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Nursing Technology Fund Second Round Application Form

Instructions for Completion

Refer to the Prospectus when completing the form Note the word limits that apply to selected questions In responding to ‘free text’ questions, focus on answering the questions posed (and not

trying to ‘sell’ your proposal) Return the completed form as a Word document Name the file in the following format:

o NTF2 [Organisation code] [Priority] Application Form – [Project title] o (for example, ‘NTF2 RHD 1 Application Form - Vital Signs Monitoring’)

Return the form together with the other requested documents

A. Core Information

A1. Contact Details

Please complete the table below, overwriting any guidance (in square brackets) as appropriate.

Organisation name: Croydon Health Services NHS Trust (CHS)Address: Croydon University Hospital

530 London RoadCroydonCR7 7YE

Organisation code: RJ6Key contact name: Claire JonesKey contact role: Associate Director of NursingKey contact e-mail address:

[email protected]

Key contact phone: 07826923382 / 0208 401 3273Alternative contact: Tony Varney - 07876653137

A2. Project Summary

Please complete the table below, overwriting any guidance (in square brackets) as appropriate.

Project title: Improving Clinical Care through Mobile Solutions.

Funds requested (FY2014/15):

£969k

Funds requested (FY2015/16):

£0

Project priority: 1

Project description:

This project will provide digital solutions to enhance clinical care in community and community maternity settings. Mobile technology including digital pens, laptops and tablets will improve the timeliness and quality of data capture and provide visibility of the whole patient record enabling greater coordination of care. The current duplication of documentation whilst in the patient home / clinic and again at staff

1 High quality care for all, now and for future generations

mailto:[email protected]


bases leads to inefficient use of staff time. This will be significantly reduced allowing increased patient contact and productivity; in addition using mobile solutions will enable improved communication between and with community based staff.

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B. Organisation Details

B1. Joint Applications

Are you submitting a joint application, where technology procured with an award is intended to be deployed across a number of organisations providing care (as detailed in section 2.1 of the Prospectus)? Please put an ‘X’ in the appropriate box below. (Note - organisations who are part of a joint application but not leading it should not submit an application for the same proposal).

No XYes

If ‘Yes’, please answer the remaining questions in section B from the perspective of the lead organisation for the application. Questions in subsequent sections should incorporate responses relating to partners where appropriate. Also, please complete the box below.

[Please provide details of your partners - 100 words maximum]

B2. Organisation Type

Please place an ‘X’ in the appropriate box below. (Note that section 2.1 of the Prospectus defines the eligible organisation types).

Type Check one boxNHS Trust XNHS Foundation TrustLocal AuthorityVCSE – company limited by guarantee and registered as a charity in EnglandVCSE – community interest company registered as a company limited by guaranteeVCSE - charitable incorporated organisation (within the meaning of section 69A of the Charities Act 1993(a))VCSE - social enterprise whose constitution meets a number of criteria (defined in the Health and Social Care (Financial Assistance) Regulations 2009) concerning distribution of profits, community benefit and distribution of assets on winding up

If you select one of the VCSE categories, then please complete the box below.

[Provide evidence that you meet the definition – for example, your charity registration number, 2 High quality care for all, now and for future generations


your company number (against which we can do a search with Companies House), or extracts from your constitution or governing documents]



B3. Location (Local authorities and VCSEs only)

Please place an ‘X’ in the appropriate box below to indicate in which NHS England commissioning region you provide the services that would be enhanced by your application. (Note that for Trusts, we can derive this information from your ODS code). Information on NHS England regions can be found at http://www.england.nhs.uk/about/regional-area-teams/.

Type Check one boxNorth of EnglandMidlands and East of EnglandLondon xSouth of EnglandNational / Multiple Regions

VCSE applicants are reminded that awards can only be spent to support operations in England.

B4. State Aid (VCSEs only)

General guidance on State Aid can be found at https://www.gov.uk/state-aid.

Is your organisation engaged in economic activity? (Note that economic activity means an activity which consists in offering goods or services on a given market and which could, at least in principle, be carried out by a private operator in order to make profits). Please put an ‘X’ in the appropriate box.

NoYes

If ‘No’, please complete the box below.

[Provide an explanation of why you do not consider your organisation to be engaged in economic activity]

If ‘Yes’, please state below the amount of non-exempt aid you have received in current and prior years. (Note that income from a commissioned contract would not be classed as aid, but it may include non-exempt grants, subsidies or financial considerations from the public purse or any other organisation disbursing funds on behalf of the state. This includes but is not limited to Lottery, Arts Council and Section 64 funding, grants from the Local Authority, business support from a public entity such as Business Link and tax rebates not available to all businesses).

FY14/15 FY13/14 FY12/13 FY11/12£ £ £ £

VCSEs should also remember to provide references, and if required annual accounts, as detailed in section 3.2 of the Prospectus.4 High quality care for all, now and for future generations

https://www.gov.uk/state-aid

http://www.england.nhs.uk/about/regional-area-teams/


C. Project FocusPlease provide the information requested below. The responses provided will be used in the screening stage, as set out in section 3.4 of the Prospectus.

C1. Capability

Please place an ‘X’ in the appropriate box(es) below, to indicate which technology-enabled capability(ies) your proposal aligns with. (Note that section 2.2 of the Prospectus provides information on the technology-enabled capabilities for which applications are invited). If your proposal aligns with more than one capability, please identify the additional ones in the third column. Please note that your application will not score more highly purely on the basis that multiple capabilities have been identified.

Capability Principal focus (check one box)

Additional (check none, one or many boxes)

Mobile access to digital care records across the community

X

Digital capture of clinical data at point-of-care XDigitally-enabled observations management XReal-time digital nursing dashboardsRemote face-to-face interactionDigital images for nursing care XEquipment tracking and monitoringSafer clinical interventions XSmart workforce deployment XDigital transformation of pre-operative assessment[Other – please specify in this cell - if multiple, please separate with semi-colons]

N/A

C2. Workforce Group

Please place an ‘X’ in the appropriate box(es) below, to indicate which workforce group(s) will be given a new or enhanced capability through your proposal.

Type Check one or multiple boxes

Nurse XMidwife XHealth Visitor XHealth Care Assistant X[Other – please specify in this cell - if multiple, please separate with semi-colons]



C3. Care Setting

Please place an ‘X’ in the appropriate box (es) below, to indicate which care settings will be impacted by your proposal.

Care Setting Check one or multiple boxes

Acute XCommunity XMental HealthLearning DisabilityUrgent CareSchool[Other – please specify in this cell - if multiple, please separate with semi-colons]

C4. Spending Intentions

Please place an ‘X’ in the appropriate box(es) below, to indicate the areas in which you anticipate spending any award. (Further information is detailed in section 2.5 of the Prospectus).

Area Check one or multiple boxes

Hardware – mobile devices XHardware – otherSoftware – commercial off-the-shelf (COTS)Software – bespoke developmentProject resourcing[Other – please specify in this cell - if multiple, please separate with semi-colons]

If you have marked ‘Software – bespoke development’, please complete the box below.

[Please provide evidence that a COTS or Open Source product does not exist that meets your requirements, and explain how the investment can be used to benefit other health and care providers - 400 words maximum]

Please place an ‘X’ in the appropriate boxes below.

Question No YesDo you understand that all awarded funding must be fully spent by the end of the financial year for which it is awarded?

X

Do you accept that all awarded funding can only be spent on items that can be classified as capital expenditure?

X

Do you accept that you will be responsible for the NHS capital charges (where applicable), depreciation and any other consequential revenue

X



or capital run-on costs arising from the initial award / procurement?



D. Leadership

The responses provided in this section will contribute to the application score. Annex 7 of the Prospectus provides guidance on what evidence the evaluators will be looking for.

D1. Nursing Involvement in the Strategic Change Agenda

In 2010 Croydon Health Services became an integrated care organisation (ICO) providing acute hospital and community based services for the people of Croydon and its neighbouring areas. Patients are assisted to stay independent and healthy, with a greater emphasis on early intervention, prevention, guidance and support thereby meeting the care closer to home agenda. This nursing strategy can only be met by harnessing technology that works in the patient’s home making the information collected visible to all partners who are involved in providing care.

Across the ICO nursing care takes place to enable patients to receive nursing and midwifery care at home as long as safely possible; there are close working relationships with our local commissioners to ensure that quality standards are met i.e. 1 midwife to 28 births and “transforming adult community services” (TACs). TACs has been developed with our local commissioners to provide a rapid response and case management service for patients. This service enables patients to avoid attending accident and emergency and contributes 600+ saved admissions to the local health economy. Our midwifery and health visiting services are fully integrated and provide care to mothers and young children that make up the most culturally diverse population of any of the London boroughs with the highest proportion of looked after children in London; working with local groups, voluntary sector and patient forums enables these services to be responsive and to reduce hospitalisation using the data held in the electronic patient record(EPR)

Our nursing strategy is based upon fundamental nursing values defined by the six C’s, which also form an essential pillar of CHS’s wider informatics strategy. Our nursing strategy is one of constant improvement through professional and individual motivation to provide the best possible care across all healthcare settings. New model processes are developing by combining data from the EPR with data from primary and community care. Our long-term vision is to create an EPR that is more efficient and effective that focuses on ‘predict and prevent’ nursing and midwifery strategies.

This project is therefore integral to both the Nursing and Informatics strategy, the development of the EPR and provides the mechanism for adopting use of digital mobile technologies to capture and share data in real-time, with clinicians, wider nursing teams and most importantly, the patient. Data captured at the point of care improves productivity, data quality and the value of that data for future information and analysis.

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D2. Nursing Leadership of the Proposal

The Director of Nursing, Midwifery and Allied Health Professionals requested nurses and midwives should identify technology that would reduce paperwork, integrate with CRS Millennium and ePEX (the two EPR systems in the Trust) and have significant benefits to both patients and staff. The project for Cerner integration and usage is led by an Associate Director of Nursing (ADN) with clinical knowledge of the community areas with the Director of midwifery as



co-chair of the nursing informatics board. The board comprises of community clinical team leaders who have developed this application and its supporting communication and training plan.

The implementation project will be led by the Head of Nursing for Informatics; a senior nurse who has been in post during the implementation of CRS millennium phase 1.This will ensure that the enhancement in technology will be viewed as the implementation of solutions and will be appreciated by nurses as adopting improvement in meeting practice needs and enhancing patient and staff experience. Strong informed nurse leadership has enabled the successful implementation of the largest footprint of clinical functionality through CRS millennium including medicines management and care plans by integrating the informatics and nursing strategies with operational delivery. Governance of these processes and projects is through project board and the ADN as the Senior Responsible Officer.

Digital pen technology and laptop solutions were evaluated by nurses and midwives across community teams with the main emphasis on ease of use and the ability to be used in patients’ homes. It was identified that mobile working solutions need to be tailored to meet the different needs of the individual services. In district nursing and midwifery services the digital pen technology outscored mobile laptops in terms of cost, training, security; maintenance and most critically ease of use. In children’s community services a pilot confirmed laptop devices are the solution as they provide visibility of a child’s electronic records enabling the nurses to access care plans and information entered by the multi-disciplinary team.

The maternity team researched and reviewed the advantages and challenges of using a digital pen and attended demonstrations of the digital pen being used with the CRS Millennium maternity module. This provided visual confirmation to midwives that the technology worked and handwriting could be accurately collected by the pen and transmitted into CRS Millennium. Nursing staff will therefore have the capability to perform patient contacts whilst accessing or updating digital patient records in real time.

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D3. Endorsement of the Application

In 2013 CRS Millennium was introduced at Croydon Health Services (CHS) to provide a single integrated clinical information system consisting of a core patient administration system and modules covering order communications and results reporting, emergency department, e-Prescribing, pathology, radiology maternity, theatres, critical care and research. As part of this deployment significant organisational transformation was undertaken, and continues, to enable staff to cope with new ways of working.

A mobile technology solution now required to increase productivity and enhance patient safety in a community setting to support clinical care and ensure a combined EPR is available to the entire organisation.

The process to sign off any computerised application or hardware within the Trust is for a Business Case to be presented to the Informatics Committee for approval. This application form and financial information provided the information required for approval.

The Nursing Informatics Board was established to assist in the implementation and



governance of CRS Millennium; this board comprising of clinicians reviewed digital solutions, the impact on nursing and midwifery care and developed this application. The Informatics Board report directly to the Director of Nursing and Head of Informatics. The outcomes of the review of digital solutions were taken to the monthly nursing board to be disseminated throughout the nursing family.

In addition the information was reviewed and approved by the Informatics Committee that is chaired by the CEO and is attended by the Directors of Nursing, Finance, Information, Human Resources, and Medicine. The Director of Finance reviewed the application with particular reference to the recurring elements of the application to confirm that the capital charge and revenue components can be funded.

Integration of electronic systems by using mobile technology is supported by the local commissioning groups. In Croydon we are also exploring integration opportunities with local social care and education in relation to children’s early years services as part of a local project known as Best Start ( this is currently part of a Local Government and communities bid). The 5 year ICT Strategy for Croydon CCG is being developed in partnership with CHS and they are seeking to engage with key stakeholders/strategic partners from the Council, CHS and other organisations. The use of mobile technology in community services links directly with this strategy and is one of the key drivers to continue the development of the Health & Social Integration Agenda which links in with the Better Care Fund Initiative.

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E. StrategicThe responses provided in this section will contribute to the application score. Annex 7 of the Prospectus provides guidance on what evidence the evaluators will be looking for.

E1. Strategic Alignment

The Trust’s strategy recognises that clinical informatics systems are a driver and enabler of positive change in the way that heath care is delivered. It has invested substantially in a senior clinical Informatics team who engage with clinicians from across acute and community services. The Trust has a clinical transformation team led by a senior Clinical Director. That team works closely with the clinical informatics team and the operational directorates to support IT enabled change. In house expertise in engagement starts with a thorough assessment of what the best clinical process is and then works with suppliers to ensure that the technology supports that. A successful champion user programme and visible leadership helped the Trust to successfully roll out a complex EPR programme and successfully attain HIMSS level 6.

Process mapping and change management are essential to ensure alignment of current and future state processes, ensuring alignment of design, build, test, training and implementation. This project will fundamentally change the way of working of over 400 frontline staff members; a substantial change project. Recognising that these staff members often work alone a different support and training model will be resourced with immediate phone and email access to champion users.

Ensuring that community services are fully integrated with acute services is a central plank of the IT and clinical strategy reflecting the Trusts commitment to leveraging IT as an enabler of genuine integration of patient pathways across our services. Key services delivered from clinic environments in the community of Croydon are already using our Trust-wide EPR. However in order to enable Community staff to effectively and efficiently use IT systems to deliver safe personalised care, a further enhancement of our systems is required to support mobile working. Consultation with key staff members has prompted a multi-modal approach to mobile working using a range of technologies suited for varying staff needs. These are linked by software that can interface with a range of community and child health systems which in turn can be linked to the main Trust EPR.

Recognising that the need for integration extends beyond our organisation the Trust is actively engaged with IT system suppliers, provider organisations and commissioners across South West London as well as with the South London Health Innovation Network (Academic Health Science Network) to ensure that our strategies align with each other and with the SW London Collaborative Commissioning Collaborative IT strategy.

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E2. Alignment with Organisational Capability

The Trust has deployed Cerner Millennium across most of its estate and has a clear roadmap for deploying additional functionality to support clinical care as well as ensuring that the whole Trust works from a single domain. There is now a mature team with deep understanding of the CRS Millennium product and the capability to make data exchange with primary care and community systems a reality. The trust has shown its capabilities in major change initiatives as it now has the largest footprint of clinical functionality in CRS Millennium. For nursing this means that within the acute setting nurses document their care electronically; they administer medication via an electronic drug chart and will utilise care plans for all adult inpatients from April 2015. These significant changes have required a robust and well governed implementation plan. Senior leadership and daily meetings in the run up to and weeks following ‘Go Live’ were central to the successful roll out of CRS Millennium Phase 1, and the subsequent deployment of E-prescribing across the wards. Abbreviated versions of this process but with similar process rigour and focussed senior leadership have been used for smaller change projects including planned downtime and maintenance releases. This process will be adapted to support the implementation of mobile technology in the community setting of an integrated care organisation. The integration of Community services within the Operational Directorate structure means that the relevant leaders are familiar with these processes. The involvement of the Clinical Informatics and Transformation teams will provide continuity and organisational memory.

Currently community nursing and midwifery staff complete paper records in patients’ homes and in clinics. In most instances they return to their nearest base later in the day and complete data recording on desktop technology. This duplication of recording (double keying) is non- productive and can lead to delays in recording, inaccuracies and increased risk of miscommunication between team members and other care providers. Satisfaction with access to the EPR in community is adversely affected by variable network performance.

The network infrastructure will be upgraded in 2015. This will improve engagement with the existing system and enhance the appetite for innovative mobile technologies that can further the benefits of access to an integrated, patient centred care record. This alignment of IT capability across the Trust will reduce inequalities in care provision by enabling access to the EPR.

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E3. Digital Paperless Roadmap

Five elements set out by DH in 2008 as the foundation for a clinical EHR are patient administration system (PAS) with integration with other systems order communications and diagnostics reporting (including all pathology and

radiology tests and tests electronically ordered in primary care) electronic discharge letters with coding (discharge summaries, clinic and

Emergency Department letters) electronic scheduling (for beds, tests, theatres) e-prescribing (including ‘To Take Out’ medicines)

Phase 1 Millennium has enabled CHS to meet these requirements and with the addition



of clinical decision support functionality led to the award of HIMSS Level 6 in October 2014. Some key nursing tasks that have moved or are moving off paper are:-

Nursing Observations have been collected electronically on VitalPac since 2009. Nurse electronic medication administration went live in March 2014. Electronic Fluid Balance Chart is being piloted and will be rolled out to all areas

in March 2015. 24 Nursing Care Plans are being made electronic on CRS Millennium and will

be completed by March 2015. Laptops are currently used in a small number of community teams

Electronic Documentation Management has been used at Croydon University Hospital for many years by the Emergency Department (casualty card) and by the Administration Hub (referral letters). All corporate information, policies and procedures etc. are held on Microsoft SharePoint.

With the re-procurement of Picture Archiving and Communications System (PACS) the Trust is installing a vendor neutral archive (VNA) with the capability of linking all clinical images and video loops with the EPR. In addition it provides formal electronic document management capability bringing all scanned documents into an integrated EHR. The organisation can take this opportunity to fully standardise clinical documentation to ensure best practice.

Community staff will receive “end user” training of the digital pen to ensure that when working remotely within the patient’s home they are conversant with their use. The use of digital pens and laptops permits inclusion of all community services within the EPR whilst keeping the practical advantages of paper for staff, patients and carers.

This combination of initiatives means that the Trust is on track to be paper lite in advance of 2018. By the completion of CRS Millennium Phase 2 the Trust will have fully automated business and clinical functions, complemented by business and clinical intelligence reporting tools. The Trust will extend its clinical reach beyond the organisation using portals and remote patient monitoring in partnership with local providers.

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E4. Alignment with NHS Vision for Integrated Digital Care Records

As an ICO the Trust has strived to achieve the gold standards of care supported by the utilisation of the Electronic health care record. As the first organisation within the UK to be awarded a HIMSS level 6 for our acute services, we now feels it’s time to commit ourselves to revolutionising the community services that we provide. Currently our community services have lack of visibility in the EPR for patients that are treated under our acute services, the reverse is also true. The procurement of digital pens, laptops and tablets and the compatibility of the supporting software with various Community IT systems underscores the Trusts commitment to non-proprietary solutions.

The Trust is committed to the use of NHS number and the use of Spine 2 to maximise the uptake and validation of NHS number. Allowing for the close proximity of a major Immigration clearing centre in Croydon NHS number completeness is high and is used across our systems as the primary identifier.



The procurement of digital pens and the compatibility of the supporting software with various Community IT systems underscores the Trusts commitment to non-proprietary solutions.

The project does not require formal interoperable standard messaging. The Trust is committed to standards based collaboration. Recognising that the need for integration extends beyond our organisation the Trust is actively engaged with IT system suppliers, provider organisations and commissioners across South West London as well as with the South London Health Innovation Network (Academic Health Science Network) to ensure that our strategies align with each other.

The Chief Clinical Information Officer (CCIO) is part of the Nursing informatics board and has established a forum of CIO and CCIOs from across SW London to ensure that the procurement of VNAs in provider organisations was capable of being federated in order to enable IHE compliant interoperability and seamless record sharing in the future. Work is planned in 2015 to establish XDS and XDSi domains across the SW London Trust VNAs.

The CCIO is also working with the SWL Commissioning Collaborative on their 5 year IT strategy to ensure that portal and other solutions to integrating Secondary/Community records with Primary and Social care are included in the roadmaps of the relevant organisations. This applies both to the specific IT solutions being deployed but also to consideration of the underlying principles e.g. the use of digital pens, laptops, tablets and enhanced voice recognition technology.

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F. ImpactThe responses provided in this section will contribute to the application score. Annex 7 of the Prospectus provides guidance on what evidence the evaluators will be looking for. Section 2.7 of the Prospectus provides further information on benefits.

F1. Impact on Practice

A positive impact on clinical practice is integral to this application; current practice means that staff leave a paper record within the patient’s home, then have to travel to a community base and re-document the same information within the current ePEX system. The current system poses a clinical risk with double data entry, two possible sources of information, potential for inaccuracy and a lack of contemporaneous record keeping. The new process will give the organisation the ability for single source of information. This will significantly reduce clinical risk, as well as release staff time as they will not have to complete double data entry thereby ensuring smarter workforce deployment associated with efficiency and productivity whilst offering safer patient/ client care through continuity of care.

Senior team leaders within the community will utilise a Laptop to complete the initial patient contact within the patient’s own home. This will give nursing staff the ability to access real time data if required from the patients’ electronic record, to rapidly access and implement an individualised plan of care. Currently staff only have access to limited paper records whilst in the patients’ home, and this potentially can significantly slow down the implementation of a plan of care for our community patients/ pregnant woman, due to lack of relevant clinical information.

During an assessment or visit if required, staff will have the ability to demonstrate the latest health information apps. Utilising smartphone and tablets staff can use the latest apps to educate the patient and relatives and advice on holistic approaches to health care as appropriate. In particular the mobile technology will enable access to information in a variety of different languages that is essential to the culturally diverse population in Croydon. In addition faster access to prescription requests, equipment and referrals will be enabled. Digital capture of clinical data at the point of care will then be sent electronically to the patient’s electronic record in real time. This may also be used by senior nurses/ midwives to oversee care delivery and monitor practice at arm’s length.

Utilising the digital pen with smart phones will also enable team leaders to alter visit scheduling information and contact staff via NHS mail/ phone. Clinical mobile applications can be downloaded and shown to patients / women. This change in working practice will improve productivity, patient experience and communication between staff. 391

F2. Delivering Qualitative Benefits

Studies have shown that most ‘end users’ of the EPR, would never want to return to conventional ways of working with pen and paper, as they understand and can immediately see the benefit of real time data capture at point of care, that is visible to all immediately. This is obviously of significant benefit for community staff that are working



remotely from the rest of their team members. A pilot of laptops in a busy community team showed that the laptop was viewed as a barrier to eye contact with the patient and therefore did not contribute to the quality agenda. Minimally intrusive digital pens that provide a paper copy for patients and staff to refer to are an effective and usable mobile technology that will encourage usage. Staff will continue to document at point of care with the equivalent of pen and paper on newly designed documentation templates that match evidenced based care plans and assessment tools. This information will pull through to the EPR and will reduce the amount of times a patient / woman is asked for information and will also show past history and identify any issues that can be addressed immediately using the supporting smart phone or tablet technology.

As Nurses and Midwives will only have to complete documentation once for the patient, this will make the team more efficient and ‘release time to care’. Also contributing to the qualitative care provided will be the faster access to prescription and equipment requests and referrals to other providers. Patients and women will be able to see and retain a copy of their own health or maternity records with information that may be required at GP appointments, A&E or ante-natal visits

Team leaders and midwives will utilise both laptops and tablet solutions to access all clinical documentation within the EPR that can influence decision making about current care within the patients’ home. This should ensure that the patients’ receive an accurate individualised care plan at first point of contact as clinical staff will no longer need to liaise with the acute setting which can cause delays to appropriate care if the right information is not available.

The mobile app solutions also available to the clinician will provide a powerful educational tool with access to information in many languages, by which to best support the patient / women in their own home environment, thus empowering their own decision making.

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F3. Realising Financial Benefits

The use of mobile technology in it variety of formats will enable staff to accurately and contemporaneously document patient / midwifery care. The current situation is that community nurses document on paper notes in the patient home and return to base once or twice a day to document the care on a desktop computer. This duplication of recording is non- productive and can lead to delays in care provision, inaccuracies and increased risk of miscommunication between team members and other care providers. Freeing up this time will enable community nurses to provide more interaction with patients at their visits and will enable them to provide more public health information, advice and support and therefore contribute to the “making every contact count” initiative.

This application has identified financial benefits that will meet the value for money ratio by reducing the time spent on duplication of data entry by 5 minutes per contact. Community nursing services conducted 366,422 contacts in 2013/14; trials have shown that mobile solutions will reduce time spent on duplicate data entry by average of 5 minutes per contact. This equates to 13.62 whole time equivalent Band 6 staff per year contributing £566,401 in financial benefits. This will enable nursing staff to provide an enhanced quality experience to patients in Croydon by increasing the amount of face to



face time given to patients / women.

Our community midwifery staff also cannot currently access an EPR whilst seeing clients at home or in a clinic setting. Mobile technology will provide that essential link between existing health records and what is being experienced by Mothers and babies at that moment in time. 4,300 women book with CHS for pregnancy care each year. Mobile working would save at least 30 minutes per woman which equates to 1.3 wte Band 6 midwives contributing £54,103 in financial benefits. This productivity saving will be utilised to give midwives more time to counsel, support and invest in mother and baby care.

Croydon is a large borough with its attendant traffic issues; community and midwifery staff make a number of visits per day back to base to enter their data reducing this by 1 visit per day will provide both time and travel cost reductions. This is currently being quantified and if we are successful the project financial and productivity benefits will be monitored by our PMO and will augment the VFM ratio.

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F4. VfM Ratio

Please restate in the box below the calculated VfM ratio from your Value for Money Analysis – the value to use is the ‘discounted benefit to cost ratio’ from the spreadsheet:

1: 2.62



G. ApproachThe responses provided in this section will contribute to the application score. Annex 7 of the Prospectus provides guidance on what evidence the evaluators will be looking for.

G1. Project Context

This project forms an integral part of CHS’s informatics and nursing strategy and builds upon existing initiatives which are designed to support the transition towards paperless processes. The strategy establishes a detailed roadmap for development of the EPR over the next five years. The EPR programme is divided into a number of phases covering all sites, staff groups and community health partners including most importantly patient groups.

CHS is working with other partners in the SW London heath community to explore opportunities of introducing new ways of working into discrete areas of the health community. These pilot areas allow functionality to be evaluated before implementation on a wider scale and inform the development of a single EPR being visible to all partners. This pilot and rollout constitutes one such strand

CHS has just completed a scoping exercise of care records: on average 1000 clinical and administrative staff use the application every day. As previously stated digital pens, laptops and tablets have been piloted with CRS Millennium and the Community EPR. The proposed integration of a digital pen solution not pose a technical challenge as this has already been developed.

The Informatics Committee has agreed the Roadmap, the major clinical items are:-

1. Completion of CRS Millennium Phase 2 April 20152. Provide mobile technology in the patient’s home.3. Upgrade WAN4. Transition to NHS mail in 20155. Transition to an enterprise wide Print Managed Service in 20156. Re-procurement of Picture Archive and Communication System by June 2015.7. Procurement of a Vendor Neutral Archive by June 2015.8. Re-procurement of CRS Millennium outside of the national programme by

December 2014.9. Re-vamp Microsoft SharePoint in 2014.10. Patient Entertainment System also used by clinicians at the bedside to access

CRS Millennium.11. Data Migration of CRS Millennium from the BT Data Centre to the Cerner Data

Centre by September 2015.12. CRS Millennium Code upgrade to at a minimum of version 20.14 by March

2016.

Funding from the Nurse Technology Fund will enable mobile technology to be rolled out much faster into the community for nursing staff, ensuring that benefits will be delivered sooner as will lessons learnt that would be carried forward into further deployments of mobile technology.

Due to technological enhancements taking place at CHS staff are already engaged and



enthusiastic about introducing new capability, which will complement existing improvements being made in Community Services.

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G2. Project Delivery Approach

This Nursing Mobility project will join a portfolio of other projects managed by Tony Varney, Programme Director/Head of ICT who is responsible for reporting on their progress against plan at the fortnightly Programme Board and monthly Informatics Committee.

The programme is managed based on the principles of Managing Successful Programmes and the individual projects are managed using Prince 2 methodology. This project has Claire Jones (ADN) as SRO and Charlotte Stockman (Nurse Informatics Lead) as Project Lead.

This model was used by CHS to deploy the largest clinical portfolio of Cerner Millennium applications as part of the NPfIT. It is acknowledged to be one of the best implementations to date. Its success was due to the IT and clinical teams working closely together and supporting each other in what was a highly technical clinical deployment. A Lessons Learnt report was produced with the key learning’s being rigorous attention to change management, stakeholder engagement, on the job support/training and communications.

A trial using laptops and digital pens has been carried out in patient’s homes to judge the viability of “remote” electronic data capture. The digital pen posed few problems as they act exactly like a biro and most staff own and are familiar with a smartphone. The laptops did require more support than envisaged as staff needed to negotiate network security, navigation too and then the use of clinical applications. The Transformation Director has become engaged in documenting workflow and assessing what changes are required to support the new ways of working.

To ensure that in the event of a successful application money is spent by the 31st March 2015 the tender documentation is being prepared for the digital pens. The laptops and Smartphones will be bought against existing NHS Framework Agreements that are used by the Trust.

Key milestones are:

Benefits Realisation Plan produced 2014 Procurement of Hardware and Software to be on site by 31st March 2015. Configure digital pens/laptops, smartphones and tablets by June 2015 Complete Data Mapping between Community EPR and Digital pen by June

2015 Produce digital pen templates for each service by July 2015 Pilot in one community service in August/September 2015 Evaluate pilot and amend components as necessary September 2015, Commence Rollout in November 2015.



The mobile solutions deployment project will have a Transformation Analyst assigned to identify change needs, assess the impact of the change and document the current and future processes.

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G3. Clinical Change Approach

The CHS emphasis for clinical transformation is to motivate and stimulate Nurses and Midwives to deliver benefits to ensure excellent standards of care and enable clinicians to streamline current practice utilising Lean methodology. The mobile solutions adoption programme focuses on improvements to clinical practice, increasing efficiency whilst stressing the importance of maintaining patient safety. High quality, safe, efficient care for patients is the key objective for CHS’s underpinned by aligning clinical change with improving the knowledge, skills and confidence of all staff. This project builds on the “Patient at the centre of everything we do” initiative.

The clinical change approach is to map out the “As is” and the “To be” processes and then re-design the workflows. SOP’s will be developed, incorporating training material describing how the applications are to be used and the associated business rules to ensure that staff are aware of the ‘why’. A key aspect of this allows logging, capture and management of change. The clinical change approach therefore involves working collaboratively with Nursing and Midwifery teams to map pathways and identify processes which will improve with the introduction of new clinical functionality. The recent deployment of the EPR and medicines management at CHS involved all of the above processes and places CHS is in a unique position to apply similar project principles to the roll out of the new functionality within the community setting to ensure a smooth transition with minimal impact to staff, and safeguarding the patient.

A champion user programme for CHS staff was initiated during the initial EPR deployment phase. By utilising our own staff we ensure quality and adaption of new functionality in a pragmatic way. Staff involved in the initial roll out are still within the organisation including the ADN, CCIO and clinical nurse lead for informatics who played a key role during the project to ensure patient safety was at the forefront. 80% of acute staff attended and passed 1 days training and were supported post Go-Live by our own Champion Users and supplier floorwalkers.

The same principles will be applied for the roll out of the community technology, ensuring that CHS staff become the experts in the new functionality supported by remote application support through smart phones and at handover within the clinical teams. This process ensures that even post implementation CHS will strive to ensure that workflows are optimised to benefit patients as well as clinical staff.

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G4. Procurement Approach



Through conducting a pilot it has been established what components are required to meet the objectives of this application.

Our NHS Supplies Department Manager sits on IT projects to ensure all purchases comply with the Trust’s standard procurement procedures.

Meetings have been held with the Trust and Community EPR suppliers to identify any constraints that would prevent the successful deployment of the digital pens. Cerner (CRS Millennium supplier) already have an interface with one digital pen supplier which has been fully tested with their Maternity system which goes live in CHS April 2015, Community midwives have attended demonstrations and confirmed it meets their needs.

Digital pen suppliers has provided CHS information on previous successful implementations in healthcare and supporting case studies. Their background and reference information gives the Trust confidence in their ability to deliver a solution that is fit for purpose.

CHS’s IM&T department and community nurses with assistance from a digital pen supplier have successfully end to end tested a mobile phone app i.e. transmitted a photograph and assessment using an Android Smartphone from a remote site into a test server at CHS.

The Trust will tender for the digital pens, their associated software and, data mapping and template design. A requirements document is currently being produced ready for issue. The tenders will be evaluated and a report produced with a recommendation for ratification by the Informatics Committee.

Laptops with a SIM Card, Smartcard Reader, N3 Gateway have been trial successfully with CRS Millennium and the Community EPR.

Laptops and Tablets will be purchased using the existing NHS Framework contract CHS uses for procuring laptops and Tablets.

Phones and SIM cards to support the functionality of digital pens will be purchased using the existing NHS Framework contract CHS uses for procuring phones.

The network infrastructure is in place for a digital pen deployment and the suppliers have stated that they will commit the resources and be able to deliver against the milestones in the project timeline.

CHS has significant experience of deploying and testing vendor products and has recently implemented new CRS Millennium functionality. The IT Department has a Test Manager who will assist and guide clinical colleagues to ensure the product matches specification and fits in with patient workflow. The IT Services department ensure with clinical colleagues that the information being collect populates the correct fields in the EPR.

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G5. Key ChallengesThe project team that developed this application have the experience of the successful implementation of the largest footprint of clinical functionality through CRS millennium including medicines management and care plans by integrating the informatics and nursing strategies with operational delivery. The members of the group reviewed aspect of phase 1 implementation and with this experience feel that the three top challenges are:-

1. Change management – a project the size of phase 1 CRS millennium roll out was managed by utilising clear training plans to achieve specific objectives. The risk to the Trust was both clinical and financial and was managed by twice daily meetings with the Chief operating officer with clearly assigned actions. This approach will be adapted to suit the context of change management within the community teams. This staff group predominantly work alone so once the training sessions have been completed manned telephone lines will be available 24/7 in the first two weeks of roll out and will then be reviewed. Activity and qualitative benefits will be measured using our PMO.

2. Communication – Croydon is London’s largest geographical and ethnically diverse borough with community and midwifery staff working in all areas. However these are established teams with established performing channels of communication. Teams have already participated in trialling both laptops and digital pens and are motivated and enthusiastic to use mobile technology. As clinical teams they are required to meet regularly to feedback about patient care and provide peer supervision. These meetings will be utilised before project roll out to communicate the how, when and why of the technology and also to troubleshoot once the project is up and running. Community based staff are well versed in using mobile phones and a text alert system is extremely well used to communicate messages and advice. The addition of smart phones will enable this communication significantly.

3. Implementation – as stated above in both paragraphs the borough is large and can be subject to poor mobile signal which may result in dissatisfaction with access to the EPR in the community. The network infrastructure is planned to be upgraded early in 2015. This will improve engagement with the existing system and enhance the appetite for innovative mobile technologies that can further the benefits of access to an integrated, patient centred care record. This alignment of IT capability across the Trust will reduce inequalities in care provision by enabling access to the EPR.

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G6. Solution Diagrams

Please ensure the two Solution Diagrams are provided separately, as detailed in section 3.2 of the Prospectus and in the Solution Diagrams Guidance.





H. Further Information

The responses provided in this section will not contribute to the screening or scoring of applications.

H1. Procurement of Mobile Devices

This question is intended to provide intelligence in order to inform the development of packages of support that successful applicants may need to deliver their proposed projects. It is recognised that proposals will be at different stages – some may have a specific solution and supplier identified, some will not have reached that stage.

If you intend to procure ‘Hardware – mobile devices’ (as indicated in C4), please complete the table below. Place an ‘X’ in the appropriate boxes to indicate the device types you intend to procure, and enter a number in the final column to indicate the approximate quantities, as far as this is known at the current time. (Please note that you will not be constrained in what you ultimately procure by the answers you provide to this question).

Type Definitely Probably Possibly Quantity of devices (approx.)AppleDell X 125Samsung X 20Digital Pens X 400

Please note that Apple and Dell procurement will be expected to be undertaken through a mechanism that will be specified at the award stage.

H2. Spending Profile

In order to help our financial planning, please outline your anticipated spending profile by completing the relevant table below. The total should be the amount of funding you are applying for from the Nursing Technology Fund. We accept that the profile provided may change, and you will not be constrained by the profile you provide, apart from the need to spend within the given financial year.

For a FY14/15 application Jan 15 Feb 15 Mar 15 TOTAL£0 502,842 465,895 968,737

For a FY15/16 application Q1 15/16 Q2 15/16 Q3 15/16 Q4 15/16 TOTAL£ £ £ £ £



And finally, please remember to…

Return the completed form as a Word document Name the file in the following format:

o NTF2 [Organisation code] [Priority] Application Form – [Project title] o (for example, ‘NTF2 RHD 1 Application Form - Vital Signs Monitoring’)

Return the form together with the other requested documents to [email protected], with a subject line of:

o NTF2 [Organisation code] [Priority] Application – [Project title]o (for example, ‘NTF2 RHD 1 Application – Vital Signs Monitoring’)

An application will comprise the following documents:o Application Form (this document)o Value for Money Analysiso Financial Analysis (for applications from NHS Trusts and Foundation Trusts only)o Solution Diagrams – Information Flow Diagram and Technology Diagramo Reference(s) (for applications from VCSE organisations only)o Latest Annual Accounts (for VCSEs not registered on the Charities Commission

website only)


mailto:[email protected]

Documents

€¦ · Web viewNote the word limits that apply to selected questions. In responding to ‘free text’ questions, focus on answering the questions posed (and not trying to ‘sell’