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NPFIT – The Strategic Health
Authority Perspective
Mike SinclairDeputy CIO, NPFIT Programme Manager
Surrey and Sussex SHA
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Agenda
• NPFIT– National– Cluster– Local
• SHA Roles & Responsibilities• How ICT & NPFIT Can Help SHAs• Local and Community Organisation• Recommendations / Actions
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Outline - NPFIT
• National Systems and Services– Spine– E-Booking– PACS– E-Prescribing
• Local Care Record– Service not System (LSP plus)– Community Wide (Deployment Families)– Modular / Bundles– Cluster-wide data centre model– Includes non-NHS (Social Care, Hospices, Prisons etc)
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HUNTER
INFORMATIONFARMING INDUSTRIAL
CARECARE
GATHERER
Progress
Time
% ofpeople
Ages of mankind
Meaning context independent
Meaning totally context dependant
Low level of understanding
High levels of understanding
Data
Information
Knowledge
Wisdom Requires brain power
Requires processing power
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Clusters
• North East - Accenture / iSoft £1099M• London - BT (CCA) / IDX £996M• North West & W Mids - CSC / iSoft £973M• Eastern - Accenture / iSoft £934M• Southern - The Fujitsu Alliance / IDX £896M
NASP Contracts:• Spine (NHS CRS)
- BT £620M• E-Booking
- Schlumberger / Cerner £64.5M
NISP Contract• N3
- BT£530m
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Investment (SMART) Objectives
• Improve Patient Experience• Improve the Quality of Care• Enable Effective Access to Clinical and
Administrative Information• Reduce Fragmentation of Care• Improve Policy Development and Health
Research
Scope and roles
Sample Set of Generic Processes
Range of Care Settings
Flexible Toolkit to Support Range of Data and Viewing Requirements
INT
EG
RA
TE
D C
AR
E R
EC
OR
D S
ER
VIC
E
Master Patient Index (eMPI)
Order Entry
Results Reporting
E-prescribingE-booking
Integrated Care Pathways
Resource scheduling
Screening
Bed Management
Ambulatory Care Management
Mental Health Act Administration
Clinical Decision Support
Confidentiality
Authentication Domiciliary Care Management
Clinical Noting
Clinical Correspondence/Summary
Management InformationGraphical AnalysisImage Management Casenote and Film Tracking
NHS Spine
Personal Demographic Services
E-booking
Electronic Transferof prescriptions
Common Services
Nationally built by NASPsand locally
implemented by LSP'sLocally configured and locally implemented by LSP's
Cardiology Anaesthesiology
Intensive Care
Diabetes Theatres
Radiology
Pathology
MaternityOld Age Psychiatry
Radiotherapy
Child Health Screening
Trauma Rehabilitation
Respite Care
Palliative CareColposcopy
Nephrology
Endoscopy
DTCsACADs
GeneralPractice
AcuteHospital
CommunityNursing
HospitalPsychiatry
Therapies(OT/PT)
CommunityMental Health
DiagnosticDepartments
Home
TertiaryCare
NHSDirect
PrisonSocialCare
HospicesPrivateHealth
AmbulanceWalk-InCentres
National ICRSLocal ICRS
ICRS Overview
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National Care Record Service (NCRS)
• Foundation for entire system• Single point of information• Informs care decisions• Increased safety• Better information for national planning
CommonIntegrated
Health Information‘The Spine’
Internal Health Information
Information
Clinical Events
Patient Care
Example Spine InformationPersonal Details
• Name, address, etcSummary Health Information
• Medication• Allergies and adverse
reactions• Problems• Procedures
Reports of Events• Clinical correspondence• Discharge summaries• Referrals
Current Care Providers
Organisational SystemsGP systems
Hospital systemsNHS Direct
… etc
CommonIntegrated
Health Information‘The Spine’
Internal Health Information
Information
Clinical Events
Patient Care
Example Spine InformationPersonal Details
• Name, address, etcSummary Health Information
• Medication• Allergies and adverse
reactions• Problems• Procedures
Reports of Events• Clinical correspondence• Discharge summaries• Referrals
Current Care Providers
Organisational SystemsGP systems
Hospital systemsNHS Direct
… etc
SpineSpine
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Spine
LSP
Patient info
Broken Leg
Patient visits A&E
Patient info
LSP
Back Pain
Patient visits GP
LSP
Patient info
Chest infection
Patient visits hospital
The Spine – clinical events through time
The information flow is repeated over time
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BundlesCore (Funded) BundlesICRS Portal2 PAS3 Enterprise Architecture 14 Clinicals5 Maternity6 Theatre7 Alternative GP Solution8 Advanced PAS9 Orders11 Advanced Clinicals12 Enterprise Architecture 214 Prescribing15 Ambulance16 Complex Clinicals17 Advanced Scheduling18 Enterprise Architecture 319 Advanced Maternity
Additional (Local Funded) Bundles20 PACS21 Pathology22 Financial Payments23 eHealth24 Document Management25 Dental26 RIS (Radiology)27 Pharmacy Stock Control28 Social Care29 eBooking to Primary Care30 Decision Support Advanced31 Long Term Medical Conditions32 Early delivery PSS (Bundle 52)33 Upgrade of early PSS (Bundle 53)34 Early delivery Prescribing (Bundle 50)35 Upgrade of early Prescribing
(Bundle 51)
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Bundle Diagram Version 0.10: Bundle Release Phasing and Pre-requisites
31/03/09
key
Advanced Clinicals
PrescribingMaternity
Advanced Maternity
ICRS
Clinicals Orders Complex Clinicals
IDX GP
Early Site
PAS
Theatre Management
Ambulance
Advanced PAS Advanced Scheduling
Phase 1 Release 1 Phase 1 Release 2 Phase 2 Release 1 Phase 2 Release 2 Phase 3
Alternative GP 1
Enterprise Architecture 3
Enterprise Architecture 4
Enterprise Architecture 1
Standalone Theatre Mngt
When any Bundle within a release is taken up, the associated foundation (ICRS or EA) with that phased release needs to be installed in the Data Centre.
Core
Additional
Functional Sub-set
Early Release
Standalone
PHASED RELEASE TO BE DETERMINED:
For the Standalones shown here, the requirements are either still to be fully defined with the Authority or there are commercial / contractual discussions underway.. Until this is done these bundles should not be placed in a
phase/release.
Document Management
E-Health(a) & (b)
Financial Payments
Pathology
PACS
Dental
Radiology (incl. RIS)
Pharmacy Stock Control
Social Care
E-Booking to Primary Care
Long Term Conditions
Mental Health
Basic Care Planning
Standalone Doc Mngt
Standalone Pathology
Enterprise Architecture 2
Standalone PACS
Standalone Pharmacy Stock Cntrl
Model Community Complete: 28/09/04 31/03/05 28/09/05 28/09/06
Alternative GP 2
CCA Core Bundle(not FJA)
Standalone RIS
Advanced Decision Support
Standalone Decision Support
Standalone Child Health
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Cluster Roles, Organisation and Issues• FJA / CCA/ IDX - Common Solutions Board• Detail Implementation Plan (DIP) (2006 – 2009)• Cluster and London Collaboration Groups
– Technical Architecture; Information Architecture; Legacy Management; E-Booking; Benefits; ..
– Clinical Advisory Group(s)– Requirements and Design– Integral with London (Common Solutions Board)
• Special Cross-Cluster Initiatives– Interim Solutions for NSFs
• Data Warehouse / Repository– Data Cleansing and Migration
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LSP Deployment Approach – Initial Overview
Nov Dec Jan Feb Mar Apr May Jun Jul/Aug
End User Training
Testing Business Processes
Reporting, IntegrationData Migration and Printers
Training PreparationTraining Materials
Train the Trainer sessions
Test PreparationScript generation
Acceptance Criteria
Local ConfigurationMaster data setup & reports
Data Migration Load and Quality Validation
Open transactions & history
User Registration on NASP
Data Cleansing
End User IT Competency Training and Evaluation
Business Change: Stakeholder Mgmt, Organisation redesign, Business process mapping, communications, benefits realisation
Registration Authority
Set Up User Registration Authentication Prep
Legacy Integration
Project Management
FJA
NHS
Go
Live C
uto
verF
inal Data Load
Security and Controls
45 day live ru
nn
ing
DK
M
Data Extraction (open transactions and history)
ToolkitsAvailable
Phase 1 : Prepare Phase 2 : Roll OutDeploy
Go
Live S
up
po
rt
Card Readers InstallationStageing and Release Management
Technical Design SupportRD
Phase&
PIDSigned
Off
Master Data Capture For Local Configuration
Business Change Implementation and Benefits SupportBusiness Change Strategy and Planning
Alpha software drop
Service Management Preparation and Establishment
First Line Service Desk Establishment
Final PECaM software drop
Warranted Environment upgrade
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Health Service & SHA Pressure& Roles
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Pressures on the NHS
• Political drive to change• Changing demographics• Modernisation of the NHS
– EBM & clinical governance– Impact of information technology– Quality regardless of geography
• Exponential increase in cost• Partnership with patients not Patronage• Putting the “S” in NHS
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Challenges to be TackledChallenges to be Tackled
• Access targets
• Emergency care system
• Mental health
• Integrated working
• Chronic disease management
• Workforce
• Capital stock, estate and capacity
• Social Care market
• IM&T
• Finance
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National Drivers for ChangeNational Drivers for Change
• Patient & public involvement
• Plurality of provision/wider choice
• Integration of health & social care
• National standards
• External regulation & performance management
• Changing workforce
• IM&T investment
• Devolution
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Local Drivers for ChangeLocal Drivers for Change
• Developing a culture of Service Improvement
• Restoring financial health & discipline
• Expanding physical & workforce capacity
• Strengthening the capability of LHSCCs to deliver
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Two Major Areas of ConstraintTwo Major Areas of Constraint
Capacity
• Physical
• Workforce
• IM&T
Culture
• Partnership working
• Person centred care
• Primary care
• Using IM&T
• Modernising the
workforce
• Finance
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The Service Model
Specialist Care
Secondary Care
Primary/Community/Intermediate/Social Care
Prevention/Promotion/Self Care
Patient & Public InvolvementForumsPALS
Scrutiny
Change &
Modernisatio
n
Investment
Capital &
R
evenue
Relation
ship
s &
Partn
ership
sDRIVERS
CONSTRAINTS
Pathways & Networks
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PPIPPI
IM&TIM&T
ClinicalClinical leadershipleadership
Care pathways & clinical networksCare pathways & clinical networks
Local care centresGPs, GDPs
specialist GPs and nursesdiagnostic tests and investigations
joint NHS/Social Services teams eg OTstep up/down (intermediate care) facilities
chronic disease managementconsultant outreach clinics
community MH services
GP practiceslinked to local care centres
Elective treatment centresDTCs concentrating on routine surgery
state of the art day case unitsmaternity services
joint NHS/social services discharge teamsclear clinical networks and links with primary care
close work with nurses and GPs with special interest Consultant outreach to local care centres
MIU, run by specialist nurses
Emergency & complextreatment centres
A&E, MAU, trauma, NICU, PICU, etcemergency surgery & medicine
complex elective surgeryintensive rehabilitation services
GPs on site – perhaps through PMSbase for out of hours and deputising services
Specialist centresclear clinical networks and links to local services
diagnostic/outpatient work done locally where possiblehonorary contracts and clinics/training for local clinicians
outreach to local providersspecialist mental health services
NHS Direct, ambulance &patient contact centre
single call centre and decision process
contact centre for electronic booking
Ack: SR
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SHA (NPFIT) Roles
• Strategy & Planning
• Integration across SHA roles
• Manage LSP Contact
• Manage SHA wide initiatives
• Coordinate London / Southern Connection
• Disseminate and Communicate
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HEALTH INFORMATICS TRANSFORMATIONSHA Inter-working
• Development
• Clinical change
• NSFs
• Policy
• Financial Recovery
• Increasingly delivery of targets
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Mapping the LDP to ICRS - Generic
• Access
• Sharing
• Carers
• Choice
• Capacity
• Prevention
• Pt/Carer Info and Support
• Pt Admin, Index, Spine• Scheduling / Booking• RR and OCs• Integrated internal
Systems• Integrated Community
System• Access to the KB• Decision Support• Health Promotion
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The NHS Plan and LDPs: Plan and Benefits
• LDP Targets
• LCR Functional Requirements
• Investment Objectives
• Service Targets
• SMART Targets
• Benefits Realisation & Management
• Engagement & Change Management
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Local & Community Organisation
• Health Informatics Services
• Organisational Leaders
• Community-Organisational Integration
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The Future Shape of NHS IT - Services
DOHDOHNational IT National IT
Programme) Programme) (RG)(RG)
NSPsNSPsLSPsLSPs
Cluster OfficeCluster Office
Modernisation Modernisation AgencyAgency
SHASHA
Health Informatics Health Informatics Services Services
NHSNHS
National Direction National Services
D.I.P
Cluster wide services: CDR, Helpdesk..etc..
Local Direction & Coordination
Local Links (MS, Choice etc..)
Local Helpdesk(s)IT Services
Delivery
Intelligent Customer
Systems / ICRS
(Spec., Impl.)
Information
&
Intelligence
Local Engagement
IM&T Support Services
(Security, Training, Data Quality, ..etc.
Change Management
IT & Admin /
Clinical Practice
Service liaison,
Strategy Development
Contract Management
, Delivery
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Organisational Structures and Processes
Organisation / Community
• Service Redesign• Change Management• Benefit Realisation• Identification of
needs
Organisational Leads for IT
• Strategy• Benefits• Champion & Lead• Communication• Accountable for
delivery
Transformation & Modernisation
• Engagement• Process Redesign• Communication of needs• Inter/intra organisational
links• Day to day relationships
HIS/SHA/(LSP)
Health Informatics Services
• Plans• Suggests• Implements• Understands
customer needs
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NPFIT Organisation - Working Groups for SAP: London/Southern
BPPDGs Executive
WorkgroupsBPPDGs Executive
Workgroups
Southern Programme
Board
London ICT Program
Common Solution Project
Board
Operations Group
Functional Design Group
Technical Design Group
Information Governance
Group
Solution Test Group
Care Record Development Board*
* Formerly “National Clinical Advisory Board** Southern Cluster Clinical Advisory Group, London CRS Implementation Board, London Cluster Clinical Reference Group
SCCAGLCRSIB& CRG**
CRDB Groups
Joint SAP Best Practice Steering
Group
Common Decisions
BPPDGs Executive Workgroups
Task Groups:eg Information
Management
BPPD Executive Groups
Assurance
Governance
Joint SAP Best Practice Process
Design Group
London SAP Reference Group
Southern Cluster SAP Reference
Group
Southern Cluster Implementation
Executive
National Programme for IT
Southern Cluster SAP Steering
Group
Southern Cluster Technical Design
Group
Southern Cluster Information Governance
Group
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OLIT role
• Strategy & Leadership• Communication & Engagement• Inteface to Service Needs and Requirement• Align and Integrate with Modernisation and Change
Management• Benefits delivery and realisation• External relationship management (SHA, HIS & LSP
etc.)
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Conclusions & Recommendations
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HEALTH INFORMATICS TRANSFORMATION –What does the Patient deserve?
• Change current status:– Discontinuities– Best practice not integrated – Information not available – Patient disempowered
Need to transform care delivery and clinical work underpinned by effective use of technology
Need to function as a single NHS
• Infers strong hands-on role for the SHA
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How Can IT Help ?• Common Infrastructure
– E-mail; NSTS; integrated availability and access to solutions..
• Data and Information Flows– Demographic (Spine)– Core service requirements– Sharing
• Supporting Issues– Confidentiality and Security– Integral with other Health Information– Integral Reporting and Monitoring
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Overall Messages
• Service Improvement• Carer/Education Focus• MDT / Community wide• Patient Based• Pt access to record
• National Programme in fast
• Different approach to management / benefits realisation
True ICRS IM&T core to service IM&T professional needs to
understand the service IM&T now a clinical tool
A new and radical change to the way we use and manage our IM&T systems
A new relationship between SHAs, LHCs and all H&SC organisations
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Issues for Resolution
Terminology Ways of Working Culture and Politics Fit with other service needs and processes Sector targets, performance framework and priorities Governance NPFIT not fully ready and in place for 6,8,10 yrs.. Information Sharing and Ownership Systems Integration Confidentiality
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Approaches• Citizen / Patient first• Centred on service processes not management • Operational Services and IT working together• Listening & Learning• Incremental through joint work and planning• Best Practice work springboard to change• Risks are part of the agenda – honestly expressed• Patience and Persistence Pragmatism - based on patient & citizen need
Ack: Ian S
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Immediate Actions & Recommendations Establish joint processes wherever possible Agree Information Sharing Protocols Establish common data definitions and terminology Explore, use and seize immediate opportunities (e.g.
Interim SAP) Pilot local schemes to test Governance and boundary
issues Connect where possible (NHS net, local networks) Use the NHS number
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• Core SHA NPFIT Roles• Local Alignment with Service Priorities (LDP, Star
Indicators etc) & Modernisation• Organisational Leads (OLITS)• Board Level leadership• HIS / IT organisation • Benefits Management & Realisation
.. all whilst moving to the live use of data and .. all whilst moving to the live use of data and information systems..information systems..
& the 7 practices of effective uses of IT systems& the 7 practices of effective uses of IT systems
Immediate Actions & Recommendations