IM&T Update for the Performance Committee August 2013

Transcription

1 IM&T Update for the Performance Committee August 2013 D 1. Introduction This paper aims to provide the Performance Committee with a summary of the IM&T activities and key issues for the directorate. 2. Key issues The Directorate continues to suffer with high staff turnover. Currently there are vacancies in Coding, Information and IT teams. Due to competing pressures on Trust resources the business case to increase IT resources has been rejected for the current financial year and will be re-considered in the business planning process for the next financial year. After many years of very high service provision for all systems we have recently had several systems failures resulting in disruption to both clinical and administrative systems. This includes three instances of failure of the ICE system, a network switch failure, an issue with the core network switch, issues with the server capacity resulting in issues with three key systems - Patient Administration System (PAS), the Clinical Order and Results System - ICE and Qlikview (providing the Insight system), breakdown of the air conditioning in the main server room, issues with the intranet and several failures of the storage array which affected the system, file servers and virtual machines. A risk assessment is being carried out of the IM&T infrastructure to ensure that we return to our high availability rates. The assessments of network switches and IT resources have been completed and have been reported to the IM&T committee. The Capital Planning Group will review the risk assessment for investment in replacement switches to make a decision on any capital allocation. Upgrades to address the issues with the PAS and ICE Servers went successfully over the weekend of 3 rd /4 th August Capital has been approved for the purchase of a new server for Qlikview and an upgrade is being scheduled with the supplier to ensure the reliability of this service. 3. Key Achievements The pilot for the Clinical Outcome system (POD) has been extended to the Joint Reconstruction team, starting with one consultant to collect PROMs data only. This will be expanded quickly to the whole team in the next few weeks. The Head of Clinical Coding is working with a large number of clinicians to define the changes that need to be made to the Trust-wide complexity measures that are meaningful to clinicians, managers and commissioners. S Patel, August 2013 Page 1 of 7

2 However the work on developing the clinician reported complexity datasets for JRU has halted temporarily to allow for consultation with the British Orthopaedic Association and the Oxford Nuffield hospital. This has delayed the roll-out of the clinician part of the data collection system to Mr Miles and other JRU/ Sarcoma consultants. A bid has been submitted to implement the clinical portal, e-prescribing and implement electronic records management system for casenotes and other clinical documentation as part of the 260m technology fund announced by NHS England. The funds will be allocated over two years 90 million for 2013/14 and the remaining in 2014/15. The allocation outcome will be announced at the end of October. Briefings have indicated that the bids most likely to succeed in 13/14 are inflight projects where procurement has already been completed and the project can be delivered by March The RNOH bid has been tailored to accommodate this. The use of ICE Clinical orders and resulting system has been extended to make electronic referrals for: Metal on Metal Joint Reconstruction Referrals EMG Neurophysiological referrals Medical Liaison Referrals Active Back Referrals Psychology Pre assessment requests for OT and Physiotherapy The Trust has now retrieved all PACS images from the BT hosted Medical Image Archive (MIA) making the RNOH the first Trust in London to successfully retrieve all its data in preparation for exiting the BT contract. The image retrieval process will now continue so that all new images will be archived to both the BT image archive and the local archive. Further to the PACS and RIS procurement options analysis presented at the last meeting, work is progressing to ensure that the best technical, clinical and commercial option is chosen for the Trust. This has been discussed at Executive level and at the Imaging Committee. At the request of the clinicians a demonstration of SECTRA IDS7 took place on the 11th July. Unfortunately it was only attended by 2 Consultants, 2 Radiologists and 4 Radiographers. A report has been issued by the lead radiologist and a meeting to discuss the way forward has been arranged for 21 st August It should be noted that a discount offered by Sectra has been extended until 18 th September There is a high risk that if a decision is not taken prior to this date on how we should proceed, the Trust will not be able to implement a RIS/PACS solution to meet the exit date of the BT Contract. S Patel, August 2013 Page 2 of 7

3 The IM&T Committee approved the following proposals: IM&T Audit Plan 2013/14 to 2015/16 Mobile Phone Signal Booster Business Case subject to a review of the locations and capital availability The IM&T Committee approved the following policies: Encryption Policy Mobile Device and Remote Working Policy The IM&T Directorate are also embarking on International Organisation for Standardisation (ISO) certification relating to IM&T Service Quality Management and an explanatory note was presented to the IM&T Committee on the approach being taken to achieve this certification. 4. Information Governance (IG) IG training figures are currently at 83%. IG training has been scheduled for the year and the team are also encouraging the use of e-learning and offering tailored sessions for individual teams and units. IG steering Group is monitoring the delivery of the IG Tool requirements and everything is on track apart from training. 5. Information Management The Head of Information has been leading the development of a comprehensive Balance Scorecard for the Trust Board and its subcommittees. The first stage is to agree the indicators to be included and the second is to provide the presentation options. A potential long list of indicators based on research, the Intelligent Board report and best practice from a sample of leading Trusts is currently out for consultation and is being provided to this meeting as a separate agenda item. The following new information is now available on Insight: SUS Data Quality report added to DQ Dashboard - missing or inactive GP practices Medical Liaison activity Development of the 18 weeks Patient Tracking List (PTL) has been completed. This replaces an old process which was not supportable or resilient. This has been a very complex piece of work taking many months to complete. Prior to the current financial year the price for Imaging was part of a locally agreed tariff managed by the Commissioning team using data supplied directly from the Information Department. From this financial year this has now been unbundled and is now subject to the Payment by Results (PbR) tariff S Patel, August 2013 Page 3 of 7

4 based on the HRG. As a result of this, imaging data now has to be submitted as part of the outpatient data file submission to SUS for PbR. As there was no mechanism to do this a new process has had to be created, including coding of the imaging data by the Coding department to generate the relevant HRG. This was completed successfully for April data prior to the freeze date. The chart overleaf summarises the information requests received by the team. The workload for the team remains high although they have been successful in significantly increasing the number of completed calls. Please note that the figures for July are for part of the month only. 6. Clinical Coding 6.1. Coding completeness deadlines at year end The deadline for coding completeness for June discharges at the beginning of July was not met. There were 285 inpatient spells uncoded by the deadline on the 3rd July 2013, including 239 Interventional Radiology daycases. This was due to the ongoing difficulties in managing a period of transition with change in staff in the coding team. A new Clinical Coder band 4 is now in post to replace the retired band 5 Senior Clinical Coder. The new Clinical Coding Manager started in May. Recruitment for vacancy due to retirement has begun. There are predictable upcoming shortfalls in capacity due to planned leave and departmental training (six whole days in August and September to meet a three-yearly Information Governance requirement). The absences plus the existing backlog (which started at year-end March 2013) means that the coding department will struggle to meet deadlines until the end of September The Head of Coding and the Coding Manager are working to deliver a range of actions to reduce the backlog and increase the productivity of the Coding department over the short and longer terms. Vacancy approval has been obtained to bring the retired Senior Clinical Coder back on hospital Bank. Successful recruitment to the full-time Coding Admin role will free the coders from some non-coding activities Specialised Services The Head of Coding has been providing support and working with the Specialised Orthopaedic Alliance (SOA) with work to help define activity within national Specialised Service Definitions, Current Rules. Just using clinical codes to identify activity is inadequate and significantly understates the true level of specialised orthopaedics work at the RNOH and other specialised providers. It is vital to the future of the RNOH that activity is correctly identified and commissioned by the appropriate body. The RNOH Foundation Trust S Patel, August 2013 Page 4 of 7

5 application depends on predictable increases in income and specialised activity levels Closer links with Clinical Units The Head of Coding is working with the new Clinical Coding Manager to deliver a series of actions to improve coding quality and resultant income based on building closer links with Clinical Teams. Work with the Peripheral Nerve Injury unit has started already and there will be overlapping projects with the Foot and Ankle unit and Joint Reconstruction as well. The main areas of development for each clinical unit are: 7. IT 1. Audit of the coding quality for relevant activity to provide base data 2. Review and update of the RNOH coding standards 3. Clinician-delivered training to support the local standards 4. Consultant validation of coded data (regular programme) 5. Re-audit to measure effect of process improvements IT Service Desk Activity The IT Service Desk continues to be very busy with April and May being record months for the numbers of requests and incidents received and closed. The average number of open requests on the IT queue has increased from to over the past month. The IT department will continue to try and resolve all calls as quickly as possible while prioritising all requests, new projects and infrastructure upgrades. As well as resolving rising help desk calls the team are working on several large infrastructure projects. These include: ICE Server Upgrade successfully implemented on 4 th August Virtual Server Infrastructure upgrade - Virtual Server environment has been upgraded to provide increased performance and resilience for all virtual servers within the Trust. The final stage of this project is to build a test environment to separate the test virtual servers from the live servers. This will both increase capacity and reduce the risk of test systems disrupting live operations. Service Desk Prioritisation and SLAs - The Service Desk prioritisation process has now been implemented within the IT department and is also being rolled out to the entire IM&T directorate for support requests and incidents over the coming weeks. A detailed report is being created for the next IM&T committee as there is insufficient data at this time to draw any valid conclusions. S Patel, August 2013 Page 5 of 7

6 Wi-Fi Spark Patient and Public Wireless - The Wi-Fi Spark service offering paid Wi-Fi access to the internet from across Stanmore and Bolsover has been operation since August The Trust currently receives 10% of the income generated from this service. The IT department will renegotiate this contract to attempt to gain a larger percentage of the income now that the initial setup costs of the implementation have been recouped by Wi-Fi Spark. Network Switch Replacement - The Trust has never had a rolling replacement program for the network switches that end user PCs connect to. This has resulted in a larger number of switches reaching 10 years old and an increasing number of network failures are occurring. A separate risk assessment report has been prepared at the request of the Capital Planning Committee and has been included as an agenda item for this meeting. Air Conditioning in IT Server and Uninterrupted Power Supply (UPS) rooms - In the last two months there have been two failures of the air conditioning units in the main IT Server room where all the Trust systems are located. Both incidents raised the server room temperature from 20 degrees to degrees which dramatically increases the risk of server and component failure. A proposal is being created to either add a third unit into the room or to replace the existing two units with more powerful and energy efficient units. This was part of the IM&T Business Plan for Integration Engine - Work is continuing to improve and develop integration between systems utilising the Trust s Integration Engine Rhapsody. A large amount of development has been completed for the RNOH POD project and shortly communications with ICE and its related systems will be made live. This is a key strategic step in working towards a co-ordinated paper light hospital over the next few years. 8. Systems update This section highlights developments for currently live systems. A separate highlight report is provided for systems under development. 8.1 PACS and RIS The manual retrieval of images for patients with outpatient appointments was stopped in April this year. Despite there being over 18 months of data in our local store, some spinal surgeons still need to retrieve images from the BT image store. This is causing issues due to very long retrieval periods. The Imaging Systems Administrator has been manually retrieving the images for the clinic but this is not a sustainable solution. Now we have all our data in the transition PACS we could approach SECTRA to ask if we can allow limited staff to have access. Their response is likely to be dependent on whether we decide to extend the SECTRA contract. S Patel, August 2013 Page 6 of 7

7 8.2 PAS The Surgical Site Infection team have tested and signed off a new Clinical Protocol to allow them to record all data relating to SSIs on PAS. The recording of this data will commence from August. The work required for the overhaul of clinics, including a separation of paediatrics where they attend adult clinics, has slowed down. This is due to the absence of resource and the outpatient refurbishment. Progress is being managed through the Income and Coding Group. 8.3 ICE Work is progressing to set up electronic referrals for: Occupational Therapy Podiatry Bone Infection Referrals OPAT (Outpatient Parental Antimicrobial Therapy) Reports are being developed by the Information Team to show the number of pathology reports viewed/filed by consultant and the other shows the test turnaround time. Additional rules have been added to some Pathology tests in an attempt to try and reduce the number of unnecessary repeat requests. The user will be asked if they are sure that they want to request this test but will not prevent them completing the order. This will be monitored at the Operations Management Group meeting to assess if this has had a positive effect. 8.4 Image Exchange Portal (IEP) An upgrade to IEP went through without any issues S Patel, August 2013 Page 7 of 7