INFORMATICS STRATEGY 2013-2016 Version 1.5.8 For ... IMT Strategy … · informatics strategy...
57
INFORMATICS STRATEGY 2013-2016 Version 1.5.8 For PORTSMOUTH, FAREHAM AND GOSPORT & SOUTH EASTERN HAMPSHIRE CLINICAL COMMISSIONING GROUPS APPROVED: NHS PORTSMOUTH CCG GOVERNING BOARD 24 JULY 2013
Transcript of INFORMATICS STRATEGY 2013-2016 Version 1.5.8 For ... IMT Strategy … · informatics strategy...
INFORMATICS STRATEGY 2013-2016 Version 1.5.8
For
PORTSMOUTH, FAREHAM AND GOSPORT & SOUTH EASTERN HAMPSHIRE
CLINICAL COMMISSIONING GROUPS
APPROVED: NHS PORTSMOUTH CCG GOVERNING BOARD
24 JULY 2013
1 Table of Contents
EXECUTIVE SUMMARY .................................................................................................. 7
CHAPTER 1 – INTRODUCTION .................................................................................... 12
1.1 PURPOSE OF STRATEGY .............................................................................. 12
1.2 BACKGROUND ................................................................................................ 12
1.3 IM&T, INFORMATION AND INFORMATICS .................................................... 13
1.4 STRATEGIC BUSINESS AIMS ........................................................................ 14
1.4.1 Portsmouth Clinical Commissioning Group ................................................ 14
1.4.2 Fareham and Gosport Clinical Commissioning Group ............................... 14
1.4.3 South Eastern Hampshire Clinical Commissioning Group ......................... 15
1.5 THE STRATEGIC AIMS OF INFORMATICS .................................................... 15
1.6 SCOPE ............................................................................................................. 16
CHAPTER 2 - DRIVERS ................................................................................................ 17
2.1 NATIONAL DRIVERS ....................................................................................... 17
2.1.1 The Information Revolution ........................................................................ 17
2.1.2 The Power of Information .......................................................................... 18
2.1.3 Everyone Counts: Planning for Patients 2013/14 ....................................... 18
2.1.4 Setting priorities ......................................................................................... 19
2.2 LOCAL DRIVERS ............................................................................................. 19
2.2.1 Collaborative Working ............................................................................... 19
2.2.2 Local Aims and Ambitions ......................................................................... 20
2.2.3 Flexible ways of working ............................................................................ 20
2.2.4 Mobile Computing ..................................................................................... 20
CHAPTER 3 – ROLES, RESPONSIBILITIES AND RELATIONSHIPS............................ 21
3.1 COMMISSIONERS RESPONSIBILITIES ......................................................... 21
3.1.1 Informatics ................................................................................................. 21
3.1.2 Information Governance ............................................................................ 21
3.1.3 Disaster Recovery/Business Continuity ..................................................... 23
3.2 COMMISSIONER’S RELATIONSHIP WITH PROVIDERS ............................... 23
3.2.1 Securing contractual arrangements ........................................................... 23
3.2.2 Data ownership ......................................................................................... 23
3.2.3 Collaborative approach .............................................................................. 24
3.2.4 Managing IT-enabled change .................................................................... 24
3.3 PARTNERSHIPS.............................................................................................. 25
3.3.1 Commissioning Support Unit (CSU) .......................................................... 25
3.3.2 Island and Portsmouth Informatics Service (IPHIS) ................................... 26
3.3.3 Working with Portsmouth City and Hampshire County Council .................. 26
3.3.4 Independent Contractors and AQPs .......................................................... 26
3.3.5 GP Systems .............................................................................................. 26
CHAPTER 4 – VISION FOR THE FUTURE, OUR STRATEGIC OBJECTIVES .............. 27
4.1 Overall Vision ................................................................................................... 27
4.2 OUR STRATEGIC OBJECTIVES ..................................................................... 27
4.2.1 Driving Integrated Care – Integrating health and care records ................... 30
4.2.2 Information to Support Patients ................................................................. 30
4.3 HELPING STAFF TO SUPPORT PATIENTS ................................................... 32
4.3.1 Our vision for Sharing care plans and records ........................................... 32
4.3.2 Electronic Discharge Summaries and GP Letters ...................................... 32
4.4 INFORMATION TO SUPPORT THE COMMISSIONER ................................... 32
4.4.1 Data capture and collection ....................................................................... 32
4.4.2 Data quality ............................................................................................... 33
4.4.3 Analysis and reporting ............................................................................... 33
4.4.4 Performance Tools and Dashboards ......................................................... 33
CHAPTER 5 – CURRENT PRIORITIES AND KEY PROGRAMMES .............................. 34
5.1 INTRODUCTION .............................................................................................. 34
5.2 ELECTRONIC DISCHARGE SUMMARIES (EDS) ........................................... 35
5.3 ELECTRONIC PRESCRIPTION SERVICE ...................................................... 35
5.4 SHARED CARE PLANS AND HHR V2 ............................................................. 35
5.5 END OF LIFE CARE REGISTER ..................................................................... 35
5.6 WIRELESS ....................................................................................................... 36
5.7 VIDEO CONFERENCING ................................................................................ 36
CHAPTER 6 – ENABLING STRATEGIC CHANGE & DELIVERING THE STRATEGY ... 37
6.1 IDENTIFYING HIGH PRIORITIES WHERE CHANGE IS NEEDED .................. 37
6.2 TEN AREAS OF HIGH PRIORITY FOR 2013/14 ............................................. 38
6.2.1 PRIORITY AREA 1 - System Integration ................................................... 38
6.2.2 PRIORITY AREA 2 - Future IM&T Provision .............................................. 38
6.2.3 PRIORITY AREA 3 - Patient Access ......................................................... 39
6.2.4 PRIORITY AREA 4 - GP Systems ............................................................. 39
6.2.5 PRIORITY AREA 5 – Electronic Prescription Service Release 2 (EPSR2) 40
6.2.6 PRIORITY AREA 6 – Electronic Discharge Summaries ............................. 40
6.2.7 PRIORITY AREA 7 – Electronic Referrals (Choose and Book) .................. 40
6.2.8 PRIORITY AREA 8 - NHS Number ............................................................ 40
6.2.9 PRIORITY AREA 9 – Clinical Support and Intelligence ............................. 40
6.2.10 PRIORITY AREA 10 - Technology supporting Local business needs ........ 41
6.3 BEYOND 2013/14 ............................................................................................ 42
6.3.1 Summary Care Record (SCR) ................................................................... 42
6.3.2 Patient Letters & Results from all Care Providers to GPs .......................... 42
6.3.3 Telemedicine, Telehealth and Telecare (Telehealthcare) .......................... 42
6.3.4 Patient Decision Aids ................................................................................. 42
6.3.5 On-going Technical Infrastructure development ........................................ 43
CHAPTER 7 – RESOURCES ..................................................................................... 44
6.4 CAPACITY AND CAPABILITY.......................................................................... 44
6.5 FINANCE ......................................................................................................... 44
APPENDIX A – ACTION PLAN 2013/14 – 2016/17 ........................................................ 46
APPENDIX B – GLOSSARY ........................................................................................... 55
DOCUMENT CONTROL & READER INFORMATION
This version: Version 1.5.8 2nd
July 2013
Previous version: 1.5.7
Document
classification:
Can be made available to the public
Amendments since
previous version:
Various additional references to Social Care, Local Authorities and Hampshire County
Council following comments from Hampshire County Council and affecting the following
paragraphs:
Influence and Drivers - Executive Summary
Managing IT-enabled change – Executive Summary
Enabling Strategic Change – Executive Summary
Para 3.1.2 Information Governance
Para 3.2.4 Managing IT-enabled change.
Para 4.1 Overall Vision
Amendment History: Version 1.0 - 1.5.3 Incorporated comments from the Informatics Strategy
Development Team (Dr Ian Bell, Dr Kevin Vernon, Jo Gooch and
Andy Wood)
Version 1.5.4 Amendments and changes following the PSEH Commissioning
Collaborative in the following areas:
Additions
Para 6.2.10.3 Portsmouth Information Portal (PIP) and Decision
Support.
Amendments
Para 6.2.9 Telehealth and the AIM project – Amended to include
Portsmouth and South Eastern Hampshire CCGs in the AIM
project to run in parallel with Fareham and Gosport CCG.
Para 3.2.4 Managing IT-enabled change - Amended diagram to
include a ‘dotted line’ between the ITECB and the IISG
Para 5.2 Electronic Discharge Summaries (EDS) –
Version 1.5.5 Amendments and changes following the joint Clinical Cabinet
(Fareham & Gosport and South Eastern Hampshire CCGs) May
22nd 2013.
Additions
Para 4.2.2.3 - Choose and Book and the new NHS eReferrals
Service.
Changes
The following paragraphs have been modified to reflect the
proposed replacement of the Choose and Book Service:
Executive Summary
Para 3.2.1 – Securing contractual arrangements
Para 4.2.2 – Information to support the patient
Para 6.2.7 – Priority 7 – Electronic referrals
Also changes have been made to paragraph 6.3.1 to reflect the
potential of deploying the Summary Care Record.
Version 1.5.6 Amendments and changes following the PSEH Commissioning
Collaborative and follow up meeting with Katie Hovenden to
address Risk Stratification Tools.
Modification
Re-named paragraph 6.2.9 “Telehealthcare” to “Clinical Support
and Intelligence”
Additions
Para 6.2.9.2 – Risk Stratification. Added paragraph to cover risk
stratification tools in general.
Action Plan – Specific work schedule for CSU to implement and
arrange training for Eclipse and Eclipse Live.
Version 1.5.7 Correct the name from “South Coast Ambulance” referenced in
paragraph 1.5 to “South Central Ambulance“ made in error.
Document purpose: Informatics Strategy for Portsmouth, Fareham and Gosport and South
Eastern Hampshire CCGs
Action required: CCG Review
Timing of action: 30th April 2013
Author: Project Officer – IT Strategy and Development
Contact Details: Portsmouth Clinical Commissioning Group
CCG HQ,
St James Hospital,
Locksway Road, Milton,
Portsmouth, PO4 8LD
Target Audience: All staff who have an invested interest in informatics related issues,
including CCGs partners across Hampshire and CSU
Distribution List: Initially, Board members for the CCGs
Description: Informatics strategy for the three CCGs that form the Portsmouth,
Fareham and Gosport and South Eastern Hampshire CCG Compact,
which considers Information Management & Technology (IM&T),
Information Communication Technology (ICT) and Information
Governance (IG).
Standard Disclaimer: Portsmouth, Fareham and Gosport and South Eastern Hampshire
CCGs makes no representations, warranties or guarantees as to the
accuracy, completeness or adequacy of the content of this document
and cannot be held responsible for any loss or damage whatsoever
which may arise from the use of, or reliance upon, this document
except as may otherwise be required by law.
Please contact us (see Contact Details, above) if you believe that
information in this document is inaccurate or out of date.
EXECUTIVE SUMMARY
INTRODUCTION
With a long and successful history of collaborative working across the geography of Portsmouth and South East Hampshire and a shared reliance in broadly equal measure on acute services provided by Portsmouth Hospitals NHS Trust the three CCGs representing the population of Portsmouth and South East Hampshire have agreed to work together by agreeing a collaborative compact.
This Informatics Strategy has therefore been developed for the following CCGs that represent the Compact:
NHS Fareham and Gosport Clinical Commissioning Group
NHS Portsmouth Clinical Commissioning Group
NHS South Eastern Hampshire Clinical Commissioning Group
From this point on all reference to “the Compact” or “the Commissioner” will refer to the three CCGs collectively.
The strategy focuses on information in its broadest sense, including the support people need to navigate and understand the information available. This is about ensuring that information reduces, not increases, inequalities and benefits all. The success of this strategy depends as much on the way patients and professionals think, work and interact as it does on IT and information systems and is set out over the following seven chapters:
Introduction
Influence and Drivers
Roles, Responsibilities and Relationships
Vision for the Future and our Strategic Objectives
Current Priorities and Key Programmes
Enabling Strategic Change and Delivery the Strategy
Resources
PURPOSE OF THE STRATEGY
The purpose of the strategy is to provide the direction of travel for Informatics over the next 3 years enabling the three CCGs representing the populations of Portsmouth, Fareham and Gosport and South East Hampshire to achieve their respective commissioning strategies and plans.
It is also the CCGs response to the 2012 Health and Social Care Act that articulates the need for patients to be able to make decisions about their care whilst emphasising the need to increase efficiency through the effective use of technology.
INFLUENCE AND DRIVERS
The strategy takes into account a number of national priorities that have an effect on the Informatics agenda including:
The Information Revolution (August 2011) describing the information people need to stay healthy, take decisions and exercise more control over their care.
The Power of Information published in May 2012 sets out a ten-year framework for achieving higher quality care and improve outcomes by the use of new technologies
Everyone Counts: Planning for Patients 2013/14 provides the underlying principle to empower clinicians to deliver better outcomes, increase information for patients and to demonstrate greater accountability to the communities the NHS serves.
From a local perspective the strategy sets out its vision as an enabler of the CCGs commissioning and business plans that include:
Keeping the local population healthy with a prevention programme targeted to attain maximum health benefits and seeking opportunities to reduce the reliance on secondary care.
Drive up productivity by reducing duplication, improved job planning and organisation of workload.
Flexible ways of working and mobility to support staff working across multiple sites ensuring they remain connected to their email, calendars and vital information sources wherever they happen to be working.
Working with partners to ensure the delivery of integrated health and social care is supported by information technology.
ROLES, RESPONSIBILITIES AND RELATIONSHIPS
Commissioners Responsibilities
The Commissioner has a dual role in terms of Informatics. Firstly, to secure effective and efficient systems to manage its core business and secondly to encourage its health and care providers to identify what is required from a patient or service user perspective.
The Commissioner is also responsible for ensuring safe and secure information under the umbrella of Information Governance and that its own IM&T service and that of its providers of care have robust disaster recovery processes and business continuity plans in place
Commissioners Relationships with its Providers
In commissioning health care for the population, the Compact will use the Standard NHS Contract which will set out the contracted activity levels, penalties, incentives and financial arrangements.
In Primary Care, GPs have to ensure that they meet the standards set out in the Quality of Outcomes Framework using the Calculating Quality Reporting Service (CQRS) to assess their achievement. Past emphasis on data feeds into key data repositories, such as SUS and the Hampshire Health Record (HHR) will continue but will also include improvements in areas such as electronic referrals, GP Letters and discharge summaries as well as the introduction of on-line services such as patient on-line access to their primary care records.
Partnerships
The Commissioner is supportive of the use of Commissioning Support Unit (CSU) arrangements for many of its back office functions including Informatics, Business Intelligence and Information Governance with arrangements already in place with NHS South CSU. Agreeing the Informatics Strategy and associated action plan with the CSU will
be essential as it will represent the Compact’s informatics work plan and operating intentions that in a large part will be delivered by the CSU
In respect of current IM&T provision the Commissioner has direct access to the Island and Portsmouth Health Informatics Shared Service (IPHIS) for day-to-day business with contractual arrangements and major project development managed by NHS South CSU. However following a local health community decision to withdraw from shared IM&T arrangements there is some doubt over the future provision of IM&T services. Finding alternative arrangements will be a priority for the CCGs during 2013/14.
Portsmouth City and Hampshire County Council are key partners of the CCGs. Working between Health and Social Care requires joined up strategic planning and early identification of duplication or non-alignment of policies and care pathways. Information therefore needs to flow between health and local authority organisations without losing meaning and context.
Managing IT-enabled change
Board level governance arrangements, in respect of the Informatics agenda, comprise of an IT-Enabling Change Board supported by a number of working groups. The Terms of Reference for the IT-Enabling Change Board set out its responsibility to lead across the free scope of strategic Informatics agenda but specifically to concentrate upon areas of priority where significant benefits can be realised. The ITECB will link with the Information and IT Steering Group, hosted by the CSU, providing a conduit for the alignment of IT plans with our CCG colleagues across Hampshire. Local Authorities are represented on the ITECB ensuring alignment with Public Health, Social Care and other Local Authority activity.
VISION - OUR STRATEGIC OBJECTIVES
Liberating the NHS: Equity and Excellence sets out the governments aims of providing a health service that puts the patient at the centre of the health and care system by providing choice and involvement in the management of their care
The Commissioner fully supports these principals but does not underestimate the challenges
facing the NHS in delivering them. It will require cooperation, innovation and creativity both
from ourselves and from our health, care and IM&T providers.
As a key enabler for the delivery of the Commissioner’s strategic objectives it is important to
have a clear informatics strategy that contributes to the integration of services agenda and
whole system sustainability. In this respect the Commissioner has 4 key strategic objectives
as follows:
1. Driving Integrated Care – Integrating health and care records through the pursuit of
a system integration agenda by investigating technical options and choosing the
direction of travel that best suits the needs of the Commissioner and its patients.
2. Information to support patients, carers and the public - supporting general
practices to make available on-line services including patient access to their records,
booking appointments and ordering of repeat prescriptions.
3. Helping staff (clinicians and social care professionals) support patients -
introduce county wide use of shared electronic care plans and End of Life Care
Register; ensuring all discharge summaries are sent electronically from Portsmouth
Hospitals Trust to GPs; implement the Electronic Prescription Service.
4. Information to support the Commissioner – Ensuring all Information required to
enable informed business decisions will be easy to access e.g. via web; easy to
understand e.g. dashboard, scorecards etc; pertinent e.g. alerts to staff/roles via e-
mails and workflows.
CURRENT PRIORITIES AND KEY PROGRAMMES
There are number of on-going IM&T projects and programmes that whilst initiated by the
PCT to support existing strategies their continuation will serve the CCGs very well in that
they will provide essential foundations for future development in meeting short/medium term
needs. There are also a number of key projects initiated by the PCT Cluster that align with
the Commissioner’s strategy going forwards these include:
Electronic Discharge Summary (EDS)
Electronic Prescription service (EPS)
Shared Care Plans and HHR V2
End of Life Care Register (EOLCR)
Wireless - Introduction of WiFi to allow safe and secure Guest across local network infrastructure
Video conferencing and meetings
ENABLING STRATEGIC CHANGE – DELIVERING THE STRATEGY
Our strategic vision is necessarily ambitious and will take time to realise. Translating it into reality will require a pragmatic and realistic approach and will be progressed with the help of a comprehensive action plan; regularly updated and performance managed. Year one will be crucial as we need to take decisions that will affect our overall direction of travel and set the scene for the future.
There is a lot to do and therefore a need to prioritise on the areas of greatest need first. Year one will include making decisions about longer term developments to support an integrated approach to sharing clinical information and ensuring a stable IM&T provision for the future. Year one will also include enabling programmes to support clinically-led commissioning set out in Everyone Counts: Planning for Patients 2013/14.
More specifically the Commissioner has identified ten areas of high priority for 2013/14 although aspects of some areas will continue beyond the first year. The ten areas of high priority for 2013/14 are as follows:
Priority area 1 - System Integration. The Commissioner will invest in the best solution for the local health community to meet short and medium term goals whilst ensuring investment secures effective interoperability for the longer term
Priority area 2 - Future IM&T Provision. The commissioner will work with the CSU during 2013/14 to develop plans and implement the re-provision of IM&T services to run concurrently from 1st April 2014.
Priority area 3 - Patient on-line Access to Primary Care services. Phased programme beginning with a small number of GP Practices concentrating on a cohort of patients with long term conditions.
Priority area 4 - GP Systems. Upgrade GP systems to latest and hosted versions of software (Priority in order to support the Electronic Prescription Service, patient access to their care records and patient access to book appointments).
Priority area 5 – Electronic Prescription Service Release 2.
- Secretary of State Directions. Prepare and apply for Secretary of State Directions to implement EPS R2 on behalf of Fareham and Gosport and South Eastern Hampshire CCGs.
- Implementation. Roll out EPS R2 across Portsmouth city.
Priority area 6 – Electronic Discharge Summaries (EDS). Following the implementation of EDS from PHT to GP Practices across Portsmouth, Fareham and Gosport and South Eastern Hampshire further develop the process so that the EDS automatically integrates into all GP practice systems workflow.
Priority area 7 - Choose and Book / NHS eReferrals Service. Encourage increased availability and more efficient use of the electronic referral service for both primary and community care.
Priority area 8 - NHS Number. Ensure the widespread use of the NHS number as the primary identifier in all information systems. This is an essential requirement in supporting system inter-operability.
Priority area 9 – Telehealthcare and the AIM project. Embark upon the clinical roll-out of the Advice and Interactive Messaging (AIM) to pilot a telehealthcare scheme that uses text messages to support patients with long term conditions or help them change life style habits.
Priority area 10 - Technology supporting Local business needs. Implement technology to supports the Commissioner’s flexible working strategy (WiFi, Open Network Infrastructure and Virtual Desktop.) and the development of the Portsmouth Information Portal (PIP) as a key communication and decision support tool.
Years two and three will see further work and increased development activity in support of the integration agenda (including across health and social care), the provision of patient on-line services to primary care, telemedicine and the development of health and care information portals.
CHAPTER 1 – INTRODUCTION
1.1 PURPOSE OF STRATEGY
This Strategy will provide the direction of travel for Informatics over the next 3 years and identify where the CCGs are on that journey in order to achieve that vision. Of fundamental importance is that the strategy is not seen as a stand-alone document but one which supports the commissioning strategies and plans and is aligned with priorities and resources available. Moreover it is vital that Informatics plays a key enabling function and becomes very much part of the lives of everyone in the NHS. Of equal importance is that the CCGs provide leadership in respect of the Informatics agenda as a whole and work closely with our service providers in ensuring our direction of travel is in alignment with their own individual strategies and theirs with ours. Providing the technological means to enable good ideas to be put into practice is not always easy. We must therefore be vigilant in recognising innovation when and where it presents itself by creating an environment that encourages and supports new ideas that have the potential to improve the health and care for our patients, carers and service users.
This strategy focuses on information in its broadest sense, including the support people need to navigate and understand the information available. This is about ensuring that information reduces, not increases, inequalities and benefits all. The success of this strategy depends as much on the way patients and professionals think, work and interact as it does on IT and information systems. It depends on making the shift to give patients more control of their health and care and on recognising that professionals collecting and sharing good information is pivotal to improving the quality, safety and effectiveness of patient care.
1.2 BACKGROUND
Both Equity and excellence: Liberating the NHS and Liberating the NHS: An Information Revolution stressed the importance of good information being a key enabler to high quality health and care services. The scale of change and challenge to the NHS proposed by the 2012 Health and Social
Care Act with the need for patients to be able to make informed decisions about their care
and an emphasis on increasing efficiency require unprecedented levels of detail in the
information used to support commissioning activity. In recognition the Department of Health
published The Power of Information, which outlines how the NHS should use information to
achieve the following:
Information used to drive integrated care across the entire health and social care sector, both within and between organisations
Information regarded as a health and care service in its own right for us all – with appropriate support in using information available for those who need it, so that information benefits everyone and helps reduce inequalities
A change in culture and mind-set, in which our health and care professionals, organisations and systems recognise that information in our own care records is fundamentally about us – so that it becomes normal for us to access our own records easily
Information recorded once, at our first contact with professional staff, and shared securely between those providing our care – supported by consistent use of
information standards that enable data to flow (interoperability) between systems whilst keeping our confidential information safe and secure
Our electronic care records become a key source of the health and care information used to improve our care, improve services and to inform research, etc. – reducing bureaucratic data collections and enabling us to measure quality.
A culture of transparency; where access to high-quality, evidence-based information about services and the quality of care held by Government health and care services is openly and easily available to us all
An information-led culture where all health and care professionals – and local bodies whose policies influence our health, such as local councils – take responsibility for recording, sharing and using information to improve our care.
The widespread use of modern technology to make health and care services more convenient, accessible and efficient
An information system built on innovative and integrated solutions and local decision-making, within a framework of national standards that ensure information can move freely, safely, and securely around the system.
It is from these principles that our informatics strategy has been developed and will help us shape our business over the next three to five years by informing our aims and objectives and prioritising on areas of greatest need. Much of the technical and analytical functions needed to help us deliver the strategy will be provided by the Commissioning Support Unit (CSU). As the CSU will also be supporting our CCG partners across the rest of Hampshire they will be best placed to take advantage of economies of scale and manage major IT projects that straddle our natural boundaries. There may however be instances where individual CCGs either have specific information needs or where strategically there is a need to develop bespoke systems for their own use. The strategic importance of IM&T in enabling the ambitions set out in this strategy cannot be underestimated, indeed, without technology the vision will not be realised. We must therefore ensure that IM&T plays a major role in the future strategic development of the CCGs and consideration will be given to the development of a role within the CCGs to manage the strategic direction of IM&T and take responsibility for the client-side relationship with the CSU.
1.3 IM&T, INFORMATION AND INFORMATICS
Whilst IM&T is the technical driving force behind information, Informatics represent the knowledge, the skills and the tools to enable information and information systems to be used, managed and shared effectively. The Informatics agenda set out in this strategy builds upon previous good work and investment in IM&T programmes which has provided firm foundations to facilitate effective use of technology. Achieving the ambitions of this Strategy will have profound positive effects on patients, service users and staff, improving safety and quality.
“High quality health and care services depend on good information. The right person having the right information at the right time can make all the difference to the experience of a patient, service user or carer. Good information also enables care professionals to make the process of care safer and more efficient. Information is a health and care service in its own right: it must be freely available to all who need it.” (Liberating the NHS: An Information Revolution – DH 18th August 2011)
1.4 STRATEGIC BUSINESS AIMS
The three Clinical Commissioning Groups representing Portsmouth, Fareham and Gosport and South Eastern Hampshire have set out their business aims in support of their individual population needs. These aims, detailed below, will inform their business decisions and significantly influence the development of the Informatics strategy.
1.4.1 Portsmouth Clinical Commissioning Group
Investment in urgent and integrated care particularly for the frail and elderly to significantly reduce non-elective admissions and re-admissions and increase the number of Anticipatory Care Plans for patients with long term conditions.
Reduce outpatient and follow-up appointments at hospital and achieve and sustain A&E clinical indicators including 4 hour wait. Also reduce the number of patients conveyed by ambulance to hospital where alternative transport is more appropriate.
Develop clinical care pathways to improve planned care by implementing care closer to home, reducing waiting times and sustained improvements in GP referrals to secondary care.
Invest in Maternity and Child Health to narrow the gap in foundation stage profile scores for communication, language/literacy and personal and social development. Also ensure the right care and programmes are available when and where they are required including access to assessments for Autism.
Improving access to services for those most vulnerable (such as those with mental health problems, learning disabilities), and those from the most deprived populations by delivering greater capacity and quality of services.
Maintain excellent track record on prescribing and medicines management through the delivery of Primary Care prescribing efficiencies and the review of secondary care prescribing (High Cost)
Investment in health promotion and social marketing in partnership with the local authority to help people stay healthy and to take greater responsibility for their own health and well being
Focus on cost and clinically–effective ill-health prevention to allow greater independence and avoid the unnecessary use of hospital services.
1.4.2 Fareham and Gosport Clinical Commissioning Group
Supporting the access of all communities to high quality care and tackling health inequalities by working with local government and voluntary sector partners.
Managing change in the health and social care system while ensuring continuity and improving quality by delivering care in the most appropriate setting.
Ensuring the best outcome for patients through the development of integrated pathways with single points of access.
Improving the quality of care and outcomes for patients by refining GP referrals through improved decision support systems and provide patient choice about where they are treated
Improving the experience and outcomes for the frail and elderly and people with long term conditions by developing and increasing the range of care services closer to home.
Improving maternity services and services for children to better meet changing needs. This will include the development of a Children and Families engagement strategy and a review of the Paediatric Nursing Services.
Transforming the acute paediatric pathway to give a single point of access and decision making.
Implement staying healthy programme focused on most deprived populations, particularly the Vascular inequalities and childhood obesity programmes.
Enabling people with mental health conditions and learning disabilities to receive care, closer to home at the right time.
1.4.3 South Eastern Hampshire Clinical Commissioning Group
Reduction of non-elective hospital admissions and particularly unplanned admissions for diabetes and cardiovascular disease.
Increase in carer support for the frail elderly and patients with dementia and greater proportion of dementia cases diagnosed early.
Increase in people dying in a place of their choice.
Increase in the percentage of discharge summaries that are electronic and issued on the day of discharge.
Increase the proportion of patients being treated by primary care and community care providers
Reduction in paediatric admissions to secondary care
Reduction in the number of women who are smokers at the end of their pregnancy
An increase in integrated multidisciplinary community mental healthcare provision to reduce the number of mental health admissions.
Primary care working in partnership with specialist teams and carers to reduce physical health inequalities for those with learning disabilities.
Overhaul medicines management to address the variance in prescribing practice, reduce in inappropriate high cost prescribing, increased effectiveness of primary care prescribing.
Reduce the percentage of children in a reception year with height/weight recorded as obese.
1.5 THE STRATEGIC AIMS OF INFORMATICS
In the context of Informatics, the strategic role of the Clinical Commissioning Group is to influence the direction of travel within the local health community and jointly agree strategic priorities across both provider and partner organisations. These include Portsmouth Hospitals NHS Trust; the Community and Mental Health Providers (Southern Health and Solent NHS Trust); South Central Ambulance (NHS 111 and 999 services); Care UK ( Independent Sector Treatment Centre (ISTC) and Out of Hours services); Portsmouth City Council and Hampshire County Council. The CCGs aim to ensure that organisational strategies for Informatics are aligned and gaps identified with clear plans to manage or act upon the areas where there is room for improvement. Historic strategic investment in local IT infrastructure and continued advancement of technology provides the potential for producing significant benefits to the local health and care system. It is important therefore that we capitalise on this position and realise the benefits in a timely and expedient manner and include:
Facilitating shared access to clinical data, which can either be patient specific or collective data used to drive improvements in quality and in making evidence based decisions.
Enabling patients to make use of their right to choose their care provider, location or type of care. Using technology to book appointments, rearrange and receive notification of appointments and get on-line access to their care records.
Strengthening communication and the sharing of information between organisations, to ensure patients are cared for seamlessly across organisations or speciality
boundaries. This will promote less duplication, improved quality and safer ways of working.
Significantly increase information collected as a consequence of a patient’s interaction with care services reducing the need to repeatedly record the same patient information.
Ensuring personal/sensitive data is kept securely and only used for the purpose it was collected in accordance with the 1998 Data Protection Act and the principles of the 1997 Caldicott report.
Achievement of financial savings, through efficient working using technology to minimise duplication or ineffective administration.
P&SEH CCGs recognise the enormous added value attributed to what can be achieved to deliver the above objectives when the local health community work together. However, it does not underestimate the challenges of driving the Informatics agenda forward at a time of significant cultural change and challenge in financial, organisational and delivery model terms.
1.6 SCOPE
The Strategy looks at the informatics provision affecting the Health Community which inevitably touches upon national systems such as SUS, the National Spine, care.data and local Informatics plans for both Commissioners and Providers of NHS care and interfaces with Local Authorities. It looks at all IM&T systems which will, in the main, be clinical systems, however informatics will also have other responsibilities that include applications such as Finance and Workforce.
CHAPTER 2 - DRIVERS
2.1 NATIONAL DRIVERS
This strategy takes into account a number of national priorities that have an effect on the Informatics agenda as well as factors influencing strategic thinking at a local and regional level. The drivers are summarised below.
2.1.1 The Information Revolution
The Information Revolution (August 2011) describes a vision [of an information revolution] in which people have the information they need to stay healthy, take decisions about and exercise more control over their care, and make the right choices for themselves and their families. This will need to include accurate records of their care which will be available to them electronically. Transforming the way information is collected, analysed and used by the NHS and adult social care services will be critical to achieving its main ambitions:
The Information Revolution benefits everyone and does not increase inequalities
Information to improve outcomes
Need for information to be linked across Health, Social Care and Public Health
Patients have access to information held in their own records
Information for Patients, Service Users, Carers and the Public
The need for clear routes to information (Help in sign-posting and navigation)
Information for Autonomy, Accountability and Legitimacy
The need for a single set of Information Standards
Summary: This chapter covers those areas of priority that has influenced the strategy both in a national and
local context.
Key references and publications:
The Information Revolution published August 2011
The Power of Information was published in May 2012
Everyone Counts: Planning for Patients 2013/14 published December 2012
Putting Patients First: The NHS England Business Plan 2013/14 to 2015/16
Key ambitions:
Keep the population healthy.
Seek opportunities to help patients with long term health conditions in managing their own care and
treatment.
Drive up productivity by reducing duplication
Introduce flexible ways of working
2.1.2 The Power of Information
The Power of Information was published in May 2012 and sets a ten-year framework for transforming information for health and care by harnessing the value of information and new technologies to achieve higher quality care and improve outcomes for patients and service users. There is a focus on information in its broadest sense, including providing the support people need to navigate and understand the information that is available and ensuring that information reduces, not increases, inequalities and benefits all. The main ambitions of the Power of Information are:
Information used to drive integrated care across all settings
Information regarded as a health service in its own right
“Nothing about me without me”
Information recorded once at first contact
Electronic care records to become the source for core information
A culture of transparency
An information-led culture
2.1.3 Everyone Counts: Planning for Patients 2013/14
The underlying principles of the national approach to Everyone Counts: Planning for Patients 2013/14 are to empower local clinicians to deliver better outcomes, increase information for patients so they can make informed choices and to demonstrate greater accountability to the communities the NHS serves. It does this by setting out 5 offers to help commissioners deliver to the public the following:
Support for routine care 7 days a week
Greater transparency of outcomes
Mechanisms to enhance patient feedback
Better data collection to drive evidence based medicine
High professional standards
It also addresses two key challenges in guaranteeing no community is left behind or disadvantaged and treating patients respectfully as customers and putting their interests first.
Informatics Planning will play a key role in supporting Everyone Counts: Planning for Patients 2013/14 and will represent year 1 of this Strategy. The key messages for 2013/14 (which includes preparation to meet commitments for 2014/15) comprise seven main health Informatics themes, which are:
Integrated information across health and social care.
Smarter, more accurate data capture - Better data, informed commissioning, driving improved outcomes
Real time patient/carer feedback and comment for any service by 2015.
Patient online access to their primary care records by spring 2015
Promote the benefits of telehealth and telecare
Move to paperless referrals by March 2015
NHS number as primary identifier across all providers by 2013/14
2.1.4 Setting priorities
With CCGs taking on new responsibilities and operating in new ways there is a clear
need for a set of core priorities. Putting Patients First: The NHS England Business Plan
2013/14 to 2015/16 sets the priorities for NHS England over the next two to three years that
is measurable against an 11-point NHS England Scorecard that will measure progress
against:
Patient satisfaction
Motivated, positive staff
Preventing people from dying prematurely
Enhancing quality of life for people with long term conditions.
Helping people to recover from episodes of ill health or following injury.
Ensuring that people have a positive experience of care.
Treating and caring for people in a safe environment and protecting them from avoidable harm.
Promoting equality and inclusion through NHS services
Embed the NHS Constitution in everything we do.
Ensuring the staff of NHS England understand their roles, are properly supported and are well motivated.
Living within our means whilst delivering our priorities.
2.2 LOCAL DRIVERS
2.2.1 Collaborative Working
There is a long and successful history of collaborative working across the geography of Portsmouth and South East Hampshire as there is a shared reliance in broadly equal measure on acute services provided by Portsmouth Hospitals NHS Trust. It was therefore seen as sensible to continue this tradition by agreeing a collaborative compact with the CCGs representing the population of Portsmouth and South East Hampshire, namely:
NHS Fareham and Gosport Clinical Commissioning Group
NHS Portsmouth Clinical Commissioning Group
NHS South Eastern Hampshire Clinical Commissioning Group
The intent to work collaboratively is set out in an agreement entitled “Compact for Collaborative Working” and from this point on all reference to “the Compact” or “the Commissioner” will refer to the three CCGs collectively.
2.2.2 Local Aims and Ambitions
The Compact aims and ambitions centre upon keeping the population healthy, with a prevention programme targeted to attain maximum health benefits. There is recognition that there is still too great a use of secondary care and that further opportunities exist to help patients with long term health conditions take some responsibility for managing their own care and treatment.
There is also a need to drive up productivity through reducing duplication, improved job planning and organisation of workload, using technology to improve care pathways and to reduce administration processes and share clinical information and good practice focusing on areas such as:
Prevention and Staying Healthy
Long Term Conditions
Unscheduled Care
Planned Care
Dementia
Clinical Leadership and Quality
Productivity
2.2.3 Flexible ways of working
The Compact work across two sites namely Fort Southwick and St James Hospital with co-opted GPs and supporting CCG teams spending a portion of their time working between both sites requiring a flexible approach to the way they work and having to use desks available at the time. Technology will be expected to provide the mobility they need keeping them connected to their email, calendars and information sources.
2.2.4 Mobile Computing
The outcome from projects set up in the recent past to pilot the use of 3G mobile devices did not meet general expectations and not just because of poor 3G network coverage but also ease and convenience of use. However there remains a pressing need to provide access to information for staff that regularly work out in the community or spend time travelling between NHS sites. Further work is needed in this area to look at mobile network coverage and a more open approach for staff to use of drop-in areas located in hospitals, community health centres, GP Practices etc.
CHAPTER 3 – ROLES, RESPONSIBILITIES AND RELATIONSHIPS
3.1 COMMISSIONERS RESPONSIBILITIES
3.1.1 Informatics
As Commissioners, the Compact has a dual role in terms of Informatics. Firstly, it has to secure effective and efficient systems and information provision in order to be able to manage its core business. Secondly it needs to encourage its providers of health and social care to look beyond their individual business Informatics requirements, to look at what is required from a patient or service user perspective, e.g. to deliver care records which can be made available in whatever care setting a patient attends and, where a patient wishes, providing them online also. It is also a Commissioner’s role to ensure that there is some alignment of priorities for investment/development or improvement across the Health Community in order to maximise the benefits of existing technology and to ensure that there is adequate governance arrangements to ensure good quality and secure data.
3.1.2 Information Governance
The Commissioners are also responsible for ensuring safe and secure patient information under the umbrella of Information Governance (IG).
IG encompasses legal requirements, central guidance and best practice in information handling, including: The common law duty of Confidentiality, Data Protection Act 1998, Information Security, Information Quality, Records Management, Freedom of Information Act 2000
Summary: This chapter covers the roles and responsibilities of the Commissioner in the context of
Informatics and describes its relationships with its providers and key partners.
Key points:
Provide leadership across the local health and care community in setting the Informatics agenda
Providing assurance against the Information Governance Toolkit
Being assured there are adequate Disaster Recovery and Business Continuity Plans across the
Provider spectrum
Provider relationships
Contractual arrangements and data ownership
Collaborative approach
Managing IT-Enabled Change
Key partnerships
The Commissioners relationship with the Commissioning Support Unit
Current support provided by the Island and Portsmouth Informatics Service (IPHIS)
Working with Public Health, and Local Authorities
Independent contractors, GPs and Any Qualified Provider
Whilst a key focus of information governance is the use of information about service users, it applies to information and information processing in its broadest sense and underpins both clinical and corporate governance. The four fundamental aims of Information Governance are:
To support the provision of high quality care by promoting the effective and appropriate use of information.
To encourage responsible staff to work closely together, preventing duplication of effort and enabling more efficient use of resources.
To develop support arrangements and provide staff with appropriate tools and support to enable them to discharge their responsibilities to consistently high standards.
To enable organisations to understand their own performance and manage improvement in a systematic and effective way.
Achievements against information governance standards are undertaken using the Information Governance Toolkit.
Portsmouth City, Hampshire PCTs, and Portsmouth and Hampshire Local Authorities have historically performed well against the standards set out in the IG Toolkit assessment leaving a good legacy for the Compact. Nevertheless, as Commissioners, there is still work to be undertaken to widen our assurance gained in respect of independent contractors and the third sector as well as improvements to our corporate information standards.
3.1.2.1 Pseudonymisation of Patient Data
National policy on the secondary use of patient data requires that patient level records should be used in non-identifiable form, except where there are valid and justifiable reasons for using identifiable data. The process of creating de-identified data is known as pseudonymisation. This is supported by providing additional derived data items instead of items that can be used to aid identification, such as age instead of date of birth and electoral ward instead of postcode. The Commissioner will remain vigilant and will work with its partners and the CSU to ensure compliance with the requirements of Pseudonymisation and to ensure that organisations from which care is commissioned comply in the use of pseudonymised data for purposes other than the direct care of patients.
3.1.2.2 Person Identifiable Information (Data) – PID
The Commissioner takes its responsibility seriously in ensuring the storage and transit of all PID is managed safely and securely. The organisation continues through its information governance management with the CSU to increase awareness of data protection issues amongst its own staff and through compliance reviews of its providers. Staff need to be made aware of their responsibilities in respect of Information Governance which is clearly set out in the Information Governance Handbook. This comprehensive guide is a ‘must read’ for all staff which is reinforced by mandatory testing of knowledge and awareness via the eLearning programme. At an organisational level the minimum standard is achievement of the Information Governance Statement of Compliance (IGSoC), however the commissioner will expect providers’ to go further and achieve the highest scores possible.
3.1.3 Disaster Recovery/Business Continuity
Technology is a fundamental day to day tool in the provision of clinical care management and administration. The Commissioner has to be confident that its own IM&T service and that of its providers of care have robust disaster recovery processes in place to ensure they can continue business in the event of a computer system disaster. For the CSU this means that they must ensure their IM&T providers have a comprehensive DR & BC plan in place that sets out a complete computer system asset list, how they will prioritise recovery and how long it will take. This document needs to be agreed and signed off by the CSU and should be subject to regular internal audit to ensure it is kept up-to-date. Our health and care providers should have similar arrangements in place and will be aware that the Commissioner can exercise its right to request an independent audit of their arrangements.
3.2 COMMISSIONER’S RELATIONSHIP WITH PROVIDERS
3.2.1 Securing contractual arrangements
In commissioning health care for the population, the Compact will use the Standard NHS Contract which sets out the contracted activity levels, penalties, incentives and financial arrangements for each provider with which it contracts for healthcare. Such contracts have to be robust, to enable performance management whilst encouraging and supporting innovation. Contracts with Providers will also set out measurements for timely and relevant information from its Providers. For instance, Acute Providers are required to feed data into SUS with their income dependent upon meeting this aim. In future sharing data with the Health and Social Care Information Centre (HSCIC) which is, England's new and independent, authoritative source of health and social care information, will become part of those contractual arrangements for all providers of health and social care. In Primary Care, GPs will have to ensure that they meet the standards set out in the Quality of Outcomes Framework using the Calculating Quality Reporting Service (CQRS) to assess their achievement. In recent years, the PCT promoted greater emphasis on data feeds into key data repositories, such as SUS and the Hampshire Health Record (HHR). The Compact will continue to build on those principles but also include across all providers (where appropriate) the following:
Improvements in the use and availability of the NHS electronic referral service (currently Choose and Book
Improvements in coding quality
Patient access to their own records online
Patient access to make make/amend appointments and order repeat prescriptions
Timely sending of Electronic Discharge Letters and Summaries to GPs that integrate seamlessly into GP Practice systems.
3.2.2 Data ownership
A fundamental principal of Equity and Excellence is that patient data belongs to the patient
and organisations that collect and process the information are the custodians responsible for
its safe keeping, sharing it only when appropriate and in the patient’s interest and only then
with the consent of the patient.
It is likely that organisations that manage and store information as part of their contract to
provide health and care services will change from time-to-time and there needs to be a
mechanism to ensure the safe and expedient transfer of data from one provider to another.
The Compact will ensure that all planned clinical and business developments involve IM&T
at the earliest possible stage of the process to ensure that appropriate processes involving
information and information governance are captured early and incorporated into contracts,
commissioning intentions and/or business plans.
This is a complex area requiring a deft touch in the development of contracts in order they
both provide the best exit terms and handover from one provider to another without being
over prescriptive and stifling innovation. The Compact will develop an Informatics Planning
Framework that will help guide and set out contractual terms of custodianship, data and
asset transfer. Whilst there may be subtle differences between service agreements it is
important that a set of standards are established so that providers know where they stand in
respect of contract exit and handover.
3.2.3 Collaborative approach
Good quality data and analytical expertise is a fundamental requirement of Commissioners thereby enabling strategic plans and decisions to be formulated based on evidence. Clearly, public health needs analysis is the start of the data flow and a close working relationship with Public Health will be crucial. However data repositories, governance, clinical and data validation, benchmarking and sharing of information, continues to be a key work stream. The Compact realises the importance of collaborating with its partners in this regard and recognises that the CSU will play a key role in the management of Business Intelligence and facilitating the continued collaboration between the CCGs across Hampshire, particularly in respect of IT enabling programmes.
3.2.4 Managing IT-enabled change
In ensuring technical infrastructure is in place to support the needed changes to the health and social care system it is vital that there is clear and unambiguous direction at a local level. An arrangement is needed that will serve to strengthen local ownership and responsibilities, allow input into the development of local strategic road maps and show/support linkages with national policy. As the local leader of the NHS in Portsmouth and South Eastern Hampshire, it is entirely appropriate that the Commissioners should:
Influence and actively drive forward the vision for Informatics set out in this Strategy.
Encourage the benefits realisation of planned investment
Promote the co-ordination of resources used in new developments and initiatives. Board level governance arrangements, in respect of the Informatics agenda, comprise of an IT-Enabling Change Board supported by a number of working groups. Membership and governance arrangements are set out below:
Portsmouth and South
Eastern Hampshire
Clinical Committee
Sustainability
Board
The IT-Enabling Change Board will play a pivotal role in managing the Compact’s informatics strategy. The main purpose of the group will be to agree the direction of travel for Informatics across the local health and care community and to put in place and provide sponsorship for projects and programmes that support the aims and objectives agreed by the group. It is envisaged that the board may need to establish IM&T working groups to be tasked to report to the board on areas of particular interest such as GP IT Systems and other areas that the board may require specialist support. The Terms of Reference for the IT-Enabling Change Board set out its responsibility to lead across the free scope of strategic Informatics agenda but specifically to concentrate upon areas of priority where significant benefits can be realised in the local system.
The key responsibilities for the IT-Enabling Change Board are as follows:
To resolve conflicts across projects and organisations
Ensure benefits are realised
Review funding issues and support reconciliation where possible.
Review/agree local health and social care community strategic plans
3.3 PARTNERSHIPS
3.3.1 Commissioning Support Unit (CSU)
The Compact is supportive of the use of the CSU arrangements for many of its back office functions including Informatics, Business Intelligence and Information Governance. This arrangement is already in place with NHS South CSU and is set to continue when the three P&SEH CCGs officially take over the commissioning from the PCTs on 1st April 2013.Agreeing the Informatics Strategy and associated action plan with the CSU will be essential as it represent the Compact’s informatics workplan and operating intentions that in a large part will need to be delivered by the CSU Within its Commissioning structure, the CCGs need to give consideration to a client function (both managerial and clinical) which sets the strategic direction and act as the “intelligent customer” on behalf of the Commissioners in liaison with the CSU.
IT-Enabling Change
Board
IM&T Working Groups (Primary Care, GP Systems …)
Compact IT Lead (Chair) Chief Financial Officer Compact Clinical Lead CSU IT Lead
Plus senior IM&T
Management from:
Solent NHS Trust
Southern Health NHS Trust
Portsmouth Hospitals Trust
Portsmouth City Council
Hampshire County Council IM&T Programme
Boards
IISG - (CSU)
3.3.2 Island and Portsmouth Informatics Service (IPHIS)
Historically IPHIS was the IM&T Shared Service provider for Portsmouth City PCT and in an
IM&T context has an excellent understanding of the local health community including its host
Portsmouth Hospitals Trust.
The Commissioner also currently enjoys a good working relationship with IPHIS as its local
IM&T provider and recognises the good work and investment made by the PCT in local
infrastructure, the Community of Interest Network and well equipped and secure computer
rooms.
Whilst the Compact currently has direct contact with IPHIS via its helpdesk for day-to-day
business contractual arrangements and major project development are managed by the
CSU.
3.3.3 Working with Portsmouth City and Hampshire County Council
Integrated working between Health and Social Care requires joined up strategic planning
and early identification of duplication or non-alignment of policies and care pathways. At a
practical level information needs to flow between organisations without losing meaning and
context which is particularly relevant in areas of joint provision such as Adult Mental Health,
Learning Disabilities, Children’s Services, frail elderly and people with long term conditions
However, both the Health and Social Care sectors have independent technology systems
which inevitably bring challenges in terms of alignment of data, duplication and data security
issues. Alignment and integration have improved over the last 5 years, but will need to
continue if gaps in information sharing are to be minimised.
3.3.4 Independent Contractors and AQPs
The Compact recognises the importance of information exchanges between the NHS and
Independent Contractors’ systems. This can be achieved through the joint use of services
provided by National Health Application and Infrastructure Services which will help to
facilitate independent health systems to integrate more closely such as the use of NHS Mail
and the NHS Network (N3) for non-NHS organisations. The Interoperability Toolkit (ITK) will
also help by providing technical standards and computer code fragments for interoperable
messaging services between disparate systems.
3.3.5 GP Systems
Work with GP Systems (GPSoC and GP2GP) is set to continue, with GPs being encouraged
to adopt a managed service solution. Also it has not gone unnoticed that the major suppliers
of GP Systems have recognised the need to work more closely with each other in areas of
data exchange demonstrated by the development of the Medical Interoperable Gateway
(MIG). It will be no surprise therefore the Compact is keen to work with the CSU and GP
Practices to investigate potential opportunities where the MIG could support interoperability
between primary care and other healthcare systems.
CHAPTER 4 – VISION FOR THE FUTURE, OUR STRATEGIC OBJECTIVES
4.1 Overall Vision
The Commissioner fully supports the accurate recording, sharing and use of health and
social care information to provide effective, safe and efficient care to its patients. We also
embrace the notion that patients have the right to access their own health data and to
receive support in understanding it. As we use information to support the commissioning
process we do so in the knowledge that it is used to ensure existing services are performing
optimally and that future services are designed with quality and efficiency in mind, both in a
clinical and a financial sense. Health information will be used to assess the future needs of
our patient population and to personalise care provided to the individual, where appropriate.
Supporting healthcare professionals with high quality and timely information about how best
to manage a patient within the local healthcare system is imperative and will therefore
support them with the information resources they need to achieve this.
4.2 OUR STRATEGIC OBJECTIVES
Liberating the NHS: Equity and Excellence sets out the government’s aims of providing a
health service that puts the patient at the centre of the health and care system by providing
choice and involvement in the management of their care
The Commissioners fully support these principles, but do not underestimate the challenges
facing the NHS in delivering them. It will require cooperation, innovation and creativity both
from ourselves and our health, care and IM&T providers.
Informatics is a key enabler in support of the delivery of our strategic objectives which are
closely aligned to the main ambitions set out in the Power of Information. As such, it is
important to have a clear strategy that will contribute to both the Compacts integration of
services agenda and whole system sustainability.
Traditionally the collection of information and reporting has largely been driven by external
demand. Now and continuing into the future, information requirements should build upon
facilitating a patient centred approach, on improving the health of the population and
maximising good clinical outcomes from health interventions
Summary: This chapter sets out the Commissioner’s Vision for Informatics in the future. Its key objective to
provide care professionals with connected information so they can deliver better safer care.
Key ambitions:
Driving integrated and therefore safer care by pursuing an integrated system agenda
Providing the information for staff to better help and support patients through the development of
shared electronic care plans and records that link with key services such as NHS 111, 999 and Out of
Hours and Single Points of Access
Providing information to Patients, Carers and the Public through the introduction of on-line services
and access to public information web sites.
Driving informed Commissioning by making information easily available via the Web, the use of
intelligent dashboards and anonymised information taken from source care records.
In this chapter we set out our key strategic objectives, the challenges associated with each
and commitment from the commissioner in terms of plans and actions in order to meet them.
Figure 1 shows the strategic vision for Informatics covering the four headline themes that
capture the Commissioners strategic aims and objectives and broadly outlined below:
Figure 1 Strategic Vision for Informatics
Health and care record
securely accessible to
clinicians and patients
Information
available at the
point of care
Information
recorded once at
the point of care
Improving
performance
management
Improving
clinical quality
and safety
Improving
information for
staff
Public
access to
health
information
Share information
Public access to
service
information
Personalised
support for
patients & public
1
Driving
Integrated
Safer Care
3
Information to
support
Patients, carers
and the Public
2
Helping staff to
support
patients
4
Driving
informed
Commissioning
1. Driving Integrated Care – Integrating health and care records
• Aggressively pursue a system integration agenda by investigating technical
options and choosing the direction of travel that best suits the needs of the
Commissioner and its patients.
2. Helping staff (clinicians and social care professionals) support patients
• Introduce county wide use of electronic shared care records based on the HHR
v2
• Implement a shared county-wide End of Life Care Register that will link with
other services such NHS 111, Out of Hours and Single Point of Access services
• By 2013 all discharge summaries will be sent electronically from Portsmouth
Hospitals Trust to all GPs across Portsmouth, Fareham and Gosport and South
east Hampshire.
• Electronic Prescription Service available from all GP practices across
Portsmouth, Fareham and Gosport and South Eastern Hampshire
3. Information to support patients, carers and the public
• By 2015, all general practices will be expected to make available electronic
booking and cancelling of appointments, ordering of repeat prescriptions,
communication with the practice and access to records to anyone registered with
the practice that requests these services.
• Information about local services and health outcomes will be published to
support patients in making decisions about their care.
• By 2013 Patients will be able to view online which GP Practices offer online
access to records.
• Sign posting and help with navigating health and social care information using a
mix of media including but not limited to the Web and social media.
• Choice - Patients will be able to choose (with support from their GP) where and
when to receive treatment. The Commissioner will be encouraging its providers
to expand the remit of electronic referrals for community services.
4. Information to support the Commissioner
• All Information required to enable informed business decisions will be:
- Easy to Access e.g. via web
- Easy to understand e.g. dashboard, scorecards, mapped - all with
(appropriate) drill-down to anonymised patient level data to support
exploration and investigation of care pathways.
- Pertinent e.g. alerts to staff/roles via e-mails and workflows
4.2.1 Driving Integrated Care – Integrating health and care records
Technology and information standards within health and social care have greatly improved
over the last five years, paving the way for a more joined up approach when deploying and
implementing information systems. With a few exceptions the local information landscape
unfortunately still remains somewhat disconnected.
A notable exception is the Hampshire Health Record which has gone some way in providing
an information bridge between clinical systems. Unfortunately the primary care data it
contains is incomplete in some areas as not all GP practices contribute information to the
HHR. Also it is not insignificant that some GPs are reluctant to use the HHR citing that it is
‘clunky’ and time consuming and doesn’t give them what they need when they need it. It
should be noted however that a recent upgrade of the Hampshire Health Record (HHR v2)
promises a much improved user experience with more intuitive user interfaces and the
inclusion of an electronic care plan. The Commissioner will be keeping an open mind and
will watch developments with interest.
What is clear is the need to use information to drive effective integrated care – within and
between organisations, and across the health, care and support sector as a whole. It is also
well acknowledged and a key ambition of the Compact that information should be recorded
once, at first contact, and shared securely between those providing patient care. This will not
only improve patient safety but will also to drive up data quality and increase efficiency by
reducing duplication.
4.2.2 Information to Support Patients
The potential to change people’s lifestyle and health behaviours using Information
Technology is a powerful and as yet mainly untapped resource in combating common and
chronic health conditions. For example remote digital or telephone support directly helping
patients to manage their health as well as peer support via forums and social networks that
encourage healthier lifestyles. Additionally they may also be used to improve attendance
rates at appointments, concordance with treatment and other aspects of the care of long
term conditions.
The use of technology to consult with, support and monitor patients outside the consulting
room is growing both in extent of use and the functions it can provide. Some good examples
of using telephone consultations to support people with long term conditions already exist
and we will continue to evaluate and encourage implementation of the best aspects of
telehealth and telecare.
We will also evaluate other interventions that offer the greatest potential for encouraging
change and will offer them to our patients, where this is both practicable and affordable.
4.2.2.1 Patient on-line access to primary care services
By 2015 patients will be entitled to access their medical record online. GP system suppliers
can already provide patients with access to the information that is held at their GP surgery.
Safeguards will need to be developed and patients counselled particularly in relation to
pathology and radiology results.
There are already a significant number of GP Practices in Portsmouth and South East
Hampshire that have systems supporting on-line access for patients to book appointments
and order repeat prescriptions. An active programme of work to upgrade practice systems
will see this type of functionality become more widely available over the next 18 months as
the programme progresses.
The Commissioner will be encouraging practices that can provide patients with on-line
access to begin rolling out pilot schemes to a cohort of patients who are willing to take part in
road testing the functionality and look to increase take up over time. This approach is
consistent with CCGs and other organisations in the health community identifying
opportunities during the lifecycle of this strategy to offer patients access to their online
records.
4.2.2.2 Patient Choice
Providing patients with choice about their care is central to a patient-centred NHS and
combined with the delivery of innovative, tailored services and ensuring good value all
contribute to improved outcomes and efficiencies.
We believe that by putting the patients' needs first, integrating care and joining up the
commissioning process will significantly improve the quality of services.
As most patients will encounter choice during a consultation with their GP we need to ensure
that GPs have a fully operational electronic referral service, available as a function of their
practice systems and supported by a comprehensive directory of services and up-to-date
slot availability from all providers of care. We will be working closely with all of our providers
to ensure that these standards are met.
We will also want to see community health and care services innovate and provide more
community based care that can be easily accessed by patients exercising their right to
choose.
4.2.2.3 Choose and Book and the new NHS eReferrals service.
National activity is currently underway to design and develop a new service to deliver
paperless electronic referrals within the NHS system which will eventually replace the
existing Choose and Book service. The new service promises to address a number issues
raised by Choose and Book stakeholder groups by including functional developments as part
of the over design of the new service and fall into the following categories:
• Enhanced support for Commissioners
• Enhanced integration with Referrer and Provider systems
• Enhanced support for the Patient
• Enhanced usability
The new NHS eReferrals service is planned to replace Choose and Book by December 2013
when the current Choose and Book contract with Atos comes to an end. From first
impressions the time-scale for the transition looks challenging, particularly in a climate of
considerable change. However the Commissioner is generally supportive of the move
provided the transition does not compromise patient safety.
4.3 HELPING STAFF TO SUPPORT PATIENTS
4.3.1 Our vision for Sharing care plans and records
Ultimately, the vision of achieving a patient record which can be accessed when and wherever it is needed is still some way off. However with exciting new developments coming through the vision is now well within our reach. For example the Interoperability Toolkit provides tools and standards for software vendors to develop systems that will inter-operate. Whilst the ITK is not a silver bullet for system integration its framework and tools are continually being added to. Providers are beginning to consolidate their positions by seeking out systems that support interoperable system standards. Some good examples already exist such as the NHS 111 messaging service used between South Central Ambulance Service and the Out of Hours service providers across Hampshire. In Primary care the development of the Medical Interoperability Gateway that promises to facilitate the viewing and updating of records between GP Practice Systems which is supported by the major GP Practice system providers.
4.3.2 Electronic Discharge Summaries and GP Letters
The Commissioner makes a clear presumption in favour of hospital discharge summaries being made available to the GP and patient (or their nominated carer) immediate following the patient’s discharge from hospital. There should also be no delay in the release of other correspondence between hospitals and GPs (and vice versa) which will be transferred electronically in real time as standard practice. It is also the intention of the commissioner that the electronic transfer of documents between systems implies that GPs will receive electronic documents seamlessly into their practice computer systems and/or workflow.
4.4 INFORMATION TO SUPPORT THE COMMISSIONER
4.4.1 Data capture and collection
Access to good quality information is a very important part of the Commissioners armoury
with the Secondary Uses Service (SUS), the local health community data warehouse and
the Hampshire Health Record currently representing three of our key information systems.
In future information will be taken from patient records, combined and anonymised. This
anonymous information will become a key source with which to:
• Assess clinical and professional performance;
• To plan and target services;
• Research new treatments;
• Improve quality and safety of services;
• Track improvements in outcomes and patient experience;
• Monitor the delivery of innovations, increases in productivity and contracts; and
• Ensure value for money.
It is also envisaged that information will feed the Health and Social Care Information Centre
(HSCIC) which will become the focal point of all collected feedback and health and care
information.
It will be the place where information is kept and where everybody will look for information.
A special secure service will be provided for health professionals to get general and
anonymised information about the health of the population.
4.4.2 Data quality
The Commissioner is determined to drive improvements in the accuracy, speed and
completeness of data collected by the services we commission on behalf of our patients.
Finance and activity data has in the past been stored and reported independently to clinical
data. With an emphasis on decisions based upon outcomes there is a need to recognise the
link between finance and activity data and analyse accordingly.
4.4.3 Analysis and reporting
The organisational model developed for the CSU and CCGs places all system analysts
within NHS South CSU. The arrangement includes a named analyst who will work on behalf
of and alongside P&SEH CCGs. A business intelligence function and data warehouse has
been developed which will provide the vehicle for analysis and the dissemination of reports.
4.4.4 Performance Tools and Dashboards
The commissioner would like to see the development and use of intelligent dashboards that
will facilitate a drill-down facility so that the information behind the indicators can be seen
and investigated. Some exciting work has already been done in this area by our CCG
colleagues in Southampton and we are keen to follow up on the work they have done so far.
CHAPTER 5 – CURRENT PRIORITIES AND KEY PROGRAMMES
5.1 INTRODUCTION
From the 1st April 2013 with the abolition of PCTs, the three Clinical Commissioning Groups that form the Compact will take over the responsibility for commissioning health and care services for the population of Portsmouth, Fareham and Gosport and South Eastern Hampshire. The transformation from PCTs to CCGs will result in a number of unfinished IM&T projects and programmes and whilst they were initiated by the PCT to support its existing strategies their continuation will serve the CCGs very well in that they will:
Provide essential foundations for future development
Provide short/medium term solutions to meet urgent need
Seamlessly support the CCGs’ strategy going forwards
The following well established programmes fall into the above categories:
Electronic Discharge Summary (EDS)
Electronic Prescription service (EPS)
Shared Care Plans and HHR V2
End of Life Care Register (EOLCR)
Wireless - Introduction of WiFi to allow safe and secure Guest access across local network infrastructure
Video conferencing and meetings management - To reduce the amount of travelling between organisations. Automatically setting up video conference calls at the desired time and place.
The following sections examines each of these programmes in more detail providing
background to each and where they fit into the future narrative of this strategy.
Summary: This chapter outlines the current priorities key programmes currently underway that support the
Commissioner’s strategic aims and objectives,
Key programmes and expected outcomes:
Electronic Discharge Summaries – Fully integrated EDS, letters and results from secondary care
providers into GP Systems by 2015
Electronic Prescription Service rolled out across Portsmouth, Fareham and Gosport and South East
Hampshire (Portsmouth City – 2013/14 and Fareham and Gosport and South Eastern Hampshire by
2014/15)
An electronic shared care plan and EOLCR for the whole of Hampshire by 2015
Wireless networks and guest WiFi at St James and Fort Southwick by first quarter of 2013/14
Automated Video Conferencing facilities at St James and Fort Southwick by first quarter 2013/14
5.2 ELECTRONIC DISCHARGE SUMMARIES (EDS)
During 2011/12 PHT initiated a project to roll out the electronic transfer of discharge
summaries to GP Practices across Portsmouth and South East Hampshire. The main
purpose of the project was to eliminate the need of sending discharge summaries by post
but also included automated capture into GP system work flows.
Whilst the project met the main objective, i.e. to send discharge summaries electronically to
GP Practices, the capture of EDS into GP system workflows resulted in a mixed outcome.
Some practices are not able to take full advantage of an integrated EDS solution and have to
manually scan documents into their systems. Nevertheless the project has served to greatly
improve the timely delivery of discharge summaries and has put in place the infrastructure
needed to fully integrate EDS and other electronic correspondence into all practice systems
and patient records in the future.
The Commissioner will continue to pursue a fully integrated solution and will engage with the
CSU to follow this up on our behalf.
5.3 ELECTRONIC PRESCRIPTION SERVICE
Portsmouth City Teaching PCT obtained Secretary of State Directions to proceed with the
Electronic Prescription Service (Release 2) in the third quarter of 2012/13. Plans are now in
place with the CSU to roll out EPS R2 within Portsmouth during 2013/14 with Fareham and
Gosport and South Eastern Hampshire to follow during 2014/15
5.4 SHARED CARE PLANS AND HHR V2
The project to upgrade the Hampshire Health Record to version 2 is almost complete. The
upgraded software has a more intuitive interface and includes a care planning module that
could be developed to provide electronic shared care plans across Hampshire.
Whilst this may not fully meet the Commissioner’s strategic longer term vision of integrated
care records it could potentially meet the urgent need to share patient information across
care pathways. The Commissioner is generally supportive of this development particularly if
it can deliver an electronic shared care plan in the short term. However the commissioner
will also want assurance that it will fit with its longer term integrated care record aims and
objectives.
5.5 END OF LIFE CARE REGISTER
Work is already well underway in Portsmouth and South East Hampshire with a programme
to create a central EOLC register. The programme is aligned to the Hampshire NHS 111,
Out of Hours GP services and the 999 ambulance service. An alert will enable services to
identify patients on the end of life care register so that the most appropriate palliative care
response is offered in line with the wishes of the patient.
Currently the register is being developed using the Adastra End of Life Care Register
(EOLCR) which is a ‘bolt-on’ electronic palliative care coordination system (EPaCCS) to the
Adastra patient management system used in out of hours and single point of access
services across Hampshire.
This development fits well into short to medium term plans by providing a shared register
across Hampshire available to view via a secure web portal over N3. It is however another
layer of complexity when considering the growing number of computer systems that health
and care professionals need to use as part of their day-to-day routines. Whilst the Compact
is keen to see the register rolled out as quickly as possible it will also want to consider how
the EOLCR will fit with future integration or interoperability plans.
5.6 WIRELESS
Work is well underway installing wireless networks across the Portsmouth and South East
Hampshire CCGs estate, both at St James Hospital and Fort Southwick. This will not only
provide Guest access to the internet but also secure access for staff who frequently work
between sites allowing them to access their emails, calendar, files and folders, as if at their
desk.
The project supports the Compact’s vision to provide a flexible working environment for its
staff and for visitors who will be able to use their own computer devices to access the
internet and their own networks via secure VPN.
5.7 VIDEO CONFERENCING
Video conferencing facilities supported by the NHS N3 network are already available in the Committee Room at Portsmouth CCG HQ at St James Hospital. When booking the room for a video conference the software automatically sets up the video conference call at the desired time and place. Plans are in place to provide similar facilities at Fort Southwick.
CHAPTER 6 – ENABLING STRATEGIC CHANGE & DELIVERING THE STRATEGY
6.1 IDENTIFYING HIGH PRIORITIES WHERE CHANGE IS NEEDED
The aims and objectives set out in our strategic vision are necessarily ambitious and will therefore take time to realise. Translating vision into reality requires a pragmatic and realistic approach that will need to be progressed with the help of a comprehensive action plan that is regularly updated and performance managed.
Realising our vision will be a journey that will follow the life cycle of this strategy with Appendix - A setting out the actions needed to get us there. Year one will be crucial as we need to take decisions that will affect our overall direction of travel and set the scene for the future.
There is a lot to do and it cannot all be done at once and therefore we need to prioritise on the areas of greatest need. Year one will include making decisions about longer term developments to support an integrated approach to sharing clinical information. This will no doubt be a continuing theme throughout the lifetime of this strategy. Year one will also include enabling programmes to support clinically-led commissioning as set out in Everyone Counts: Planning for Patients 2013/14, meeting the urgent needs of our local population and supporting the Commissioners’ business aims and objectives set out earlier in this strategy.
Summary: This chapter sets what needs to be done to deliver the Informatics Strategy beginning with seven
strategic priorities for 2013/14 that will set the strategic direction of travel for three years.
Key priorities for 2013/4
Set the strategic direction of travel for system integration/interoperability
Ensure plans are in place to secure IM&T future IM&T provision
Ensure that all NHS Patients have a right to secure online access, where they wish it, to their personal
GP records by 2015
Upgrade GP Systems to latest versions and preferably hosted arrangements
Implement the Electronic Prescription Service across Portsmouth, Fareham and Gosport and South
Eastern Hampshire
Encourage increased availability and more efficient use of Choose and Book and transition to the new
eRefferals service.
Ensure the use of NHS number by all its providers in the Local Health Community including Social
Services
Ensure technology is in place to support the Commissioner’s flexible and mobile working strategy
Priorities for 2014/5 to 2015/16
Potential deployment of the Summary Care Record
Lead the delivery of electronic Patient Letters & Results from all Care Providers to GPs
Expand the use of Telehealth, Telemedicine and Telecare
Explore the benefits of using Patient Decision Aids in Primary Care
Continued and on-going development and investment in the local technical infrastructure
6.2 TEN AREAS OF HIGH PRIORITY FOR 2013/14
6.2.1 PRIORITY AREA 1 - System Integration
There are a number of different models and approaches to integrating information and
information systems that broadly fall into three categories:
• Single system approach - Providing support across the whole health and social care
system
• Interfaced – A single shared data repository fed by individual health and care
systems (HHR, data warehouse, information portal etc)
• Interoperability - Inter-system data read and write
The Commissioner wants to invest in the best solution for the local health community that
will meet short and medium term goals of the Commissioner whilst ensuring any investment
secures effective interoperability for the longer term.
It is widely acknowledged that this is a complex area and one that will take time to fully
realise its potential and therefore a set of more immediate solutions may need to be found to
meet the pressing need to share health and care information.
To meet that need the Commissioners are generally supportive of developing the electronic
shared care plan module within the HHR v2 subject to further discussions with the CSU
about its potential and provided it can be rolled out across Portsmouth and South East
Hampshire by 2015. Decisions about the next steps require careful consideration to
establish, for example, if the HHR v2 will be a short to medium measure or part of the longer
term interoperability strategy that contributes to a fully interoperable system landscape for
the future.
The Compact has therefore agreed to urgently commission a report into the options
available for integrating clinical information across the local health and care community to
help and inform a debate across the wider health and social care community on the best way
forward.
6.2.2 PRIORITY AREA 2 - Future IM&T Provision
Traditionally IM&T services have been provided by NHS hosted shared service
arrangements that over time and due to numerous NHS re-organisations became a poor fit
for some of the organisations they served. As a result the two major community service
trusts, Solent NHS Trust and Southern Healthcare concluded that it was in their best interest
to reconfigure their IM&T arrangements and gave notice of withdraw from the shared service
agreements that would take effect from April 2014.
In response and in order to protect IM&T services for its host organisation Portsmouth
Hospitals NHS Trust IPHIS announced its intention to withdrawal from the provision of
shared IM&T services altogether by giving notice of cessation by April 2014. IPHIS has
however indicated a willingness to continue to provide IM&T support for the Compact
beyond the April 2014.
The commissioner is keen to pursue this as an option and form part of the joint review with
the CSU for provision of IM&T services going forward. This is a high priority as it represents
a potentially high risk to the CCGs. The commissioner will work with the CSU during
2013/14 to develop plans and implement the re-provision of IM&T services to run
concurrently from 1st April 2014.
6.2.3 PRIORITY AREA 3 - Patient Access
6.2.3.1 Online access to Patient Records
All NHS Patients will have a right to secure online access, where they wish it, to their
personal GP records by 2015. It is envisaged that this will be a phased programme
beginning with a small number of GP Practices and concentrating on a small cohort of
patients. During Phase 1 the Commissioner will need to:
• Identify and engage with practices that can support access to care records.
• Identify willing group of patients (likely focus will be on patients suffering from long
term conditions)
• Support pilot practices through the preparation process (consultation and support of
patients particularly related to pathology results)
• Training and go-live for pilot practices
Phase 2 will need to be aligned with the GP System upgrade programmes so that all GP
practices have systems that support remote access for patients. Implementing a full roll out
of the programme will be no insignificant task for the CSU, GPs and the Commissioner who
will all need to work very closely together.
6.2.3.2 Online access to book appointments etc
By 2015, all general practices will be expected to make available electronic booking and
cancelling of appointments, ordering of repeat prescriptions, communication with the practice
and access to records to anyone registered with the practice that requests these services.
As Commissioners we will need to show signs of movement during 13/14 from our current
baseline of GP Practices which have enabled patients to have access electronically.
Although providing access to services is likely to be less problematic than access to records
it none-the-less will be a significant task to implement. It makes sense to run the two
programmes together (access to records and access to book appointments)
6.2.4 PRIORITY AREA 4 - GP Systems
There is already an on-going programme to upgrade GP practice systems and promote the
benefits of migrating to hosted arrangements. There is a pressing need to ensure that the
programme is expedited as quickly as possible as other high priority areas depend upon
systems that support the Electronic Prescription Service, patient access to their care records
and patient access to book appointments.
6.2.5 PRIORITY AREA 5 – Electronic Prescription Service Release 2 (EPSR2)
In parallel with the implementation of EPSR2 for Portsmouth City during 2013/14 the
Commissioner will ask the CSU to develop documentation and apply for Secretary of State
Directions for Fareham and Gosport and South Eastern Hampshire as soon as possible. The
implementation of EPS R2 will follow the successful application of Secretary of State
Directions.
6.2.6 PRIORITY AREA 6 – Electronic Discharge Summaries
The Commissioner recognises the good work undertaken by the CSU and IPHIS to deliver
discharge summaries electronically from PHT to GP practices in Portsmouth, Fareham and
Gosport and South East Hampshire. However the Commissioner is keen to see further
development in this area that will enable the EDS automatically integrated into all GP
practice systems workflow.
6.2.7 PRIORITY AREA 7 – Electronic Referrals (Choose and Book)
Some progress has been made in enabling wide availability of Choose and Book but there is
still much to be achieved. The Commissioners will be working to encourage increased
availability and more efficient use of the facility at Portsmouth Hospitals NHS Trust and
where appropriate will encourage and support the community and mental health providers to
continue to develop and use Choose and Book technology (and subsequently the
replacement eReferrals service) for patients who are accessing their services.
6.2.8 PRIORITY AREA 8 - NHS Number
The Commissioner is required to secure the use of NHS number by all its providers in the
Local Health Community including Social Services. The NHS number is the key record
through which all connecting systems would be linked. There are a number of second
record fields which provide further control to prevent error. There is already agreement with
Portsmouth City Council to use the NHS number for all patients’ records held in their
systems. However, more work is required to achieve 100% compliance across all
organisations, particularly in respect of written correspondence to patients.
6.2.9 PRIORITY AREA 9 – Clinical Support and Intelligence
6.2.9.1 Telehealth and the AIM project
The Commissioner in partnership with Portsmouth City Council and Stoke-on-Trent CCG will
embark upon the clinical roll-out of the Advice and Interactive Messaging (AIM) to pilot a
telehealthcare scheme that uses text messages to support a wide group of patients to help
them manage their long-term conditions or change lifestyle habits that may improve their
health.
Whilst NHS Fareham and Gosport CCG will take an early lead with the AIM project both
NHS Portsmouth and South Eastern Hampshire CCGs will quickly follow with a parallel work
programme across the Compact as a whole.
6.2.9.2 Risk Stratification
Risk stratification has the potential to significantly improve quality of care whilst increasing
efficiency and productivity. For example the John Hopkins Adjusted Clinical Groups (ACG)
can help with case and resource management and disease profiling whilst Eclipse can help
mitigate risks associated with medicines management and possibly avoid unnecessary
admissions to hospital.
The Commissioner recognises the enormous potential that these tools can offer but also
understands their dependency on high quality primary care data and the importance of
enhancing that information through appropriate record sharing. It is therefore important that
the CCGs work with GPs and the CSU when determining what tools to deploy and ensure
that data is captured both safely and appropriately.
6.2.10 PRIORITY AREA 10 - Technology supporting Local business needs
6.2.10.1 Open Health and Care Network Architecture
Wireless networks are already being installed across the CCGs’ headquarters at Fort
Southwick and St James Hospital providing Guests with WiFi access to the internet whilst
using their own devices. The Commissioner will also want the wired infrastructure to support
similar access enabling visitors to ‘plug-in’ their laptops or tablet computers so they too can
get access to the internet.
6.2.10.2 Virtual Desktop (iDesktop)
iDesktop enables users to access their active desktop running on their PCs whilst on the
move using a mobile device such as a laptop computer. This allows the user to get access
to files and folders as well as email, calendars and the intranet whilst on the move. It also will
‘free up’ a user’s desktop PC so that it can be used by someone else.
The Commissioner is keen to trial this technology as soon as possible as it fully supports its
flexible working strategy and will engage the CSU to begin implementation during the first
quarter of 2013/14
6.2.10.3 Portsmouth Information Portal (PIP) & Decision Support
Historically the PIP has served GP Practices in Portsmouth City very well providing up-to-
date clinical information and guidance to the local GP community. It was developed by the
NHS Portsmouth using web technology and made available over N3 using Internet Explorer
to make it both accessible and easy to deploy.
During 2012 the CSU (formally SHIP) embarked upon the development of PIP to extend its
functionality as a communications and decision support tool for CCGs. The Commissioner
considers PIP to be a key part of its communications and commissioning support arsenal
and is therefore keen for this work to be completed early 2012/13.
6.3 BEYOND 2013/14
Years two and three of the strategy will see a continuation of technical development in
support of the service integration agenda. Access to patient on-line services is also set to
continue, with patients who wish it, having access to their health records held by their GP by
2015. Ordering repeat prescriptions and booking GP appointments on-line will also be
available within the same time frames.
6.3.1 Summary Care Record (SCR)
At present (April 2013) the Hampshire Health Record holds a significant amount of shared
care record information extracted from primary and secondary care sources that can be
accessed (with explicit patient consent) by care professionals across Hampshire. However
the HHR is not available to health care professionals working outside Hampshire and as a
result will not benefit our patients being treated out of area. The Commissioner will therefore
work with the CSU and CCG colleagues (during 2013/14) across Hampshire to explore the
benefits of contributing to the Summary Care Record which is widely available to NHS
organisations in England for treating patients in an emergency or out of hours.
6.3.2 Patient Letters & Results from all Care Providers to GPs
The Commissioner will take the lead in ensuring ALL providers are encouraged and
supported to deliver all patient correspondence to GPs electronically and that projects are
appropriately sponsored and delivered to specification and on time.
6.3.3 Telemedicine, Telehealth and Telecare (Telehealthcare)
The Commissioner recognises that Telehealthcare has the potential to support and deliver
care closer to home, prevent unnecessary hospital admissions, provide choice and support
independent living. The Commissioner will use the experience gained from the AIM project
to explore further opportunities in this area and expects to see significant progress in the
take up and use of Telehealthcare by 2017.
6.3.4 Patient Decision Aids
Patient Decision Aids (PDAs) are designed to help patients make difficult decisions about
their treatments and medical tests. Research shows that PDAs are really effective in helping
patients make informed choices about their healthcare and increase patients’ awareness of
the expected risks, benefits and likely outcomes.
The Commissioner recognises the potential benefit of PDAs , given the ambitious informatics plans for 2013/14 this will not a priority in this first year. However the Commissioner will be keeping a ‘watching brief’ on provider plans in support of PDAs by requesting regular strategy updates from providers at the IT-Enabling Change Board.
6.3.5 On-going Technical Infrastructure development
Underpinning the delivery of informatics projects and initiatives there is a need to provide on-
going development and maintenance of a robust technical infrastructure. The CSU has
been working hard to provide a modern and technically up-to-date working environment. For
example the CSU has done well to upgrade from mixed versions of the Microsoft Office suite
to Office 2010 across for all. However more needs to be done but it will take time to
implement. The Commissioner would like to see progress over the next three years in the
following areas:
• Upgrade to the next stable Windows O/S platform (Windows 7)
• Consolidate and improve the underlying network and data centres including robust 1system fail-over and disaster recovery
• Server virtualisation to reduce on-going costs and deliver against rapidly changing
demands
• Enhancing hardware and software asset management
• Continue to develop flexible mobile working solutions
• Consolidate and improve remote access solutions
• Continued investment in desktop infrastructure
• Further development of email and message archiving systems
• Linking disparate phone systems to reduce costs and enable mobile working
• Web and video conferencing
1 Systems that switch to redundant or standby computer system upon failure or abnormal termination
CHAPTER 7 – RESOURCES
6.4 CAPACITY AND CAPABILITY
In order to maximise the benefits realisation of Informatics, it is necessary to identify what constraints are slowing down or preventing achievement of this aim. One of the major themes in the Strategy is the need to implement and join up (through technical solutions) systems and data. However, the need to identify the Informatics capability and resource is also paramount. The capacity and capability simplistically falls into two areas:-
Professional leadership in respect of Informatics staff (Technical and Information Analysts provided by the CSU)
Developing the Informatics capability of Commissioners It is recognised that there is a general shortage of skills required in both areas. A national review by the Department of Health in 2008 concluded that there are shortfalls in skills relating to the informatics supported change programme, from integrated planning, technical deployment, business change and benefits realisation. Whilst the national review was conducted some time ago unfortunately it is not thought that this position has improved. Turning data into information and understanding and using the information in managing performance and making business decisions is a key skill. Simplistically for Commissioners’, they must be able to identify the data they require, be able to analyse and interpret it and know when it is applicable and relevant and use it in informing their strategies, and commissioning plans. Commissioners need also to be able to consider the broader implications of their strategies and plans which will include Informatics. However, this will require inclusion of IM & T expertise in strategic planning sessions and contract performance management. The relationship between the commissioner and the Commissioning Support Unit that will be providing the lion’s share of the Informatics function, will be a key factor in the success of the CCGs. It is not surprising therefore that the Commissioner anticipates a very close working relationship with the CSU that will include dedicated expertise in both IT, IM and IG if we are to:
Expand the availability of technology
Change working practices to maximise the benefits of IT
Build the analytical capability to fully utilise information
Develop information analytical capability including predictive modelling and benchmarking skills
Continue to ensure systems and processes keep personal and sensitive data secure
6.5 FINANCE
As the CCG’s develop detailed work plans a financial plan will be developed alongside looking at the requirements of each project. The speed of implementation will depend on finding affordable solutions to our Informatics ambitions. The CCG’s will finance projects from within its allocation e.g. from non-recurrent headroom, where possible and affordable. Major IT re-development e.g. for integrated care systems may need more innovative financing solutions or look to bid from national allocations should these become available.
GP IT costs will be met from a funding allocation that will be delegated from the NHS England to the CCGs.
APPENDIX A – ACTION PLAN 2013/14 – 2016/17
Ref
High
Priority
Area
Theme
Action expected from Compact Strategy Enabling Projects / Specific Actions / Expected
Outcome By
When Commissioner Providers Para
Priority Title Narrative
13/14 14/15 15/16
Priorities for 2013/14
AP1. 1
Integration
“Drive integration across
and between services”
Investigate options, share with
the LHC (via IT-Enabling
Board) and wider Hampshire-
wide community via the CSU-
Led IM&T Strategy Group
6.2.1
System
Integration/
Interoperability
Review
Expected Outcome
System Integration Review. The review is
to include:
Description of the technical landscape
Meeting urgent needs (short/medium term)
Meeting longer term ambitions
Finance
Capacity & capability
Q2
2013/14
Seek alignment with Providers
plans to integrate services and
care record information.
All Health and Care
providers
Providers to share their
integration plans with the
Commissioner
Providers to:
Share integration plans at the IT-Enabling
Board
Q2
2013/14
Decide, in response to the
System
Integration/Interoperability
Review, the direction of travel
for system integration /
interoperability.
CSU
Work with the Commissioner (assist with the decision making process).
System
Integration /
Interoperability
Programme
Commissioner to:
Establish Integration / Interoperability
IM&T Working Group to review and
provide oversight of provider plans in light
of the System Integration Review.
Commissioner and CSU to:
Explore consensus on direction of travel from CCGs across Hampshire and align plans. Work up plans/schedule for
deployment/development of agreed
option(s) going forward.
Expected Outcome
Alignment / agreement of direction of
travel
Q3
2013/14
Ref
High
Priority
Area
Theme
Action expected from Compact Strategy Enabling Projects / Specific Actions / Expected
Outcome By
When Commissioner Providers Para
Priority Title Narrative
13/14 14/15 15/16
AP2. 2 Future IM&T Provision
Provide programme
sponsorship
CSU
Organise & manage transition programme and seek willing partners for possible joint procurement.
Engage the procurement team
Provide Project Management
6.2.2
IM&T Re-
provision
CSU to:
Establish Programme Board and agree ToRs
Embark on procurement
Appoint provider
March
2014
AP3. 3
Patient Access
“By 2015, all general
practices will be expected
to make available
electronic booking and
cancelling of
appointments, ordering of
repeat prescriptions,
communication with the
practice and access to
records to anyone
registered with the
practice that requests
these services”
Provide programme
sponsorship
CSU
Work with GP Practices, with
the backing of the
Commissioner, to identify
willing partners, who have
systems that can support the
necessary functionality to
provide patients with on-line
access to their systems, to
become ‘early adopters’.
GPs & CSU
Early adopter GPs, with
support from the
Commissioner/CSU, will need
to engage with GP System
suppliers in order to ensure
the necessary system
functions are switched on.
CSU & GPs
Identify/agree a cohort of
willing patients (say with LTC)
that will be provided with
access to their medical
records.
GPs / Commissioner
Communicate with patients so
they are aware of the ability to
get access to the care record
on-line
6.2.3
On
lin
e P
ati
en
t A
cc
es
s t
o P
rim
ary
Ca
re S
erv
ices
Ph
as
e 1
- A
cc
es
s t
o r
eco
rds
Commissioner to:
Provide sponsorship and establish Project
Board with support from the CSU.
Identify and engage with GP practices
that have systems that can support
Patient Access and who are willing to be
early adopters.
CSU to:
Nominate a Project Manager
CSU/GP to:
Engage with the GP System supplier to
turn on functionality to allow on-line
access to patient records and test.
GPs/Commissioner to:
Consult with patients to discuss specific
details and safeguards associated with
areas such as pathology and test results
Communicate with patients.
Expected Outcome
On-line access for a small cohort of
patients (from nominated GP practices) to
their GP Records.
Q4
2013/14
Ref
High
Priority
Area
Theme
Action expected from Compact Strategy Enabling Projects / Specific Actions / Expected
Outcome By
When Commissioner Providers Para
Priority Title Narrative
13/14 14/15 15/16
AP4. 3
Patient Access
“By 2015, all general
practices will be expected
to make available
electronic booking and
cancelling of
appointments, ordering of
repeat prescriptions,
communication with the
practice and access to
records to anyone
registered with the
practice that requests
these services”
Provide programme
sponsorship
GPs (Supported by the
Commissioner)
Communicate with patients so
they are aware of the ability to
Book/Cancel appointments
and order repeat prescriptions.
6.2.3
On
lin
e P
ati
en
t A
cc
es
s t
o P
rim
ary
Ca
re
Serv
ices
Ph
as
e 2
– A
cc
es
s t
o s
erv
ice
s
CSU/GP to:
Engage with the GP System supplier to
turn on functionality to allow booking and
cancelling of appointments and ordering
repeat prescriptions and test.
GPs/Commissioner to:
Communicate to the cohort of patients
who have been given access to their
records.
Expected Outcome
On-line access to book / cancel
appointments and order repeat
prescriptions.
Q4
2014/15
AP5. 4 GP Systems
Commissioners to encourage
GP Practices to adopt hosted
systems.
CSU
Set out its plans and timetable taking into account the timely delivery of:
EDS
EPS(R2)
Patient access to their care record
Patient access to book appointments
6.2.4
GP System
Programme
CSU to:
Provide the lead for a programme of GP
system upgrades and where necessary
the replacement of ageing PCs
Establish Programme Board reporting to
the ITECB and ensuring alignments with
the following Programmes:
EDS
EPS(R2)
Patient access to their care record
Patient access to book appointments
Expected Outcome
GP Systems across Portsmouth,
Fareham and Gosport and South Eastern
Hampshire to have adopted hosted
systems that will support the above
programmes
March
2015
Ref
High
Priority
Area
Theme
Action expected from Compact Strategy Enabling Projects / Specific Actions / Expected
Outcome By
When Commissioner Providers Para
Priority Title Narrative
13/14 14/15 15/16
AP6. 5
Electronic Prescription
Service (R2)
Commissioner
Assume sponsorship for the
programme.
Adopt the documentation and
communication developed
during the process of
obtaining SOSD for
Portsmouth and extend into
Fareham & Gosport and East
Hants CCG areas.
Pharmacies are encouraged
to provide electronic
transmission of prescriptions
using printed labels featuring
barcode scanning for
medicines.
6.2.5
EPSR2
CSU to:
Establish/re-establish EPS R2
Programme Board and establish links with
the GP System Upgrade Programme.
Ensure training and support programmes
are in place for practice and pharmacy
staff.
Expected Outcome
EPS R2 Implemented across Portsmouth
City
Q4
2013/14
CSU to:
Adopt agree and approve documentation
from Portsmouth City and apply for
Secretary of State Directions for Fareham
& Gosport/East Hants -
Q2
2014/15
CSU to:
Extend the Portsmouth City EPS R2
(ToRs and appropriate membership)
Programme Board. Ensure training and
support programmes are in place for
practice and pharmacy staff.
Expected Outcome
EPS R2 Implemented across Fareham
and Gosport and South Eastern
Hampshire
Q3
2014/15
Ref
High
Priority
Area
Theme
Action expected from Compact Strategy Enabling Projects / Specific Actions / Expected
Outcome By
When Commissioner Providers Para
Priority Title Narrative
13/14 14/15 15/16
AP7. 6 Discharge Summaries Provide sponsorship
CSU
Investigate and implement
mechanisms to automate EDS
directly into GP System
Workflow.
6.2.6
EDS
CSU to:
Identify the technical solution(s) and or
barriers to success.
Develop a technical specification and
report any exceptions (where it is not
possible and why)
Develop implementation plan
Commissioner / CSU to:
Agree on best solution and way forward.
Expected Outcome
Technical specification / report
Project intentions/plan
Q4
2013/14
AP8. 7 Electronic Referrals
(Choose and Book)
Provide sponsorship and
leadership All providers 6.2.7
Electronic
Referrals
(Choose and
Book)
Commissioner / CSU to:
Establish Choose and Book/eRefferals
IM&T Working Group reporting to the
ITECB to:
Resolve /reduce slot issues
Resolve technical issues
Revisit/refresh Directory of Services
Training for GPs/Practice staff
Set out/agree target usage and
performance manage via the ITECB
Expected Outcome
Raise the profile and increase the use of
Choose and Book (and transition to the
new eReferrals service) across all
providers.
2013/14
Ref
High
Priority
Area
Theme
Action expected from Compact Strategy Enabling Projects / Specific Actions / Expected
Outcome By
When Commissioner Providers Para
Priority Title Narrative
13/14 14/15 15/16
AP9. 8 NHS Number Provide leadership All providers 6.2.8
NHS Number
Providers to:
Review NHS Number usage both within
health and care systems and patient
correspondence; report any gaps to the
IT-Enabling Change Board.
Produce Action Plan and schedule to
rectify any gaps.
Q4
2013/14
AP10. 9
Clinical Support and
Intelligence
a) Telehealthcare
b) Risk Stratification
Provide sponsorship
Partners:
Portsmouth City Council
NHS Stoke-on-Trent
6.2.9.1 FLO
The Compact CCGs to pilot AIM (the FLO
model) – Advice and Interactive
Messaging - of telehealth developed by
NHS Stoke.
Q4
2013/14
Provide sponsorship /
facilitation
Commissioning Support Unit
and GPs 6.2.9.2
Medicines
Management
CSU
Work with GPs and the Medicine
Management team to implement and
organise the training of Eclipse and
Eclipse Live
Q3
2013/14
Ref
High
Priority
Area
Theme
Action expected from Compact Strategy Enabling Projects / Specific Actions / Expected
Outcome By
When Commissioner Providers Para
Priority Title Narrative
13/14 14/15 15/16
AP11. 10
Technology supporting
local business needs:
c) Wireless
d) PIP
Develop business case and
write Business Request for the
implementation of Wireless
and mobile solutions
6.2.10
CSU and IPHIS to:
Install wireless and Guest WiFi at Fort
Southwick and St James (CCG HQ)
Hospital.
Implement virtual Desktop
Q1
2013/14
Q3
2013/14
Commissioning Support Unit 6.2.10.3 PIP
Development
CSU
Complete the PIP development
Q2
2013/14
Beyond 2013/14
AP12.
Extended Patient
Access
“GPs will be encouraged
to extend over time the
range of transactions that
people can deal with
online, for example:
electronic booking (and
cancelation); of GP/nurse
consultations; repeat
prescriptions and patient
nomination of pharmacy
(for online prescription
services); access to test
results; and online secure
communications between
GPs and patient”.
Provide programme
sponsorship.
Note:
Phase 3 of the programme will
be dependent on the GP
system upgrade programme
(See AP4)
GPs (Supported by the
Commissioner)
Communicate with patients so
they are aware of the ability to
Book/Cancel appointments
and order repeat prescriptions.
6.2.3
On
lin
e P
ati
en
t A
cc
es
s t
o P
rim
ary
Ca
re S
erv
ices
Ph
as
e 3
– F
ull r
oll o
ut
CSU to:
Incorporate / weave in the GP System
Upgrade Programme to take account of
the dependency of this programme.
Work with GPs to increase the number of
patients with access to their records &
services such as booking appointments &
ordering repeat prescriptions.
Expected Outcome
Open up on-line access for patients to
view their GP records, book / cancel
appointments and order repeat
prescriptions for all patients who wish it.
Q4 2015
Ref
High
Priority
Area
Theme
Action expected from Compact Strategy Enabling Projects / Specific Actions / Expected
Outcome By
When Commissioner Providers Para
Priority Title Narrative
13/14 14/15 15/16
AP13. - Patient Letters and
Results to GPs
Take the lead in ensuring
Providers are encouraged and
supported and that projects
are delivered to specification
and on time (Managed by the
ITECB)
Providers (PHT, LA, Solent
HC and Southern Health,
SCAS and Care UK)
Encouraged to ensure safer,
quicker, more efficient care by
transferring electronically all
correspondence about
patients and service users,
including referrals, discharge
summaries, medication
details, assessments
(including CAF), outcomes
and letters, between
professionals and services.
These data transfers should
be coded and structured as far
as possible, in particular in
respect of discharge
diagnoses. This will enable
increasingly automated
derivation of national data
sets, national statistics (such
as Hospital Episode Statistics)
and national outcome metrics.
6.3.2 Clinical 5
On-going programme increase the use of
electronic communications between
community and secondary care providers
to GPs and vice-versa.
Q1
2014/15
AP14. - Picture Archiving and
Communications
Commissioner to add to
ITECB Agenda
Providers are encouraged to
ensure test results, X-rays and
scans are exchanged safely
between all settings by
building on national
information standards (such
as the National Laboratory
Medicines Catalogue), and
ensure test orders and results
are communicated in a
standard, interoperable,
electronic format.
-
PACS
The re-procurement of PACS will include
a programme of ensuring X-rays and
scans can be safely exchanged between
all settings.
Include access for GPs
Ref
High
Priority
Area
Theme
Action expected from Compact Strategy Enabling Projects / Specific Actions / Expected
Outcome By
When Commissioner Providers Para
Priority Title Narrative
13/14 14/15 15/16
AP15. - Telehealthcare
Compact to encourage more
rapid take up of teleheath and
telecare in line with patient
need (access to digital tools to
help them manage health).
Provide evidence to support
their strategies for the roll out
of Telehealthcare 6.3.3
Continue with the development and
expansion of telehealthcare On-going
AP16. A -
Wider access to
information for patients
and professionals
CCGs to encourage Providers
to enable their patients and
service users to participate in
their health care using
technology. Managed through
the ITECB
Providers to come up with
innovative ways using
technology to allow patients
and service users to
participate in their health and
care. Examples include
enabling service users to enter
information into their care
records, including self-
assessed test results,
feedback on treatment
progress, updating
demographic information and
general comment. Suppliers
are encouraged to develop
their systems to allow this
functionality in partnership
with the services. -
Await outcome of System Integration
Review
CCGs to encourage Providers
to make care records
electronic and available to
patients on-line. Managed
through the ITECB
Providers are encouraged to
make existing shared and
patient-held records, such as
maternity records and parents’
Red Book information,
electronic & accessible to
patients online.
Await outcome of System Integration
Review
CCGs to lead the
development of an information
portal for secure access to
patient records and health
information for care
professionals
In partnership with CCGs
implement personal and
professional access to view
records across specialties and
settings through ‘portals’ or
other solutions.
Await outcome of System Integration
Review
CCGs to encourage providers
to provide secure ways to
transfer information to service
users
Providers to develop
electronic links to transfer
information from providers to
service users.
Await outcome of System Integration
Review
APPENDIX B – GLOSSARY
Acronym Description
ADSL Asynchronous Digital Subscriber Line (Cable network technology)
AIM Advice and Interactive Messaging
AQP Any Qualified Provider
BCP Business Continuity Plan
BMA British Medical Association
CCG Clinical Commissioning Group
CFO Chief Financial Officer
CIO Chief Information Officer
CPU Central Processor Unit (with reference to Personal Computer
Speeds)
CQRS Calculating Quality Reporting Service (Replacement of QMAS)
CSU Commissioning Support Unit
DCS Document Control System
DH/DoH Department of Health
DoF Director of Finance
DPA Data Protection Act (1998)
DR Disaster Recovery
DRP Disaster Recovery Procedures
EDM Electronic Document Management
EDS Electronic Discharge Summarry
EH PCT East Hampshire Primary Care Trust
EOLCR End of Life Care Register
EPS (R2) Electronic Prescription Service (Release 2)
ESR Electronic Staff Record
FOI Freedom of Information (Act 2000)
FY Financial Year
GP General Practitioner
HC Healthcare Commission
HHR Hampshire Health Record
HIS Health Informatics Service
HITS Hampshire IT Solutions
HR Human Resources
HSCIC Health and Social Care Information Centre
ICT Information Communication Technology
IG Information Governance
IGSoC Information Governance Statement of Compliance
IM Information Management
IM&T Information Management & Technology
IPHIS Island & Portsmouth Health ICT Services
IQA Information Quality Assurance
IS Information Security
ISTC Independent Sector Treatment Centre
IT Information Technology
ITECB IT-Enabling Change Board
ITK Interoperability Toolkit
LAN Local Area Network
LDP Local Delivery Plan
MIG Medical Interoperable Gateway
MIS Management Information Systems
N3 NHS National Network
NCB National Commissioning Board
NHS National Health Service
NHSE NHS England
NHSIA National Health Service Information Authority (Now defunct)
NHSnet National Health Service (IT) Network
NSF National Service Framework
P&SEH Portsmouth and South East Hampshire
PACS Picture Archiving and Communications System (Radiology)
PAS Patient Administration System
PbR Payment by Results
PC Personal Computer
PCT Primary Care Trust (Replaced by CCGs)
PHT Portsmouth Hospitals NHS Trust
PID Person Identifiable Data
SAP Single Assessment Process
SCR Summary Care Record
SLA Service Level Agreement
SUS Secondary Uses Service (To be replaced by HSCIC)
VOIP Voice Over Internet Protocol (telephone system using computer
network)
VPN Virtual Private Network (Secure connection between two points)
WAN Wide Area Network
WLAN Wireless Local Area Network
