IT Strategy Oxleas NHS Foundation Trust 2012-2015€¦ · · 2016-08-19IT Strategy Oxleas NHS Foundation Trust 2012-2015 . Oxleas NHS Foundation Trust ... medical record folder,

Oxleas NHS Foundation Trust Pinewood House Pinewood place Dartford Kent. DA2 7WG Tel: 01322 625700

IT Strategy Oxleas NHS Foundation Trust 2012-2015

Oxleas NHS Foundation Trust Pinewood House Pinewood place Dartford Kent. DA2 7WG Tel: 01322 625700

Contents Introduction ............................................................................................................ 2 Strategic Drivers .................................................................................................... 2 Summary ............................................................................................................... 3 Strategy Roadmap ................................................................................................. 5 Governance arrangements .................................................................................... 11 Key workstreams………………………………………………………………………….12

The future of RiO and electronic records 2015 ........................................... 12

Wide area network re-provision .................................................................. 13

Rio development and Release 1 deployment ............................................ 15

Use of new technologies ............................................................................ 17 Appendix 1 Financial summary .............................................................................. 20 Appendix 2 Significant IT Systems in Use .............................................................. 24

Oxleas NHS Foundation Trust Page 2 of 29

Pinewood House Pinewood place Dartford Kent. DA2 7WG Tel: 01322 625700

Introduction

ICT is a key enabler which supports services through the use of computerised systems and new technologies. The current Trust IT Infrastructure supports key clinical systems such as RiO, as well as Finance and HR systems, allowing services to use and share information essential to clinical care, performance monitoring and quality in a secure and reliable way. This document sets out the strategic direction for ICT Services within Oxleas NHS Foundation Trust over the next 3-5 years and describes the key developments that will deliver benefits including quality and productivity gains. Oxleas is seen as a successful user of IT systems, and was the first Mental Health and Learning Disability Trust to complete an end to end deployment of an electronic clinical records system (RiO). With the adoption of RiO, the use of ICT within Oxleas has expanded significantly and services are reliant on ICT systems to carry out their daily work. The Trust requires it’s IT infrastructure to be resilient, available at the time and place it’s needed and of sufficient performance to support key systems. To be fully effective, the IT infrastructure must also be flexible enough to support new developments. Looking forward this will include technologies such as remote working and video conferencing as well as other new ways of working that supports improved use of information and data quality to improve services and deliver efficiencies. This strategy comes at a key time. The future direction for ICT within the NHS is outlined in the white paper “Liberating the NHS: An Information Revolution” which describes a move away from centralised IT systems to local design and integration to better support decision making, data quality and choice. This approach frees NHS organisations to procure IT systems that better meet local needs whilst supporting the development of services and partnerships. However some of these freedoms come at a price and this strategy anticipates the loss of central funding for clinical systems such as RiO as well as the N3 network infrastructure that currently supports the NHS.

Strategic Drivers

There are a number of internal and external drivers shaping the IT Strategy:

The requirements of a new/changing organisation with dispersed services

The requirement for a reliable resilient high performing network to support services

The need to support service transformation and productivity

Developing an IT Capable Workforce

The need to improve data quality, to support information for commissioners and Payment by results

Supporting Choice and information for patients

The end of centrally funded national contracts

Improving clinical records keeping, security and information governance

Externally driven software support requirements



Summary The reliance on IT systems for day to day activities requires an IT capable workforce, even more so if we want to deliver transformation and achieve the benefits of IT enabled change. We know that IT literacy in some parts of our services, particularly where there is a reliance on paper systems, is less developed than elsewhere. IT Skills will be developed through the ongoing delivery of accessible IT training including a mixture of traditional classroom training and e-learning modules. Staff competence testing at recruitment has been developed to ensure that new starters have the basic IT skills needed to effectively deliver care. The national contract that provides the RiO clinical information systems to the NHS expires in 2015. The Trust will continue to develop the use and scope of the RiO systems prior to the end of the contract to improve clinical services and the availability and security of information during the remainder of the contract and the Trust plans to deploy one significant upgrade (RiO Release 1 previously called RiO v6) to Community Health and Mental Health services during 2012. The Trust is fully involved in the London wide groups helping to steer the future development of RiO and will be working with the LPfIT and partners to ensure we maintain the clinical benefits accrued since 2006 when RiO was first deployed, whilst preparing for the end of the national contract. Planning for a replacement clinical IT systems has already started with the bulk of the procurement activity taking place in 2012/13. This provides the Trust with an opportunity to tailor the replacement system to better match service and patient’s needs and deliver greater benefit. A locally specified and procured system will allow the Trust to significantly improve the sharing of information within the Trust and to other partners and stakeholders. A key driver for this strategy is the need to consider how the Trust can support people who use our services, commissioners, GPs and other partners with improved access to accurate information. We will continue to support the Social Inclusion agenda ensuring information for Patients and Service users is available electronically via the Internet and at all Trust sites and locations. The Trust has already adopted technology to allow emails to be sent securely to any internet or NHSmail recipient and the use of NHSmail is increasing throughout the NHS. During the strategy we will review the strategic use of NHSMail to assess if it is a feasible alternative to the local mail service currently adopted. The Community Provider Services utilise a number of systems for clinical record keeping. Between 2007 and 2009 some services adopted RiO as the main clinical record, however others have remained paper based or utilised GP and Acute Hospital Systems. The strategic approach is that community services will adopt the electronic record as the primary electronic health record facilitating the provision of timely clinical information. With the transfer of Greenwich Community Health services to the Trust in April 2011, we now have two instances of RiO supporting community services. These services will be consolidated onto a single Community RiO instance under the direct management of the Trust requiring all Community services to go-live with RiO release 1 at the same time.. There are no plans nationally or locally to integrate instance of RiO across Community and Mental health care settings but an expected benefit of a local procurement will be the ability to incorporate both community and mental health service requirements within a new clinical information system. The increased reliance on ICT systems requires the Trust to invest in developing resilient infrastructure. The current network is largely based on N3 infrastructure, which was made



available to Trusts via the National Programme for IT. Though N3 is a highly resilient service there are limits to performance due to restricted bandwidth, and it is also unlikely that the costs will continue to be centrally funded. A program to replace the current N3 provision with a locally procured, high performance alternative is already underway. This will improve performance and capacity and future proof our network infrastructure by enabling the future adoption of other technologies such as network based telephony services. We will support the dispersed nature of services and the large number of Trust locations through supporting new ways of working such as Video Conferencing. These new ways of working will require additional setup and revenue investment. The implementation of these services will be carried out with care, to ensure that critical systems, such as RiO are not adversely affected and that adequate support mechanisms are in place to ensure that the benefits are maintained. Technologies that deliver benefits such as efficiency improvements improved access to clinical information will be rolled out to other services. Community staff currently have access to clinical information at Trust locations only; mobile working technologies have been tested within the Trust and are available for service to develop to enable them to access RiO and other systems from a patient’s home providing the most up to date information regarding their needs. The NPfIT is responsible for specifying the Information Governance standards required of Trusts, and has developed the Toolkit to assess Trust’s compliance against these standards. We have demonstrated strong performance in previous years, and although the toolkit is revised each year, we expect to meet the core requirements and will continue to work through other areas. The desktop operating system infrastructure within Oxleas has standardised on Windows XP since 2005, and has not been subject to significant upgrades. Microsoft have announced that support for Windows XP will cease in 2014, and it is expected that other software suppliers will also ceases supporting Windows XP with their systems by the same time. To manage the risks associated with using unsupported software, we will need to plan a migration to Windows 7 once it is supported for our main systems. To facilitate the migration, the Trust has ensured that the desktop operating system licences for Windows XP are capable of being re-used to licence our use of Windows 7 at no additional cost. A number of PCs however will not be able to run the new operating system, and so will require replacement or upgrade as part of the Trust’s regular replacement programmes. With the move to RiO being the primary record the PC has become the equivalent of the medical record folder, and its continuing functionality is therefore critical to providing clinical care. We will ensure the continuing functionality of PC through the use of IT systems to create “self-repairing” configurations and limits on end users ability to change the configuration of PCs. This development will bring the resilient approach taken to the underlying infrastructure to the devices used on the network in order to ensure that the IT infrastructure has maximum end-user availability.



Strategy roadmap This strategy is comprehensive and ambitious and to ensure we have the capacity to deliver it will be taken forward through four key workstreams:

The future of RiO and electronic records 2015 - Replacement clinical information system Wide area network re-provision Rio development and release 1 deployment Use of new technologies and new ways of working.

The strategy roadmap sets out the expected timelines and high level work plans for the workstreams that deliver the strategy. The wide area network re-provision is a supporting technology to enable and support new ways of working and the wider aims of the strategy.

The future of RiO and electronic records 2015- Replacement Clinical IT system

Jan-12 Apr-12 Jul-12 Oct-12 Jan-13 Apr-13 Jul-13 Oct-13 Jan-14 Apr-14 Jul-14 Oct-14 Jan-15 Apr-15 Jul-15 Oct-15

Nov-15

End of BT Contract

Jan-15 - Nov-15

Contigency

Jul-12 - Jan-13

Procurement preparation

Apr-12

2015 project group closes

Jan-13 - Jan-14

OJEU Procurement

Jul-13

Contract award

Jan-14 - Nov-15

Build and implement

Jun-12

GCHS R1

Oct-12

MH R1Sep-13 - Dec-14

RiO R2 rollout

Jun-13

RiO R2 First of type

Dec-13

Earlier transfer of service?

Dec-12

Shorter procurement?

Jan-12 - Jul-12

Procurement preparation

Jul-13 - Jan-15

Build and Implement

Jul-12 - Jul-13

OJEU Procurement

Jan-15

Transfer of service

To prepare for the end of the national contract a project group has been set up by the MH and CH Programme boards to help trusts develop their plans, and facilitate collaborative working. The proposed timeline would involve Oxleas deploying the final version of RiO between September 2013 and December 2014, whilst also building and implementing the replacement system. This is based on a 12 month procurement process, followed by an 18 month implementation. The Trust may also be able to complete the project to alternative timelines, by starting earlier.

a. Starting the project in January 2012 would complete transfer by January 2015, providing 10 months of contingency,



b. Compressing the procurement and implementation phases could potentially bring forward the adoption of a new system to December 2013,

Compressing the timescales will introduce additional risk, and limit the availability of collaborative partners, but will mitigate the wider London risks of supplier capacity. A compressed timeline will necessitate limited application development through the use of “off-the-shelf” products.



Wide area network re-provision

Jul-11 Oct-11 Jan-12 Apr-12 Jul-12 Oct-12

Jul-11 - Aug-11Buying solutions tender

Aug-11

Evaluation complete

Virgin selectedSep-11

PO Raised and

Project kick off

Aug-11 - Sep-11

Design

negotiationsSep-11 - Nov-11

Equipment ordering

Nov-11 - Feb-12

Site preparation

Oct-11 - Jan-12

Site surveys

Wayleaves

Route planning

Apr-12

Target Go-live

Jul-12

Olympics start

Dec-11 - Mar-12

Critical Line installations

Sep-12 - Dec-12

Remaining installations

The rapid implementation of the replacement wide area network is essential to enable the Trust to benefit from using new technologies as soon as possible. The design and procurement processes have already started and the contract agreed with the supplier, Virgin. Delivery of the new network will coincide with the Olympic Games in 2012 which means that the supplier will be subject to external restriction on installation work to minimise disruption to the event. Implementation of the network will need to prioritise the installation of network connections at key sites prior to the Olympics with the remaining sites connected after the Olympics.

Rio development and Release 1 deployment

Oct-11 Jan-12 Apr-12 Jul-12 Oct-12

Sep-11

CH Project Start up

Jun-12

GCHS R1 Go-live

Oct-12

MH R1 Go-Live

Sep-11 - Nov-11

CH Readiness Assesment

May-12 - Jun-12

CH End user training

Jan-12 - Mar-12

MH Readiness Assesment

Sep-12 - Oct-12

MH End user training

Aug-12

MH Training dates released

Aug-12

MH Gate 3a

Ready to deploy

Jun-12

MH Gate 2b

preparation

Dec-11 - Jun-12

BCHS Data migration

Mar-12

CH Gate 3a

Ready to deploy

Mar-12

CH Training dates released

May-12

MH Gate 2a

Pre-deployment

Jan-12

CH Gate 2b

preparation

Dec-11

CH Gate 2a

Pre-deployment

Jan-12

MH Project Start up



The Trust has committed to deploying the next version of RiO in both Community and Mental Health settings during 2012. During the Community implementation, the Trust will combine the two community instances into a single instance. A pilot data migration will be carried out within a representative service between December 2011 and January 2012 prior to roll out to all other Bexley community services, to complete before the R1 go-live. RiO Release 1 will therefore go-live in both BCHS and GCHS at the same time; Bexley Community staff will therefore need to be included in the planning of the R1 upgrade.



Use of new technologies and new ways of working

A number of technological developments are proposed to pilot new ways of working in services. The individual work plans will be developed via the IT Strategy group, with the outcome including planned benefits; resources required and roll out plan.

Jul-11 Oct-11 Jan-12 Apr-12 Jul-12 Oct-12 Jan-13 Apr-13 Jul-13 Oct-13 Jan-14

Dec-11 - Mar-12

Digipen Pilot

Scope, procurement, testing

Mar-12

Digipen pilot evaluation

Jul-12 - Sep-12

Olympics

Jan-11 - Jun-12

Video conferencing pilot

Nov-11

Tele-health evaluation

Jan-12 - Jun-12

Tele-heath rollout

Nov-11 - May-12

Choose and Book

GCHS

May-12 - Nov-12

Choose and Book

Mental Health

Sep-12 - Dec-12

Windows 7 Rolout

Dec-11 - Apr-12

Voice recognition pilot

May-12

Voice recognition evaluation

Feb-12

BIS launched

Feb-12 - Aug-13

BIS Develoment

Dec-12 - Jun-13

Review IT service model

Jul-12

Self service password recovery

The exact timescale for each development will be established during the initial scoping and planning stages, but preliminary timescales can be shown as above. A number of these developments are essential to the Trust’s ability to deliver its objectives and are driven by both internal and external factors. The Trust is already committed to areas such as the further development of Telehealth and use of video conferencing, whilst others are optional and will be taken forward following evaluation of benefits. Whilst optional, a number of new ways of working based on existing technologies, have already been implemented in some areas. Services will need to develop protocols around their use and assess suitability for their services. Optional developments will be supported through the delivery of the IT strategy, but will require local resources to roll-out. Essential developments include:

Tele-health

Business information system

Windows 7 roll out

Choose and Book

eRostering roll out



Optional developments

Video Conferencing

Scanning to RiO

Digital dictation

Managed print service (move to network printing and rationalisation)

Mobile working

Digital pens

Voice recognition Self service is a strategic aim for many currently centralised functions. These functions can be seen to be unresponsive and costly to run, providing end users with the ability to manage their own support can lead to increased take up and satisfaction. Self service is being developed as part of the roll out of eRostering, which will be deployed throughout the Trust, integrating rostering with bank staff systems. Self service facilities for Datix are in pilot, and self service password recovery is being rolled out to Safeboot users and in the future network passwords. The model of IT service provision will be reviewed in 2013 following the upgrade to Windows 7, to evaluate the appropriateness of the Service desk model and asses the underlying systems against available alternatives such as email and other back office systems. NHSMail will be specifically reviewed to assess whether it should be adopted as the Trust email system. Enabling these technologies will require an IT literate workforce, as well as the underpinning infrastructure. An IT Training strategy will be developed following a Trust wide Training needs assessment to ensure that the Trust’s workforce is able to utilise the technologies available. Information security remains as the underlying measure against which technologies will be assessed, to ensure that benefits are not achieved at the expense of the Trust’s security.



Governance Arrangements

Delivery of the IT strategy will be overseen by the IT Strategy Group, which will report to the Executive Committee. Membership of the group will represent the Clinical, Technical and Business domains within the Trust and it will be chaired by Stephen Firn, the Chief Executive.

Representatives will also act as the sources of support and expertise in relation to the impact of developments in their directorates and be authorised to commit resources from within their directorates to support the group or sub-groups as required.

The IT Strategy group will review proposed IT Developments and ensure a co-ordinated approach across services is taken, and will maintain a list of proposed developments. The group will monitor the delivery of agreed IT developments and the realisation of benefits and will have oversight to decide on business cases and resource allocation for projects.

IT Developments may be proposed by services or corporate directorates, and may result in the creation of sub-groups to evaluate proposals and develop bids, business cases, etc as required. The group will identify individual leads for each workstream who will report to the IT strategy Group.

The IT Strategy group will agree which proposals are taken forward to pilot stage and beyond, and steer their progress subject to an agreed timescale. Once a pilot has successfully demonstrated benefits, a wider roll out plan will be presented to service for local adoption. Funding for future revenue requirements will generally remain the responsibilities of services from efficiencies delivered.

The group will develop and maintain a risk register.

The group will also act as the RiO Programme Board overseeing the remaining deployments across community and mental health services and the consolidation of RiO Community instances.

The group will agree the deployment schedules for future RiO releases and ensure the implementation of future versions of RiO are within the identified resources available (both Financial and staff) and to time. The group will manage the risks and corresponding contingency planning for the projects. Operational risks will be held by the relevant governance groups.

The group will agree the specification and monitor the procurement of future Clinical IT systems, as well as the re-provision of the wide area network infrastructure.



Key workstreams The future of RiO and electronic records 2015 - Replacement Clinical IT system The Trust accesses RiO via the national contract struck between the National Program for IT and BT (the LSP), which is managed locally through LPfIT and NHS London. The LSP contract expires in October 2015 and the Trust therefore must plan for a replacement system. The process of establishing requirements, undertaking an OJEU procurement and the replacement supplier’s develop and build period is likely to require significant time and resources. In order to complete the transition to a replacement system, with adequate contingency, the Trust must start preparation before the end of 2011. It is assumed that central funding for RiO will cease at the point of expiry in October 2015 and therefore all costs incurred after October 2015 will fall to the Trust. This would include any contract extensions required for Trusts who have not migrated from the BT service. It is anticipated that these costs will be unsustainable, as the whole costs of the contract will be borne only by those Trust still receiving a service. It is key that Oxleas migrates away from the BT service provision in good time to manage this financial risk. Planning for this will take several years, with the development of local specification and tender processes, and will therefore need to start during the financial year 2012/13. The Trust will have the freedom to choose RiO or an alternative Clinical IT system, and will need to maintain the practices and benefits achieved through the use of RiO into any new system. Given the timescales, and previous experience with bespoke system development, both locally and nationally, a solution utilising commercially available products would be favoured. This would provide assurance on the availability and functioning of any system, and still allow adequate time for smaller scale developments to better match the Trusts requirements. The Trust will need to agree its approach to the specification and procurement in the early stages of the planning process. A London wide project group has been formed, reporting to the MH and Community Programme Board, to develop a framework of procurement options and describe common system specifications to support individual Trusts procurement decisions., Clinical records keeping has become fragmented as new services have been developed and RiO can no longer be regarded as the primary electronic health record in all services. The Trust will move to a primary electronic health record in all Community services, albeit not necessarily RiO. Within Community services a number of services are still predominantly paper based, in addition the following systems are used:

SOEL Health – Dental

Vision – Sexual Health and The source in GCHS, District nursing in BCHS

Sam Shaw – wheelchair services

IAPTus – Greenwich Time to talk

SystemOne – prison services

MH Clustering – MH services During the planning process, the Trust will need to agree the scope of the replacement system. This will include whether those services not currently using RiO, such as IAPT or Sexual Health, will be included. The trust will be looking for the next generation of clinical system – it



must deliver at least the functionality currently employed by the Trust to maintain the practice improvements and benefits accrued through the use of RiO. The Trust will only adopt RiO release 2 through the current BT/LPfIT contract is RiO is selected as the replacement clinical system through the procurement process. Any replacement system must therefore deliver the planned benefits that would be available from RiO R2 as well as supporting the Trust’s other strategic aims around information sharing. Key factors that will be required of any new system are:

Local configuration control

Interoperability with other clinical systems via an Integration Engine

Pathology order comms and result reporting

Supporting patient involvement

Support of payment by results/MH Clustering

Wide Area Network re-provision

Although the design of the IT network was suitable to support the use of RiO as a single primary electronic record, it is no longer able to fully support the Trust’s strategic goals. The increase in the number of Trust-wide systems in use, as well as the more intensive use of these systems has already resulted in poorer IT network performance. A step change in the network design is required to enable adequate support for new ways of working. The bandwidth provided by N3 has remained fixed at that specified several years ago, and although natural growth of PC devices was included, the specification could not take into account other unforeseen changes which have increased the number of PCs in use. Local change programs and consolidation of the Trust building estate have increased the pressure on network links resulting in growth outstripping previous predictions. This is particularly so at sites such as Ferryview or Bexleyheath Centre where large numbers of staff are now located. The lack of available bandwidth means that systems perform slower and affects the productivity of staff as time is wasted waiting for systems to respond. The future of the centrally funded N3 service is under question; although N3 is considered essential NHS Infrastructure, in line with other national arrangements, it is likely that at some point in the future the cost of N3 services will be transferred to local NHS organisations. The commercial value of N3 to the Trust is £620k. To meet these challenges, the existing wide area network will be replaced with a completely new service. In considering the new design, the key criteria of resilience and minimal single points of failure must be maintained to ensure that the IT network continues to support business critical IT systems such as RiO. Furthermore, flexibility in the design is essential to ensure that the service is “future proof” and can cope with the organisational changes over the next 5-7 years. The geographic nature of the Trust limits the options available, as unlike an acute Trust, with a single campus, we would be reliant on public utilities to provide the network links. Traditionally this would require the installation and rental of many network links to provide the level of resilience required, with links over longer distance costing more. The resulting network would meet the needs of the Trust by delivering high performance and resilience (multiple connections to each server site), but would cost many millions of pounds and would not be flexible to future changes.



A competitive tender process has already been undertaken to seek out a cost effective model which meets our requirements:

Resilience

Cost-effective

High performance

Flexibility Virgin Media Business have been selected as the supplier with the ability to deliver against the Trust’s criteria, which can be scaled up as demands on the network increase over time. The design provides for the installation of services into each of the Trust premises which will more than meet the current expected demands and still have the capacity to increase usage 10 fold without redesign. With this new infrastructure in place, extending into new areas can be achieved by installing the service into any new or transferred premises, without requiring any network re-design.



RiO development and Release 1 Deployment

The Trust had adopted RiO as the primary electronic record in the majority of services and has developed clinical practice supported by RiO. The ongoing development of RiO is managed by LPfIT across London in conjunction with SPfIT in the South of England. This produces a controlled development plan for the life of the system, though limits the Trust’s ability to integrate with other systems. Each deployment of a new version of RiO has been subject to a separate Business case outlining the costs and resources required. The scale of deployment costs will vary depending on the additional functionality delivered in each release and the scale of the corresponding change to clinical processes by end users. The Trust has committed to deploying Release 1 first in community services followed by Mental Health services, through the annual planning process.

RiO high level functionality roadmap for community and mental health systems

Non-mandatory functionality

Results and reports management

RiO2RiO integration 1

Prescribing and administration 2

Bloodspot Screening

RiO R1 (2012)

Validation of clinical notes within cae

plans

Screening surveillance scheduling 1

Cross care setting messaging 1

BT Data warehouse feed

RiO v5 (delivered)

Spine compliance – C&B, PDS,

Smartcard, RBAC

Prescribing and administration 1

Organisation and professional contacts

lists

Field level validation on RiO forms

Validation of clinical notes within

assesments

CPA Review scheduling

Annotated clinical digrams

SNOMED CT

Bed planning and scheduling

RiO R2 (2014)

Mandatory and non-mandatory

RiO2RiO integration 2

Equipment and facility scheduling

Care pathways

Screening surveillance scheduling 2

Decision support

Order comms

Cross care setting messaging 2

Prescribing 3

Spine compliance - eTP, PSIS, LRS,

sealed envelope

The development of community services within Oxleas has increased the complexity of RiO implementations as Community and Mental Health services are not able to use the same instance of RiO, and instead use separate instances.



The provision of RiO Community for Bexley Community services is via an SLA with Bexley PCT and is shared with South London Healthcare Trust. This service limits the overall control that the Trust has over the configuration of RiO, and introduces Information Governance risks that need to be managed through the effective management of the SLA. Within Greenwich community services, Oxleas took responsibility for the management of RiO and so the Trust therefore has access to 3 different instances of RiO, fragmenting the availability of information and limiting clinical benefits. The consolidation of the two community instances will be undertaken as part of the deployment project into GCHS, further consolidation would be desirable, but is not possible within the confines of the BT service provision. Both Bexley and Greenwich community services will therefore go-live at the same time on RiO Release 1. RiO Release 1 and beyond will deliver additional functionality in both mandatory and non-mandatory slots. The Trust will need to assess the benefits of the non-mandatory functionality within each business case and agree the deployment options with BT and LPfIT. However, non-mandatory functionality is delivered separately from mandatory, through a new deployment project, allowing the Trust to take a reasoned view without impacting on the deployment of mandatory functionality. The timescale of moving to a replacement clinical system at the end of the contract will coincide with the availability of R2 to the Trust and so the Trust will only adopt R2 if RiO is selected as the replacement clinical IT system.



Use of new technologies and new ways of working

The use of new technologies to support new ways of working will be developed to support services to deliver local improvements in productivity or care through improving access to systems and information. The technologies used will aim to assist services in improving care, reducing admissions and managing clinical risks as well as achieving QUIPP improvements, CRES and productivity targets. Some technological developments will be essential to maintain services and will generally be the result of external drivers for change. These “must do” developments will be prioritised to assure delivery. Other “optional” developments will generally be the result of internal drivers for change, and are likely to require local resources and agreements on the scope and scale of future deployments following a successfully pilot evaluation. The evaluation of these technologies will be two-fold: Partly a test of the adequacy of the technology and assessment to its value and partly to test the benefits accruable from practice changes. The choice of technologies will be selected to support local and Trust wide aims. Individual projects will be evaluated to capture the detailed benefits and individual timelines and resources required, and ensure that benefits continue to outweigh costs. Underpinning the availability of new technologies will be a number of infrastructure improvements and enabler. The Trust network will be re-provided as described earlier, as well as the adoption of a modern IT desktop environment though the adoption of Windows 7. The Trust will need to maintain an IT literate workforce to enable the effective use of these technologies which should not be intrusive for staff to use, but will also need to be affordable. The information Governance issues raised by the wider use of technology will need to be managed to ensure that the trust complies with its obligations to protect personal information. Remote and mobile working technology is already available to services to facilitate remote access to the Trust IT systems from any location. The technology selected is based on the same solutions evaluated in the National Mobile Health worker pilot undertaken by the Department of Health and has been developed to meet the Information Governance requirements of the wider NHS and the Trust. The average productivity savings of such technologies was evaluated at over £3000 per clinician per year. The roll out of mobile working will be influenced by capacity and affordability and teams will need to develop protocols around its use, recognising the growth of mobile working may increase security risks. Other developments in progress against this agenda are:

Electronic rostering. This will enable the system to allow services to efficiently match shift staff requirements to Bank staff availability within Mental Health and Community services. This project is in conjunction with the Temporary staffing team.

Video Conferencing. The large geographical spread of the Trust leads to significant direct and indirect travel costs and intricate communication and referral pathways. Video conferencing provides one opportunity to tackle this issue by reducing staff’s need to travel by providing improved and modern communication links for staff and service-users. Significant financial and clinical benefits have already been demonstrated prompting a widening of the pilot.

Tele-health. The Trust is piloting the use of a system to help patients manage their long term health condition at home. The system enables patients with conditions such as heart failure or lung disease, to make a range of checks appropriate to them, such as measuring blood pressure, heart rate, oxygen levels, temperature and weight in their



own home. The results are then sent directly, to a “virtual ward”, where they are regularly checked by clinicians.

Digital dictation. A pilot is underway within Greenwich Community services to assess the benefits from Digital Dictation systems to improve the flow, throughput and timeliness of dictation.

Business information system. The availability of accurate and timely information to clinicians and managers is essential to deliver care and manage services effectively. The development of a BIS will enable staff to access summary and performance information quickly and easily. The initial scope of the development is targets on reporting RiO information to deliver Key performance indicators, but will continue to be developed to include more information systems and outputs.

Choose and Book. Choose and Book is key to the success of the new Long Term Conditions services and it is proposed to extend this facility to all other Community and Mental Health Services. This will form a template for the Trust in relation to structuring electronic referral processes and access for future business planning of current and future innovative service models

Potential technologies for evaluation:

Voice Recognition, a number of individual users already have access to Voice recognition software to dictate text into Word, RiO or other applications and this technology could be more widely evaluated to identify efficiencies through reduced duplication of effort and typing, and the subsequent improvement in timeliness of record keeping. It is expected that medical staff (Doctors, etc) will benefit the most from this technology, as they generally already have the underlying dictation skills.

Digital Pens. A large number of health professionals within community services do not have access to electronic systems at the point of providing care, or operate a joint paper record with other agencies, many of these joint records are stored within the patients’ home. The use of digital pens to capture written text and transfer it to our electronic health records would significantly improve the sharing of information between clinicians and provide an effective mechanism to manage clinical risk.

The output of the pilots for all new development will include the resources needed to develop the technology further and expand its use throughout the Trust, and identify the benefits to teams, as well as an ongoing benefits realisation process. Identifying and developing opportunities to transform services will require additional capacity to support services and the IT Department. It is proposed that a 2 year fixed term project resource (8a) be developed to work with services and the IT team to bridge the two. The role will identify potential service improvements within services, targeting cross-service opportunities. Working with Clinical and Business staff to map existing processes and identify where technology could deliver efficiencies (both clinical and financial). The role will also involve the active researching of new healthcare applicable technologies and raising awareness within the Trust’s clinical services of such technologies.

Priority will be given for Trust wide solutions, and these may become mandatory and consistent across directorates. The standardisation approach will ensure the cost-benefit remains positive. Once a pilot has been completed successfully, a template business case and project implementation plan will be developed to either roll-out the benefits Trust-wide (as an authorised solution) or for more local implementation (as a catalogue service). The templates



will include detailed costs for implementation and expected benefits. Ongoing benefits realisation evaluation for each implementation will be undertaken.

To fully support the use of new technology and ensure that the Trust is able to use new software, the PC estate will also need to be reviewed and upgraded. The IT replacement budget has not kept pace with the growth in IT equipment, and is only sufficient to replace approximately 200 PCs per year, equating to 800 PCs on a four year rolling replacement programme. With the current PC estate, it would take 16 years to replace all devices. In previous years, one-off funding has been used to good effect to replace large numbers of superseded IT equipment and a similar one-off project to bring the Trust minimum specification up to a standard that would support future developments and improve current working practices is proposed.



Appendix 1 Financial summary

The main strategic infrastructure developments have previously been funded via national contracts, providing access to software solutions for single sign on and desktop management at no cost to the Trust. Individual developments supporting the strategy will require their own Business Case to fully cost the project and identify benefits. A number of projects are already underway (Business Information System, eRostering, Choose and Book and Telehealth) with approved business cases. Costs and benefits for these are therefore identified within the individual business case. To support the implementation of the Strategy, additional capacity is required to work with services to develop and evaluate new ways of working and develop the subsequent Business Case and costing models for review and approval by the IT Strategy Group.

Strategy implementation role 2 years Band 8a, at £64,000 per year Where a Business Case is yet to be developed, indicative costs are shown below.. The business case for the re-provision of the Wide Area Network has been agreed with one-off funding of approximately £660k, and revenue funding of approximately £580k.

WAN business case approved for £660k set up and £580k revenue. In addition to re-providing the WAN, local PC bottlenecks will also require resolution through replacing the most obsolete PC equipment:

PC replacement project £202k additional funding required. The opportunities fund has provided the funding for specific pilot projects. Scanning to RiO pilot costs of £37,000 has been funded through an opportunities fund bid, deployment costs will be met by individual services, through efficiency savings delivered by the scanning process and Video conferencing pilot is being funded through Bexley Adult services.

Scanning to RiO pilot of £37k funded through the opportunities fund. Rollout costs would depend on the scope and uptake and equate to £816 per workstation using existing PCs; allowing two scanners per site/building/ward would require an investment of approximately £250k for a trust wide implementation.

The Trust has made a commitment for funding for the RiO R1 upgrade project (as it was then identified as Version 6) in previous years, though this has been delayed. During the Annual planning process an allocation of £200,000 has been identified to support the delivery of R1, and a full Business Case will be developed to confirm the funding requirement.

Anticipated RiO R1 project costs of £200k already identified plus a further £50k to include the combined BCHS and GCHS instances.

There have been further commitments in the Annual plan to support the development of new ways of working through funding of £30,000 each for two pilot projects. Services will need to make allowance in their own annual plans for the roll out of new technologies, with the expectation that these technologies will release more savings than the revenue costs. The use



of these technologies is not widespread, so the specific detail relating to suppliers and system availability is still to be assessed. The costs presented are therefore only indicative.

Funding for pilots of Voice recognition and Digi-pen technology has been identified within the Annual planning process of approximately £30,000 per pilot

The cost for procuring a new clinical IT system will fall predominantly from 2015 onwards once the Trust is fully responsible for the costs of the replacement service. However, the process of specifying, developing and tendering for this service is due to start in this period and will require additional external support, expected to cost in the region of £200,000. This process will enable the Trust to evaluate and identify the full cost of managing the new IT system in Oxleas. The current financial benefits of the RiO instances are approximately £330k each, giving a total of £660k once the community instances have been merged. The Trust should anticipate similar funding requirements for a locally procured solution

RiO replacement procurement costs anticipated at around £200,000 plus consortium costs of around £28,000

RiO replacement system ongoing costs between £350k and £650k annually The IT department has developed a remote access solution to provide remote and mobile access to RiO and other central systems. The technology used to deliver the solution and therefore the systems available remotely has been limited by the security requirements of RiO and compliance with the warranted environment specification (WES). The WES describes the technical environment in which RiO is tested and assured to work. The system utilises the VPN single worker solution provided by N3 and is a highly secure solution using RSA hardware based tokens to ensure all data in transit is fully protected to NHS encryption standards. The solution adopted for remote access is the same as piloted by the DoH in the mobile worker pilot project, as well as deployed in other Trusts, and is available to services. There has been interest in a number of services for a mobile working solution, particularly Community Health services, and it is anticipated that at least several hundred remote working laptops may be required. Similar Trusts have invested heavily in this technology to deliver significant savings on the estate – for example South West London and St Georges have deployed 800 mobile working laptops to community mental health staff.

IT support processes already in place, equipment costs of £1400 per laptop, plus £250 revenue subject to level of service chosen. Wide adoption of this technology could equate to an additional 300 laptops assuming that a reasonable proportion of the current estate of laptops can be upgraded (the Trust has approximately 800 laptops in use)

A review of the IT service provision may require short term investment and well as ongoing investment in staffing to deliver changes to systems and processes. Migration to NHSMail is likely to be cost neutral as in line with other nationally funded systems, it would be reasonable to expect that central funding will be reduced or removed. NHSMail has a commercial value of approximately £60k to the Trust, which is similar to the cost of our locally provided service, albeit, the Trust system is more flexible. Other changes, such as re-structuring the Helpdesk to improve first-time fix rates, would require additional ongoing technical resources dependant on the response rates require by services.



The cost assumptions are based on the current structure and services delivered by the Trust, and do not reflect future organisational changes. The infrastructure will be designed to support any changes, but as the trust grows and changes additional ICT resources will be required and there will be a financial impact.



Financial Summary Essential Developments and changes

2011/12 2012/13 2013/14 2014/15 2015/16

Oneoff Revenue Oneoff Revenue Oneoff Revenue Oneoff Revenue Oneoff Revenue

Strategy implementation support

£16k £64k £64k

PC Replacement/ Windows 7

£202k

WAN Re-procurement (Business Case Agreed)

£660k £584k £584k £584k £584k £584k

RiO R1 upgrade (Annual Plan 2011/12)

£80k £170k £35k £35k £35k £35k

RiO replacement Procurement costs

£102k £61K £34k £31k

RiO replacement System costs

£350k £350-650k £350-650k

Assume go-live on replacement in 2014

Note: Estimated costs are shown in italics



Existing developments Business cases for the development and implementation of a number of systems have been approved separately from this strategy and costs and benefits plans are therefore included within these business cases.

Telehealth

Service transferred from BCHS

Business Information System

Existing business case approved for costs of £380k

Choose and Book

Existing business case approved for costs of £25k via Opportunity fund bid

eRostering rollout

Service transferred from GCHS

Video Conferencing

Existing business case approved for costs of £260k via Opportunity fund bid



Optional Developments and changes

2011/12 2012/13 2013/14 2014/15 2015/16

Oneoff Revenue Oneoff Revenue Oneoff Revenue Oneoff Revenue Oneoff Revenue

Scanning to RiO Pilot

£37k £816 per workstation local cost scope to be agreed

Following project evaluation, local deployment scope and timing to be agreed likely to be around £250k

Voice recognition pilot

£30k £1219 per workstation local cost scope to be agreed


Digi-Pen pilot £30k £420 per workstation local cost scope to be agreed


Mobile working £1400 per laptop local cost scope to be agreed

£250 per laptop

£250 per laptop

£250 per laptop

£250 per laptop

Costs are on a per device basis and vary on service chosen likely to be around £420k

Note: Estimated costs are shown in italics



Appendix 2 Significant IT systems in use

System Name System Location Asset Type (Patient, Staff, Finance, Admin, Other)

System User base

Information Held Purpose System Owner Reporting

E-mail - GroupWise Hosted on three central file servers at Memorial, Pinewood, Green Parks House

Admin All Trust staff All internal and external emails, calendars

internal and external messaging and calendaring

Lee Christie, ICT

N/A

RiO MH and Community

Hosted by BT at 2 data centres. Connectivity via N3

Patient All clinicians and directorate admin staff

Patient Demographics, care plans, progress notes, inpatient stays, assessments, attached electronic documents

Patient Administration and recording of patient based information - forming the primary health record

Sally Smith, ICT Data Quality reports, Statutory returns, Clinical information reports, Activity and management reports, KPIs

Integra Hosted on Olympus server at Pinewood includes POP

Finance Finance and supplies staff, Bexley and Greenwich PCTs

Finance and management accounting information. Purchase orders.

Financial management

Gwenda Cunnington, Finance

Financial accounts, budget reports, KPIs

ESR Hosted by McKesson. Connectivity via N3

Staff Payroll and HR

Staff demographics, payroll, absence records

Staff management

Pat Britten/ Emyr Rowlands, Payroll

Staff absence reports, payroll reports, KPIs

ASCribe Hosted on BEXNW01 virtual server at Pinewood

Patient Pharmacy Medicines dispensed and in stock

Pharmacy stock control

Lyn Gathercole, Pharmacy

Intranet and Website Hosted on 3rd party

internet server Other All Trust staff Corporate

information and policies

Access to information

Russell Cartwright, Communications

N/A

Datix Hosted by SQL server, Datix at pinewood.

Admin Nursing and Governance

Risk registers; incidents reports; complaints; PALS; legal claims; training records; FOI and DPA requests

Integrated risk management database

Sue Owen, Governance

Risks reports, incident reporting, complaints, compliance, KPIs




System User base


WinDIPe Hosted by SQL server, WinDIP at pinewood.

Patient Authorised clinicians and admin staff

Archived medical records

Access to archive medical records

Julie Lucas, ICT N/A

IAPTus N3 hosted application provided by Mayden Health

Patient Greenwich IAPT service


Patient Administration and recording of patient based information

Matthew Foulsham, Greenwich Time to Talk

Only local reporting

Helpdesk Hosted on SQL Server Poseidon at Pinewood

Admin ICT Staff IT Service requests, orders, problems

IT administration

Lee Christie, ICT

Service desk performance

BSMS Trinity (including eRostering) Hosted on SQL Server GPSD90 server at Highpoint

Admin Nurse Bank staff

Staff details, shifts worked on Bank, staff rosters

Staff and Nurse bank administration

Yvette Knight, Temporary staffing

RA system Provided by NHS CfH connectivity via N3

Other ICT Staff Staff details, picture, role

Role based access control to national systems

Sally Smith, ICT N/A

eLearn – Moodle Hosted on Internet service

Staff All staff Training records, PDR records

Platform for delivering eLearning and recording completion

Phil Bottle, L&D Mandatory training compliance, KPIs

HonosPbR (MHCT) Hosted on LAMP Server on Ox01MHCT virtual server at Greenwich

Patient Clinical staff RiO ID, Honos assessment outcome, cluster allocation

Allocate patients to treatment clusters

Pratima Singh, Quality

PbR reporting, KPIs

GP Vision N3 hosted application provided by iNPS

Patient Bexley community District Nurses The Source Primary care service Greenwich CASH



Elspeth O’Doherty, GCHS Kathy Williams, GCHS





System User base


SystmOne Prison hosted system

Patient Kent prisons Patient Demographics, care plans, progress notes, inpatient stays, assessments, attached electronic documents


Prison Health Only local reporting

MI (Medicines Information) Databank Hosted on OX01SQL

Other Pharmacy staff

Medicines information

Record medicines enquiries.

Rochelle Tsang, Pharmacy


SOEL Health Hosted on GCHS01SQL database server

Patient Dental staff Dental clinical records

Clinical care Graham O’Brien, GCHS Dental

Activity reports, KPIs

Yangu 3rd party internet

server Staff All trust staff PDR records Platform for

PDR recording Phil Bottle, L&D PDR

compliance, KPIs

IT systems in development

ProWellness Hosted on oracle server GCHS01ORA

Patient COPD Teams and external GPs

TBA, not yet in service

Clinical care Jane Blackwell TBA, not yet in service

Synergy Hosted on SQL server FinanceSYN

Finance and patient

Finance dept TBA, not yet in service

Costing of patient care episodes

Gwenda Cunnington, Finance

TBA, not yet in service

Documents

IT Strategy Oxleas NHS Foundation Trust 2012-2015€¦ · · 2016-08-19IT Strategy Oxleas NHS Foundation Trust 2012-2015 . Oxleas NHS Foundation Trust ... medical record folder,