meet the 62 outcomes and 10 Universal Priorities and agree what is done at Local level and what will be done across all 3 CCGs (majority of new projects will be at 3 CCG level)

o Planning Day with Kernow CCG to ensure their requirements/key differences detailed o Planning Day with South Devon & Torbay CCG to ensure their requirements/key differences

detailed o Planning Day with New Devon CCG to ensure their requirements/key differences detailed o Three CCG planning meetings to agree approach and timelines for new projects o Presentation to Private Meeting of the NEW Devon CCG Governing Body

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May 2016 o Three CCG Costing workshops to agree cost estimates and funding requirements o 5th May all Partners Roadmap Workshop to discuss and gain consensus of the newly defined

Projects and approach of a shared procurement. o 12 May IM&T Strategy Group to identify Current Initiatives and Achievements o Engagement and sign off process for all stakeholders o Presentation of Roadmap to the Executive Committee of the CCGs o Presentation of Roadmap to the Governing Body of the CCGs The sign off process for the final version is detailed in Section 1.2 and details of each meetings attendee can be found in Appendix J Work is also progressing on a single Information Sharing Agreement across all CCGs Footprints, with all stakeholders in favour of adopting a single Information Sharing Charter.

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5 Vision

5.1 Vision for digitally enabled transformation (Section 6.4 – 6.7)

5.1.1 Background Kernow, South Devon and Torbay and NEW Devon Clinical Commissioning Groups and the stakeholders within these footprints, serve a total population 1.7 million. Our populations and their needs are similar and we have similar aspirations for our future model of delivery. The local Joint Strategic Needs Assessments (JSNA) identifies current and future health and wellbeing challenges across Cornwall and Devon include: • An ageing and growing population

• Rurality and access to services

• Complex patterns of deprivation linked to earlier onset of health and social care problems in more

deprived areas (10-15 year gap)

• Housing issues (low incomes / high costs)

• Giving every child the best start in life and ensuring children are ready for school

• Poor mental health and wellbeing, social isolation and loneliness for both adults and children

• Poor health outcomes caused by modifiable behaviours

• Pressures on services (especially unplanned care) caused by increasing long-term conditions, multi-

morbidity and frailty

• Unpaid care and associated health and social care outcomes

• Shifting to a prevention focus

Our population is already older than in many parts of the country and this will continue to increase (for example, currently in Cornwall 60-70% of patients over 70 years old have co-morbidity and the complexity and cost of hospital care increases with co-morbidities). The challenge is to redesign care and meet the needs of these people, improving their outcomes and reducing the risk of them being admitted to hospital. Deprivation is a significant issue with complex patterns of deprivation linked to earlier onset of health and social care problems in more deprived areas (10-15 year gap in life expectancy). We have a fragmented system with multiple access points, which everyone finds difficult to navigate. Different organisations have different boundaries (e.g. CCGs, Local Authorities, Hospital footprints) that overlap in complex ways. We can make more effective use of the capacity we have and stop people waiting too long to get care and support, and spending longer than medically needed in bed based care settings. Enabling partners to identify the risks to children and share these with other professions when making safeguarding decisions is also an important factor in our work. A key focus of the two Sustainability and Transformation Plans (2016 – 2021) covering Devon and Cornwall is the need to radically change services delivery to improve population health, the experience of care and the cost per head of the population. The implementation and take up of technology will enable and accelerate this process as long as it is intrinsically aligned to transforming the whole system.

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Local people have told us how they would like to experience care, they have described how they wish to take greater responsibility for staying well and independent and are able to plan their own care with people who understand them. With access to information, they want the help and support to make decisions about their own care. They want to tell their own story once, know who is coordinating their care and receive joined up, seamless care across organisational and team boundaries. Across the whole Peninsula there are IT Information and Communications Strategies, which set out the local ambition in terms of achieving (NHS England Five Year Forward View (2014) and Personalised Health and Care: a framework for action (National Information Board, 2014): (i) Paper-free at the Point of Care

(ii) Digitally enabled self-care

(iii) Real-time data analytics at the point of care

(iv) Whole systems intelligence to support population health management and effective commissioning, clinical surveillance and research

During the process of developing the digital roadmap over the last eight months, the work plans and priorities have been amalgamated into one programme of work to effectively enable the delivery of the above transformation in relation to the health and wellbeing challenges across Cornwall and Devon. A key aim is to work together wherever it makes sense to do so and we have a unique opportunity to work together in order to deliver a single, sustainable and affordable solution delivering and sharing digital clinical information at the point of care (at the bedside, in the clinic, in the patient's home and including virtual consultations), revolutionising the way patients are cared for and treated across the South West Peninsula.

5.2 Our Vision

One Person, One Digital Record

We will (with the correct information governance and information and data sharing agreements in place) safely and securely bring together the information we already hold in many different organisations to enable health and social care professionals to provide better and safer care for our population. It will be a key enabler to our commissioning priorities and the health and care needs of our population and is in line with the requirements of the NHS England 5 year Forward View and Personalised Health and Care 2020, where all Patient and Care records are required to be digital, interoperable and real time by 2020. To do this we will need to:

• Build the foundations: Health and care organisations need to reach digital maturity - ensure plans

are in place for all the health and social care organisations across the patch to reach digital maturity at the earliest possible point in time, i.e. they are able to capture information digitally at the point of care and are interoperable (compliant with international standards which enable sharing of information).

• Leverage the capability: Connect all the digitally mature organisations– procure and deploy the infrastructure which enables information exchange between organisations to assimilate and create a consolidated view of the records held for a person.

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• Leverage existing capabilities: Identify what can be achieved ahead of the 2020 deadline – establish a programme of works that ensures that the information that can be shared and will deliver value, is routinely exchanged by organisations in the quickest possible timeframe. These include the nationally mandated “universal priorities” by 2018 and a range of other locally identified projects.

• Exploit the opportunities: Enable citizen access – create a single view of the records held for a person and provide citizens and patients with the ability to access and upload information to their integrated digital record.

5.3 Our Principles

The establishment of the Integrated Digital Care Record (IDCR) will enable the vision of ‘One Person, One Digital Record’. The scope of the work includes paper-free at the point of care, digitally enabled self-care, real-time data analytics at the point of care, whole systems intelligence to support population health management and commissioning informed by local priorities. The way that we work will reflect the following principles to ensure a sustainable health and care system for the future:

o Optimise and make best use of any funding sources to ensure that we maximise income within this

programme of work

o That all organisations within the Peninsula work to common standards for data structures,

technology and information sharing

o Work collaboratively and apply our “Do it Once” methodology across the Peninsula

o Make the best use of national systems

o Make best use of our combined procurement power to ensure financial sustainability

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6 Baseline Position

6.1 Overview of digital maturity of key primary, secondary and social care providers (Section 6.8)

We have undertaken a detailed survey of all partner organisations listed in Section 4.1 in order establish a baseline position of digital maturity across the CCG catchment areas. The results of this survey provide us with intelligence of the current position of each organisation with regards to their IT strategies and delivery plans. This survey also provides us with details of delivery timeframes, costs and prioritisation each organisation is working to. The Digital Maturity Assessments for our Local Authority Areas and Primary Care are currently being collated at a national level. Once published these will be used to further inform our Digital Roadmap, including the timescales and cost impact. By using this intelligence, it is possible to analyse the data to show areas where a number of different organisations are looking to find technology solutions to similar challenges. By working together, we will be able to procure software solutions that will meet the requirements of a number of different organisations, this could potentially see either the procurement of single systems across multiple organisations or further adoption of an existing system across other areas, where this is appropriate. This will save resources in the form of time money and effort, and also allow a co-ordinated approach to applying for National Funding when it becomes available. Our approach will be to work collaboratively across all organisations to ensure that we can meet the requirements of the 2020 vision. Figure 1 illustrates the current position for each of our Secondary Care Providers in relation to the National Average which shows that although good progress has been made within individual organisation for different Capabilities, we still are below the National Average for Medicines Managements and Optimisation and Decision Support in many areas together with low ranking in the league table for the Digital Maturity Assessment for many of our Secondary Care Providers, as detailed below:

League Table Rank Trust Average score

42 Plymouth Hospitals NHS Trust 72.3

61 Cornwall Partnership NHS Foundation Trust 68.0

70 Torbay and Southern Devon Health and Care NHS Trust 66.7

71 South Western Ambulance Service NHS Trust 66.3

100 Royal Devon and Exeter NHS Foundation Trust 63.0

141 Northern Devon Healthcare NHS Trust 58.3

154 Royal Cornwall Hospitals NHS Trust 56.0

239 Devon Partnership NHS Trust 26.0

We have also run an analysis on the current projections within each Secondary Care organisation to becoming be ‘Paper Free at the Point of Care’ by 2020, from this we now understand that will not reach the required targets without substantial funding. As part of the Roadmap we have looked at the requirements for each Capability and the outcomes we have decided are a priority. A number of projects

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have been identified to fill these gaps and these are detailed in Section 9.2. Evidence of the current projection for ‘Paper Free at the Point of Care’ is detailed in Figure 2. Providers have identified the levels of funding they would need to move their current systems to become paper free and interoperable. They have identified £150m over 5 years (2021) required to achieve this and currently advise that this is additional funding over and above their capital programmes. It may be possible to bring some of this work forward with additional funding to achieve the requirements by 2020 HOWEVER it is important that further diligence takes place over the summer to clearly identify: • What is deliverable within their capital programme and by when (i.e. with no additional funding) • What additional funding would deliver the paper free at the point of delivery by 2020 • What additional funding would achieve a pragmatic outcome somewhere between 2020 and any

projections set out in their capital programmes.

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Figure 1 - Secondary Care Current Capabilities in Relation to National Average

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Records, Assessments & Plans

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Medicines Management & Optimisation

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Figure 2- Secondary Care Provider Capability Projection for 2020

* Please note that after further review the baseline results for Torbay and Southern Devon Health and Care NHS Trust have been rebased for Medicines Management and Optimisation and Asset and Resource Optimisation. The full details of the gap analysis results can be found in Appendix A

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Royal Devon andExeter NHS

Foundation Trust

DevonPartnership NHS

Trust

Torbay andSouthern DevonHealth and Care

NHS Trust

Records, Assessments & Plans

Transfers of Care

Orders & Results Management

Medicines Mgt & Optimisation

Decision Support

Remote Care

Asset & Resource Optimisation

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6.2 Summary of key recent achievements (Section 6.8)

At the IM&T Strategy Group held on 12 May 2016, we identified the achievements we are proud of

having achieved to date, these are captured in Appendix L. There is consistent progress across all

organisations in relation to our approach to information sharing and agile working (which give our staff

flexibility and the tools to support effective practice).

6.3 Summary of key current initiatives (Section 6.8)

We have identified the existing initiatives our stakeholders are currently working on and these are detailed in Appendix M, this together with our gap analysis has identified 12 projects that we will scope and run at Peninsula level, many of which will leverage the existing capability and provide sharing of information ahead of 2020. We will also continue to consider and test the full list of initiatives against our principles which are detailed in Figure 4.

The 12 Projects are as follows:

Project Number

Project Title

1 Information Sharing Agreement across the 3 CCG areas

2 Availability of GP Record in all care settings

3 Extension of electronic Appointments and Referrals

4 Child Protection Information System

5 Secure eMail including care homes

6 Self-Care (including Patient Held Record and Prevention)

7 Virtual Consultations

8 Decision Support for clinicians

9 Secure Hotspots for Health and Care Workers

10 Support End of Life Wishes and Shared Care Plans

11 Bed Management across the “whole system” including care homes

12 Integrated Digital Health and Care Record in all care settings across the 3 CCG areas

Full details of each of these projects can be found in Appendix D

7. Identification of rate limiting factors (Section 6.9) As with all large scale IM&T implementations, we recognise that there will be challenges to delivering this programme of work. Our surveys and analysis provide us with detailed intelligence of each organisations plans and timeframes to deliver the 2020 vision. Our challenge will be to pull all these work streams and organisations together and form a comprehensive and joined up delivery plan. This plan will clearly identify what is to be delivered and how it is managed and at what level i.e. at a Peninsula level, CCG level or by individual organisations the governance of the work will then reflect this. We have listed below areas that we know we will need to address and resolve in order to successfully manage and co-ordinate a programme of work of this size.

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As we move from the detailed planning stage to deployment, a central project team will be established to manage all aspects of the delivery of the strategy, and address and resolve the Rate Limiting Factors described below:

The complex landscape with varying digital maturity

Aligning the governance and decision making across partners (Minimum of 22 partners)

Limitations on accessing Funding/Finance to deliver these projects

Internal pressures on each organisation to implement their internal electronic patient record in

parallel to contributing the Peninsula wide workstreams

Staff resourcing for the key stages of all workstreams including design, build, implementation and

exploit

This is not an exhaustive list, and we anticipate undertaking further detailed planning work as we move into the deployment stages of the programme.

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8. Readiness

8.1 Set out leadership, clinical engagement and governance arrangements (Section 6.10)

Strong managerial and clinical leadership is key to the successful delivery of this programme of work. With strong leadership and the sign up and commitment of all organisations, we will build on work and plans already in place and underway at many of our partner organisations, to ensure that we can successfully deliver our vision of ‘One person, One Digital Record’. Each CCG has a CCIO and a number of organisations have the same or similar positions with clinical leaders for IT. They are fully engaged in this process and have an active leading role. This digital programme is an essential enabler to both Kernow and Devon’s STPs and success regime where applicable; therefore it must be an integral part of the governance arrangements required for the delivery of the STPs overall.

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Figure 3 – Governance Arrangements

Cornwall STP Devon STP

*Further work is required to define the local programme structure and to align with the STP arrangements which start at the Peninsula Digital Health and Care Steering Group **This is based on the assumption that the existing STP PMO will be used. The arrangements above in Figure 3 are aligned with both the Cornwall and Devon Sustainability and Transformation Plan governance arrangements and these are detailed below:

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8.2 Cornwall

NHS England requires that each planning footprint area produces a Sustainability and Transformation Plan (STP) in order to access the Sustainability and Transformation Fund. The STP will provide a local strategic plan that will deliver an improved, more sustainable health and care system and the Local Digital Roadmap (LDR) will be one of its key enablers. NHS Kernow CCG, CFT, RCHT, Cornwall Council, the Council of the Isles of Scilly and Kernow Health CIC will be principle signatories in acknowledgement of the key roles these organisations play within the wider system. The strategic leadership for the STP will be provided by the Joint Strategic Executive Committee (JSEC), jointly chaired by the Chair of the CCG and the Portfolio Holder for Adult Care. The JSEC reports into the Cornwall Health and Well-Being Board (CH&WBB) and is attended by Chief Officers of all the key health provider organisations in Cornwall and the Isles of Scilly, the two Council portfolio holders for adults and children’ services, and the Chair of the CH&WBB. The Board of Directors / Governing Body of each of the Health institutions have provided delegated authority to their Chief Executive attendee at JSEC to approve the STP and the LDR on behalf of their organisation. It is also proposed that the STP and the LDR are presented to Cornwall Council’s Informal Portfolio Holder Briefing, rather than to Cabinet for formal approval. Each project board member will take responsibility for presenting the STP and LDR to their own institution’s Executive Management Team / Corporate Directors Team, as and when they deem appropriate. Leadership and oversight for the STP is provided by a project board made up of the Executive Planning Leads from each of the institutional partners, chaired by the Chief Executive of Cornwall Foundation Trust. Programme Direction for the STP and underpinning LDR is from the NHS Kernow CCG Director of Strategy, supported by a project team with representatives from each of the institutions. The programme governance described here does not yet reflect changes in corporate governance, which remains with the individual institutions. There has been a high turnover of System Leaders within the footprint over recent time and we are currently out to advert for additional leadership capacity to act as substantive Senior Responsible Owner for the work.

8.3 Devon The two communities already have robust and inclusive governance arrangements in place to support development and delivery of the success regime (NEW Devon) and the ICO transformation plan and

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urgent care Vanguard (South Devon & Torbay). However, the two CCG areas are coming together under an integrated set of governance arrangements for the delivery of the Sustainability and Transformation Plan. The success regime is already working in a system inclusive way to develop transformation plans for NEW Devon, as are the ICO transformation plans in South Devon & Torbay as the ICO is by far the largest provider in SD&T and plans have been jointly developed. Angela Pedder has been appointed as the Sustainability and Transformation Plan Nominated Lead. Laura Nicholas is the Sustainability and Transformation Plan Programme Director and Interim Joint Director of Strategy across the two CCGs. A number of support posts are currently being recruited. An external provider - Carnall Farrar are providing Diagnostic and Planning Development Support also as part of the success regime and in South Devon and Torbay. The communities of NEW Devon and South Devon & Torbay already undertake a wide range of planning and commissioning together. We will continue to build on these areas and we plan to engage with stakeholders in developing new joint strategic content as part of the Sustainability and Transformation Plan under which our transformation plans will sit. This will consist of joint narrative covering public health needs assessment, system vision, strategic objectives and a high level prioritised delivery plan to include extended joint planning arrangements for, for example, workforce, IT, estates, engagement, and acute and specialised service configuration . This will develop further during 2016/17 as a more detailed integrated model of care becomes defined and key transformational deliverables clarified.

8.4 Identification of change management approach(es) / model(s) to be followed (Section 6.11)

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There is much evidence on how major change projects succeed or fail. The NHS Change Model is a composite of international evidence on enabling successful change. In order for us to assess the strengths and development opportunities within the Digital Roadmap Programme, Chief Information Officers stakeholders were asked to complete a questionnaire relating to the domains of the NHS Change Model on 12th May 2016. The collated information is found at Appendix C and the key themes are described below The majority of respondents agreed that we have a clear vision with a shared understanding, however we need to ensure some stakeholders come to the table and also that we increase the level of clinical engagement. Whilst there was a sense that many stakeholders were engaged respondents felt that this could be enhanced with some bigger engagement events and further continued joint working with other colleagues such as the finance teams. There was a clear sense that we have leaders that bring together all parts of the health and care system and collaborate, however clinical engagement continued to be acknowledged as a gap, as well as the need to extend the work to smaller providers (such as care homes) as the programme progresses. One of the proposals we will explore as we move into the next phase is how we use technology to enable clinicians to participate effectively and efficiently in spite of our geographical spread. Given that both STP processes will include patient and public engagement, we will use the outcomes of this work to provide the context for the people we serve. However, we recognise the importance of patient and public engagement in the Digital Roadmap programme and will ensure this is a key component of the design as projects are scoped during summer 2016. The level of transparency in the process has enabled some sharing and learning, however it was acknowledged that this was an area where we could further develop and accelerate good practice. The majority of respondents identified that we were unclear about the “Change Methodology” for each programme/project and it was noted that this is an area for future development during the summer as the work is scoped. Respondents considered that our approach to delivery (through programme and project management techniques) could be enhanced by ensuring that we have a detailed methodology, to which everyone signs up, and that there is proper funding of programme/project resources. A gap in our current approach is the clarity about how we will measure the success of our programmes/projects. There was an optimism that this would become clearer as we move to the next stages and this is an important element of the work planned throughout the summer. Respondents felt there was a clear gap in terms of aligning other system drivers, such as contracting, to enable this work. Whilst there are elements in the national contract and a service delivery and improvement plan has been agreed with major providers, there could be a more coordinated approach to maximise system drivers, including accessing national funding. Finally there was overwhelming feedback from respondents that there is a good balance between the things that motivate them in the programmes/projects and the level of performance management/accountability. A continued focus on ensuring this balance will help motivate us all as we progress this major work.

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8.5 Identification of approach to benefits management and measurement (Section 6.12)

Potential benefits will be identified for each project and held at a steering group level to prevent double counting and to monitor against the defined metrics and project delivery objectives. We will clarify and agree a consistent approach to benefits realisation across the peninsula as part of our work throughout the summer 2016. It is our intention to measure our current state in relation to each of our projects for our benefits to be realised. As part of the Benefits Realisation approach we are also incorporating a mapping to the 3 challenges defined in the Sustainability and Transformation Plan: Care and Quality Gap By linking and integrating IT systems across multiple organisations, the care that our health and social care professionals provide will be significantly improved. For the first time information will be available to be shared across all our partner organisations, which will allow front line health and social care professionals to be able to provide the most appropriate care and services based on detailed knowledge of the individual. Finance and Efficiency Gap Patients will be treated with the most appropriate care based on their medical history, this will improve patient flow in the clinical environment, reduce unnecessary diagnostic tests (as they may have already been completed by the GP recently), and improve patient care. In the social care setting for example, the ability to know when a patient is either admitted to hospital or discharged will allow packages of care to be stopped and started at the correct time. By working together in a co-ordinated and joined up way, additional savings could be realised – for example, having one procurement process for implementing one of the many IT systems that will be required as part of this programme of work, and by having a central team with responsibility for the delivery of the programme.

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Health and Well Being Gap Sharing of information is key to driving out efficiencies, and improving patient care. All aspects of this programme of work will play a part in closing the financial gap, the care and quality gap and also the health and wellbeing gap. By working together we improve the Care and Quality Gaps, Finance and Efficiency Gaps and the Health and Well Being Gaps and an illustration of this can be seen in the example below:

Example: Clinicians in urgent and emergency care settings will be able view information held by GPs for patients presenting at A&E departments. Clinicians will be able to make more informed decisions based on clinical history, and save time and effort contacting GP Practices to get copies of medical records and therefore this will enable better care

8.6 Identification of known, anticipated and target sources of investment (Section 6.13) Following an initial enquiry to all providers, it is clear that further work is required to clarify the future costs of delivering the digital vision. The information collated from providers is of differing quality and status. It is unclear if these are funded within provider capital programmes, or additional costs. If additional costs, it is unclear what is the intended source of funds. What is clear is that the overall capital programme, across 22 organisations, and across 5 years will be at least £150m, with ongoing annual revenue consequences of £15m. Please note some providers did not provide this information so the costs are likely to increase. This excludes the specific Peninsula wide projects set out in the roadmap, which would cost between £12m and £22m. This would be dependent on clarification of a number of issues including: • The consent model • The capital cost of implementation • The phasing of implementation • Concurrent or sequential implementation Furthermore, response from most organisations for the initial costing for the implementation of patient safety initiatives has revealed at least a £5.9m cost. These initiatives include: • Cyber Security • Clinical Safety • Data Quality • Data Protection and Privacy • Meeting Accessible Information Standards • Business Continuity and Disaster Recovery • Unwarranted or Unlicensed Software Not all organisations have responded to this, nor has any diligence or challenge been provided on these numbers. There is a clear piece of work required to ensure that there is a consistent data collection that

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is meaningful and this will take some time and will be part of the work programme over the summer 2016.

8.7 Overview of programme / project structure for 16/17 (Section 6.14) The defined and recommended programme structure to deliver the Digital Transformation across the three CCGs is made up of 12 Projects which will be scoped and managed at a Peninsula level supporting the collaborative model we have chosen to adopt together, these 12 projects address the 62 Outcomes and 10 Universal Priorities. Where progress has already been made within a CCG, consideration will be given to extending this project to the other CCGs, if this is deemed the most appropriate approach. In addition to the 12 new Projects, each CCG has a number of projects in progress that will continue as is, with individual providers also delivering their own programme of work which will work toward the ‘Paperless at the Point of Care’ and Interoperable model.

We will also continue to consider and test these projects against our principles and look at them in greater detail during summer 2016.

8.8 Outline of how resources can be utilised more effectively (Section 6.15) To ensure that resources in the form of staffing and finances can be utilised efficiently, a Peninsula wide project team will be established with responsibility for the overarching management, co-ordination and

Child Protection Information SystemSupport End of Life Wishes and Shared

Care Plans

Bed Management across the “whole

system” including care homes

Decision Support for cliniciansInformation Sharing Agreement across

the 3 CCG areas

Integrated Digital Health & Care

Record in all care settings across the 3

CCG areas

Virtual ConsultationsSelf-Care (including Patient Held

Record and Prevention)

Extension of electronic Appointments

and Referrals

Secure Hotspots for Health and Care

Workers

Availability of GP Record in all care

settingsSecure eMail including care homes

CCG Projects Kernow NEW Devon South Devon & Torbay

National 111 National 111 National 111

Patient Online Patient Online Patient Online

Secondary Care EPR Secondary Care EPR Secondary Care EPR

eDischarge eDischarge eDischarge

National eReferals National eReferals National eReferals

National ePrescribing National ePrescribing National ePrescribing

GURU & SCR MIG MIG & SCR

Care Plan & EoL EPR EPR

GPIT Projects GPIT Projects GPIT Projects

Integrated Commissioning Programme

(under the Cornwall Deal)

Integrated Early Help Hub

One Public Estate Programme

delivering Cloud Printing and Faster

Wireless for Health and Council

Individual Partner

Projects

3CCG Wide

12 New Projects

Local Implementation

of a National System

Local Projects

Full Details can be found in Appendix A

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delivery of the Digital Roadmap plan. This team will engage with and work alongside local organisational delivery and project teams in a supportive and co-ordinated way and ensuring that priorities and delivery is aligned with the requirements set out in the STPs. With this approach, organisations will be able to focus on their own local delivery of the plan, whilst the overarching programme team would manage and co-ordinate multiple workstreams where appropriate, for example, procurement of a medicines management system may need to undertaken across more than one organisation. With an overarching approach savings should be made around the procurement process i.e. only one process needed, and additional savings may be realised if expertise around implementation of the systems should be shared amongst organisations. There is a track record of joint working between organisations in the Peninsula and this approach builds on the foundation that exists. We have the motivation from all organisations to “Do it once” and through the sign up to this document an explicit commitment to continue working this way (See Figure 4 below). This will save time, money and resources by not procuring and implementing numerous different systems across multiple organisations.

Figure 4 – Key Principles for our Peninsula Approach

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9 Capability Deployment

9.1 Identification of current maturity for each of the 7 Paper Free at the Point of Care (PF@PoC capabilities) (Section 6.16)

The surveys and analysis we have undertaken (as mentioned in Section 6.1) allow us to identify the current maturity positions for each of the 7 capabilities across our Secondary Care partner organisations. These organisations have completed detailed analysis for each of the capabilities, showing which of their IT programmes of work meet each requirement. The analysis also shows the current status of each project (In progress / deployed etc.) as well as which supplier is delivering the solution. The analysis is further enhanced as a planned timeline to deploy information is also included. All our Secondary Care organisations are below the national average for a number of capabilities as defined by the Digital Maturity Index and this is illustrated in the ‘Secondary Care Current Capabilities in Relation to National Average’ Graph in Section 6.1. The Social Care and Primary Care Digital Maturity Assessments were not available at the time of publishing this roadmap, but will form a fundamental part of our digital transformation planning moving forward. A detailed breakdown of all the outcomes and the progress against the Universal Priorities can be found in Appendix B. In addition to this the specific projects these have been allocated to can be found in Appendix N.

9.2 Capability deployment schedule (Sections 6.17- 6.18) Following the Gap Analysis exercise and the identification of the required outcomes by 2020, we were then able to pull together a number of layers of planning. 1. Build the foundations: Health and care organisations need to reach digital maturity - ensure plans

are in place for all the health and social care organisations across the patch to reach digital maturity

at the earliest possible point in time, i.e. they are able to capture information digitally at the point

of care and are interoperable (compliant with international standards which enable sharing of

information).

2. Leverage the capability: Connect all the digitally mature organisations – procure and deploy the

infrastructure which enables information exchange between organisations to assimilate and create

a consolidated view of the records held for a person.

3. Leverage existing capabilities: Identify what can be achieved ahead of the 2020 deadline –

establish a programme of works that ensures that the information that can be shared and will

deliver value, is routinely exchanged by organisations in the quickest possible timeframe. These

include the nationally mandated “universal priorities” by 2018 and a range of other locally identified

projects.

4. Exploit the opportunities: Enable citizen access – create a single view of the records held for a person and provide citizens and patients with the ability to access and upload information to their integrated digital record.

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Build the foundations: Health and care organisations need to reach digital maturity Digital innovation delivers considerable benefits in terms of driving efficiencies in day to day working and continued progress in key patient’s safety areas (National Information Board 2015). Before we can connect all organisations and enable information exchange between them we have to ensure that each organisation has the capability/digital maturity to enable the sharing to take place. Each health and care provider has their own digital roadmap which identifies how they might achieve this digital maturity. Further work is required during summer 2016 to understand the detailed plans, the costs of these plans and whether funding has been allocated. The graphs in Figure 1 and Figure 2 in Section 6.1 show the current and projected capabilities to 2020. Leverage the capability: Connect all the digitally mature organisations We have identified the need for an Integrated Digital Health and Care Record (IDCR) that covers all elements of a person’s health and care record. This project is one of 12 that we will scope, procure and deliver at a Peninsula level.

The Scope will include: o Clinical Portal

o Patient Portal

o Analytics Functionality (further consideration will be given to the inclusion of analytics in the scope

of this project during the Summer 2016 planning exercise)

Leverage existing capabilities: Identify what can be achieved ahead of the 2020 deadline There are ten Universal Priorities in areas where we are required by NHS England to make significant progress by 2018. These are listed below: 1. Professionals across care settings can access GP-held information on GP-prescribed medications,

patient allergies and adverse reactions

2. Clinicians in urgent and emergency care settings can access key GP-held information for those

patients previously identified by GPs as most likely to present (in U&EC)

3. Patients can access their GP record

4. GPs can refer electronically to secondary care

5. GPs receive timely electronic discharge summaries from secondary care

6. Social care receive timely electronic Assessment, Discharge and Withdrawal Notices from acute care

7. Clinicians in unscheduled care settings can access child protection information with social care

professionals notified accordingly

8. Professionals across care settings made aware of end-of-life preference information

9. GPs and community pharmacists can utilise electronic prescriptions

10. Patients can book appointments and order repeat prescriptions from their GP practice

These expectations together with opportunities identified from analysing the gap analysis have resulted 12 projects being identified for scoping and delivery at a Peninsula level. There are also a number of other projects relevant only to a specific area (CCG or provider).

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These projects will be scoped in detail, costed and prioritised during the summer 2016 with the road map updated in September 2016. All progress will be monitored through a single Programme Management Office, currently being set up to support the STP processes and the Peninsula Digital Health and Care Steering Group will provide recommendations and assurance on delivery to the Joint Strategic Executive Committee and the Programme Delivery Executive Group (for Cornwall and Devon respectively). Details of each of the 12 new projects are as follows:

Project 1: Information Sharing Agreement across the 3 CCG areas Narrative: A Peninsula Information Sharing Charter will be established and would aim to provide Devon and Cornwall health and care organisations with a robust foundation for the lawful, secure and confidential sharing of personal information between themselves and other public, private or voluntary sector organisations that they work, or wish to work in partnership with.

Project 2: Availability of GP Record in all care settings Capability: Records, Assessments and Plans Universal Priority: Professionals across care settings can access GP-held information on GP-prescribed medications, patient allergies and adverse reactions Narrative: Health and Social Care professionals across all organisations will be able to access GP patient records at the point of care. This will allow Health and Social Care professionals to make informed decisions on the most appropriate care for their patients - GP practices will no longer have to be contacted to fax / send information to where the patient is being treated, therefore saving time and resources.

Project 3: Extension of electronic Appointments and Referrals

GP Referral to Secondary Care

Online booking for GP by Patients

Online booking and changes to Secondary Care appointments by Patients

Capability: Records, Assessments and Plans Narrative: Online booking and changes to secondary-care appointments by Patients. This is a national requirement and is the first phase of a much wider scope of work that could include appointments for example: mental health, learning disability and health visitor services.

Project 4: Child Protection Information System Capability: Decision Support Universal Priority: Clinicians in unscheduled care settings can access child protection information with social care professionals notified accordingly Narrative: Functionality will exist that will allow clinicians to be made aware of child protection issues or concerns when a patient presents at an out of hours or emergency care setting (possibly a child protection flag within their clinical system). This will then allow clinicians and other health and social care professionals to co-ordinate the care, or flag up to other clinicians any concerns they may have.

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Project 5: Secure eMail including care homes Narrative: We can communicate easily and effectively using a secure mechanism with other health and care professionals including care homes, reablement services, domiciliary care providers.

Project 6: Self-Care (including Patient Held Record and Prevention) Capability: Remote and Assistive Care Narrative: The use of telecare and telehealth equipment will be utilised to improve patient care, and allow patients to take control and responsibility of their conditions. For example, remote diabetic equipment could be used for patients to self-monitor; intervention could then be made if their results fall outside of pre-set limits.

Project 7: Virtual Consultations Capability: Remote and Assistive Care Narrative: By utilising technology such as secure video conferencing, patients could initially be consulted remotely, before a decision on the correct treatment pathway - this would reduce travel from the patient’s side, and allow clinicians to only see patients that really needed to be seen. Patients could be signposted to the most appropriate care setting. There are also uses in the Multi-Disciplinary Team setting where video conferencing across health and social care can provide benefits to both professional and service user. In applying both remote consultations and telehealth technologies, reductions in GP attendance at nursing homes could be achieved, as well as face to face hospital appointments could be reduced. Instead appointments could be utilised by patients needing high levels of intervention. Advances in security around video conferencing will allow clinicians to carry out consultations directly with patients on their own IT equipment.

Project 8: Decision Support for clinicians Capability: Decision Support Narrative: Implementation of intelligent software that would show conflicts and contraindications of drugs to assist clinicians with their prescribing decisions. Shortcuts and hyperlinks to be embedded within software solutions that will provide links to up to date guidelines and information for clinicians, to include analysis of real time data to assist with clinician decision making process.

Project 9: Secure Hotspots for Health and Care Workers in all health and council locations Narrative: Allow any care professional, with an enabled device, the capability to access their applications and data over the WLAN network throughout the Peninsula. Set up secure hotspots to allow staff from different organisations to use each other’s Wi-Fi securely and is likely to take the form of a Peninsula HealthRoam.

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Project 10: Support End of Life Wishes and Shared Care Plans Capability: Decision Support Narrative: Ensuring that end of life wishes of patients is incorporated within the data sets that are available to clinicians within the out of hours services.

Project 11: Bed Management across the “whole system” including care homes Capability: Asset and Resource Optimisation Narrative: All organisations in the care system will have a real time view of bed base and occupancy across the complete system (including Care Homes etc.)

Project 12: Integrated Digital Health and Care Record in all care settings across the 3 CCG areas

Capability: Asset and Resource Optimisation, Records, Assessments and Plans, Medicines Management and Optimisation and Decision Support Universal Priority: Professionals across care settings made aware of end-of-life preference information Scope: Clinical Portal, Patient Portal and Analytics Functionality (further consideration will be given to the inclusion of analytics in the scope of this project during the Summer 2016 planning exercise).

Full details of all these projects including an initial review by our providers and the themes of their feedback can be found in Appendix D

9.3 Capability deployment trajectory (secondary care) (Section 6.23) The Digital Maturity Assessment results for each of the Secondary Care Providers in the Peninsula has been provided as the baseline for each of the 7 capabilities and projected progress detailed in the attached spreadsheet (Appendix E) for 2016/2017, 2017/2018 and 2018/2019. Given that this was the first time providers completed the Digital Maturity Assessment and further validation is needed, they have taken a more prudent approach to increasing capability during the first year (2016/17). As we work through the detail in the next three months we will have greater clarity and consistency in the approach taken.

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The Digital Maturity Assessments for our Local Authority Areas and Primary Care are currently being at a national level, once published these will be used to further inform our Digital Roadmap, including the timescales and cost impact. Illustrated in Figure 5 below is the projected enabling of each of the capabilities by the information sharing agreement and data flow across the peninsula. As we have yet to confirm the scheduled delivery of our 12 new projects the grid below reflects the local projects provides an indicative view of the roadmap progress and an updated grid will be provided in September 2016 following more detailed analysis.

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Figure 5 – The Roadmap and Information Sharing and Standards Trajectory

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10 Universal Priorities Delivery Plan

The following information will be found in detail in Appendix F

• Current baseline (for each universal priority) (Section 6.27)

• Ambition (for each universal priority) (Section 6.28)

• Key activities (for each universal priority) (Section 6.29)

• Rationale for using alternatives to national services / infrastructure / standards (for each universal

priority) (Section 6.29)

• Proposals for evidencing progress towards the defined aims (for each universal priority) (Section 6.30)

Surveys for each CCG have been undertaken to establish the baseline position, ambition, key activities, and rationale for using alternatives to national services / infrastructure / standards and the proposals for evidencing progress towards the defined aims with regards to the delivery of the Universal Priorities targets.

Figure 6 – Current Assessment of Progress towards Universal Priorities

Universal Priorities NEW Devon South Devon & Torbay

Kernow

Professionals across care settings can access GP-held information on GP-prescribed medications, patient allergies and adverse reactions

Plan in place, on track



Clinicians in urgent and emergency care settings can access key GP-held information for those patients previously identified by GPs as most likely to present (in U&EC)




Patients can access their GP record

Complete, increase in

uptake req’d



uptake req’d

GPs can refer electronically to secondary care


uptake req’d



uptake req’d

GPs receive timely electronic discharge summaries from secondary care

Plan in place risk to delivery

Plan in place risk to delivery Plan in place

risk to delivery

Social care receive timely electronic Assessment, Discharge and Withdrawal Notices from acute care

To be scoped To be scoped To be scoped

Clinicians in unscheduled care settings can access child protection information with social care professionals notified accordingly


Professionals across care settings made aware of end-of-life preference information


GPs and community pharmacists can utilise electronic prescriptions

Plan in place risk to delivery

Plan in place risk to delivery Plan in place

risk to delivery

Patients can book appointments and order repeat prescriptions from their GP practice


uptake req’d



uptake req’d

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Each of the Universal Priorities have plans detailing how we intend to progress these and a summary of the target completion dates are reflected in the table below.

Scheduled Completion

Date

Universal Priority

TBC Professionals across care settings can access GP-held information on GP-prescribed medications, patient allergies and adverse reactions

April 2017 Clinicians in urgent and emergency care settings can access key GP-held information for those patients previously identified by GPs as most likely to present (in U&EC)

April 2017 Patients can access their GP record

April 2017 GPs can refer electronically to secondary care

April 2017 GPs receive timely electronic discharge summaries from secondary care

October 2017 Social care receive timely electronic Assessment, Discharge and Withdrawal Notices from acute care

TBC Clinicians in unscheduled care settings can access child protection information with social care professionals notified accordingly

TBC Professionals across care settings made aware of end-of-life preference information

August 2017 GPs and community pharmacists can utilise electronic prescriptions

April 2017 Patients can book appointments and order repeat prescriptions from their GP practice

Full details of these plans can be found in Appendix F.

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11 Information Sharing

11.1 Information Sharing Approach (Section 6.32) A Peninsula Information Sharing Charter will be established and provide Devon and Cornwall health and care organisations with a robust foundation for the lawful, secure and confidential sharing of personal information between themselves and other public, private or voluntary sector organisations that they work, or wish to work in partnership with. It will enable all organisations that they work, or wish to work, with in partnership to meet their statutory obligations and share information safely to enable integrated service provision across the Peninsula and better care outcome for individuals. The principles of this Charter will be to:

a) identify the lawful basis for information sharing;

b) provide the framework to ensure that information is kept secure and meets the legal requirements

associated with confidentiality and information sharing;

c) address the need to develop and manage the use of Information Sharing Agreements (ISA);

d) encourage the flow of personal data and develop good practice across partners and integrated

teams;

e) provide the basis for Peninsula wide processes which will monitor and review data flows and

information sharing between partners;

f) protect partners from unlawful use of personal data;

g) reduce the need for individuals to repeat their story when receiving an integrated service;

h) support the development of the Local Digital Roadmap.

The information governance professionals from across Devon and Cornwall have a track record of working together to find solutions to the challenges similar to those presented by the Digital Roadmap. They will continue to support the development of appropriate systems and processes to ensure that all organisations involved in integrated care meet their responsibilities under the data protection act. They will work closely with other Information Governance Networks both locally and nationally. In terms of the Information Sharing Governance, the information governance professional will act as a mechanism for generating expert advice and guidance, but cannot govern. A suitable forum will be required to discharge the responsibilities relating to information governance and data sharing for the Peninsula.

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11.2 Plans for a common information sharing agreement with all providers signed up (Section 6.34)

11.3 Current status of adoption of NHS number / steps to address gaps / gaps that will persist into 17/18 (Section 6.35)

Our analysis of the adoption of NHS Numbers shows that all partner organisations have a 100% for the adoption of NHS numbers, those that are robust plans in place and they are as follows: South Western Ambulance Service NHS Trust - DMA Result 51-75%, Full implementation by Q4

2016/17

Isles of Scilly Council – DMA not applicable, Deployment planned for Summer 2016

Cornwall Council – DMA not applicable, Deployment planned for Summer 2017 (TBC)

Torbay Council - (Children's services only) – DMA not applicable, Deployment Full implementation

by Q4 2017-18

We recognise that the adoption and continued use of NHS numbers is key to our overarching plans and strategy, to link and share information across our CCG catchment areas. As the programme moves into the deployment stages, this area of work will be revisited to ensure continued compliance and use of NHS numbers as the prime identifier is still being achieved. The use of NHS number is affected by national guidelines. Social care (especially children's services) relies on partnership with Education and Police. The NHS Number is not currently supported in these areas however it is the obvious identifier across agencies where there is a duty of care and the management of safeguarding. It is an area in which we would value national support in achieving widespread roll out of the NHS number across multi-agencies. The full details of the survey results can be found in Appendix G

Development of High Level Information Sharing Charter

(In Progress) Completion Due - Q3 2016

Development of Consent Model with Public and Organisational Agreements

Completion Due - Q2 2017

All Partners Sign Off


Detailed Mapping and Data Flow


Governance Board Set Up

Q4 2017

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11.4 Plans and milestones for adoption of information sharing standards (Section 6.36)

Additional surveys have been carried out to ascertain our position with regards to information sharing standards and technical architecture standards. We know that this area of work will be key to enabling the linking and integration of IT systems as we progress with the delivery of our programme of work. All partner organisations are aware that consideration will need to be given on integration functionality of all systems either being or planned to be procured over the coming months and years. We will ensure that only systems that meet the required standards and needs of the health and care system will be procured. In addition to the surveys carried out, we commissioned a consultancy firm (J2), to make recommendations on what the technical architecture could look like when we get to the point of linking and integrating IT systems. Discussions with technical infrastructure colleagues will continue in order for us to form an agreed way forward that will not only meet the requirements of individual organisations, but also ensure that systems can be linked together in the future. In order to support the vision of “One Person, One Digital Record”, enterprise architectures and systems must hold data in a structured format and be able to support interoperability by sharing and exchanging information directly between different systems and disparate organisations. This is will be achieved by having common technical standards and protocols which include a single information sharing model across the Peninsula, the adoption of common open standards for data structures and technology, an integrated network backbone and Role Based Access Control (RBAC). Examples of these are as follows: • Implementation of a full-featured Enterprise Master Patient Index (EMPI) solution

• Adoption by participating organisations of the following IHE interoperability standards:

o Patient Identity: PIX, PDQ, and XPD

o Document Sharing: XDR, XDM, XDS.b, XCA, and HPD

o Security and Privacy: ATNA, BPPC, XUA

o Notifications: DSUB

• Two options for sharing data across the community using XDS affinity domains

• Adoption of a Health Service Bus design to integrate legacy systems and support present and future

interoperability requirements

• Implementation of a full-featured interoperability / HIE platform that supports our recommended IHE

profiles

The full J2 Interoperability Architecture Specification document can be found in Appendix H, and following a review by HSCIC their feedback can be found in Appendix I, which will be taken into consideration going forward. A survey of the adoption of the Dictionary of Medicines and Devices (dm+d) has shown a relatively low update to date, however plans from the relevant partners are in place to transition over to these standards over the next 2 years. In terms of the current position with regard to SNOMED-CT, this mirrors the position with DM+D with plans in place within each of the applicable provider organisations to improve this position across the landscape. The detailed results of the SNOMED-CT and DM+D Surveys have been included in Appendix G.

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12 Infrastructure

12.1 Current status of the mobile working infrastructure (Section 6.39) A survey of the current status of the mobile working infrastructure across all of our partner organisations was conducted for the purposes of the Roadmap and it shows that considerable progress has been made to develop the mobile working infrastructure; the main themes are as follows:

NHS Mail is used across all providers

19 out of 22 organisations support Wi-Fi to enable staff to work from any office in the workplace

18 out of 22 organisations support secure remote access (via home or public networks) to enable

staff to work from "anywhere" i.e. in a client’s / supplier property

13 out of 22 organisation have single-sign-on to allow staff easy access to (authorised) applications

A full breakdown of the survey results can be found in Appendix G.

12.2 Confirmation that individual providers have plans to develop their mobile working infrastructure (Section 6.40)

We can confirm that robust plans are in place for each organisation to develop and roll out mobile working functionality across our catchment area. Part of our programme management approach for the delivery of the 2020 vision, will be to include this as one of the key workstreams to ensure that progress continues to be made and that the output of this work will complement the overarching delivery of strategy. Please see the completed survey in Appendix G for the consolidated survey results and plan details for each partner.

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12.3 Description of system- wide initiatives to develop the mobile working infrastructure (Section 6.40)

Cornwall

Mobile working infrastructure is now in all major health locations; a rolling programme is underway to deploy Wi-Fi in all GP Practices. N3 connections were refreshed in 2013-14 throughout Cornwall and the current agreement for the N3 Wide Area Network comes to an end in March 2017 and will be replaced by a single Health and Social Care Network (HSCN). This is a key opportunity for joining up access and sharing across health and care settings as well as addressing the bandwidth and resilience challenges due to the increased roll out to branch surgeries, together with the move to cloud based systems.

NEW Devon

Mobile working is in place for some parts of the health and social care system in NEW Devon but it has not been planned at a system-wide scale. NEW Devon CCG is currently planning to increase the mobile access for GP Practices by providing tablet devices loaded with the right clinical system to allow GPs to have ‘Access at the Point of Care’ and we have submitted a bid to the Primary Care Transformation fund for capital to enable this. Due to Devon rural nature coverage plans will need to accept that there will be limits to the connectivity of front line service being delivered.

South Devon & Torbay

Remote working is available to all GPs who require it, and currently 75% of the CCG GP practice staff have access to this technology, which is available on request. SystmOne Mobile is available to practices that wish to utilise mobile working, as is EMIS Mobile. Practices can also request access to a laptop for Disaster recovery where required. Wi-Fi is available in 25% of GP practices, with plans being drawn up as to how to deploy to the rest of the primary care estate. Main to branch site N3 links have been or are in the process of being upgraded as more pressure is put on these links. Plans to expand the infrastructure within practices to allow more flexibility in agile working to include Wi-Fi, telephony and networking.

Peninsula Wide

In 2016/17 we will work with organisations across the health and social care system across Devon and Cornwall to enable the sharing of mobile working infrastructure across the two counties, for example by allowing staff from any accredited health or social care organisation access to Wi-Fi facilities at partner organisations.

12.4 Current status and future plans to improve collaboration between professionals from different organisations (Section 6.42)

It is envisaged that as with all the IT plans and strategy set out within this document, that enabling health and care professionals from different organisations to collaborate through telephony, secure email and other emerging mechanisms will complement the developing Sustainability and Transformation Plan, is a key enabler to meeting the requirements for a more flexible and mobile workforce. We have identified this work as a key priority to scope across the 3 CCG area and aim to extend this ability to hospices and care homes as part of our solution.

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NEW Devon CCG in collaboration with Plymouth City Council is keen to pilot the new Health and Social Care Network through its shared IT setup in the form of Delt Shared Services Ltd. The details of the Secure Email project can be found in Appendix D. South Devon and Torbay CCG are eager to evolve a whole community network over their footprint to enable seamless working across the combined estates. NHS Kernow CCG, health providers and Cornwall Council are actively engaged on a number of collaborative initiatives and have deployed joint health and social care teams in a number of localities. Future plans include: • Integrated Commissioning Programme (under the Cornwall Deal);

• Integrated Early Help Hub;

• One Public Estate (OPE) Programme delivering cloud based printing and faster wireless for Health

and Council staff.

12.5 Summary of current or planned initiatives to share infrastructure (Section 6.43)

The commitment to close joined up working of all partners (as set out in this document), coupled with a single programme delivery team - will ensure a co-ordinated approach to the implementation of the infrastructure to support mobile working. Within each CCG the following shared infrastructure arrangements are in place:

Cornwall / Kernow

At an infrastructure level, RCHT's IM&T Directorate Cornwall IT Services (CITS) provides managed services to the Cornwall Healthcare Community covering the hosting environment, bulk storage, networking and support for end user devices. During 2015 there was significant investment made in the back-end compute and storage platforms and these are considered fit for purpose for the next 5 years.

There is a single Community of Interest Network (CoIN) that enables any healthcare worker to access their systems and data from any health location. Options to extend this across to Cornwall Council locations to enable healthcare workers to access their systems from local authority sites and vice versa are currently being explored.

NEW Devon

The infrastructure within healthcare and local authorities in NEW Devon is currently separate for each organisation and does not often allow sharing. NEW Devon CCG has established a project to run in 2016/17 that will merge the Microsoft Active Directory domains across the 122 separate GP Practices to allow for easier working for GP staff across different practices. NEW Devon will explore sharing IT infrastructure across different organisations through the joint owned vehicle of Delt Shared Services Ltd as an opportunity. We will investigate ways we can share services such as Wi-Fi between different organisations to make working across different health and care settings easier.

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South Devon & Torbay

In South Devon and Torbay CCG, all GP practice end user devices (PCs/Laptops) are supported by the South Devon Health Informatics Service, who also support 50% of the GP Practice Server infrastructure. Access to Acute software for Order Comms and Radiological Imaging is available from all practices. Where required staff can work on any N3 connected site. Our vision is to enable an infrastructure (depending on availability of funding) where any member of staff can securely access all software required to work effectively from anywhere, including both within and outside of the NHS N3 network)

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13 Minimising risks arising from technology

13.1 Confirmation that robust plans, policies and procedures in place across the system to minimise risks / steps to address gaps (Section 6.45)

By having agreements in place to share and work together in the delivery of this programme of work, we will be able to co-ordinate our approach to the areas set out in the guidance. We will work towards for example, shared policies and procedures that cover Business Continuity and disaster recovery etc., as once systems start to be linked together and integrated, having multiple individual processes from multiple organisations won’t work. We see this programme of work as an opportunity to develop a single approach to all of the areas set out in this document. All projects will be assessed for risk including specifically clinical safety and the NHS information Standard requirements (e.g. ISB 0160). The results of the survey we have undertaken, show that whilst there is a good level of confidence in the existing policies and procedures across the landscape, a further significant investment is required which is currently estimated to be around £5.9 million is needed in order to fully meet the requirements of this section. It is understood that this is not captured within the capital programmes for each organisation and further work to understand the detail will completed during summer 2016. A summary of the confidence levels across the landscape, for each area is detailed below:

By referring to the attached summary, you will see that our partner organisations have set out the details of funding required for each section. Each of these areas will need to be incorporated into all IT systems

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being implemented; the overarching programme management approach will ensure that we have a co-ordinated approach to this. In summary the estimated investment for each section is as follows:

Full details of the survey can be found in Appendix K.

13.2 Confirmation that individual providers are moving forward with GS1 adoption (Section 6.46)

GS1 standards are a standardised approach to barcoding and are used within the healthcare industry for Catalogue Management, Patient Identification and Location Numbering. From the responses received our GS1 Standards adoption survey shows the following results:

Mental Health Trust (Devon Partnership) – need to procure a new system, current plan for

implementation Q4 2017/18

Acute Trust (Torbay & South Devon) – replacement printers required, current plan for replacement

dependant on available funding

Acute Trust (Northern Devon) – planned implementation Q2 2016, no plans to implement Location

Numbering

Acute Trust (Plymouth Hospital) – already implemented

Acute Trust (Royal Devon & Exeter) – patient identification in place, specimen tracking underway,

catalogue management outline plan in place no timeframe for implementation.

Acute Trust (Royal Cornwall) – plan to implement Patient Identification by Q1 2017, and catalogue

management by Q4 2016

Ongoing monitoring of the implementation of the GS1 Standards will be built into the programme management of the overarching project. Full details of the survey can be found in Appendix G.

Cyber Security 1,256,000£

Clinical Safety 939,000£

Data Quality 1,925,000£

Data Protection & Privacy 605,000£

Meeting Accessible Information Standards 310,000£

Business Continuity & Disaster Recovery 565,000£

Unwarranted or Unlicensed Software 387,000£

Total Funding Requirement 5,987,000£

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Appendix A - Detailed Gap Analysis and Local Provider Plans

LDR Plans - Consolidated Plans & Gap Analysis.xlsx

Appendix B - Annex 2 Capability Deployment Schedule Illustration

Annex 2 - Capability Deployment Schedule Illustration.xlsm

Appendix C - Ready to Deliver Change Feedback

Appendix D - New Projects Details

New Projects Details.xlsx

Appendix E - DMA Trajectory Results

NHS England - Capability Trajectory (Secondary Care).xlsx

Appendix F - Universal Priorities Forms for each CCG

SD&TBY - Universal Priorities Forms.xlsx

NEW Devon - Universal Priorities Forms.xlsx

Kernow - Universal Priorities Forms.xlsx

Appendix G - SNOMED-CT / DM+D / NHS Numbers / Mobile Working Infrastructure / GS1 Standards (Barcode) Survey Results

Surveys - MASTER.xlsx

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Appendix H – J2 Interoperability Architecture Specification

Appendix I – HSCIC Feedback on J2 Interoperability Architecture Specification

Appendix J - Roadmap Process Meeting Representation Details

Appendix K - Patient Safety and Reputational Risk Survey

Patient Safety and Reputational Risk Survey - Master.xlsx

Appendix L - Achievements

Appendix M – Current Initiatives

Appendix N – Outcome to Project Mapping

Outcome to Project Mapping.xlsx

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Glossary

A&E Accident and Emergency

CCG Clinical Commissioning Group

CCIO Chief Clinical Information Officers

CFT Cornwall NHS Foundation Trust

CH & WBB Cornwall Health and Well Being Board

DM+D The NHS Dictionary of Medicines and Devices

DMA Digital Maturity Assessment

eDischarge Electronic Discharge

EoL End of Life

EPR Electronic Patient Record

ePrescribing Electronic Prescribing

eReferrals Electronic Referrals

GPIT Projects General Practice Information Technology

GS1 Standards (Barcodes)

Global Standards Barcoding (formerly known as EAN numbers)

GURU A clinical data-sharing tool that enables remote access to GP patient records

ICO Information Commissioner's Office

ICT Information Communication Technology

IDCR Integrated Digital Care Record

IM&T Information Management and Technology

IT Information Technology

JSEC Joint Strategic Executive Committee

JSNA Joint Strategic Needs Assessment

Kernow Health CIC Kernow Health Community Interest Company

LDR Local Digital Roadmap

LMC Local Medical Committee

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MIG Medical Interoperability Gateway

NEW Devon North East and West Devon

PF@POC Paper Free at the Point of Care

PMO Project Management Officer

RCHT Royal Cornwall NHS Hospital Trust

SCR Summary Care Records

SD&T South Devon and Torbay

SNOMED-CT Systematised Nomenclature of Medicine – Clinical Terms

STP Sustainability and Transformation Plan

SW AHSN South West Academic Health Science Network

U&EC Urgent and Emergency Care

2020 Digital Roadmap: ‘One Person, One Digital Record’ Devon IMT Strategic Vision Statement...

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