NHS Fife eHealth Strategy

2008-2010

December 2007

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FOREWORD

Despite its title, this Strategy is not about technology.

Technology is simply a means to an end, and in this case the end is harnessing electronics to the improvement of care. Our goals are more reliable records, speedier and more secure communications, and more accessible decision support – all leading to better outcomes for patients and population, and easier ways of working for clinical staff.

That means an emphasis on responding to user needs and priorities. eHealth is no longer, if it ever was, the province of an elite few. Instead it is a toolbox to be brought into play, by skilled individuals, in ways which deliver improvements as determined by staff, patients, users and carers.

NHS Fife, through this Strategy, is in the process of transforming the way care is provided. The investment that is going into expanding our capacity is to enable and support clinical change. Whether through PACS, clinical e-mail, SCI store, EPR, G-PASS as direct systems or through HR and Finance systems in support, the way we work is changing beyond recognition, and the rate of change will continue to accelerate.

This Strategy is about how we keep up with the pace.

George J BrechinChief Executive

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Contents

FOREWORD

Page Number

1 Introduction 42 Current Status Of eHealth Across NHS Fife 4-53 The Governance Arrangements and Structure of eHealth

in NHS Fife5-6

4 National Developments 65 EHealth Vision for NHS Fife 76 Work Towards A Single Patient Record System Within

NHS Fife7-8

7 Develop the NHS Fife Information Service 88 Support the Development and Implementation of Key

Business Systems9

9 Develop the IT Infrastructure to Support Clinical and Business Systems

9-10

10 Promote the use of eHealth Technology Within an Appropriate IT and Information Governance Framework

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11 Financial Expertise and Resources To Support The eHealth Agenda

10-11

12 Working With Partners To Improve The IT Infrastructure, Information Sharing And Development Of Clinical Applications

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13 Promote A Culture That Supports And Encourages The Use Of eHealth Applications As Part Of Routine Practice

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14 General Hospitals And Maternity Services/St Andrews Project

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15 Telehealth 1316 Implementation of Strategy 13

Appendix 1 eHealth Directorate 14Appendix 2 eHealth Target Architecture 15Appendix 3 Top Clinical and Business Applications 16Appendix 4 Glossary 17

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NHS FIFE

Report to The Board on 18th December 2007

eHEALTH STRATEGY 2008 - 2010

1. INTRODUCTION

NHS Fife developed its first IM&T Strategy in 2003, following a prolonged period of consultation with key stakeholders. This Strategy was updated and renamed 'the NHS Fife eHealth Strategy' in 2005. The second Strategy which covered the time period 2005-07 and was based on national strategic direction, attempted to move the agenda towards a focus on the redesign agenda and the production of information to support performance management.

The purpose of this document is to describe the eHealth strategic direction which NHS Fife will pursue over the next two years to support its overall strategic aims. It does so by outlining:

the current status in relation to eHealth across NHS Fife the current structure and governance arrangements national eHealth developments the NHS Fife eHealth vision how the vision will be achieved how NHS Fife will monitor the implementation of the Strategy.

2. CURRENT STATUS OF EHEALTH ACROSS NHS FIFE

The eHealth agenda has benefited from having a clearly documented strategic direction for the past four years. This in turn has facilitated targeted investment of Capital and Revenue resources in IT infrastructure, clinical system development and additional staff within IT, training and development.

The eHealth Directorate now has well established managerial systems which accurately reflect the developing eHealth governance arrangements at national level. Risk management is embedded in all activities and close working with colleagues in both Internal and External Audit ensures that annual work plans and investment, particularly in IT infrastructure, take account of the eHealth agenda outlined in national documents including the Priorities and Risks Framework.

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NHS Fife is now delivering clinical benefit from its investment in eHealth and is able to celebrate significant advances delivered over the past four years. The 2006-07 eHealth Annual Report described some of the significant clinical advances as a result of investment in technology.

Across General Medical Practices, the use of clinical systems to support patient care is advanced with approximately 25% of General Practices working in “paperlite” fashion. Approximately two thirds of all referrals to secondary care within NHS Fife are sent electronically through SCI gateway.

The clinical IT infrastructure is also advanced within the Operational Division where x-rays and laboratory results are viewed electronically. Some clinical areas are using wireless trolleys during ward rounds which allow access to the aforementioned results at the patient's bedside.

The ophthalmology service also operates in a “paperlite” fashion and has won two national awards for innovations in service delivery supported by eHealth.

eHealth has not yet been in a position to support significant developments within community specialties where the IT infrastructure is more complex and the use of clinical systems is often rudimentary.

NHS Fife has reached the contractual agreement with Siemens to extend the Oasis clinical system across NHS Fife with the exception of the independent contractors. The implementation which will be taken forward over the next 18 months will deliver major eHealth improvements in Mental Health and Community Services.

The development of the Information Service within eHealth has progressed more slowly than the IT and clinical system development agenda. NHS Fife is now at the stage of implementing an agreed structure for this service. Resources have been identified to develop the service in line with the direction agreed following input from NSS and discussion with the involved staff.

3. THE GOVERNANCE ARRANGEMENTS AND STRUCTURE OF EHEALTH IN NHS FIFE

The Executive Lead for eHealth reports directly to the Chief Executive of NHS Fife. The eHealth Board, which is Chaired by the Executive Lead for eHealth has an agreed role and remit with membership from all stakeholder interests including the public, finance, staff side and Fife Council. Internal Audit is in attendance at the eHealth Board meetings. The eHealth Board reports to the Redesign Board and to the NHS Fife Clinical Governance Committee.

The work of the eHealth Board is planned on an annual basis, with regular reports being received from the key areas within its remit. These reports are made available to the CHPs and the Operational Division.

The Executive Lead for eHealth attends the key strategic and risk management groups across NHS Fife ensuring that eHealth has become integral to the operation and strategic development of NHS Fife services.

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The eHealth Board is supported by the eHealth Directorate which is responsible for the operational delivery and development of eHealth services to support NHS Fife in achieving its strategic objectives. The high level structure of the eHealth directorate is shown in Appendix 1.

Technical and Clinical Working Groups have been established within eHealth. The Technical Working Group, which has representation from Fife Council, works to ensure that the technical architecture supports the delivery of the eHealth Strategy.

The Clinical Working Group, which has broad representation from across NHS Fife, facilities communication between clinical groups and eHealth professionals. This Group has facilitated many of the clinical developments between Primary and Secondary Care.

In addition to the above groups the eHealth Programme Director meets with managerial leads from the OD and CHPs to improve joint working and communication.

All new or proposed eHealth projects are authorised by the eHealth Board. An eHealth business case and project pack has been developed to ensure that all eHealth projects are established, managed and closed in line with Prince 2 methodology. The eHealth Programme Director provides professional leadership and management support to all eHealth Project Managers.

In Summary eHealth has established robust governance systems which are subject to regular review.

4. NATIONAL DEVELOPMENTS

The national eHealth Strategy is currently under review. Over the past 12 months the Scottish Government eHealth team has reviewed its structure, governance arrangements and Strategy to ensure that it is equipped to support the agenda described within the “Kerr Report”. To deliver the aspirations within the “Kerr Report” and “Better Health, Better Care” the Scottish Government eHealth team is currently undertaking a major recruitment drive.

Business cases are being finalised nationally for the procurement of a theatre system, a secondary care Patient Management System (known as PMS) and a Primary and Community Care System (known as IPACC).

NHS Fife has expressed an interest in using the national theatre system and has been closely involved in the procurement process for this system.

As the national eHealth Strategy is reshaped it is fully anticipated that NHS Fife will adopt the direction it outlines when considering the deployment of new systems. This will include the adoption of systems such as the national system for sexual health (NaSH).

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5. EHEALTH VISION FOR NHS FIFE

Strategy Aim

The eHealth Strategy will support NHS Fife's overall strategic aim to provide the highest quality care to, and improve the health of, the population of Fife within the resources available and in partnership with its staff, community planning partner organisations and the citizens of Fife.

The eHealth Strategy will support this by continuing to:

work towards a single electronic patient record (EPR) within NHS Fife develop the NHS Fife Information Service develop the IT infrastructure to support clinical and business systems promote the use of eHealth technology within an appropriate IT and information

governance framework ensure that appropriate financial support and resources are available ensure relevant staff are equipped with the necessary skills to effectively utilise

eHealth technologies and systems build on opportunities to work closely with academic and community planning

partners to improve the IT infrastructure, information sharing and the development of clinical applications

promote a culture that supports and encourages the use of eHealth applications as part of routine practice

6. WORK TOWARDS A SINGLE PATIENT RECORD SYSTEM WITHIN NHS FIFE

NHS Fife has successfully concluded negotiations with Siemens to extend the Electronic Patient Record (EPR) known as OASIS across NHS Fife with the exception of the independent contractor groups (General Medical and Dental Practitioners, Pharmacists and Optometrists). This project, which will be implemented over the next 18 months provides the building blocks of a comprehensive EPR within secondary and community care.

Independent General Practices have highly developed clinical systems. Using nationally available technology, links have been developed to facilitate sharing and exchange of information across primary and secondary care as well as an information store to which clinicians across primary and secondary care will have access.

Using this mixture of local and national tools we will continue to build a cohesive system which will form the EPR. Appendix 2 outlines the target architecture of the NHS Fife EPR.

In particular, we will achieve this by:

implementing the OASIS system across NHS Fife with the exception of the independent contractors

mapping the resource requirements to ensure that, following successful completion of the implementation project, the OASIS system is embedded across the whole organisation with the exception of the independent contractors

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continuing to develop the SCI suite of products to facilitate communication between primary and secondary care as well as the storage of shared information

working with independent General Practitioners to develop their clinical systems and to review the case for changing the clinical systems they use

continuing to work with independent GPs and take account of national developments such as IPACC

implementing the national theatre system within Fife over the next 18 months working with clinical and managerial colleagues to develop an eHealth solution to

support the implementation of the Balance of Care framework procuring the Long Term Conditions system(LTC) from Tayside and working with

colleagues to embed this across the primary /secondary care interface working with colleagues nationally to determine the most appropriate time for NHS

Fife to move to the national PACs solution continuing to the drive towards use of CHI as the unique patient identifier used in all

clinical communications and records promoting the use of the NHS net email system to support the secure exchange of

clinical information between NHSmail accounts and secure government domains

7. DEVELOP THE NHS FIFE INFORMATION SERVICE

One of the key aims of this Strategy is to move the focus of eHealth from the provision of individual systems towards the delivery of meaningful information to support strategic and operational management as well as information to support Clinical Governance and Patient Safety at the level of individual clinicians and teams.

The Information Service is currently working with NSS to develop a local “dash board” which allows unvalidated data to be made available to support operational managers in their routine work.

In order to achieve this we will:

Complete the restructuring of the Information Service by June 2008 Develop an integrated Strategy for the information and intelligence functions,

enabling NHS Fife to acquire and use information at the strategic, operational and individual levels in response to prioritised strategic initiatives by December 2008

Develop and implement a support structure to meet the needs of the Strategy Work with the CHPs, the Operational Division and the Corporate Directorates to

plan and deliver the information they require in a timely and “user friendly” manner. Continue the development of the local “dash board” with colleagues in NSS.

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8. SUPPORT THE DEVELOPMENT AND IMPLEMENTATION OF KEY BUSINESS SYSTEMS

Computer systems are used across a very wide range of support services within NHS Fife. Within Finance, Human Resource, Organisation Development, Public Health, Redesign and the Estates and Facilitates Directorates the effective use of computer systems underpins their ability to achieve their strategic aims. Appendix 3 identifies the current key business and clinical systems in use.

The eHealth Directorate is acutely aware of the requirement to develop a proactive approach to the implementation and continued development of these business critical systems.

To ensure the development of a proactive approach we will:

establish a regular review system with each of the key business functions to identify and plan for the implementation of new systems and the development of current systems

ensure that business system developments are fed into the Capital and Revenue planning process within eHealth.

9. DEVELOP THE IT INFRASTRUCTURE TO SUPPORT CLINICAL AND BUSINESS SYSTEMS

The IT infrastructure has benefited from a Capital Plan which has seen £1 million per year invested in eHealth for five years from 2004/05. In addition, non-recurring monies made available from the Scottish Government have facilitated additional developments. The basic IT infrastructure across NHS Fife is now of a high standard and its development is guided by industry standards such as COBiT and ITIL.

The Acting Head of IT works closely with Internal Audit to ensure independent review of the planned and achieved developments. The pace of change in technology is such that the infrastructure within NHS Fife is unlikely to be at a stage where no further developments will be required.

The eHealth team will ensure that the resources available to develop the infrastructure are appropriately targeted by using intelligence networks, being aware of new developments and structuring our investment based on evidence and industry standards.

Business continuity and disaster recovery arrangements are a fundamental part of a modern, safe and consistent IT service. While NHS Fife has made good progress in developing an appropriate suite of plans to support this developing agenda, further work will be progressed in consultation with the NHS Fife business continuity manager.

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Over the next two years we will continue the development of the IT infrastructure by:

developing an IT Strategy to support the higher level eHealth Strategy by April 2008

implementing best practice processes and procedures based on ITIL and COBiT working with the NHS Fife Business Continuity Manager to ensure that the IT

plans for business continuity and disaster recovery provide adequate protection to enable NHS Fife meeting its statutory requirements

10. PROMOTE THE USE OF eHEALTH TECHNOLOGY WITHIN AN APPROPRIATE INFORMATION GOVERNANCE FRAMEWORK

The Information Governance standards outlined in the NHS QIS Healthcare Governance and Risk Management Standards and the NHS Scotland Information Governance standards provide a framework to integrate the areas of work involved in this complex agenda. The Information Governance Group led the development of an Information Governance Framework to take this work forward and to provide assurance to the Fife NHS Board of its compliance with the standards. The framework addresses key legislative requirements and Caldicott guidance.

Our approach to Information Governance will demonstrate to staff, users and carers that patient confidentiality and information security is viewed as an important issue across the organisation.

In order to achieve this we will:

Work collaboratively with the Director of Public Health, the Fife NHS Board Medical Director, the Information Governance Group and other key stakeholders to take forward the implementation of the 7 areas of the Information Governance Framework. These areas include legislation, Caldicott guidance, confidentiality, NHS Scotland Code of Practice, NHS Data Quality Assurance (Data Accreditation), records management, and the information security standards.

11. FINANCIAL EXPERTISE AND RESOURCES TO SUPPORT THE eHEALTH AGENDA

eHealth is benefiting from a rolling five year Capital Investment Plan which has enabled a significant improvement in the IT infrastructure. The assurance of this available Capital funding allows the eHealth Directorate to plan ahead to meet the developments required in future years through the process of ‘banking funds’ until required for significant investments.

The Finance Directorate provides excellent support to the eHealth agenda. An Assistant Director of Finance is a member of the eHealth Board and contributes to the planned developments and monitoring of the Capital plans for eHealth. At operational level the eHealth Directorate is supported by a Management Accountant who monitors and reports on all revenue expenditure associated with eHealth and provides financial advice to all budget holders to facilitate the management of resources.

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A national benchmarking of eHealth spend has just been carried out. This exercise indicates that NHS Fife spends approximately 2% of its available budget on eHealth. National comparative data is not yet available. Blue chip commercial organisations spend between 6-7% on information technology. While the NHS cannot be compared with commercial organisations, External Auditors use industry standards particularly in their assessments of the IT security and disaster recovery systems within NHS Fife. While NHS Fife continues to make very significant progress, we do not yet meet the industry standards.

To ensure that we identify adequate resources for the development of the eHealth agenda in Fife we will continue to:

Work with colleagues in Finance to quantify the costs and identify the benefits which accrue from increased Capital and Revenue funding in eHealth.

Develop an annual Capital Investment Plan which is robustly scrutinised to ensure equity of investment across clinical and business systems and that the investment supports longer term plans.

Work with operational managers to identify the revenue requirements arising from the implementation of new systems identified in the strategy

12. WORKING WITH PARTNERS TO IMPROVE THE IT INFRASTRUCTURE, INFORMATION SHARING AND DEVELOPMENT OF CLINICAL APPLICATIONS

NHS Fife currently works with a number of partners to exploit synergies in relation to the IT infrastructure. A recent example is the development of the NHS Fife Intranet based on Fife Council's technology platform.

NHS Fife is also working with NHS Tayside, the University of Dundee and Sun Microsystems in the development of a clinical portal which will allow clinicians to use a single password to gain access to all the systems they require to carry out their clinical practice.

NHS Fife works jointly with NHS Tayside on a number of systems including finance systems and the delayed discharge system, EMPTAAYD.

NHS Fife is using the contacts developed through community planning to share anonymised data which can be used to inform policing plans and is using these working relationships to explore research opportunities around aspects of alcohol abuse in the community.

NHS Fife has a responsibility to work with its community planning partners to take forward the data sharing agenda. The Fife Data Sharing Partnership, chaired by the Deputy Chief Constable of Fife Constabulary, has been established to oversee the development of this agenda. The Executive Lead for eHealth represents Fife on this partnership.

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Resources were made available nationally to all Data Sharing Partnerships for a three year period to take forward electronic data sharing, particularly in relation to Child Protection and the Single Shared Assessment. A small team has been established to take forward this project.

The above activities bring benefits to the population of Fife while providing opportunities for staff development. NHS Fife will continue to develop this work over the next two years by:

Developing the NHS Fife Intranet and Internet sites with Fife Council Developing and implementing data sharing technology and business systems with

our community planning partners Achieving the targets of electronic information sharing with community planning

partners in relation to Child Protection and the Single Shared Assessment Working with NHS Lothian and NHS Borders to develop cancer clinical systems Contributing to the development of multi agency Information Sharing Protocols to

support service delivery

13. PROMOTE A CULTURE THAT SUPPORTS AND ENCOURAGES THE USE OF EHEALTH APPLICATIONS AS PART OF ROUTINE PRACTICE

This third NHS Fife eHealth Strategy demonstrates the commitment of the Fife NHS Board to develop a culture where eHealth applications are used as part of routine practice.

While very significant progress has been made within independent General Medical Practices and the Operational Division, the availability of eHealth solutions within primary and community care services remain rudimentary. The implementation of the Operational Division’s EPR across NHS Fife with the exception of the independent contractor groups presents the ideal opportunity to promote an eHealth culture across the organisation.

We will do this by:

continuing the production and wide distribution of the eHealth Newsletter continuing the production of regular eHealth reports which can serve numerous

reporting requirements across the organisation developing measurable key performance indicators for eHealth by April 2008 and

communicating our progress towards them on a regular basis taking opportunities to communicate eHealth successes in the local and national

media working with the NMAHP eHealth leads, the Operational Division’s Director of

Nursing, the CHP Heads of Nursing and the NHS Fife Board Nurse Director to promote awareness across the nursing and midwifery and Allied health professional groups

working with managerial colleagues within the operational division and CHPs who have identified responsibilities for eHealth to ensure that they are well informed and able to promote eHealth developments

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continuing to organise regular eHealth awareness sessions across the organisation and ensuring an eHealth presence at CHP protected learning sessions

developing the training resource within the eHealth Directorate to ensure the training needs of staff utilising eHealth technologies are identified and met.

14. GENERAL HOSPITALS AND MATERNITY SERVICES/ST ANDREWS PROJECT

Information Technology (IT) plays a significant role in the provision of clinical and non-clinical services in the modern health care environment. There is an increasing reliance on the IT infrastructure to meet these requirements both in terms of performance and availability.

The Strategy developed for the IT provision within the confines of both projects is clearly defined within the ITN documentation as a Responsibility Matrix for the various IT systems and associated interfaces.

A key factor for the GH&MS Project in general is that of whole site integration and how the new build elements interface with the existing hospital and the services provided. A major item for IT is the relocation of the existing IT Datacentre, which is within a building due for demolition. This work will be implemented as part of the non-PPP package.

NHS Fife has deliberately retained ownership and responsibility for the active data network, telephone system, servers, PCs, applications and bedside entertainment systems, as this will facilitate a more direct and cost efficient route to the provision and support of IT services.

eHealth will continue to work with both Projects to ensure innovative IT solutions are deployed to support the delivery of patient care.

15. TELEHEALTH

NHS Fife has been working with the Scottish centre for Telehealth (SCT) to explore local opportunities to exploit the technology to improve patient care.

Following a recent successful demonstration of the technology to support care for patients with Uveitis (a serious eye condition), eHealth has agreed to work with SCT to develop the project as a National demonstrator in 2008. We will also explore the use of telehealth in A&E and Psychiatry over the lifespan of this strategy.

16. IMPLEMENTATION OF THIS STRATEGY

Implementation will be taken forward and monitored by the eHealth Board. Annual work plans based on this Strategy will be developed and reported through the eHealth Board, the eHealth Annual Report and the NHS Fife Performance Management systems.

DR STELLA CLARKExecutive Lead for eHealth

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APPENDIX 1

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APPENDIX 2

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APPENDIX 3

Top Clinical and Business Applications

Application DescriptionClinicalPACS/CRIS Radiology picture archiving system and the radiology

management systemsOASIS Patient records and clinical information system for the operational

division. Previously known as ' the HOISS project ' PIMS Patient records and clinical information system for community.

LabCentre Laboratory system.SCI Store An information repository to provide clinicians with secure access

to patient information at the point of care such as laboratory results, x-ray reports and pathology reports.

SCI Gateway Integration system between primary and secondary care systems which allows the electronic transfer of further letters. In future it is planned that discharge letters will be sent electronically using this system

SCI DC Diabetic management and clinical system which bridges primary and secondary care enabling clinicians to access the most up-to-date information about a patient's diabetic care regardless of their geographical location

Unisoft Endoscopy management and clinical system.Ascribe Pharmacy system.Auditbase Audiology system.SCCRS Cervical cytology management and clinical system.Adastra Out of hours emergency care clinical information system.

BusinessCedar Financial system.E-mail Internal and external e-mail system.Intranet Web site for the organisation.Powergate Stores and supplies ordering system.WIMS Works management system.Datix Risk and incident recording system.SSPS Payroll system.SSTS Standard timesheet recording and management system.Personnel Director Personnel management system.Assyst IT service desk system.

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APPENDIX 4

GLOSSARY

PACS Radiology picture archiving system and the radiology management systems.Sci Store An information repository to provide clinicians with secure access to patient information at the

point of care such as laboratory results, x-ray reports and pathology reports.Sci – Suite of Products

SCI Store - NHSScotland has developed SCI Store to provide clinicians with secure access to patient information at the point of care. Store is an information repository which is integrated to other local systems though its communication interfaces.

SCI Gateway is a national system that integrates primary and secondary care systems using familiar yet highly secure Internet technology. SCI Gateway is fully integrated with the GPASS primary care system, enabling GPs to access SCI services on-line and can also be integrated with commercial systems. View the Product Description for a complete overview of the application.

EPR Electronic Patient Record, being developed in Fife.HOISS Health Organisation Information Solution and Services. This is the Electronic Patient Record

system within NHS Fife due to be rolled out across community care and mental health.G-PASS General Practice Administration System for Scotland, currently owned by the Scottish

Government and developed and supported by the NHS Common Services Agency of Scotland.PMS Procurement being taken forward nationally to develop a Patient Management System.IPACC Procurement being taken forward nationally to develop an Integrated Primary and Community

Care System.OASIS Patient records and clinical information system for the Operational Division. Previously known

as ‘the HOISS Project’.PIMS Patient records and clinical information system for community.NaSH National Sexual Health system, procured nationally.NSS National Services Scotland.CoBIT The Control Objectives for Information and related Technology (COBIT) is a set of best

practices (framework) for information technology (IT) management created by the Information Systems Audit and Control Association (ISACA), and the IT Governance Institute (ITGI) in 1992. COBIT provides managers, auditors, and IT users with a set of generally accepted measures, indicators, processes and best practices to assist them in maximizing the benefits derived through the use of information technology and developing appropriate IT governance and control in an organisation

ITIL The Information Technology Infrastructure Library (ITIL) is a set of concepts and techniques for managing information technology (IT) infrastructure, development, and operations.

EMPTAYDD Management and monitoring of electronic patient management system for delayed discharges (EMPTAYDD) to support joint discharge planning and early intervention, including patients from out of area.

ITN Invitation to Negotiate.Non PPP Package

Public-private partnership (PPP) describes a government service or private business venture which is funded and operated through a partnership of government and one or more private sector companies. Non PPP is a scheme that is funded and operated by the purchasing organisation i.e. NHS Fife.

DATIX Risk and incident recording system.CHI Community Health Index – A unique patient identifier.Paper light A working environment whereby incoming paper documents are scanned, stored electronically

the paper copy shredded, then enabling electronic distributionNSS National Services Scotland. Part of the NHS in Scotland.NMAP Nursing, Midwifery & Allied Health ProfessionalsNaSH National System for Sexual Health

.

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