Board of Directors’ Meeting Report – Agenda item 209/14 · Board of Directors’ Meeting Report...

Board of Directors’ Meeting Report – Agenda item 209/14

Title

IM & T Strategy - Update

Sponsoring Director

Director of Human Resources

Author

Alan Tuckwood, Head of IT

Purpose

To provide the Board with an update on progress with delivering the IM & T Strategy that was agreed in January 2014.

Previously considered at

N/A

Executive Summary: The IM & T Strategy describes how the IM&T service enables service transformation to deliver improved

patient care through harnessing technology. Ultimately, the Trust’s aim is to become a modern, efficient

and paperless hospital by 2018.

Excellent progress has been made on both low-cost tactical, high impact “quick wins” and moves

towards the adoption of self-funding IM & T technologies.

A number of key projects have been completed including patient Wi Fi access via their personal device,

SMS appointment reminders and Radio Frequency Identification (RFID) pilot for tracking high risk

infusion pumps.

The Trust has been successful in bidding for funding from the Safer Hospitals and Nursing Technology

Funds, and the following projects are underway:-

E-Prescribing;

Pre-Operative Assessment.

The Trust has submitted a bid to the Digital Care Fund (formerly Safer Hospital Fund) to expedite

delivery and further develop the Trust’s Clinical & Patient Portal. A further two bids are being finalised

for the Nursing Technology Fund for patient e-Observations / alerts and Community Midwife mobile

devices.

Related Trust Objective

All Corporate Objectives are supported by this Strategy.

BAF objective 3

Related Risk

Legal implications / regulatory requirements

Compliance with Information and IT governance

Quality impact assessment Each scheme within the programme will be assessed.

Equality impact assessment

As far as can be considered this paper has no detrimental impact for the 9 protected characteristics under the Equality Act 2010.

Action required by the Board

Approve Assure X Note

IM&T Strategy Page 1 of 4 Progress Tracker 30th July 2014

IM&T Strategy Progress Tracker

30th July 2014

The IM&T Strategy describes how the IM&T service will build upon the current position and enable service transformation through the use of technology. Excellent progress has been made on both the low-cost, tactical, high impact “quick wins” and moves towards the adoption of self-funding IM&T technologies which enable business efficiencies and result in more cost effective maintenance and support functions. Investments will underpin strategic objectives and deliver maximum value for money, ensuring that IM&T enables business transformation through the innovative application of technology. The IM&T Strategy Board has active clinically led representation and commitment from all Business Units. The progress described in this report is based on the final programme described in Appendix 2 of the IM&T strategy which presents a direction for an achievable programme of innovation and change to become digitally enabled, both locally and across the wider health community. The Trust’s aim is to become a modern, efficient and paperless hospital by 2018; by April 2015, as a consequence of enhancements made to the Trust`s own CED (clinical electronic documentation) solution, patients will be able to view their information online via a new Patient Portal and share this with the healthcare professionals involved in their care.

IT – current status As a result of a SWOT analysis carried out in the latter part of 2013 and the potential to provide services to other organisations, it is increasingly important to develop and improve our IT service management and customer service capabilities by implementing recognised industry standard methods of working through the adoption of ITIL (Information Technology Infrastructure Library) Service Management processes which may be an important differentiator in attracting further business to the Trust. July saw the launch of a 24/7 Self Service function for staff to log service issues, provide their own updates and track progress through to resolution. IT will continue to be represented at the BUDs/ABUDs operational group which will be the forum for agreement and on-going review of IT service Key Performance Indicators. Technology Bids As a result of successful bids to the Safer Hospitals and Nursing Technology funds, the E-Prescribing and Pre-Operative assessment projects are now underway. Since the last update to the Trust Board, NHS England has announced that Round 2 of these funds are now open to bids. The Trust has submitted a bid to the Safer Hospital fund (renamed Integrated Digital Care Fund) to expedite delivery and further develop the Trust’s Clinical & Patient Portal.

A further two bids are currently being prepared for the Nursing Technology Fund, patient e-Observations/alerts and Community Midwife mobile devices.


1. A Modern and Efficient Hospital: Quick Wins

Project Description Owner Status

1.1 Referrals Hub Centralised, web-based method for creating referrals. Ric Pullen Complete

1.2 Mobile Working and Bring Your Own Device (BYOD)

A service to connect the Trust’s Apple or Android devices and to allow staff to connect their personal IT device (phone, tablet or laptop) to the Trust`s Wi-Fi network and access information securely.

Matthew Poxon Complete

1.3 SystmOne / Clinical Record Viewer (CRV)

SystmOne access being deployed Trust-wide to reduce clinical risk, improve co-ordination with community clinicians and strengthen relationships with GPs and CCGs.

Nick Butler Ongoing

1.4 CED development to support Noteless clinics

Trust-wide implementation of CED (clinical electronic documentation) to alleviate the pressure on the existing medical records centre and remove associated offsite storage costs

Scott West Complete

1.5 SMS Appointment Reminders Successful proof of concept in Outpatients, IT supporting Information Governance and Information teams to deploy a Trust-wide SMS appointment reminder service.

Denise Townsend Complete

1.7 eLearning The use of e-Learning as the primary delivery vehicle for statutory and mandatory training.

Lynda Steer Complete


2. A Modern and Efficient Hospital: Major Projects


2.1 Electronic Patient Record (EPR) EPR Project structure in development Neil Rothnie Ongoing

2.1 a) Clinical Portal Presenting a single view of information from third party systems in the context of a patient. In other words, a clinician working on a patient list in an outpatient clinic can look at X-Rays for that patient without having to log in to the PACS.

James Brown / Devesh Sinha

Ongoing

2.1 b) Clinical Proformas To track patients throughout their hospital journey from referral to treatment and beyond for all specialties from simple to complex clinical assessment proformas.

NA Deferred due to Medway upgrade

2.1 c) Electronic whiteboards For multi-disciplinary teams to plan and manage patient care without multiple paper-based handovers and referrals transforming the way different staff types become a team, reducing length of stay.

NA Deferred due to Medway upgrade

2.1 d) eCorrespondence Patients electing to receive their letters electronically will be provided with access via a secure web-based Patient Portal. Initially this will contain discharge and appointment letters but will be further developed to allow patients to complete pre-operative assessments online.

Alan Tuckwood Pilot target completion April

2015

2.3 Radio frequency identification (RFID) Pilot

An RFID pilot is providing live tracking of fifty high risk infusion pumps across all three levels of the Cardigan Wing.

The system shows the precise location of the equipment in real time.

The system is scalable to accommodate new medical equipment and modalities.

Paul Goodfellow Complete


2.5 Single Sign-On (SSO) Pilot Streamline authentication process by managing all username and password information behind the scenes to provide secure, immediate access without interruption. Proof of concept currently being scoped for Vascular and Stroke

Alan Tuckwood Target completion December 2014

2.6 e-Prescribing Delivering improvements to patient safety and overall quality of care, e-Prescribing will significantly reduce the risk of medication errors and reduce costs relating to lost prescriptions. Warnings and alert systems, active at the point of prescribing, will ensure correct dosing and checking against drug allergies, adverse reactions and duplicate therapies.

Evelyn Allen Target completion August 2015

3. Access and Control for Patients, Staff and the Social/Healthcare Community: Quick Wins


3.1 Mobile Computing Wireless connectivity for healthcare professionals via the Trust’s network to support seamless patient care pathways. Council social workers are now able to connect their own equipment to the Trust wireless network when working across the hospital site.

Nick Butler Complete

3.2 Patient WiFi Access Provide patients with free access to the Internet via their personal device, allowing us to meet our patients’ consumer expectations by bringing the Trust in line with services provided at airports, trains and coffee shops.

Matthew Poxon Complete

3.3 Video Conferencing and Collaboration Tools

Provide improved communications and collaboration across healthcare boundaries and social care. This will enable time saving efficiencies and increased staff productivity.

Konrad Hutchins Complete

Southend University Hospital NHS Foundation Trust

IM&T Strategy version 6.0

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Information Management & Technology Strategy

SPONSOR (Information Asset Owner):

Sandra Le Blanc – Director of HR

AUTHOR (Information Asset Administrator): Alan Tuckwood – Head of Information Technology

RATIFIED BY:

Executives

APPROVED BY: Trust Board 29th January 2014

TARGET AUDIENCE: All Trust employees

VERSION NUMBER:

6.0

This document is available in large print format and alternative formats. Should you or someone you know require this in an alternative format please contact us on 01702 435555 x6455 or email [email protected]

mailto:nicky.frost@southend



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VERSION AND REVISION RECORD:

Date Version No Details Review date

2013 03 2.0 Approved strategy 2013 05

2013 05 3.0 Revised strategy to include Board recommendations and actions

2013 07 – deferred

2013 09 4.0 Details of additional access methods (page14 Section 5 - Staff); BUDs/ABUDs tier removed from governance structure (page 17 appendix 1)

2013 09

2013 09 5.0 Appendix 2: updated impact scores and timescales

2013 09

2014 01

6.0 Revised to incorporate actions from September 2013 Trust Board



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Contents

1. Introduction ................................................................................................... 4

2. Purpose .......................................................................................................... 5

3. Strategic Context ............................................................................................ 6

4. Stakeholder Requirements ............................................................................ 7

5. Vision for IM&T .............................................................................................. 10

6. Strategic Aims ................................................................................................ 14

7. Current Status ................................................................................................ 15

8. Monitoring and Review .................................................................................. 20

9. Conclusion ...................................................................................................... 21

Appendix 1. Key Innovation Aims 2013-2018 ................................................ 22

Appendix 2. Plan, timescales and Business Unit priorities ............................ 27



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1. Introduction

This document presents the future strategic vision for return on investment in information management and technology at Southend University Hospital NHS Foundation Trust (the Trust) over a five year period commencing 2013. It describes how the IM&T service will build upon the current position and enable service transformation through the use of technology.

The strategy will be carried out at a time when traditional capital and revenue funding will be limited requiring new sources of funding. It initially concentrates on areas which are low-cost, tactical, high impact “quick wins”. It moves towards the adoption of self-funding IM&T technologies that enable business efficiencies and more cost effective maintenance and support functions. As IT adapts its approach to support service transformation, examples are provided of potential parts of a new programme. The actual schemes will only be initiated following prioritisation by the IM&T Strategy Board. The majority of the projects, whilst containing significant IM&T elements, are fundamentally transformational. The introduction of technology will involve significant changes to ways of working and the delivery of patient care, resulting in a more effective, efficient and clinically safe practice. The strategy will support the Trust’s overall strategy and operations by ensuring that information and information technology is used to support Trust staff in giving patients the highest quality care and experience, both within the Trust and across organisational boundaries. It captures the strategic ambitions of the Trust both as a provider of patient care and as a business, and sets out a vision in which these objectives are supported and enabled through the innovative use of IM&T. Key stakeholders have identified the high level information needs of clinicians, managers and patients and the strategy has been developed to articulate a vision for IM&T that will underpin the Trust’s ambition to be first in Essex within three years and first in the East of England by 2017/18.

2. Purpose

The Trust makes excellent use of available technologies and has been an early adopter for elements of the NHS National Programme for IT (NPfIT), for example, it has been at the leading edge in its use of PACS. NPfIT has now been dismantled and it is clear that as a national programme, it was not entirely successful in delivering interoperable systems capable of meeting the differing needs of NHS care settings. There is now consequently an opportunity for NHS organisations to make their own decisions at a local level regarding



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system choice, enabling the Trust to procure IT systems which meet its needs and enable transformation of services. Technology must support the Trust’s clinical strategy and business plans. Many elements of Liberating the NHS (remote working, out-reach clinical services, community working and integration with local partners such as social care, local authority, GPs, etc.) will bring significant benefits and outcomes to patients and the Trust. These will be dependent on continued investment in technology, infrastructure and applications supported by a corresponding programme of business transformation, change and training.

3 Strategic Context

The Trust’s vision is: ‘to provide excellent care by excellent people’ and its ambition can be summarised as:

Our Goal - We want to grow our healthcare services to deliver excellent care for the people of Essex from excellent people

Our Strategy - This means our patient focus keeps getting better. Our staff feel proud to work here and keep making a difference. Our services are sustainable; we keep the core strong and grow selectively. We use research, training and

Fast, reliable, relevant electronic information

Reliable and credible IM&T services

Improved patient

care

Enabling service transformation

2013

2018

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innovation to invest in our future. We recognise and act on the value of partnership of our hospital in our community

Our Priorities - We work together so patients feel satisfied and cared for. Families, carers and visitors feel assured and supported. Staff feel proud and included; health partners feel they can rely on us. Our community supports us and our regulators hold us in high regard.

Our People - All staff contribute to patient satisfaction; quality of care and clinical excellence define us. Anybody can suggest improvement; everybody is listened to. To care, we actively partner with others across the NHS and other relevant organisations. We are accountable, we make decisions, we learn openly from what we do. Our leaders take collective responsibility in ensuring everybody matters and every detail counts.

Our Organisation - We understand detail; each experience is unique and personal. We challenge ourselves to improve our core services every day and to select new areas where we can make a difference. We learn from the experience and knowledge of our patients and staff; we measure our performance openly; we act to improve every detail because everybody matters.

A Seven Day Hospital

The Trust is in the process of developing a clinical site strategy that will build a hospital fit for purpose now and in the years to come. Its foundation is what we know is good practice, what is efficient and what is practical. It aims to reflect the needs of patients, the rapid developments of clinical practice in a new era of financial austerity. Everyone Counts: Planning for Patients 2013/14 signalled that the NHS will move towards routine services being available seven days a week – a development which is essential to delivering a much more patient-focused service and one which offers the opportunity to improve clinical outcomes. Ten new clinical standards are proposed that describe the standard of urgent and emergency care all patients should expect seven days a week, each supported by clinical evidence and developed in partnership with the Academy of Medical Royal Colleges. They describe, for example, how quickly people admitted to hospital should be assessed by a consultant, the diagnostic and scientific services that should always be available, and the process for handovers between clinical teams. He recommends they be adopted by the end of the 2016/17 financial year. The Trust submitted a bid in October to become an early adopter in this programme and has been successfully selected as one of 13 sites nationally.



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4 Stakeholder Requirements

In line with current NHS Policy set out in Liberating the NHS, patients will be placed at the centre of their care, participating actively in the control of their care. Patients will need:

To know how to access NHS services and contact those involved in their care;

Online access to their health records including clinical letters; laboratory results; centrally held patient data; community services information; personal care plans for people with long terms conditions; care plans relating to social care services;

patient information resources containing information on health and lifestyle;

Choice of appointments and admission dates;

Confidence that those caring for them are fully informed about their history, condition and treatment to date;

Information about them to be accurate, complete, secure and shared as appropriate;

To know where they are in their care pathway, have full visibility of timescales for ongoing treatment and make informed choices about their care options.

Opportunities:

Single point of contact for patients to book treatment by supporting centralised booking services with systems which enable resource management (beds, theatres, clinics), and tracking of patient pathways;

Free patient WiFi Internet access service (pilot to commence April 2014);

Improved communications with patients, their relatives and those caring for them by directing calls to named nurses, providing email and direct telephone numbers for booking services;

Communicate with patients electronically utilising email;

Review the Trust’s intranet and internet sites to signpost patients to appropriate sources of trusted information, ensuring information is always timely and relevant;

Patient administration should be transparent to the patient, facilitated through the use of a patient pathway management system;

Real-time capture of the patient experience during their hospital journey.

Clinicians Want:

Access to an integrated patient record via a single username and password, giving accurate, complete and immediately available information on history, attendances, clinical correspondence, investigations and interventions, across all agencies, available from all clinical locations, within and outside the hospital;

Access to guidelines and knowledge which support decision making about patient treatment and care, supporting life-long learning;



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Access to information to evaluate the effectiveness of the treatment and care that they give patients including clinical outcome indicators, such as rates of preoperative deaths, complications and complexity of case mix;

Provision of computer hardware of sufficient quantity and quality to ensure clinical time is not wasted;

Clinical systems that can be accessed remotely wherever care is provided to patients;

Communication with and access to information from other specialists;

Rapid communications with colleagues internally and across organisational boundaries.

Opportunities:

Provision of a single Trust-wide integrated EPR system based on the new Medway PAS would bring together clinical systems to provide a clinical portal view from the context of the patient;

An single electronic pre-operative assessment system will ensure the appropriate assessment is completed digitally and readily accessible to all clinical staff involved, enabling nurses to spend considerably more time with patients.;

Further utilisation of the Bring Your Own Device network will improve access for clinical staff to systems throughout the hospital;

Currently evaluating cost effective mobile technologies in partnership with Business Units;

Further development and rollout of CED to assess whether this can provide a medium term Electronic Document Management (EDM) solution;

Clinical decision support which can access knowledge bases in the context of the clinical process;

Opportunities for telemedicine including outreach support to primary and community care.

Managers/Decision Makers Want:

Better information for monitoring and managing the performance of the Trust;

Better information to determine what works and what doesn’t, including efficiency indicators – average length of stay, delayed discharges and cancelled operations;

Real-time information to enhance ward efficiency and assist bed management;

Real-time information at caseload level to enhance efficiency and improve standards of care;

Accurate information to support the most effective targeting and use of resources including bed availability, clinics, transportation and theatre lists;

Sophisticated resource modelling and what-if scenario planning with forecast information based on historic trends and external predictors;

Support for document sharing, workflow and remote access support;

Electronic storage of documents to reduce paper.



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Opportunities:

Integration of information in different systems to support Trust-wide reporting;

Provision of training and support to enhance managers’ use of information;

Trust-wide, real-time bed management will be rolled out during 2014/15;

Real-time information to support management control of the business and identify bottlenecks;

Move towards more forward-looking information and real-time indicators.

5 Vision for IM&T

The Trust aims to develop a fully integrated digital healthcare environment, capable of supporting staff, patients and partners to deliver patient focused services. It will exploit new technology to support the following themes: 5.1 Supporting Agile Working

A secure and resilient IT infrastructure will be available to all staff and will incorporate:

Stable, supported network operating platforms Robust wireless network infrastructure to support mobile access Remote access to Trust systems across the local health community.

Modern IT systems and devices will support clinicians to provide a high quality service to patients regardless of the location;

Mobile and wireless technology will be deployed where this can enhance patient care and safety. This could include handheld devices to view results, input patient observations, view PACS images, electronic requesting of diagnostics investigations and prescribing;

Digital pens and voice recognition software will improve the efficiency, quality and timeliness of clinical noting and correspondence;

Clinicians will have access to all necessary information about the patient via a single logon. Contextual logins will ensure that clinicians only need to log in once to gain access to all relevant patient information;

The use of personal devices such as tablets, smart phones and laptops will be encouraged and supported through further development of the “Bring Your Own Device” wireless network service;

5.2 Eliminating Paper

The Trust will strive to become paper free by 2018.

The Trust will work towards becoming paper-light across all care settings by making best use of email, SMS messaging and social networking technologies;



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The complete care record will be held electronically and viewable simultaneously in multiple locations, including remote locations, if required;

Electronic patient information will be provided at the point of care to enable timely and safe decision making. This will include patient history, results and investigations including PACS images and clinical correspondence presented via a single portal;

Legacy paper records will be scanned and incorporated into the EPR. Records which are not requested will be destroyed in line with the Trust’s records retention policy. The generation of new paper records will be discouraged, but would be scanned and added to the record where necessary.

The Trust will implement e-Prescribing across the organisation and integrate this with GP discharge summaries;

5.3 Reducing Administrative Overheads

Management information will be produced as a by-product of clinical, operational and administrative processes. It will be supported through a centralised Information Management solution with information presented to users in the form of standard reports, performance reports and dashboards. Analysis will include forecasts predicted from past trends of historic data as well as benchmarking and identification of improvement opportunities.

Back office processes will be streamlined as much as possible, incorporating aspects of employee self-service and minimising the use of paper. This will be achieved by implementing document workflow, automating the way expenses are claimed and authorised and providing self-service access to financial information for budget holders.

5.4 Enabling Integrated Care

The Trust will implement a Trust-wide Electronic Patient Record (EPR) bringing together all clinical and administrative patient data in a single, logical view. Where appropriate, the EPR will be integrated with systems that are used across the wider health and social care communities;

Enterprise-wide scheduling will ensure patients follow convenient and efficient integrated care pathways. Appointments for consultations, interventions and tests will be scheduled together, with prerequisite activities undertaken in advance, allowing time for patients to move around the hospital. Choice will be provided so that patients can select convenient times and locations;

Resource scheduling will ensure that expensive resources such as beds, theatres, equipment and staff are utilised in the most efficient way. RFID (Radio Frequency Identification) technology will support capacity control and patient flow, ensuring progress through the patient journey can be monitored and delays minimised;

Real time bed management will enable more effective communication regarding bed turnover and availability;



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Clinicians and operational staff will be supported by system-generated work lists, aligned to integrated care pathway-driven workflows, moving patients through defined and agreed care models;

Decision support will be implemented within order communications and e-prescribing to ensure requests are cost-effective, avoid duplication and are in line with clinical best practice. Rules and escalation alerts will ensure that results are viewed and acknowledged within agreed timescales;

Point of care testing, remote monitoring and telehealth will enable the Trust to care for patients outside the hospital setting and supported by providing patients with online access to their clinical information i.e. long term conditions management;

5.5 Improving Patient Experience

Patients will access a summary of their clinical record which they can share with health professionals.

Patients will be given online access via a secure internet portal, access via Digital TV and patient-held smart cards;

They will be able to add information and interact with those that provide their care.

Mobile technologies including handheld tablets devices, will facilitate discussions with patients and capture patient feedback;

Reception areas will be equipped with self-check-in kiosks which patients can also use to check and correct their own information or view information about their condition and treatment;

Communication devices can be issued to patients, allowing them to move around the hospital, receiving updates on waiting times and a call to clinic when their appointment is due;

High quality, timely information will be provided to commissioners, enabling the development of services which meet the needs of the local population;

The Trust will work with partner organisations, particularly GP practices, social care and third party services, to ensure that IM&T supports seamless care across organisational boundaries.

Communication with GPs will be electronic and delivered by providing a GP portal or by feeding information directly into GP systems.

6. Strategic Aims

IM&T will be a key enabler for the achievement of the Trust’s strategic direction. The following principles will ensure that IM&T supports the Trust’s strategic requirements:

1) Alignment with Business Unit and Corporate Service strategies through the IM&T Strategy Board. This IM&T strategy will be a living document, being updated in response to changing business requirements and evolving needs; 2) Support clinical governance and continuous quality improvement in the delivery of patient care;



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3) Support new models of innovative patient led, integrated care throughout the Trust and across the local health community; 4) EPR will be an advanced, clinically driven solution which is tightly integrated with existing clinical systems; 5) Consistent standards will ensure that all IM&T solutions fit within a strategic technical architecture to enable the sharing and exchange of information; 6) Information Technology Infrastructure Library (ITIL) standards will be adopted and supported by accreditation. ITIL is the most widely accepted approach to IT service management providing a cohesive set of best practice drawn from the public and private sectors; 7) Professional project management principles (PRINCE 2) will deliver IM&T solutions in accordance with NHS best practice standards; 8) A formal change management process will be adopted for all changes to systems, procedures and infrastructure to ensure that operational and infrastructure impacts are fully understood and progress monitored; 9) Quality control will be applied to the delivery of all software developments to ensure consistency and conformance to appropriate standards; 10) Training and support will be provided for all Trust staff to maintain the effective use of systems; 11) A high quality IT service delivery function will be delivered which is both service based and customer focused, and will balance flexibility with responsiveness to provide a resilient, high availability infrastructure; 12) A strong ‘culture of innovation’ will not deflect focus from achieving Corporate objectives; 13) IM&T governance structures will be aligned with corporate and clinical

objectives; 14) Active promotion of collaborative working with partner organisations.



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7. Current Status

7.1 Value for Money & Benchmarking

The IT department has recognised that a reduction in available funding and increased competition will make greater efficiency of back office services and technologies an imperative. Significant steps have been taken to restructure, simplify, disinvest in poor value services/assets, and implement new scalable and efficient technologies that have started to deliver real benefits to the Trust in terms of clinical engagement, quality of service and cost. Procurement procedures for IT services and assets have been strengthened to eliminate waste, promote innovation and extract maximum value from new and existing services and assets. To help measure IT performance against acute peers and the wider Healthcare environment, benchmarking data is periodically collated via networking and FOI requests, analysed and incorporated into the IT Continuous Service Improvement (CSI) programme. Nationally, the end of a large number of NPfIT initiatives and Enterprise Wide Agreements has brought about opportunities and challenges to the IT department and the Trust as a whole. Whilst there is now a greater choice of services and technologies which best suit the Trust’s clinical and operational requirements, the central funding that was available as part of the NPfIT programme has quickly disappeared, meaning that the Trust must now find local funding to maintain and/or procure these services and technologies. The most recent NHS annual survey of IT spend (the NHS ceased to conduct this annual survey in 2010) recorded National IT spend as being 3.15% of total NHS revenue, with individual Trusts on average committing 1.97% of their revenue to IT. The 2010 back office QIPP (Quality, Innovation, Productivity, and Prevention) benchmark report identified the Trust’s IT department as having `average` annual revenue spend. Since this report was published, the department’s increased focus on efficiencies has meant it’s CIP target for the past two financial years has been exceeded and is also on track to meet the identified CIP saving for 2014/15. Since the beginning of 2012/13 over £550K of savings have been achieved, with a further £173K identified in 2014/15 (the majority of which are recurrent). This represents a total of £723K or an average save of 7.5% per annum against the annual IT base revenue budget. Working practices that have enabled these savings; contracts negotiation, Value for Money analysis and adoption of best practice standards have been embedded and strengthened within the department and further schemes to deliver savings or quality improvements will be continuously explored. The Trust’s capital spend on maintaining the existing infrastructure and systems is incorporated within the IT five year capital hardware and software refresh programmes. The



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value of the five year refresh programme is £6.3m and is risk assessed annually to obtain maximum possible value for money. Quarterly reviews are undertaken to ensure it remains aligned with factors such as changes in the Trust’s strategic and clinical direction, new emerging technologies, KPIs and organisational requirements. Whilst these measures have reduced the programme by over £3m since 2012/13 there have been significant cost pressures as a result of the cessation of NPfIT initiatives. For example, the end of the National Enterprise Agreement with Microsoft in 2011 now means the five year plan incorporates circa £1m to maintain the Trust’s Microsoft licencing compliance. The department will be vigilant of these changes to the national programme and will take steps where possible to mitigate any financial and quality impact. The Trust’s capital investment in new service development schemes in 2013/14 was £2.16m due to schemes such as new PAS, RIS and e-Rostering, compared with £1.7m in 2014/15. In summary;

• IT services revenue spend in 2014/15 is forecast to be circa £3.0m or 1.27% as a percentage of Trust turnover;

• IT capital spend in 2014/15 is forecast to be circa £2.65m or 1.12% as a percentage

of Trust turnover; • Total planned cash spend on IT in 2014/15 will be £5.65m or 2.39% as a percentage

of Trust turnover. These figures are favourable in comparison with national spends defined within a number of national reports including Wanless (2002 & 2007) and QIPP (2010). They highlight a downward trend in spend from previous financial years whilst still delivering robust and resilient IT services that are strategically aligned with the Trust’s operational requirements and values. As a result of successful implementation of systems, strengthening of IT service capability and the Board’s investment in IT services, the Trust is now ranked 56 out of 160 in the nationally regarded Clinical Digital Maturity Index (CDMI) ahead of most other Acute Trust’s in the South Essex region. This ranking will improve in 2014/15 as a result of recent and planned implementations of Medway PAS, Soliton RIS, ePrescribing and wider deployment of CED.



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7.2 High Level SWOT Analysis

SWOT

Anaylsis

robust, resilient and modern IT infrastructure

clinically led IM&T Strategy Board

skilled and motivated IT staff

clinically led innovative and enabling technologies

technologies to enable mobile and wider community working

executive board support

IT staff and processes compliant with ITIL standards

strategically aligned with Business Units and Corporate Services

strong information governance engagement and controls

adaptable to change

excellent project management

Strengths

better ways of working through adoption of new technologies

emergence of practical and cost effective mobile technologies

technology to support the achievement of BU efficiencies

Internet access for patients

modern and scalable IT infrastructure

shared PAS and infrastructure expertise

RFID compliant infrastructure

green IT

Internal IM&T skills

seamless integration with primary care systems

Opportunities

IT resource bottlenecks affecting timely delivery of IM&T projects

organisational change capacity

loss of clinical and Business Unit engagement

strategic direction across the Trust not aligned

outsourcing of IT service leading to loss of control and knowledge

loss of tacit knowledge, reliant on experts

reduction in funding reducing quality of IT service provision

local changes within the NHS

lack of funding in partner organisations

lack of Trust funding

externally hosted systems misaligned with Trust objectives

Threats

IT programme may not be achievable with current resources

strategic vision not widely owned

innovation constrained by inflexibility of business critical systems

no single accountable body to ensure benefits realisation

better promotion of IM&T services

inconsistent quality of support provided by third party suppliers

asset life of desktop hardware extended to eight years

single data centre

cessation of national enterprise agreements

customer service

Weaknesses



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7.3 Better Patient Care Through Joint Working Scalable, shared service options with Basildon are currently under consideration with particular focus on the following areas of commonality:

• Infrastructure development and deployment

• Application development and implementation

• Infrastructure and operations management

• IT Service Desk

• Application support; Basildon and Southend both use Medway PAS

• IT financial and contracts management

• Data and Telephony Communications

7.4 Innovation and NHS England Funds

As capital and revenue funding is limited, alternative sources of funding must be sought. The Trust has a proven track record in securing central funding to deliver enabling technology projects.

7.4.1 In July 2013 NHS England announced the Safer Hospitals Safer Wards Technology Fund. The Trust’s application was successful, securing £535k (50% total project cost) to deploy e-Prescribing during 2014/15.

7.4.2 The Trust has also submitted multiple bids to the Nursing Technology Fund launched at the beginning of December 2013. This is aimed at helping free up nurses’ and midwives’ “time to care” by equipping them with technologies designed to help provide safer, more effective and more efficient care to patients and service users. A total of £30m is available in FY2013/14 and £70m in FY 2014/15. The eligible technology types selected include:

• Digital pens; • Mobile technology; and • Systems for collection and logging of vital signs and essential clinical

information that enables uploading to EPR.

7.5 Commercial Opportunities

The Trust’s aim is to increase market share and new business through the innovative use of

new technologies. It will be agile in exploiting these opportunities to optimum advantage,

building and publicising its reputation as a beacon site to attract innovative solution



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providers. Further development and marketing of CED and services provided to the

successful Pathology JV partner may generate additional income.

7.6 National Independent Healthcare Awards

Over the past few years, Southend has been recognised nationally for its use of innovative

technology to enhance patient care;

Southend’s rapid-access seven-days-a-week TIA clinic was the winner in the Secondary Care Service Redesign category for patients at risk of a life changing stroke: HSJ Awards 2013.

The Southend team won the ‘Best use of IT to support clinical treatment and care category’: eHealth Insider Awards 2013.

Runner-up ‘Best use of Business Intelligence for improved patient outcomes category’: Centre of excellence healthcare analysis awards 2013.

7.7 Clinical Innovations

A new Applications Innovations Group consisting of clinician and software developers was formed in October 2013. The main objective of this group is to target and prioritise the development of innovative software solutions where gaps currently exist.

Areas where two recent initiatives were identified by the clinically led Applications Innovation Group are a Radiology Waiting Times screen to update patients on current waiting times and a web-based Referral Hub which has consolidated and streamlined the previous inefficient referral process. Both developments will be live within the 2013/14 financial year.



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8. Monitoring and Review

A clinically led IM&T Strategy Board (IMTSB) has been initiated which has representation from all Business Units. This board ensures that key decision making comes from stakeholders and the IM&T programme is aligned to the Trust’s Corporate Objectives. Board members are encouraged under the guidance of the IM&T service to explore the latest and most effective solutions to meet those objectives. The Programme Management Office (PMO) is represented at the IMTSB and ensures:

quality of new proposals for investment

delivery of objectives and benefits are monitored

strategic developments are aligned to the Cost Improvement Programme

The strategy will be reviewed annually. The Corporate Team, via the PMO governance framework, will be responsible for reviewing the strategy, monitoring its effectiveness and ensuring any amendments or additions are managed via formal change control. This will be delivered through:-

• Maintaining links and identifying dependencies between the IM&T and Estates Groups;

• Quarterly IM&T strategy update to the Corporate Team;

• Six-monthly report to the Trust Board.



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9. Conclusion

It is the Trust’s strategy to move towards a modern, efficient and paperless hospital by 2018. By April 2015, patients will have online access to the electronic health records that the Trust holds, meaning that healthcare professionals involved in a patient’s care will be able to share information safely. The electronic content will grow as paper systems are superseded. The Trust will realise benefits from its IM&T investments to underpin strategic objectives that deliver maximum value for money and ensure IM&T becomes a service which enables business transformation through the innovative application of technology.

Since the agreement of the IT vision, governance structures, including an IM&T Strategy Board, have been set up to enable active representation and commitment from Business Units. Progress has been made on a number of projects highlighted in this strategy as tactical “quick wins” following endorsement for delivery by the IM&T Strategy Board.

The final programme described in Appendix 2 presents a direction for an achievable programme of innovation and change to demonstrate how IM&T will support Business Units and Corporate Services to become digitally enabled, both locally and across the wider health community, where patients will be able to access the information relevant to them.



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Appendix 1. Key Innovation Aims 2013 – 2018

This section contains two key areas which together encompass the innovation technologies capable of supporting the entire patient care pathway:

A Modern and Efficient Hospital – how IM&T can support the Trust in delivering its clinical and business objectives through the utilisation of existing and emerging technologies;

Access and Control for Patients, Staff and the Social/Healthcare Community– how IM&T can support patient care pathways across the wider social and healthcare community.

These two key areas are broken down into tactical ‘quick wins’ using technology and resources currently available, and other projects which will be taken forward subject to prioritisation and initiation by the IM&T Strategy Board.

1. A Modern and Efficient Hospital – Quick Wins

Reduced dependency on major projects and greater focus on identifying quick, low cost solutions to duplicated and paper-based ways of accessing and updating information. Some proposals for 2013-14 are outlined below, but the key to this methodology is a continuous approach to finding solutions for Business Unit needs and delivering them rapidly.

1.1 Referrals Hub

An area of development prioritised by the Applications Innovation Group for a common, centralised method of creating referrals. A web-based referral hub will consolidate and streamline the referral process.

1.2 Mobile Working and Bring Your Own Device (BYOD)

Clinicians already carry this technology in their pockets and mobile devices will be key in delivering improved efficiency and more effective care.

Nurses will be able to monitor patients’ vital signs at the bedside using iPad or similar devices which can then be viewed from within the EPR system.

1.3 SystmOne and the Clinical Record Viewer (CRV)

By April 2014, Palliative Care, DME, Stroke and Renal will have access to over 5,000 shared patient records with primary care. A&E and Pharmacy have access to SystmOne’s Clinical Record Viewer (CRV), providing a ‘read only’ view of a patient’s medical information.

SystmOne access will be provided Trust-wide reducing clinical risk, improving co-ordination with community clinicians and strengthening relationships with GPs and CCGs.



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During 2013/14 Child Protection, Midwifery, Vascular Surgery, Rheumatology, Pre Assessment and Diabetes will be provided with access to Primary Care records via SystmOne.

1.4 CED Development to support Noteless Clinics

As a first step towards a full Electronic Document Management (EDM) solution and the replacement of paper-based records, the Trust-wide implementation of the locally developed clinical documentation solution (CED) will alleviate the pressure on the existing medical records centre, remove associated offsite storage costs and support the Trust in its ambition to be paperless by 2018.

The initial projects will concentrate on digitising. This is fundamental to safety given the multiple specialist notes that are routinely created for the same patient.

1.5 SMS Appointment Reminders – help patients and reduce wasted clinic time

Following a successful proof of concept in Outpatients, IM&T will work alongside Information Governance and the Information team to deploy an SMS appointment reminder service to reduce DNA rates.

1.6 Electronic Forms

eForms will support the streamlining of routine non-clinical processes, supporting staff in a Seven Day hospital by replacing routine non-clinical processes, such as expense forms, with an electronic equivalent.

1.7 eLearning

The Human Resources directorate is reviewing training delivery methods across the Trust and aims to implement, where practicable, e-Learning as the primary delivery vehicle for statutory and mandatory training. This will be agreed with the Head of Leadership, OD & Learning and align with the forthcoming Learning & Development Strategy.

2. A Modern and Efficient Hospital – Major Projects

This section provides details of longer term projects to move the hospital more significantly towards paperless or more efficient working.

2.1 Electronic Patient Record (EPR)

The Trust went live with the System C Medway PAS at the beginning of December 2013. This provides the Trust with a foundation on which it can now build its EPR - beginning with real time bed management - potentially generating substantial benefits which could include the elimination of medical records storage and administration costs by replacing paper case notes with electronic documentation; reduced clinical risk by providing immediate access to



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patient data and checklists; combining data about a patient from several sources e.g. primary care systems, ICE and PACS to create a single snapshot of patient activity;

a) Clinical Portal to present information from third party systems in the context of the patient. In other words, a clinician working on a patient list in an outpatient clinic can look at X-Rays for that patient without having to log in to the PACS.

b) Clinical proformas to track patients throughout their hospital journey from referral to treatment and beyond for all specialties from simple to complex clinical assessment proformas.

c) Electronic whiteboards for multi-disciplinary teams to plan and manage patient care without multiple paper-based handovers and referrals transforming the way different staff types become a team, reducing length of stay.

Bed and patient status can be displayed in real-time improving bed capacity planning and communicating real-time information on patient discharges and transfers, alerting doctors and nurses when tests are to be carried out or when results are ready.

d) eCorrespondence patients electing to receive communications by email and letter attachments will be automatically included to facilitate centralised letter printing and despatch.

2.2 Electronic Document Management (EDM)

The scheme will revolutionise access to patient notes by providing an electronic version of the original paper documents leading to significant efficiency savings in terms of time and cost. EDM will ultimately benefit patients and ensure that resources are applied optimally. With the reduction of physical storage space required for paper notes, the space can be better utilised to support improved patient services.

Shared records will be held electronically and accessible by clinicians, GPs and patients, from any location at any time.

Electronic access to patient health records at the point of care is critical to ensure:

• Provision of high quality and efficient patient care; • Improved service delivery models; • Conformance with NHSLA standards

2.3 Radio frequency identification (RFID)

RFID technology can provide identification, tracking, location, security and capabilities which can address the major issues currently experienced by healthcare organisations; being able to correctly identify a patient and know where that patient is at all times; locate mobile assets such as beds and medical equipment; identify current inventory preventing cancelled operations.



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2.4 Big Data & Healthcare Analytics

Data sources will grow dramatically over the next ten years, Big Data will provide a proactive business intelligence solution able to analyse huge amounts of disparate data and allow the Trust to predict trends, readmissions (up to 86% accurate), days in hospital, elective surgery episodes, complications, hospital acquired infections, illness and disease progression.

2.5 Single Sign-On (SSO)

SSO streamlines the authentication process by handling all of the username and password entry behind the scenes to provide secure, immediate access without interruption. By utilising authentication technologies such as proximity cards, finger biometrics or smart cards it is possible to replace usernames and passwords with a tap of a badge or swipe of a fingerprint.

2.6 e-Prescribing

Delivering improvements to patient safety and overall quality of care, e-Prescribing can significantly reduce the risk of medication errors which can lead to adverse drug reactions, reducing costs relating to lost prescriptions and reductions in time and resource requirements. Warnings and alert systems are active at the point of prescribing, ensuring correct dosing and checking against drug allergies, adverse reactions and duplicate therapies. Active alerts then provide direct hyperlink access to the patient’s medical history.

3. Access and Control for Patients, Staff and the Social/Healthcare Community – Quick Wins

3.1 Mobile Computing

Provide wireless connectivity for healthcare professionals via the Trust’s network to support seamless patient care pathways. For example, social workers employed by Southend Borough Council and Essex County Council will be able to connect their own equipment to the Trust wireless network when working across the hospital.

3.2 Patient WiFi Access

Provide patients with free access to the Internet via their personal device, allowing us to meet our patients’ consumer expectations by bringing the Trust in line with services provided at airports, trains and coffee shops.

3.3 Video Conferencing and Collaboration Tools

Provide improved communications and collaboration across healthcare boundaries and social care. This will enable time saving efficiencies and increased staff productivity, reducing costs associated with travel expenses.



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Future applications of this technology will ultimately supplement face to face clinician/patient consultations.

4. Access and Control for Patients, Staff and the Social/Health Care Community – Major Projects

Mobile Health

a) Machine to machine (M2M) – connecting mobile devices across the Internet will allow real time monitoring of patients. Deteriorating chronic conditions e.g. diabetes, pulmonary disease etc. can be identified immediately and clinicians alerted, speeding up the treatment of patients requiring medical intervention;

b) Implementing mobile technologies to proactively capture information from a patient, allowing the clinician to review this data prior to the appointment. This could potentially negate the need for the appointment and as a minimum would reduce appointment times leading to further improvements in the quality of patient care;

c) Mobile device applications capable of sending alert triggers when patients report significantly out of range indicator levels, to deliver improvements in patient care for diabetes sufferers. Interactive questionnaires on diabetes self-management could capture patient responses making them instantly available for healthcare providers to review and follow up.



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Appendix 2. Plan, timescales & Business Unit priorities SUHFT IT Programme & Project Portfolio

CATEGORY DESCRIPTION

Mandatory Programme/project driven nationally/legal or by system reaching end of life or at capacity

Strategic Medium or long term programme/project to deliver a Modern and Efficient hospital

Tactical Short term programme/project to deliver a Modern and Efficient hospital

Admin - BAU Maintaining current systems and support

Innovation Small, high risk project to prove emerging technologies to support new ways of working

Cost Improvement Projects to deliver BU and corporate CIPs

TRUST IMPACT

1- Critical Major impact on hospital services if not delivered

2- Highly Desirable Significant impact on hospital services if not delivered

3 - Desirable Minor impact on hospital services if not delivered

TOTAL COST OWNERSHIP (TCO) INVESTMENT

Major + £5M to £10M

Major £1M to £5M

Significant £100K to £1M

Minor £0 to £100K



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PROGRAMME/PROJECT NAME PROJECT TYPE

(Large/Medium/Small)

TCO INVESTMENT

(See above)

BUSINESS CHANGE

IMPACT

(Major/Significant/Mino

r)

BENEFITS - SAVINGS,

QUALITY & SAFETY

(Major/Significant/Min

or)

SPONSOR CATEGORY

(See above)

TRUST

IMPACT

(See above)

Corporate Objective 2013/14 2014/15 2015/16 2016/17 2017/18

Mobile Working and Bring Your Own Device (BYOD) Medium Project Minor Minor Significant RW Tactical 2 PF, S, GS, CS, RIE, P X

BYOD tablet devices Small Project Minor Minor Significant RW Tactical 2 PF, S, GS, CS, RIE, P X

Clinical devices i.e. cardiac monitors etc. Small Project Minor Minor Minor RW Tactical 2 PF, S, GS, CS, RIE, P X

Patient Wi-Fi Small Project Minor Minor Significant RW Tactical 3 PF, S, GS, CS, RIE, P X X

SystmOne and the Clinical Record Viewer (CRV) Medium Project Minor Minor Significant RW Tactical 2 PF, S, GS, CS, P X X

Pharmacy Small Project Minor Minor Significant DP Tactical 2 PF, S, GS, CS, P X

Midwifery Small Project Minor Minor Significant AP Tactical 2 PF, S, GS, CS, P X

Paediatrics Small Project Minor Minor Significant AP Tactical 2 PF, S, GS, CS, P X

Vascular Surgery Small Project Minor Minor Significant SS Tactical 2 PF, S, GS, CS, P X

Diabetes Small Project Minor Minor Significant SS Tactical 2 PF, S, GS, CS, P X X

Ophthalmology Small Project Minor Minor Significant RA Tactical 2 PF, S, GS, CS, P X X

Pre-assessment Small Project Minor Minor Significant KK/JL Tactical 2 PF, S, GS, CS, P X

Patient SMS Appointment Reminders Medium Project Minor Minor Significant Tactical 2 PF, S, CS, RIE, P X X

Outpatients pilot Small Project Minor Minor Significant CC Tactical 2 PF, S, CS, RIE, P X

Trust-wide implementation Medium Project Minor Minor Significant RW Tactical 2 PF, S, CS, RIE, P X X

Patients of Interest Result Alerting Medium Project Minor Significant Significant Tactical 2 PF, S, CS, RIE, P X

Acute Oncology Small Project Minor Minor Major DP Tactical 2 PF, S, CS, RIE, P X

Clinical trials Small Project Minor Minor Major NR Tactical 2 PF, S, CS, RIE, P X

HOT-TIA Small Project Minor Minor Major DS Tactical 2 PF, S, CS, RIE, P X

Diagnostic results Small Project Minor Minor Major DP Tactical 2 PF, S, CS, RIE, P X

Electronic Patient Record (EPR) Programme Major + Major Major RW Strategic 1 PF, S, CS, RIE X X X

PAS Phase1 Large Project Major + Major Major RW Mandatory 1 PF, S, GS, CS X

PAS Phase2 Large Project Major Major Major RW Strategic 2 PF, S, GS, CS, RIE, P X X X

Whiteboards Medium Project Significant Significant Major RW Strategic 1 PF, S, GS, CS, RIE, P X X

Real time bed management Medium Project Minor Significant Major SSt Tactical 1 PF, S, GS, CS, RIE, P X X

Clinical Noting (care pathways) Large Project Major Major Major RW Strategic 2 PF, S, GS, CS, RIE, P X X

Portal Large Project Significant Significant Major RW Strategic 2 PF, S, GS, CS, RIE, P X X

Clinical Forms Large Project Significant Major Major RW Strategic 2 PF, S, GS, CS, RIE, P X X X

eCorrespondance Medium Project Minor Minor Major RW Strategic 2 PF, S, GS, CS, RIE, P X X X

Electronic Document Management (EDM) Programme Major + Major Major NR Strategic 1 PF, S, GS, CS, RIE, P X X X X X

CED Development to support Noteless Clinics Medium Project Minor Minor Major NR Cost Improvement 2 PF, S, GS, CS, RIE, P X X

Rehab Small Project Minor Minor Major GP Cost Improvement 2 PF, S, GS, CS, RIE, P X

Cardiology Small Project Minor Minor Major CC Cost Improvement 2 PF, S, GS, CS, RIE, P X

Vascular Surgery Small Project Minor Minor Major MS Cost Improvement 2 PF, S, GS, CS, RIE, P X

Anaesthetic Preassessment Small Project Minor Minor Minor BB Strategic 2 PF, S, GS, CS, RIE, P X

EDM System (Scott West to advise) Large Project Major + Major Major SW Strategic 1 PF, S, GS, CS, RIE, P X X X X X

Big Data & Healthcare Analytics Large Project Minor Minor Major SW Admin - BAU 1 PF, S, GS, CS, RIE, P X X X

All Clinical Outcomes Large Project Minor Significant Major SW Mandatory 1 PF, S, GS, CS, RIE, P X X X

Cancer Outcomes and Services Dataset (COSD) Medium Project Minor Significant Minor SW Mandatory 1 PF, S, GS, CS, RIE, P X X

Single Sign-On (SSO) Large Project Significant Minor Major RW Tactical 2 S, GS, CS, RIE X X

e-Prescribing Large Project Major Major Major DP Strategic 1 PF, S, GS, CS, RIE, P X X

RIS Replacement Large Project Significant Major Significant DP Mandatory 1 PF, S, GS, CS X

Board of Directors’ Meeting Report – Agenda item 209/14 · Board of Directors’ Meeting Report...

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