Public DCHS Information Management and Technology Strategy ... · and Technology (IMT) Strategy sets out how we will use information and information technology to support DCHS’

Quality Business

Information Management and Technology Strategy

2012 – 2015 Final February 2012

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Section 1 – Executive Summary

Section 2 – Introduction 2.1 Progress to Date 2.2 Our Vision for the Future Section 3 – Where are we now? 3.1 Information 3.2 Technology

• 3.2.1 Current Systems

• 3.2.2 Efficiency through Technology Section 4 – Where We Need to Be 4.1 Supporting the DCHS Integrated Business Plan

• 4.1.1 Integration of Services

• 4.1.2 Single Point of Access

• 4.1.3 Increased Mobility of Staff

• 4.1.4 Efficiency of Clinical Services

• 4.1.5 Reduction of Estate

• 4.1.6 Delivering Care Closer to Home

• 4.1.7 Communication with other Care Givers

• 4.1.8 Increasing Reliance on Information

• 4.1.9 Evidencing Outcomes and Patient Satisfaction

• 4.1.10 Patient Level Information

• 4.1.11 Improving Information Governance

4.2 The National IMT Agenda

4.3 The IMT Response

• 4.3.1 IBP Themes and Enabling Technology

• 4.3.2 Unified Clinical System

• 4.3.3 Cross Provider Network and System Linkages

• 4.3.4 Electronic Clinical Records

• 4.3.5 Mobile Health Workers

• 4.3.6 Telehealth

• 4.3.7 Efficiency Technologies

• 4.3.8 Business Intelligence

Contents

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Section 5 – How Do We Get There? 5.1 Unified Clinical System 5.2 Cross Provider Networks and System Linkages

• 5.2.1 Single Point of Access

• 5.2.2 GP Communications

• 5.2.3 Interface to Non TPP SystmOne GP Systems

• 5.2.4 Connectivity with Social Care

• 5.3 Electronic Clinical Records

• 5.3.1 ORMIS

• 5.3.2 Contraception and Sexual Health Services System

• 5.3.3 Electronic Prescribing (e-prescribing) 5.4 Mobile Health Worker 5.5 Telehealth 5.6 Efficiency Technologies

• 5.6.1 Service Specific Implementations from the IBP

• 5.6.2 VOIP

• 5.6.3 Providing for Agile Working

• 5.6.4 Personal Computing

5.7 Business Intelligence 5.8 Information Governance

• 5.8.1 NHS Mail

• 5.8.2 Facsimile

• 5.8.3 Electronic Notes

• 5.8.4 Clinician Recording

5.9 Organisational Development 5.10 Infrastructure 5.11 Delivery and Support Section 6 – Plan and Timescales Section 7 – Resources Section 8 – Risks 8.1 Failure to Deliver TPP SystmOne 8.2 Resistance to Strategy from other Stakeholders 8.3 Lack of Resources 8.4 Organisational Development 8.5 Changes to the National Programme for IT 8.6 DHIS

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Section 9 – Conclusion and Recommendations Appendices Appendix 1 Current Systems Appendix 2 High Level Plan

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Derbyshire Community Health Services NHS Trust is moving into a very difficult period both financially and in terms of change within the NHS. How the Trust’s services are commissioned and measured will change dramatically over the next two years. The further push for precision over activity and currency, along with the shift of commissioning responsibilities to GP consortia, create a significant challenge for the Trust. The ability to:

• collect, store and report on a wide range of data and information,

• aggregate and dissect data and information differently in line with new structures,

• provide more detailed information about clinical interventions

• provide more detailed information to support clinical decision making

• understand the demographic profile of our service users in order to meet their needs

• demonstrate accurate performance,

• benchmark with competitors,

• make quick and accurate clinical and business decisions,

• react in a timely way to changing demands of the population served

will be essential to the Trust meeting the challenges on both the internal and external environment. A high level plan is included at the end of the document, however in meeting the challenges of the changing NHS environment and our plans for Foundation Trust Status, our key strategic intentions over the period of the strategy are set out below:

• Contribute to patient safety through the use of high quality and robust information systems

• To maximise the use of the electronic patient record containing the health information for every patient in our care

• To facilitate and support genuinely seamless care for patients by linking information throughout the organisation and the wider health community, ensuring data is available wherever it is needed

• To provide performance management information, in line with the Performance Framework that facilitates and supports decision making, the organisational assurance process and a ‘ward to board’ information culture.

• To place emphasis on information systems and technology improving patient care and supporting innovative solutions to change pathways and support the organisations service development strategy.

The technical solutions to meet these strategic aims are generally available. Clinical information systems will meet the requirements for patient safety, electronic care records and improved information. Improving technologies already enable services to work in more efficient ways. While these solutions are in part already in place, a significant proportion of our services still require development.

Section 1 – Executive Summary

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The Derbyshire Community Health Services NHS Trust (DCHS) Information Management and Technology (IMT) Strategy sets out how we will use information and information technology to support DCHS’ delivery of high quality and efficient services over the next five years.

2.1 Progress to Date

The IMT Strategy 2011- 2015 continues and expands upon the progress we have already made in utilising IMT to support our business. Over the last two years we have delivered digital x-ray facilities to our hospitals, ensuring a safer and more effective service for our patients. We have increased access to clinical systems for our front line clinicians, giving them access to shared patient records to inform their decision making and helping deliver a more effective service. We have facilitated the delivery of electronic pathology results to our hospitals ensuring that clinicians and patients no longer have to wait for blood results to arrive in the post. We have provided mobile computing to some of our community based clinicians to enable them to see more patients by spending less time travelling to and from bases to collect and record information. Over the past two years we have increased the quality of information we collect, enabling us to make more informed decisions about the services we provide and at the same time ensured the confidentiality and security around the information we hold. All of these developments, and many more besides, have helped us to better understand our patients’ needs, improve the patient experience, have supported our clinicians as safe and effective practitioners and have enabled us to better understand the effectiveness and efficiency of the services we provide. There remains much more to do and the opportunities that improvements in technology provide mean that the potential to bring even greater benefit to our patients is considerable. The DCHS IMT Strategy 2011-2015 sets out our plans to further exploit the potential of information technology and information management to support the delivery of high quality health services.

2.2 Our vision for the future

The implementation of information technology is not an aim in itself. It is clear however, within health services as within any other walk of life that the use of information technology will be essential in supporting and modernising the way we work. Within health we are faced with an increasing demand for services that cannot be met by simply doing things in the way we have always done them. We must become more efficient and new technologies, coupled with high quality information that helps us understand our business, can help us do that. The future direction of the National Health Service (NHS) also places upon us a number of overarching tenets to which IMT will be central. The need to deliver care closer to home, the empowerment of patients through the control of their information and the need to become more efficient are key among a number of themes. The requirements placed on us by our needs as an organisation, by our commissioners, by the wider NHS and by the expectations of our service users will all contribute to determining the agenda of IMT within DCHS. Moreover they help forge a broad vision for the future development of IMT locally. That vision can be expressed as:

Section 2 – Introduction

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‘To use technology to enable DCHS to deliver effective and efficient pathway focused health services closer to patients’ homes and to provide clear and reliable information, securely

held, to patients, and those that commission our services.’

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held, to patients, and those that commission our services.’

3.1 Information

The last two years has seen a continuous improvement in our information capacity with an increasing number of services collecting patient based electronic information. Additionally a smaller number of services have moved to using electronic systems to record their clinical notes, creating and contributing to a detailed care record, while others have begun to record outcome measures. A very small number of staff are recording their information electronically at the point of care. These examples provide evidence of the potential to use the systems we have to deliver on the emerging requirements that we will need to meet in 2011 and beyond. Our challenge will be to ensure that these elements of advanced practice are promulgated across all of our services. An analysis of the information capacity and current systems which our services utilise are included in Appendix 1. In general terms, DCHS is well placed to respond to the challenges ahead though there are notable gaps in capacity. In particular, the need to move the remainder of children’s services, community nursing and intermediate care on to a patient based electronic system is an imperative. The areas which are newer to DCHS include the requirements to afford patients greater control of their record, to increase and systematise patient recorded outcome measures and patient experience in general, to understand the demographic profile of our service users and use this to improve our services and the way in which they are delivered, and the move to greater transparency through the increased publication of data. These areas will require further development as part of this strategy and will need to become part of the services we deliver. Information Governance within DCHS is well established and in a good position to meet the on-going requirements expressed through the information governance toolkit. Challenges do still exist in trying to minimise the risk of data security and breaches in confidentiality. The production, handling and distribution of paper based communication, the continued use of facsimile communication and the inappropriate use of non-secure email for patient information present an on-going risk. The increasingly formal contractual environment allied with the expanding competitive environment within the NHS make understanding our business critical to DCHS’ success. Currently, although a great deal of information is at our disposal, its availability to and exploitation by services is basic. Developments are already in place to make information more accessible and valuable to service managers through the implementation of a business intelligence system. This facility and way of working will need to be further embedded into the way DCHS functions in the future.

3.2 Technology

In reviewing the current status of technology it is useful to separate the information technology primarily concerned with recording clinical and administrative information

Section 3 – Where Are We Now?

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3.2.1 Current Systems

TPP SystmOne – TPP SystmOne is our primary clinical system to support DCHS’ community based services. The system has formed a central plank of previous DCHS IMT strategies as it offers the ability to support clinicians with online clinical information and build an electronic health record for our service users. Increasingly, TPP SystmOne is being used as the sole method of clinical recording, producing activity data as a by-product of that recording. iPM – iPM is the current patient administration system (PAS) used to record our minor injuries, inpatient and outpatient activity. To date the system has met our requirements for basic patient related information. Increasingly, the desire to record more clinically focussed information has highlighted potential inadequacies of the system to meet future requirements. Additionally, iPM is not easily linked to our community systems or those of GPs. A number of services, clinical and non-clinical, currently sit outside of these primary systems. Increasingly, these systems are not able to meet the more sophisticated demands for information being placed upon them. It is envisaged that many of these systems will need to be replaced in the near future.

3.2.2 Efficiency through Technology

It has been made clear that there are a number of technologies that can significantly contribute to improving the efficiency and productivity with which we undertake our business. Wireless – the recent increase in the provision of wireless access points across the DCHS estate provides for both clinical and non-clinical staff to easily access systems and information from a variety of locations. Voice Over Internet Protocol (VOIP) – the use of our local and wide area computer networks to transport our telephone calls offers the potential for a considerable reduction in our telephone costs. Enabling our sites with VOIP is already underway and will need to be continued over the coming months. Picture Archiving and Communication System (PACS) – the ability to capture, store and retrieve digital x-rays and other images has been introduced in DCHS in conjunction with our partners from local acute trusts. The introduction of these systems has proved a huge improvement for our diagnostic services and the patients they serve. Time is no longer spent searching for lost images, and images can be viewed my multiple clinicians at any one time, allowing for real time advice from specialist and reducing the need for onward referral. Results Reporting – the majority of our hospital and clinic based services now have electronic access to pathology results. This not only provides clinicians with the most up to date information on which to base their decisions but also prevents unnecessary repetition of tests which were often undertaken as a consequence of paper based results being unavailable. Mobile working – a small number of our clinical staff operate on a fully mobile basis. They have access to online information in the patient’s home and are able to record their clinical notes within the clinical system, in situ. This not only increases patient safety but also reduces the amount of time clinicians spend travelling to and from traditional clinical bases, allowing them to see more patients. It will be of great importance to increase the numbers of staff working in this way in the future.

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Communication to GPs – all NHS providers are charged with providing electronic letters to GPs in order to speed up communication relating to patients. DCHS continues to develop this functionality and will look to implement a solution in 2011. Telehealth – telehealth, the remote monitoring of patients through the deployment of technology into the patient’s home, has not been exploited within DCHS. Evidence from elsewhere in the country suggests telehealth offers considerable potential for the improved management of patients with long term conditions along with the ability for clinicians to focus their visits on those patients with the greatest need. Teleconferencing – the use of telephone conferencing to replace traditional face to face meetings has been heavily promoted within DCHS. Evidence has shown that this approach saves considerable time and money which again can be reinvested into our frontline services. There remains however, much greater scope for the use of telephone conferencing.

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The landscape for IMT and for the NHS as a whole has changed markedly since the previous DCHS IMT Strategy (2009-2011) was produced. The economic environment within which the NHS has to operate places an increased emphasis on value for money for the service as a whole and for IMT developments within the service. The reconfiguration of the NHS has redrawn relationships between organisations within the health and social care community. DCHS achieving NHS Trust status; the advent of a more formal relationship with our previous host Primary Care Trust (PCT); the rise of General Practice (GP) commissioning; the increasing role of local authorities in the health agenda all demand changes to the way DCHS works and what is required of IMT in supporting those ways of working.

4.1 Supporting the DCHS Integrated Business Plan

The first priority of the DCHS IMT Strategy must be to meet the requirements of DCHS. Most obviously IMT needs to support the delivery of our frontline and support services as set out within our Integrated Business Plan. The broad extent of staff engagement which is reflected in our organisational plans going forward is also reflected within the IMT Strategy. Developments within the sphere of IMT will be referenced to the Integrated Business Plan (IBP) and to the Quality Service, Quality Business and Quality People approach that sets a framework for how DCHS works. The potential for technology and the information that such technology delivers improve the service we deliver and support our business needs to be identified and clearly stated. The DCHS IBP represents the detailed service plans on which DCHS needs to deliver. These plans contain both explicit and implicit requirements for information and information technology. The IMT Strategy not only reflects the requirements of these plans but the plans have been formulated with an understanding of information requirements and the potential of IMT to support and transform our services. The IBP has a number of themes which impact upon the IMT Strategy.

4.1.1 Integration of Services

The integration of our services is designed to provide more seamless care to those that use our services. It will draw together clinicians from across specialties and will therefore require clinical information to be easily shared between those involved in an individual’s care.

4.1.2 Single Point of Access

It is the intention of DCHS to simplify referral process into our services and to co-ordinate the deployment of resources through a Single Point of Access (SPA) model. This will require significant support for IMT both to ensure efficient information flow and to schedule resources in response to demand.

4.1.3 Increased Mobility of Staff

The increased mobility of our staff is a prerequisite to delivering efficient services. Enabling staff to be less reliant on specific bases reduces travel, enables more patient contact time and reduces the need for estate. We will need to provide the appropriate staff with suitable technology to allow them to deliver their care with greater mobility and flexibility.

Section 4 – Where We Need To Be

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4.1.4 Efficiency of Clinical Services

Increased mobility is one aspect of delivering efficient services. Services which are hospital based will need to deploy technology to increase efficiency. This requirement is not restricted to our clinical services and our organisation as a whole will look to technology solutions that will make our ways of working, more efficient.

4.1.5 Reduction of Estate

Our IBP envisages a marked reduction in the amount of estate we currently utilise. This will require greater flexibility in the way we work which may encompass mobile working, hot desk usage and home based working. IMT will be required to reduce the need for estate and utilise what we have more efficiently.

4.1.6 Delivering Care Closer to Home

The delivery of care closer to home is an integral part of our IBP. We intend to shift our focus away from the hospital setting towards caring for people in their own surroundings. This shift requires a shift in our IMT to ensure that we are able support the clinician in a patient’s home and support that patient when a clinician is not there.

4.1.7 Communication with other Care Givers

Our IBP is clear that the care of our patients and services users will often go beyond DCHS’ boundaries. General Practice, local authorities and other providers within and outside of the NHS may all form part of the care pathway and it will be crucial for information to travel with the patient throughout their care. Our strategic alliances and partnerships will be heavily reliant on information exchange for their success. IMT will be key to facilitating that communication across the spectrum of care.

4.1.8 Increasing Reliance on Information

Understanding the efficiency and effective of the care we provide as DCHS makes it essential that we access to information on the performance of the services we provide. Our information needs to be of high quality, timely and easy to access. As an organisation we also need to draw together information from human resource, financial and other systems as well as our clinical activity information to fully understand and improve our business. System will be needed to daw this information together and make it readily available to senior managers and service leaders.

4.1.9 Evidencing Outcomes and Patient Satisfaction

DCHS are committed to providing quality services. Our commitment makes it essential to be able to understand the clinical effectiveness of the care we give, whether our services meet the needs and requirements of our patients, and our patients’ satisfaction with that care. To do this we need to systematically collect and analyse such information and will need to develop systems to do this.

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4.1.10 Patient Level Information

Underpinning our need to understand the outcomes of and satisfaction with the care we provide is the need for patient level information. The provision of patient level will also be essential to satisfy the requirements of commissioners, our obligations under the Equality Act 2010 and the Equality Delivery System, and to meet our obligations to the Department of Health and Monitor as an aspiring Foundation Trust. It is a priority that we are able to provide patient level information across all of our services.

4.1.11 Improving Information Governance

Alongside our development of high quality patient level information we have a duty to our patients and a legal obligation to ensure the security and confidentiality of the information we process and hold. As an organisation we will need to ensure that our process and systems are designed to eliminate or mitigate risk wherever possible and need to seek solutions to help us. 4.2 The National IMT Agenda The DCHS IMT Strategy is further informed by the Government’s strategy for the NHS and its accompanying information and technology implications. These drivers include the collection of information, on an individual patient level at, or as near as possible to, the point of care; greater patient control of records and transparency of organisational information; a greater focus on outcome and patient experience information; the use of technology to deliver greater efficiencies. These requirements are woven through both our Integrated Business Plan and our IMT Strategy and are underpinned by our commitment to further improve our information governance procedures to help ensure the quality, security and confidentiality of the information we hold. 4.3 The IMT Response The emerging themes within IBP have specific IMT implications. For example, the integration of services will be best facilitated by a common clinical system across those services, using electronic clinical records. Set out in the table below are the key themes that run through many of our plans for the next five years. These plans can be matched against broad, headline technologies which will be developed to form the basis of our IMT Strategy. 4.3.1 IBP Themes and Enabling Technology

Technology

IBP Theme

Unified clinical system

Cross provider Network and

system linkages

Electronic clinical records

Mobile health worker

Tele-health Efficiency technologi

es

Business Intelligence

Integration of services ��

Single Point of Access

��

Increased mobility of staff

��

Efficiency of clinical services

��

Reduction of estate ��

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Delivering care closer to home

��

Communication with other care givers

��

Increasing reliance on information

��

Evidencing outcomes and patient satisfaction

��

Patient level information

��

Improving Information Governance

��

4.3.2 Unified Clinical System A unified clinical system, supporting electronic clinical noting will be an essential part of our IMT Strategy. Such an approach supports integrated working and puts in place a foundation to deliver a Single Point of Access and mobile working by providing access to a unified, patient focussed record to any authorised clinician in any setting. It provides patient level information through a controlled system which will improve the quality and security of the information collected. A single system collecting electronic patient data will provide centralised, near real time information which will be critical in meeting the requirements of our commissioners and the governance requirements of becoming a Foundation Trust. 4.3.3 Cross Provider Network and System Linkages The delivery of care pathways requires DCHS to have the ability to communicate with other care providers both within and outside of the NHS. A unified system for electronic records will provide a platform for such communication. At present, our ability to easily pass and share information with colleagues in social care, the acute hospital sector and general practice is limited. It is critical that we are able to further develop links between DCHS and other providers. 4.3.4 Electronic Clinical Records Electronic clinical records will play a fundamental role in the future of DCHS. They will allow for the quality assurance of information collected, the sharing of records within and beyond the boundaries of DCHS and increase information security. Electronic notes will gradually replace paper notes and their accompanying demand for storage, handling and transportation. 4.3.5 Mobile Health Workers The use of technology to support clinicians delivering care in the patients’ home is a significant requirement within the IBP. Mobile access to records delivers efficiencies in reducing the need for travel and office space, delivers improved care by providing the clinician with essential information at the point of care and improves information security by removing the need to transport paper records. In addition it supports Single Point of Access and lone worker safety by offering the potential for GPS location of staff. 4.3.6 Telehealth The remote monitoring of patients through technology installed in their own homes allows DCHS to maintain care closer to the patients’ home. Evidence from across the country also suggests that Telehealth delivers efficiencies in reducing visits to patients and preventing admissions through early intervention to address exacerbations in existing conditions.

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4.3.7 Efficiency Technologies A range of technologies exist that offer the potential to contribute to the efficient running of our services and support specific IBP initiatives such as the reduction of estate. These include wireless technologies, Voice Over Internet Protocol (VOIP), and the provision of facilities and technology to support agile working. In addition, there are some specific solutions designed to meet particular requirements within the IBP. These include digital dictation, e-rostering, room booking systems and self check-in systems for patients. 4.3.8 Business Intelligence Being an efficient and effective provider of health care services places a heavy reliance on information. We will require information to help us monitor and improve our performance, understand the quality of our services, ensure that we are meeting our patients needs and to effectively budget. This information needs to be near real time and analysed and presented in ways which are easily accessible to staff, service managers and board members alike. A business intelligence system, providing a one stop resource for activity, financial and performance information will be critical to the success of our business in the future.

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To meet the developing national agenda and to progress towards our vision for IMT within our organisation the DCHS IMT Strategy 2011 – 2015 must develop the comprehensiveness and sophistication of its use and collection of information. In responding to the need for innovation, efficiency and productivity information technology has a pivotal role to play. DCHS needs to ensure that these technologies are fully exploited in redesigning our services for the future. In pursuing these two themes we must ensure that we engage with all stakeholders and, in particular care providers both within DCHS and in the wider health and social care community. To date, the implementation of information systems within DCHS has taken a county wide approach. This approach has ensured that we have a solution for all staff and has given us economies of scale through the standardisation of processes. While it remains essential that we have solutions that cover all of our services, the implementation will be increasingly affected by the emerging GP consortia. IMT solutions for the future must be sensitive to these consortia and to the local health and social care environment in general. Our approach to future deployments will be more focused on phasing the delivery of solutions by consortia.

5.1 Unified Clinical System

The use of TPP SystmOne to date in DCHS has proved very successful in developing a local electronic health record and meeting the basic information requirements of patient level data. Its success has generated considerable demand within the services which is outlined in the service development plans of the operational divisions within DCHS. The system is also being used locally to develop outcome measures. The increasing use of TPP SystmOne has enabled DCHS to build up some expertise in its exploitation and reduced the number of systems DCHS need to interact with. Notwithstanding the evident benefits that wide scale use of TPP SystmOne brings, we remain committed to ensuring that colleagues within General Practices using other systems are not adversely affected. We will therefore remain open to suitable alternatives in those areas where TPP SystmOne does not offer the best solution.

• We will make TPP SystmOne the standard for all appropriate DCHS community services.

• All DCHS services using TPP SystmOne will, where not already doing so, move to electronic clinical noting within the system.

Given the wide coverage of TPP SystmOne in both community and primary care, consideration will be given to placing DCHS’ hospital services onto the same system. TPP SystmOne can be used for inpatient and outpatient care as well as within minor injuries settings. The potential for a single care record across all of these services, with the benefits that shared care records are acknowledged to bring merits a feasibility study to that end.

• We will undertake a feasibility study to determine the rationale for migrating our inpatient, outpatient and hospital based services on to TPP SystmOne

•

5.2 Cross provider networks and system linkages

The ability to share information with other organisations involved in the care of a patient continues to increase in significance. The existing relationships between DCHS and General Practice, local authorities and other providers within and outside of the NHS is crucial if

Section 5 – How Do We Get There?

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information is to travel with the patient throughout their care. We will seek to develop our Single Point of Access The intention of DCHS to co-ordinate the deployment of resources through a Single Point of Access (SPA) model is a major part of our IBP and will require significant support for IMT. Mobile working and unified clinical systems will contribute significantly to the SPA but it will also be critical that we develop linkages and information transfer between a call handling facility and our emerging community record.

• We will deploy technologies to assist the information flows and meet the emerging requirements of the SPA process.

• We will examine the potential of harmonising systems with strategic partners involved in the delivery of the SPA

5.2.1 GP communications

Rapid and reliable transfer of information between community based services and GPs is recognised as considerable benefit to patient care. Within DCHS there is considerable scope for improvement in ensuring that communication to GPs is part of a systematic and quicker process. While this process is underway, it is yet to be embedded within our services.

• We will continue to embed electronic communication to GPs for all admissions and discharges.

5.2.2 Interface to non TPP SystmOne GP systems

Despite the increasing prevalence of GP practices using TPP SystmOne, and the potential for information sharing that this offers, it remains a business imperative to improve our ability to transfer electronic information between DCHS systems and General Practice using other systems.

• We will look to exploit currently available solutions to enable greater connectivity between the clinical records held by DCHS and those held in general practices not using TPP SystmOne.

5.2.3 Connectivity with social care

Liberating the NHS points the way to ever closer working between health and social care. Our IBP reflects this intention and the need to liaise more closely in delivering care and exploit opportunities for shared estate.

• We will work with colleagues in Derbyshire County Council to develop our connectivity with them to support shared estate and the appropriate transfer of information for individuals within our care.

• We will look to exploit currently available solutions to enable more effective information exchange to support our delivery of joint care.

.

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5.3 Electronic Clinical Records

The proposals for the further roll out of TPP SystmOne will form the backbone of the delivery of electronic clinical noting. In addition, we will deliver a number of other solutions aimed at replacing exiting paper based clinical systems

5.3.1 ORMIS

ORMIS is a theatre management system used to record patient level activity and support theatre utilisation.

• We will deploy ORMIS within our operating theatres.

5.3.2 Contraception and Sexual Health Services system

The Contraceptive and Sexual Health Service currently operate using paper based systems. The service are currently procuring a new electronic clinical system.

• We will support the deployment of an electronic patient record within the Contraceptive and Sexual Health Service.

5.3.3 Electronic prescribing (e-prescribing)

The ability to prescribe, order and record the administration of medication through electronic systems offers a considerable step forward in enhancing patient safety making the process of prescribing more efficient. DCHS currently uses a number of different external providers for its pharmacy services and any development will be reliant upon those service hosts. Chesterfield Royal acute trust is in the process of deploying e-prescribing and there is potential to roll this service out to DCHS sites.

• We will look to exploit e-prescribing in conjunction with our primary suppliers of pharmacy services.

5.4 Mobile Health Worker

The use of technology to support clinicians delivering care in the patients’ home meets a number of the requirements identified within our IBP. Supporting care closer to home, using technology to deliver efficiencies, collection of information at the point of care and supporting the green agenda are all supported by enabling health workers to be mobile.

• We will significantly extend the mobile health worker programme across our services.

5.5 Telehealth

The increasing use within England of telehealth to support the care of patients in their home has evidenced considerable benefits. Evidence suggests that telehealth improves the care of patients and provides efficiencies for the providers of health care. There is an requirement for telehealth within the Integrated Community Based Services Development Plan which looks to respond to the telehealth initiative outlined in the Derbyshire System Integrated Plan2012-13.

• We will seek to exploit the opportunities presented by telehealth within its service portfolio.

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5.6 Efficiency Technologies

5.6.1 Service specific implementations from the IBP

DCHS’ IBP outlines the need for technologies to increase the efficiencies of its services. These include the deployment of e-rostering for ward based clinical staff, patient kiosks for automated check-in, digital dictation to support the secretarial function and a room booking system to improve asset utilisation.

• We will work to deploy specific solutions to support the development of individual services including e-rostering, patient kiosks, digital dictation and a room booking system.

5.6.2 VOIP

VOIP provides an opportunity to reduce costs and offer greater flexibility for our telephony services.

• The roll out of VOIP will be continued across the DCHS estate in line with the DCHS estates strategy.

5.6.3 Providing for Agile Working

Agile working aims to increase the efficiency of work by making it less dependent on specific locations. It looks to provide staff with the ability to work from numerous locations and, in doing so, create efficiencies from the reduction of travel and estate requirements. From mobile clinical health working to hot desks for administrative staff, agile working has the potential to generate significant efficiencies within services as well as benefiting individual members of staff. While agile working is not strictly a function of IMT, it is predicated on a number of appropriate IMT solutions.

• DCHS will seek to exploit the potential of agile working by engaging in a planned programme of IMT developments to support agile working.

5.6.4 Personal computing

New technologies offer the chance to not only support the move towards agile working but also to move away from a PC based infrastructure to one based on thin client technology and remote access to files and applications. These technologies offer the potential for savings and a reduction in CO2 emissions.

• We will continue to explore the adoption of thin client technologies with a view to introducing them as a gradual replacement for desktop PCs.

5.7 Business intelligence

High quality performance information, available to and used by all levels of management within the organisation will be a critical to our success.

• We will build on the foundations of the existing business intelligence system to provide a system which is more comprehensive in its coverage of information

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and more widely available to staff.

• Our developments will aim to make our business intelligence system the focal point for all performance information in the future.

5.8 Information Governance

It will be crucial to the delivery of our commitments to Quality Service and Quality Business, and to the reputation of DCHS to ensure that our information is not only of high quality but is also held and handled in a secure manner. To that end we must be in a position to give assurance to the DCHS Board and others that our information is of high quality. We must also ensure that our information governance is of a high standard and that action is taken to minimise security risks wherever possible. It will be a key responsibility of DCHS to meet the requirements of the NHS Information Governance Toolkit as part of delivering high quality and securely held information. A work programme to meet these standards will form an essential strand of our strategy as these requirements evolve. There also exist a number of others areas of development that can further enhance the standards of information governance within DCHS.

• We will continue to make the Information Governance Toolkit an essential part of our Information Governance approach and strive to achieve the highest attainment scores.

• We will give assurance to the DCHS board on data quality by putting in place a data quality kite mark to indicate the robustness of service and organisational data.

5.8.1 NHS mail NHSmail is a national email system which offers email accessible to all NHS staff. It is the only email system which provides for the secure transmission of patient identifiable information without the need for additional encryption. NHSmail is already widely used across Derbyshire partly because it is accessible from any computer which has access to the internet.

• DCHS will examine a proposal for full migration from local email systems to NHSmail.

5.8.2 Facsimile The use of facsimile (fax) for communication has for a considerable time been a widespread method of transmitting information within the NHS. The use of faxes does carry a number of information governance risks. The danger of sending to the wrong address, the risk of faxes arriving in an unsecure environment, the deterioration of the quality of the original fax and the potential need to incorporate the fax into an electronic record.

• An awareness campaign aimed at reducing the use of fax communication will be instituted within DCHS with the aim of eradicating fax usage wherever possible.

5.8.3 Electronic notes The move towards electronic notes is underway within our community based services. Within our hospitals, the majority of clinical notes for inpatients and outpatients are paper based. The use of electronic notes in hospitals would facilitate the same kind of benefits that are now being realised in the community setting; the rapid and reliable retrieval of notes, reduced issues with legibility and a reduced need for storage.

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• We will continue to move our remaining community based services away from paper notes to electronic clinical noting.

• We will look to extend the use of electronic notes into our hospital based services.

5.8.4 Clinician recording Much of the work undertaken within DCHS follows a pattern of clinicians recording their outcomes on paper. Those outcomes and notes are then coded onto systems. This contrasts with the modus operandi within general practice where the clinician records directly onto the electronic systems. Clinician recording would result in shorter turnaround times for clinical coding and has been shown to be more accurate.

• We will seek to increase the percentage of clinical staff who record directly into electronic information systems.

5.9 Organisational Development

The deployment of information management systems and new technologies cannot be superimposed on top of an organisation maintaining its existing ways of working and skill sets. Many staff will need to be supported through elements of change and in the acquisition of new skills.

• We will ensure that our organisational development plan puts in place training and other resources to allow current staff to adapt to new ways of working. In addition, our recruitment processes will ensure that newly recruited staff are equipped with the appropriate skills to work with such systems.

5.10 Infrastructure The current information technology infrastructure is in part shared with other DHIS NHS clients across the local health economy. The shared aspects centre on networks, currently provided via the Community of Interest Network (COIN), and storage. Emerging strategies within the public sector are exploring the use of Public Sector Networks (PSN), linking health, local government and other public bodies allowing for better collaboration and increased information sharing. The use of internet based (Cloud) storage and service provision is also gaining ground within the wider business community. Both developments, and in particular PSN, offer considerable potential for DCHS.

• We will seek to develop and exploit Public Sector Networks with local partners where appropriate to do so and explore the benefits of Cloud technology.

DCHS’ desktop infrastructure is predominantly desktop and laptop computer focussed. We are currently developing the use of tablet devices, thin client technologies and exploring the possibilities of staff self-provided technology with a view to increasing the efficiency and flexibility of our technology estate.

• We will increase the use of alternative devices for users where such technologies provide efficiencies for the organisation.

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5.11 Delivery and Support An increasing reliance on technology demands a reliable and capable IT support service. DCHS currently hold a service level agreement with Derbyshire Health Informatics Service (DHIS) for the provision of IT support for its network infrastructure, hardware and software. DCHS needs to assure itself that it is in receipt of a high quality service and that such provision is secure moving forward.

• We will continue to manage our service level agreement with DHIS and, through the continued use of Key Performance Indicators, ensure that it receives a high quality service.

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The requirements outlined above represent a significant programme of work within the sphere of IMT. Appendix 2 sets out this programme along with the principle benefits of individual initiatives. It also looks to prioritise those initiatives in line with the demands of the integrated business plan and the drivers identified earlier on in this document. The work plan described in Appendix 2 will deliver the following: By April 2012 we will have

• delivered TPP SystmOne to our Children’s Services and a number of smaller specialist services

• delivered electronic clinical noting to our community podiatry services

• commenced delivery of TPP SystmOne to our community nursing and Rehabilitation and Intermediate Care services

• significantly developed the capability of our business intelligence system

• delivered an electronic clinical information system to our Contraceptive and Sexual Health Services.

By April 2013 we will have

• delivered TPP SystmOne to our community nursing and Rehabilitation and Intermediate Care services

• delivered TPP SystmOne to all other appropriate services including Speech and Language Therapy Services

• ensured most services using TPP SystmOne are using the system for clinical noting

• transformed a significant number of clinical staff to a mobile health working platform.

• Initiated the use of Telehealth with DCHS

• Completed the roll out of VOIP across our estate. By April 2014 we will have

• ensured all services using TPP SystmOne are using the system for clinical noting

• Mobile working rolled out to all appropriate areas.

• Begun to transform clinical recording within our hospital settings The exact phasing and timescales for the programme will be dependent upon the resource available to implement the plan. Furthermore, the Strategy will be responsive to changes within DCHS and nationally and as such will undergo regular refresh.

Section 6 – Plan and Timescales

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The extent of the work programme will require additional resource to that currently available if it is to be completed within the timetables outlined above. The services to which the individual projects relate will also be required to increase their input to the projects in relation to the previous requirements placed upon them. The implementation phase of this programme represents only one half of the challenge to current resourcing. To ensure sustainability and the exploitation of the new environment which will be created it will be necessary to consider improving the current resource dedicated to supporting this transition. Increased capacity for analysis, for technical support within the informatics service, for trainers and equipment will all be required to support the increasing numbers of people using systems in increasing sophisticated ways.

Section 7 – Resources

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8.1 Failure to deliver TPP SystmOne

A failure to achieve the roll out of TPP SystmOne would militate against us being able to achieve effective integrated working, the sharing of electronic clinical records and mobile working. It also places us at considerable risk of not being able to meet the requirements of our commissioners, the Department of Health and Monitor for the provision of information. Such a failing would result in us being unable to secure our income streams for the provision of services. We shall mitigate this risk but setting out a costed implementation plan for deployment of TPP SystmOne across our services. This plan will then be controlled through the governance structures of DCHS. 8.2 Resistance to strategy from other stakeholders

The intention to move community nursing and children’s services on to TPP SystmOne has met some resistance from the GP community who wish to retain input to their local systems. This resistance poses a risk to further roll out. GPs may insist on retaining input to local systems or may threaten to decommission services. We shall attempt to mitigate this risk by ensuring a close dialogue with commissioners and by seeking technical solutions to a more seamless transfer of data to non TPP SystmOne GPs. 8.3 Lack of Resources

The IMT Strategy sets out an ambitious programme of technological development in support of the IBP. The programme places demands on implementation and on-going resource that is not currently secured. We will mitigate this risk by ensuring the implementation of the IMT Strategy is fully costed and that any resources required to sustain developments are also identified. 8.4 Organisational Development

The failure to deliver the business change support and technical training for current and new staff will risk the failure of the IMT Strategy as a whole. We will mitigate this risk by ensuring that the appropriate measures are written in to our organisational development strategy and included within specific project implementations. 8.5 Changes to the National Programme for IT

The future of the National Programme for IT remains uncertain and any significant changes to it could result in contractual changes. Under the current arrangements TPP SystmOne and iPM PAS are a free good. We will maintain strong relationships with the wider NHS IT community to ensure advance warning of any changes and allow for contingency planning.

Section 8 – Risks

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8.6 DHIS

The provision of services by DHIS to multiple clients and the potential for those clients to withdraw from using DHIS generates a potential risk not only to DHIS but also to the continuity of service provided to DCHS. DCHS will continue to work with other DHIS clients through the established contract management group to mitigate such risk as far as is possible and will construct contingency plans to cover such an eventuality.

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DCHS has made good progress in equipping itself for the demands it faces in delivering care as an NHS Trust and aspiring Foundation Trust. Considerable challenges remain in meeting the basic requirements within some service areas and in exploiting technology at a pace and scale which will place the trust in a competitive position moving forward. The programme outlined above represents a substantial but realistic stride forward in ensuring we have the IMT support to deliver quality services and become a quality business.

Section 9– Conclusion and Recommendations

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Appendix 1 Current Systems

Division Service Current System Patient-level

data?

HWI Health Visiting eCSAC / TPP Partial

HWI School Nursing eCSAC / TPP Partial

HWI Speech & Language Therapy STAR Yes

HWI Contraception & Sexual Health Database No

HWI Vasectomies iPM PAS Yes

HWI Health Promotion Paper collection forms No

HWI Dental - North R4 Kodak Yes

HWI Dental - South Software of Excellence Yes

HWI Dental – Leicestershire Software of Excellence Yes

HWI Prisons TPP Yes

HWI Health Psychology Database Yes

HWI Tier 3 Weight Mgt TPP Yes

HWI Chlamydia Screening Office Care CSP Yes

ICBS Inpatients iPM PAS Yes

ICBS Community Therapy - AV and ERE TPP / eCSAC Yes

ICBS Community Therapy - other localities eCSAC No

ICBS Older Peoples Mental Health iPM PAS Yes

ICBS Learning Disability - Inpatients iPM PAS Yes

ICBS Learning Disability - Community TPP Yes

ICBS Stroke Support Services TPP Yes

ICBS Community Nursing eCSAC No

ICBS Community Matron TPP and GP Systems Yes

ICBS Continence Care eCSAC No

ICBS Respiratory eCSAC / TPP Yes

ICBS Heart Failure eCSAC No

ICBS Cardiac Rehab eCSAC No

ICBS Tissue Viability eCSAC / TPP Yes

ICBS Diabetes Specialist eCSAC No

ICBS Neuro eCSAC No

ICBS MacMillan Database No

ICBS Pharmacy Acute Trust systems Yes

ICBS Traumatic Brain Injury TPP Yes

ICBS Minor Injury Units iPM PAS Yes

ICBS Day Hospitals iPM PAS / TPP Yes

OPC Outpatients - Derbyshire iPM PAS Yes

OPC Outpatients - Leicestershire Clinicom PAS Yes

OPC Community Podiatry TPP Yes

OPC Podiatric Surgery iPM PAS Yes

OPC Musculoskeletal TPP / iPM PAS Yes

OPC Specialist Wheelchairs - North ELMS Yes

OPC Specialist Wheelchairs - South BEST Yes

OPC Daycase - Derbyshire iPM PAS Yes

OPC Daycase – Leicestershire Ormis Yes

OPC Diagnostics PACS, RadWeb and RIS Yes

OPC INR Nurses DAWN Yes

OPC Phlebotomy Spreadsheets No

HPES Estates Planet FM N/A

HPES Hotel Services Clean 4 Credits N/A

HPES Sites No current system N/A

HPES Patient Transport Services No current system No

HPES Logistics No current system N/A

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Appendix 2 High level plan

When What Principle Benefits Source / Driver

2011-2012 Complete the roll out of TPP SystmOne to Children’s Services

Quality Business:

• Increase efficiency through the use of electronic health records

• Meet the demand for patient level data Quality Service:

• Increase safety and the experience of service users by ensuring clinicians are well informed

• Support clinicians in the delivery of service

• Supporting care pathways

• HWI Service

Development Plan

• Contractual requirements for patient level data

• DH requirement for patient level data

Implement TPP SystmOne mobile health worker solution (Phase 1) to the Rehabilitation and Intermediate Care and Community Nursing services within the Erewash locality.

Quality Business:

• Increase efficiency through the use of shared electronic health records





• ICBS Service Development Plan



Develop the Business Intelligence system to include a wider range of measures and functionality

Quality Business:

• Increased availability of timely and accurate business intelligence

• Increased knowledge based decision making for services

• Support the DCHS integrated business plan

Establish and embed outcome measures in key service areas

Quality Business:

• Increased understanding of effectiveness of interventions.

• Evidence for commissioners of effectiveness of service.

Quality Service:

• Ensure interventions are evidence based.

• Information Revolution

• Commissioner requirements

Implementation of the ORMIS theatre system

Quality Business:

• Improved resource utilisation Quality Service:

• Reduced clinical risk through better information capture

• Reduced waiting time for patients

• Planned Care Service Development Plan

Implement an electronic health record system within the Contraception and Sexual Health Service (CaSH)

Quality Business:





• HWI Service Development Plan



Increase the number of DCHS premises using

Quality Business:

• Reduce the costs of telephones through • Support the DCHS

integrated business

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VOIP technologies to carry phone calls

the deployment of new technologies

• Provide greater flexibility to support agile working

plan

Complete Phase 2 of Wireless roll out

Quality Business:

• Increase efficiency through the use of agile working


• Support clinicians in the delivery of service by allowing data capture at the point of care


2012-2013 Complete roll out of TPP SystmOne to Community Nursing Services

Quality Business:





Supporting care pathways




Migrate dental services to one information system across the county.

Quality Business:

• Increase efficiency through the use of single system

• Meet the demand for patient level clinical data

Quality Service:

• Ensure patient information is kept on one system for dental services


Implement a room booking system to support asset utilisation

Quality Business:

• Increase efficiency by optimising use of assets within DCHS.

• HPES Service Development Plan

Implement IMT infrastructure to support SPA initiative

Quality Business:

• Ensure efficient use of our resources Quality Service:

• Supporting timely and appropriate treatment




Implement TPP SystmOne to the Speech and Language Therapy service

Quality Business:







Implement mobile working to the Speech and Language Therapy service

Quality Business:







Increase the number of services using electronic systems for clinical noting

Quality Business:


Quality Service:

• Increase safety and the experience of service users by ensuring clinicians are


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well informed

Deliver Phase 2 mobile health working to community nursing and children’s services staff.

Quality Business:

• Greater efficiency through reduced mileage and estate requirements.

• Increased patient contact time as a result of reduced travel.

Quality Service:

• Increased patient safety through access to online information at the point of care.

• Support clinicians in the delivery of service by allowing data capture at the point of care



Deploy automated check in kiosks for planned care

Quality Business:

• Greater efficiency through requirements for manual registration.

Quality Service:

• Increased patient satisfaction through reduced queues.

• Planned Care service Development Plans

Deploy e-rostering for inpatient and MIU based staff

Quality Business:

• Greater efficiency through more effective staff rostering.

• ICBS Service Development Plans

Deploy telehealth systems to support the care of people with long term conditions

Quality Business:







Complete the roll out of VOIP to DCHS premises.

Quality Business:

• Reduce the costs of telephones through the deployment of new technologies

• Provide greater flexibility to support agile working


Complete Wireless roll out

Quality Business:

• Increase efficiency through the use of agile working

• Meet the demand for patient level data Quality Service: Support clinicians in the delivery of service by allowing data capture at the point of care


2013-2014 Deploy e-prescribing, where available, to inpatient services

Quality Business:

• Improve efficiency of ordering and prescribing of medication

Quality Service:

• Improve patient safety through use of electronic systems


ensure all non inpatient and outpatient services are using electronic systems for clinical noting

Quality Business:


Quality Service:




Phase 3 delivery of mobile working to community based services

Quality Business:

• Greater efficiency through reduced mileage and estate requirements.

• Increased patient contact time as a result of reduced travel.

Quality Service:



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• Increased patient safety through access to online information at the point of care.

Subject to feasibility study, commence deployment of TPP SystmOne Community Hospital module

Quality Business:


• Meet the demand for patient level clinical data

Quality Service:




• ICBS Service Development Plans


• Commissioner requirements

2014 onwards Move to full electronic notes in all settings across DCHS

Quality Business:


Quality Service:


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Documents

Public DCHS Information Management and Technology Strategy ... · and Technology (IMT) Strategy sets out how we will use information and information technology to support DCHS’