1 Assembly

1 Assembly

15 Trusts

22LHBs

135Hospitals

15,000Beds

81,000Staff

3,000,000Patients

£3bnBudget

~2000 GP

Practices

3 Regions

Revenue Secondary Care Budget

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Legacy

VelindreVelindre

I Soft/PIMSI Soft/PIMS

PMSPMS

MyrddynMyrddyniSoft/‘Green screen’

iSoft/‘Green screen’

PIMSPIMS

CWS/I SoftCWS/I Soft

PembsPAS

PembsPAS

WASWAS BSCBSC

Legacy

• In the south, mid and west of Wales the tradition is local development

Typically:

– PAS

– Clinical work station

– Departmental systems

– Some primary care (GP system) links

Usually developed in single Trust, two were later shared with neighbours

Legacy

• North Wales has commercial systems of varying vintages with more limited in house development capacity

Almost all Trusts use national systems from the corporate era:

– Radiology

– Pathology

– Pharmacy

Population by System Type

Our Health Informatics People

• Reflect the legacy

• Variations in capacity, resource levels and skill sets across Wales

• Many Trusts have strong in house teams

– Successful implementations

– Invaluable knowledge of clinical processes

– Excellent relationships with local clinicians

• We are know seeking to exploit this resource

• Two pieces of strategic work

– Deployment and utilisation

– Professional development

Staff Deployment and Utilisation Strategy

• Four phase production of strategy

• First two phases completed

– Best practice model derived

– Service wide survey and gap analysis against model completed

• CEOs have approved phase 2 report and authorised phases 3 and 4

• Stage 3 - appraisal of options to improve the utilisation of workforce and meet future requirements

• Stage 4 - recommended option, strategy and implementation plan (completion October 2006)

Professional Development Strategy

• Recruitment

• Retention

• Career progression

• Workforce planning

• Leadership development

• A4C/KSF

• Succession planning

• Recruitment

• Retention

• Career progression

• Workforce planning

• Leadership development

• A4C/KSF

• Succession planning

• HI National

Occupational

Standards

• UKCHIP

• Other professional

standards

• HI National

Occupational

Standards

• UKCHIP

• Other professional

standards

• Bursary scheme

• Vocational schemes

• Modular E&T products

• CPD initiatives

• Bursary scheme

• Vocational schemes

• Modular E&T products

• CPD initiatives

• Community of practice

• Body of knowledge

• Professional bodies

• UK HI professional

development bodies

• Branding & marketing

• Community of practice

• Body of knowledge

• Professional bodies

• UK HI professional

development bodies

• Branding & marketing

Professional Development Programme

Professional Development Programme

Talent

Management

Talent

Management

StandardsStandards Education

Training CPD

Education

Training CPD

Identity &

Community

Identity &

Community

Local ‘Readiness’

• Programme inheritance 1% of NHS resources

• NHS Wales target 2%, Wanless 4%

• Initially emphasis therefore on strengthening generic weaknesses

• So in first three years of programme

– £41m invested – 65% through local organisations

– 15 project managers and 19 support staff employed locally

– Networks improved (150 extra sites)


• Over 8000 ‘access devices’ deployed

• Microsoft enterprise agreement - 35,000 desk tops

• Data cleansing and quality

– 100 staff deployed locally

– Over 780,000 records processed by July 2006

– Duplicates down 4.6% to 1.4%

– Missing NHS numbers down 31% to 13%

• Foundation skills – European Computer Driving License

– 13,000 registered

– 25,000 modules passed


• Future readiness

– Derived from CMiS, IHR and Service Improvement Projects

– National work needed e.g. common clinical terminologies / coding

• But cannot continue to operate at 65% local allocation

• Higher proportion will be national

• Local requirements subject to business cases and benefit realisation

Engaging with NHS Wales

• This has been a top priority for the IHC Programme

• Stakeholder and communications strategy

• Some traditional approaches

• But key has been ‘hearts and minds’ through face to face relationships e.g.– Every organisation visited by Implementation Director at three

monthly intervals

– Programme funded project managers in every Trust

– Residential stakeholder events e.g. National Architecture Event

– Stakeholder assurance groups for key projects

– Programme Director attendance CEOs meetings

– Key strategic thinking explained and tested locally

• Position achieved: we are working ‘in common' is the default

Engaging with NHS Wales

• This activity must now ‘ramp up’ further

• We must ‘reach down’ further into organisations

• Must make use of local internal communication arrangements

• Deploy professional communication techniques

• Use our health care professionals to engage with professional communities

• These activities are resource intensive but a critical success factor in technology supported change

Current Position

• Overall

– We have an underinvested and fragmented legacy position (systems and staff)

• But …

– Programme regarded as moving to new phase and changing pace

– Delivery of strategic partner and CMiS foundation phase seen as key

– Engagement approach continues to be commended – Trust level and events

– Increasing sense of ‘corporateness’, partnership and realism

– IHC Programme is increasingly expected to give leadership & direction

Mrs Jones’ Journey

Time

Hospital unitHospital unit

Diagnostic unitDiagnostic unit

Multidisciplinary teamMultidisciplinary team

Radio/chemotherapy centreRadio/chemotherapy centre

Surgical centreSurgical centre

Home nursingHome nursing

HospiceHospice

Primary carePrimary care

Symptomatic careSymptomatic care

Follow-upFollow-up

Follow-upFollow-up

Second case conferenceSecond case conference

Follow-upFollow-up

First case conferenceFirst case conference

specialist consultationspecialist consultation

investigationsinvestigations

consultation & referralconsultation & referral

second treatmentsecond treatment

SurgerySurgery

Specialist palliative careSpecialist palliative care

pre-operative treatmentpre-operative treatment

Record 1

Record 2

Record 3

Record 4

Record 5

Record 6

Record 7

Record 8

Information in silos

Patient Journey with New Information Services

Time

Hospital unitHospital unit

Diagnostic unitDiagnostic unit

Multidisciplinary teamMultidisciplinary team

Radio/chemotherapy centreRadio/chemotherapy centre

Surgical centreSurgical centre

Home nursingHome nursing

HospiceHospice

Primary carePrimary care

Symptomatic careSymptomatic care

Follow-upFollow-up

Follow-upFollow-up

Second case conferenceSecond case conference

Follow-upFollow-up

First case conferenceFirst case conference

specialist consultationspecialist consultation

investigationsinvestigations

consultation & referralconsultation & referral

second treatmentsecond treatment

SurgerySurgery

Specialist palliative careSpecialist palliative care

pre-operative treatmentpre-operative treatment

Record 1

Record 2

Record 3

Record 4

Record 5

Record 6

Record 7

Record 8

Information in silos

New information servicesNew information services

What have we done so far?

• Network improvements

• Improving access to technology

• IT skills

• Electronic library

• Reducing duplicate records

• Service Improvement Projects

– My Health On-Line

– Diabetes Monitoring

– Individual Health Record – ‘Out of Hours’

– Transfer of Care Communication

ProgrammeProgramme Sub-programmeSub-programme ProjectProject

NHS business change resources, benefits management

NHS business change resources, benefits management

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Pro

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National architecture

National architecture

Service improvement

projects

Service improvement

projects

Individual Health Record


ProjectsProjects

ProjectsProjects

ProjectsProjects

Corporate programme resourcesCorporate programme resources

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Sta

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Te

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Pro

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Informing HealthcareInforming Healthcare

Organising to Deliver

IHC Strategic Partner

• Why do we need one?

– NHS Wales does not yet have the required collective internal capacity & capability to deliver the programme

– There is a need for significant flexibility in constructing teams (skill share, scarce resources)

– To scale up and deploy existing services and support new developments

– Create momentum as quickly as possible.

The success of this relationship and a combined ability to craft change is of equal importance to the more formal, contractual obligations


• Some of the things the partner will do for us …

– Joint working with NHS Wales and other countries

– Capability and capacity

– Hosting services

– Management of the catalogue – a restricted choice of common services only

– Technical development expertise

– Continuity support – legacy


• Some of the things they will not do for us …

– Overall design

– Final choice of systems

– Stakeholder engagement

– Implementation plan

Supplier Engagement

• To date, open dialogue prior to procurement – Do suppliers fully understand IHC’s approach?

– How do suppliers view working with IHC?

– How will suppliers approach securing the market capability and capacity to support the Programme?

– Do suppliers actually have the capability to support the IHC design principles?

– Is the scope of the programme commercially attractive to suppliers?

Approach

• Supplier Day: March 2006

• Phase 1 workshops: May - July 2006

• Phase 2 workshops: July - September 2006

• Intellect UK Briefing: May 2006

• Concept Viability: September 2006

• Issue OJEU Notice: Jan - march

• 7 months of constant dialogue with the market place

• 20 workshops within supplier community

• 50 hours of open dialogue outside workshops

• 50+ responses to Prior Information Notice (PIN)

Findings

• Incremental approach of IHC is much welcomed

• Catalogue approach best approach to meeting service requirements

• Strict governance around management of the catalogue is required, but flexible enough to meet service requirements

• Broad support for service orientated architecture approach – helping to leverage existing and new capabilities

• Delivery using service orientated architecture approach is relatively untried in healthcare

• Strong governance will be needed to balance IHC & the partnership

Investment Decisions

Sustained investment determined by service change priorities

Sustained investment determined by service change priorities

Sustained investment ahead of service changeSustained investment ahead of service change

Shared view of care

Shared view of care

World classinfra-

structure

World classinfra-

structure

Enablingchange

Enablingchange

Core foundationservices


Catalogue of information services required to deliversafe, effective and efficient healthcare


Regional plans, clinical futures, Delivering integrated services, care close to home




IHCAIMS IN

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Implementation Strategy and Benefits Realisation

Sustained investment determined by service change prioritiesSustained investment determined by service change priorities


Shared view of care

Shared view of care

World classinfra-

structure

World classinfra-

structure

Enablingchange

Enablingchange









IHCAIMS

Timescale for Designed for Life (Yrs)Timescale for Designed for Life (Yrs)00 9933 66




Shared view of care

Shared view of care

Clinical correspondence via portal

Clinical correspondence via portal

IHR in emergency careIHR in emergency care

IHCAIMS


MHOL patient accessMHOL patient access

Patient Record ServicePatient Record Service

IHR for long term conditionsIHR for long term conditions




World classinfra-

structure

World classinfra-

structure

IHCAIMS


Readiness – Data Quality, Info Gov. – Existing ServicesReadiness – Data Quality, Info Gov. – Existing Services

Mobile and fixed networkconnectivity for all clinicians

Mobile and fixed networkconnectivity for all clinicians

Cancer Information – Existing Service (CANISC)Cancer Information – Existing Service (CANISC)Video conferencing, Access to IT, Knowledge & Learning – All Existing ServicesVideo conferencing, Access to IT, Knowledge & Learning – All Existing Services

Medicines ManagementMedicines ManagementNational email serviceNational email service

PathologyPathologyImagingImaging

Referrals/DischargeReferrals/DischargeOrdering & Results Rep.Ordering & Results Rep.

SchedulingScheduling

Patient Authentication for internet access to summary record

Patient Authentication for internet access to summary record

Legacy Integration ServicesLegacy Integration Services

Local and NationalMessaging ServicesLocal and National

Messaging Services

Patient ID Service (PMI)- home countries & RoIPatient ID Service (PMI)- home countries & RoI

Registration & Audit Authority

Registration & Audit Authority

Data storage & Processing facilities

Data storage & Processing facilities

Portal servicesPortal servicesPt & Carer Emp.Pt & Carer Emp.

INC

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Enablingchange

Enablingchange

IHCAIMS


Decision SupportDecision SupportIntegrated Care PathwaysIntegrated Care Pathways

Patient SafetyPatient SafetyProject 2009Project 2009

Care close to home – (e.g. National Tele-Dermatology & National Minor Injuries Service)Care close to home – (e.g. National Tele-Dermatology & National Minor Injuries Service)Bro MorgannwgBro MorgannwgClinical FuturesClinical FuturesRegional PlansRegional Plans

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Documents

1 Assembly