Informatics Strategy 5 Year Forward View

Transcription

1 Informatics Strategy 5 Year Forward View

2 Informatics Strategy Forward View Bolton NHS Foundation Trust Versions: Version Date Amendment V0.1 17/03/15 Internal first draft QA V0.2 10/04/15 Changes to layout and tables V0.3 16/04/15 Comments back changes made V0.4 20/04/15 Further detail added V0.5 04/05/15 CCIO changes V1.0 18/05/15 Final Document V Update- EPR Business case refresh 5 Year View Approvals: Name Lead Date of Review Date of sign-off Version Phillipa Winter and Ken Bradshaw David Haider, Simon Irving and Brendan Lane CIO CCIOs Brett Walmsley CTO Trust Board Chairman 1 P a g e

3 Informatics Strategy Forward View Bolton NHS Foundation Trust 1 1 EXECUTIVE SUMMARY STRATEGIC CONTEXT NATIONAL CONTEXT LOCAL CONTEXT NATIONAL TARGETS FOR INFORMATICS STATUS OF INFORMATICS STRATEGIC DIRECTION VISION STRATEGIC OBJECTIVES ELECTRONIC PATIENT RECORD (EPR) AND OTHER SUPPORTING CLINICAL SYSTEM DEVELOPMENT INFRASTRUCTURE SHARED SERVICES TELEMEDICINE COMMUNITY INTEGRATION UNIFIED COMMUNICATIONS SKILL DEVELOPMENT MOBILE WORKING HEALTH INNOVATIONS BUSINESS INTELLIGENCE DELIVERING THE STRATEGY SUPPORTING AREAS APPROACHES AND METHODOLOGY CONNECTION TO THE BUSINESS CHANGE DELIVERY HIGH LEVEL PLAN CONCLUSION APPENDIX A TEAM SIZE AND SPENDING ANALYSIS... APPENDIX B DELOITTE BUSINESS CASE CATEGORIES... 2 P a g e

4 Informatics Strategy Forward View Bolton NHS Foundation Trust APPENDIX C DIGITAL MATURITY INDEX... APPENDIX D BUSINESS INTELLIGENCE STRATEGY P a g e

5 2 Strategic Context The world outside the NHS is changing rapidly and the NHS has acknowledged it is struggling to keep up. In the outside world access to information and services is easier, social interactions no longer require face to face environments, consumers are no longer passive and transparency is increasing. While the NHS productivity and efficiency challenge remains, there is increasing consensus that Bolton NHS Foundation Trust needs to transform in line with the outside world to improve quality, experience, outcomes and efficiency. Over the last 18 months the Trust has made considerable progress in Informatics achievements including the analysis of community IT needs, securing funding for the community IT initiative and delivery of phase one of this programme. The Trust also engaged with an independent 3 rd party to carry out an assessment of the Trust s Informatics burning platform to aid in the definition of scope for replacement and the production of a business case to address this issue The Trust is now entering a period of unprecedented change. Nationally, focus on efficiency, productivity and quality is increasing whilst locally, the Healthier Together reconfiguration and the Greater Manchester Devolution Agreement echo the national aims. While the challenges are vast and the transformational change needed is bigger than any before, the Trust is dedicated to moving forward and providing high quality healthcare for its local community. Strategic Challenge There are a number of key areas that will enable this transformation but nationally and locally it is recognised that creating a digital future through information and technology will be critical. As a result, this document sets out the key Information management and technology focus for the Trust over the next five years. To create this strategy we reviewed key documentation and spoke to the CCIOs and other key stakeholders. We gathered information on the national context, local context, current Informatics capability and vision for informatics. This gave us a clear view of the challenge ahead and the ability to meet the vision for informatics. The gap between the vision and the ability of the Trust identified the key objectives for informatics that will move us forward. Strategic Vision "To facilitate exceptional patient care through informatics that is innovative, reliable, resilient, agile and for informatics to become a valued corporate asset. The high level aims of this strategy are 1. Digital enablement: Providing clinical staff with the tools to use technology to support the deliveryof patient care through the use of systems as the ibleep replacement and eobs. Supporting the use of technology at the point of care. 2. EPR for hospital and community services: A key deliverable based on a revised approach to procurement and implementation of an electronic patient record and developing a supportive culture that enables clinicians to use and exchange information to improve the quality and safety pf patient care 3. Infrastructure: Upgrade our hardware to deliver leading edge technology enabling lower cost of ownership and better performance 4. Mobilising our workforce and empowering patients: Supporting patients to help in the their own care through the use of telehealth and telecare 4 P a g e

6 In order to address the strategic challenges highlighted above, this strategy identifies priorities for development which are set out below. 1. Electronic Patient Record (EPR) To move to a world where all information is captured and available electronically allowing care to be truly patient centric. 2. Supporting Administrative Systems - Patient Administration System (PAS) convergence The operation of a single administration system across acute and community services. - Enterprise Master Patient Index (EMPI) Establishing a patient index across the North West Sector. 3. Electronic Document Management System (EDMS) - Enable the trust to move to a paperlight operation. 4. Supporting Clinical Systems - ibleep replacement - E-obs - Theatre system replacement - OpenEyes - PACS and VNA 5. Infrastructure To create a stable, modern infrastructure that provides a robust foundation for future Informatics requirements. 6. Shared Services To provide the best possible IT service for staff and patients potentially as part of a regional shared service. 7. Community Integration To integrate health and social care to support economy wide accessibility and integration. 8. Unified Communications To deliver a modern communications solution that enables flexible and more agile working. 9. Skill Development - Ensure all staff are informatics literate and confident. 10. Business Intelligence Implement the business intelligence strategy. 11. Mobile Working Delivery of the technology and process change to enable the ability to provide care at the right time and at the right location. 12. Telehealth/ Telecare To provide telehealth and telecare solutions to our patients to support patient empowered care and greater efficiencies in care provision. 13. Shared Data To enable data access and data sharing for patients to enable the Trust to reach national and local initiatives. (Datawell) 14. Health Innovations Delivery of truly innovative technologies that support the delivery of patient centric and patient empowered care. These strategic objectives and the required supporting themes are discussed below. Delivering the Strategy The key for the strategy is to create an approach that can be flexed to adapt to the changing landscape in Greater Manchester and the financial status of the organisation. This strategy clearly sets out the focus for the next 5 years and will be supported by a robust operational plan, related business cases and informatics enabled transformational change. 5 P a g e

7 3 3.1 National Context The national context for NHS organisations across the country is increasingly challenging. In October 2014, NHS England produced The NHS Five Year Forward View that aims to articulate why change is needed, what change might look like and how to achieve it. The Five Year Forward View (FYFV) states that the biggest challenges the NHS faces remain: - Changes in patient health needs and personal preferences. - Changes in treatments, technology and care delivery and the need to provide care that is genuinely co-ordinated around what people need and want. - Changes to funding/continued decline in funding growth. The Five Year Forward View sets out a number of key themes that need to be addressed to overcome these challenges. Subsequent National Information Board and HSCIC strategies have echoed the FYFV. Overall there are eight key themes that Trusts need to focus on and Informatics needs to enable: Quality - raising the bar for all NHS organisations; Prevention - enabling healthier futures; Patient & Communities - joined up care pathways with patient access to their own information; New Models of Care - the introduction of new models of joined up multi-specialty care providers; Leadership & Workforce - development of skill sets and upskilling programmes for staff; Efficiency & Productivity - delivery of high quality care whilst responding identified financial pressures; Information & Technology - the joining and sharing and management of information across healthcare providers; Health Innovation - delivering clinical care through technologies such as apps and telemedicine. An analysis of the key themes and there implications can be found in the next table: 6 P a g e

8 Meeting the Challenge of the five year forward view - Informatics Implications No. Key Themes Detail Implications for INFORMATICS Quality Prevention Patient & Communities New Models of Care Leadership & Workforce NHS organisations must narrow the gap between the best and the worst whilst raising the bar for all. Enabling healthier futures. Focus on targeted prevention, healthier workforce and integrated working. Patients must have access to their healthcare information and must have increased control over their care. Needs inclusion of wider community, including carers, third sector and general citizens. Introduction of new organisational types/ care models including; Multi-specialty Community Providers (MCPs); Primary & Acute Care Systems (PACS) Help mobilise leaders and workforces to - Access to robust data, information and knowledge. - Systems and processes to easily capture information. - Increased transparency of information. - Technology and access to information that supports citizen owned care. - Data to track trends and support prevention. - Access to data for research processes. - Online systems that fully support patient interaction and ownership. - Ability to have meaningful 2 way contact and communication between healthcare providers and patients and carers. - Ability to connect communities and appropriate share information. - Infrastructure provision that can be flexed to the needs of any future care model. - Ability to integrate systems as and when required. - Provide one patient review regardless of care provider. - Better connection between INFORMATICS Trust Strategic Aims - Implement business intelligence strategy - Create stable and modern infrastructure - Implement EPR - Deliver modern communication solutions. - Enable data access and sharing - Provide Telehealth and telecare solutions to support patient empowered care - Deliver modern communication solutions that enables flexible and agile working - To fully integrate the community and acute informatics service - Implement EPR - Support mobile working to enable right care, right time in the right location. - Ensure all staff are informatics 7 P a g e

9 work differently, develop the newly needed skills, values, behaviours and numbers to deliver the improvements needed. and the business. - Ability to support the workforce to develop the knowledge and skills needed. - Ensure staffing, skill mix and resilience is adequate to fulfil the informatics agenda/strategy. literate and confident. - Undertake IT training needs analysis - Improve investment in informatics resources 6 7 Efficiency & Productivity Information & Technology Doing more, including increasing quality, with static or reduced funding. 20 billion savings due in 2015 with an additional 30 billion required by Information and technology being the key enabler to the changes the NHS has to make. National focus on key systems that will provide the electronic glue to work better together. - Infrastructure, systems and processes that enable different ways for working and delivering care. - Comprehensive transparency of performance data. - Systems that support robust activity tracking. - Expanding set of NHS accredited health apps to support digital inclusion; - Fully interoperable electronic health records continuing the move towards paperless; - Family Doctor appointments and prescriptions online, everywhere; - Better audit data; - Increased focus on technology including smart phones; - Support to help build capacity and help those unwilling or unable to use technology. - Review potential opportunities for Shared Services and Assets. - Develop Business Intelligence (BI) systems and services - Implement EPR - Deliver modern communication solutions. - Ability to support integrated services through interoperable systems and adhere to interoperable standards. - Ability for pathways to run seamlessly across the entire local health economy and local partners. - Ensure all staff are informatics literate and confident. 8 P a g e

10 8 Informatics Strategy Forward View Bolton NHS Foundation Trust Health Innovation In relation to research, personalised care, accelerated innovation in ways of delivering clinical care and the unexploited opportunity to combine different technology such as apps and telemedicine. - Better connection to the research agenda. - Understand implications of future applications and wearable devices - Develop infrastructure, systems and processes to support telemedicine. - Deliver innovative technologies that support patient centric and patient empowered care. - Flexible, robust infrastructure ready for any future changes - To enable data access and data sharing in relation to illhealth, prevention and research (DATAWELL) Note: Some of the Informatics implications were taken from the National Information Board Report, Local Context Our Trust is made up of 5370 (including Bank = 8544) brilliant staff and has an annual turnover of 292 million. Our vision is: To be an excellent integrated care provider within the Bolton and beyond, delivering patientcentred, efficient and safe services. Our Organisations primary objectives are to: Integration of hospital and community services Services for Women and Children Major A and E provider. Continuously improve the quality of our services. Our Part in Greater Manchester; In February 2015 the 37 NHS Organisations and Local Authorities in Greater Manchester signed a landmark agreement with the government to take charge of health and social care spending and decisions in our city region. We will not achieve this in isolation, We will work both across sector in collaboration with our partners to deliver the best care for our most sick patients and commissioners and providers within Bolton to deliver place based care at pace tailored to meet the needs of our residents. Informatics will be the enabler to support integration and collaboration across Greater Manchester. 9 P a g e

11 Bolton NHS Foundation Trust 2016/2017 Operational Plan No. Strategic Goals Detail Implications for Informatics 1 Quality and Safety and patient experience 2 To be a valued provider 3 To be a great place to work The trust signed up to Sign up to safety campaign in And linked this work to the Quality improvement strategy and integrated patient family and carer experience strategy. The trust works closely with the CCG Bolton council and NHS England to develop realistic and aligned activity plans. To improve system resilience to enable timely and appropriate flow through the hospital having clear plans in place to ensure our IT systems are fit for the future. The team should feel fully engaged in their work, well recognised and fairly rewarded. Informatics currently has limited resource capability to support the Trust, the capacity to deliver Informatics programmes proves challenging. Ability to capture information electronically to be able to accurately report and inform quality and safety agenda. Supporting electronic systems to record information, from falls, escalation and rota s. Replace out of date desktops and roll out virtual desk top environment. Improve accessibility to WIFI for staff and public Move to single PAS Need to integrate and provide parity of service so Acute and Community feels like one organisation. Ability for pathways to run seamlessly across the entire local healthcare economy. Need to address the management of skill sets and resources required across all Trust IT programmes that are planned to run concurrently. 4 To be well governed As part of the Trust Turnaround process information was moved from Informatics and placed with finance. Need to proactively work more closely with information to ensure IT enables accurate and timely information. IT needs to understand the information strategy in order 10 P a g e

12 to better support programmes or work. Adhere to governance process and risk management. Look to gain ISDN Foundation Accreditation. 5 To be Financially viable and sustainable The trust is forecasting a surplus of 1.8 million for 2015/2016 however there is a significant non recurrent element to this. The underlying position is a deficit of 5.9 million. Creation of robust businesses cases with strong case for change and clear return on value. Review of current finance models to provide the ability to cost change initiatives to ensure successful deployment and full benefits realisation. Systems and data to support efficient financial management. Ability to mobilise Informatics team to deliver the required infrastructure programme and EPR as required. The right skills and business relationships to deliver the programmes of work. The ability to maintain business as usual with a failing platform. 6 To be fit for the future In February 2015 the 37 NHS Organisations and Local Authorities in Greater Manchester signed a landmark agreement with the government to take charge of health and social care spending and decisions in our city region Flexible, robust infrastructure ready for any future changes. Ability to support integrated services through interoperable systems and adhere to interoperable standards. Table 1: Local Context and Informatics Implications. 11 P a g e

13 3.3 Informatics Strategy Forward View Bolton NHS Foundation Trust National Targets for Informatics NHS Digital, formally NHS England s Five Year Forward View (October, 2014) the National Information Board s Personalised Health and Care 2020 Using Data and Technology to Transform Outcomes for Patients and Citizens (November, 2014) and the HSCIC s strategy Information and Technology for Better Care (February, 2015) all emphasise the importance Informatics in enabling the NHS of the future. There are four major targets that NHS organisations are moving towards. These are captured in the table below. Date Target 2016 Implementation of new Data Standards Significant progress to be made towards 3m people with Long Term Conditions being able to benefit from telehealth and telecare Digital information to be fully available across NHS and Social Care 2020 All patient and care records will be digital, real time and interoperable. National and Local Implications Table 2: National Targets. Both the national and local contexts have numerous implications for Informatics. There are also a number of national targets that must be met that require large investment. Due to the financial situation of the Trust consideration is needed as to what level of Informatics delivery is possible over the next 5 years. 12 P a g e

14 4 The turnaround situation of the Trust had a disruptive impact on the Informatics department. National guidance states that NHS Trusts should be spending 4% of their overall budget on Informatics. Historically the Trust has been spending less than 1% on Informatics and, with the additional 20% cuts due to turnaround, the spend has been reduced even more. The Trust has re-focused on Informatics and created four Chief Clinical Information Officer (CCIO) roles. This newly created Multi-Disciplinary Team (MDT) is already having a positive impact by building better connections between Informatics and the business and by giving Informatics a stronger voice at board level. The MDT team works closely with the CIO role and together they continue to raise the profile and importance of Informatics across the Trust. There will be an increased need for enhanced clinical leadership, including further development of the CCIO roles, Associate CCIO s and Clinical Champions to support the delivery of this strategy. In addition to the general need for improved levels of IT, the Trust is also facing the following challenges: end of the national programme. limited service delivery skills with no ITIL upskilling development programme; an Informatics team with limited resources or programme managers to deliver future projects; smallest team with the lowest level of funding in the sector (see Table 4 in appendix A of this document). In July 2014, Deloitte worked with the Trust to produce The Digital Trust Informatics Essential Services Options Analysis. This paper set out the funding needed to deal with the burning platforms and key areas of focus. This business case was submitted to the Department of Health and Monitor as a case for additional funding. The Trust was successful in its application and is in the process of completing phase one of the programme, which will see the replacement of obsolete infrastructure. The Clinical Digital Maturity Index (CDMI) is a benchmarking tool which aims to provide NHS Trusts with a better understanding of how investing in and using information technology can provide benefits. The Index is based on a nine-level electronic patient record rating. Recommended by NHS England, the Trust aims to us this model to support its future journey. In Appendix C, Bolton NHS Foundation Trust scores above average for leadership, governance, information governance and transfers of care, but below average for resourcing, records, assessment and plans, decision support and standards. All of which will be improved significantly by the implementation of an electronic patient record and investments from the burning platform programme. However the Informatics service is still significantly benchmarked below its peers in relation to resources. Key Consideration Current Status of Informatics The Trust s strategy, vision for Informatics and national targets cannot be achieved with the current levels of resource and investment in Informatics. A longer term, strategic view of Informatics is needed to deliver these areas and the required efficiencies and savings across the Trust. 13 P a g e

15 5 The following section sets out the vision and strategic objectives for Informatics. The vision depicts what the delivered strategy looks like and the strategic objectives set out the key areas the Trust needs to deliver, over the next five years, to achieve the vision. 5.1 Vision The Vision for Informatics is to; "To facilitate exceptional patient care through informatics that is innovative, reliable, resilient, agile and for informatics to become a valued corporate asset. This will create a digitally mature Trust which will support care in the right location at the right time. 5.2 Strategic Objectives Through the context review, stakeholder interviews and current status analysis, ten strategic objectives have been identified. These objectives set out the areas of focus needed to close the gap between the current status of Informatics and the vision for Informatics and achievement of the national targets. The objectives for the next 5 years are: 1. Electronic Patient Record (EPR) To move to a world where all information is captured and available electronically allowing care to be truly patient centric. 2. Supporting Administrative Systems 3. Patient Administration System (PAS) convergence The operation of a single administration system across acute and community services. 4. Enterprise Master Patient Index (EMPI) Establishing a patient index across the North West Sector. 5. Electronic Document Management System (EDMS) - Enable the trust to move to a paperlight operation. 6. Supporting Clinical Systems 7. ibleep replacement 8. E-obs 9. Theatre system replacement 10. OpenEyes 11. PACS and VNA 12. Infrastructure To create a stable, modern infrastructure that provides a robust foundation for future Informatics requirements. 13. Shared Services To provide the best possible IT service for staff and patients potentially as part of a regional shared service. 14. Community Integration To integrate health and social care to support economy wide accessibility and integration. 15. Unified Communications To deliver a modern communications solution that enables flexible and more agile working. 16. Skill Development - Ensure all staff are informatics literate and confident. 17. Business Intelligence Implement the business intelligence strategy. 14 P a g e

16 18. Mobile Working Delivery of the technology and process change to enable the ability to provide care at the right time and at the right location. 19. Telehealth/ Telecare To provide telehealth and telecare solutions to our patients to support patient empowered care and greater efficiencies in care provision. 20. Shared Data To enable data access and data sharing for patients to enable the Trust to reach national and local initiatives. (Datawell) 21. Health Innovations Delivery of truly innovative technologies that support the delivery of patient centric and patient empowered care. These strategic objectives and the required supporting themes are discussed below. The Strategic development for Information technology will be supported and complimented by the development of the business intelligence services and robust Information Governance practices. 5.3 Electronic Patient Record (EPR) and other supporting clinical system development Modern Electronic Patient Records (EPR) offer the potential to embed computerised decision support into day-to-day care delivery and record-keeping to provide full patient information, promote best practice, minimise errors and hence improve safety, quality, efficiency and effectiveness. An Electronic Patient Records provides; a single integrated patient record with a common look and feel that supports a more seamless provision of clinical and operational information across the health economy. improved data quality and reporting that enables better care planning, operational planning, clinical coding and day to day decision making. better safety and quality of care through more holistic patient and clinical information and access for the right people at the right time. support for new models of care delivery including integrated care by providing more accurate information, data and interoperability options. more efficient use of clinical information which will support more patient facing time, less duplication and a reduction in possible areas for clinical incidents. more efficient working practices through streamlines processes, more timely access to information and the ability to see a holistic view of patient and service information. a rationalisation of the current suite of Trust clinical IT systems and reduce the risks associated with multiple, disparate systems creating far greater efficiencies and freeing up Informatics time to concentrate on providing exceptional INFORMATICS and future strategic requirements. replacement of aged, often slow and clunky IT systems with a modern, integrated and flexible approach that does not constrict or constrain how care should be delivered; the ability to customise IT solutions to best suit the needs of the Trust, its staff and patients rather than being stuck with a range of off the shelf solutions that cannot be enhanced or integrated. a reduction in the reliance on paper to capture and share information making it easier, quicker and safer to share information. 15 P a g e

17 What does the future look like? The adoption of the Allscripts EPR across the Northwest Sector, to provide a shared digital care record is the goal for achieving integrated care across the sector. At the present time, the Salford and WWL instances of Allscripts are independently hosted and managed by their respective organisations. The creation of a Bolton instance of the Allscripts EPR presents a number of hosting options and opportunities for the sharing of resources, skills and knowledge. A key decision will be on how and where the application should be hosted, these options are listed below: Internally hosted by Bolton NHS Foundation Trust Hosted by Salford Royal NHS Foundation Trust Hosted By Wrightington, Wigan and Leigh NHS Foundation Trust Hosted externally by a commercial partner Given that the preferred solution is to adopt the Allscripts application across the Northwest sector. The issue then is to determine the preferred delivery solution. The high level pros and cons of the hosting options are set out below: 16 P a g e

18 Bolton Hosted Salford Hosted WWL Hosted PRO Ease of delivery PRO Local control over pace of delivery PRO simplifies business case development PRO local control over configuration which is key to clinical engement CON Potentially higer costs PRO Expereience of succesful implementation CON May delay business case development CON Potentail procurement issues CON Potential limit to adopt BNFT policy and proactice CON Timescale for delivery due to Salford contract renegotiation PRO Similar scope to Bolton PRO Recent experience of delivery CON May delay business case development CONPotential delay until WWL implementation completes Externally Hosted PRO Scalability CON Cost of delivery CON May not be supported by Allscripts The approach to implementation clearly needs to reflect the aspirations and capabilities of the organisations involved. Regardless of the chosen delivery route, it is imperative that implementation should not prevent the realisation of the potential ultimate goal of a centrally hosted EPR across the sector running on a single platform which delivers a fully integrated digital care record. It is proposed that for the first cut of the business case that a locally hosted standalone version of the Allscripts Application is costed. This is a pragmatic solution, as it is one that least impacts each organisation from an implementation perspective and also does not require immediate consideration of the system architecture and design, factors which would need to be completed to determine potential costs. This proposal does not prevent ongoing discussions with other partners about other hosting options. The proposed option does not prevent a future linking of the Allscripts applications across the sector to provide a shared digital care record. The locally hosted option can still embrace the notion of shared resources through the transfer of knowledge and skills and some high level sharing of resources. The following diagram highlights the opportunity to progression to a shared digital care record for the North West Sector of Manchester, based on an implementation of the Allscripts EPR solution. There are a number of supportive technologies that are required to support the delivery of the vision of EPR delivery in Bolton and which will prepare the way for a digitally enabled Trust. These include: Single PAS The Trust is committed to the merger of its two patient administration systems to provide an integrated PAS for hospital and community services. This is also an essential step into ensuring we have an integrated approach to the delivery of an EPR. Patient Flow It is proposed that the existing Extramed system is retained and integrated with the Allscripts applications. Allscripts are currently reviewing their commercial offering for patient flow and it would be prudent to at this stage continue the use of Extramed and to integrate that with the Allscripts. This allows the Trust to continue to develop Extramed to meet the challenges of managing patient flow. 17 P a g e

19 eobs Informatics Strategy Forward View Bolton NHS Foundation Trust The Trust is in the process of procurement and implementation of a replacement hospital at night solution to support escalation of deteriorating patients out of hours. The solution can be extended to enable the transition from the manual recording of patient observations and calculation of MEWS to a fully digital solution that enable the electronic recording of observations including device integration. The e-obs system would be capable of integration with Allscripts and would be a first step towards a digitally enabled workforce, improving timeliness and accuracy of the recording of patient observations and providing more time to care through the reduction in time taken to carry out this critical clinical activity. It would also provide the opportunity to transition from an organisation dependant on paper to a digitally enabled organisation. OpenEyes To address compliance with national audits, high productivity virtual working and the drive to paper light operation, the Trust is implementing OpenEyes in the Eye Unit. OpenEyes is an open source EPR for ophthalmology that is championed by NHS England and designed by clinicians. OpenEyes has the functionality needed to tackle the specific challenges ophthalmic care provides. The software is capable in integrating with our planned Trust-wide EPR. Funding for this project has been provided by an award from the Technology Fund. EDM Another key area in relation to the move to EPR is Electronic Document Management (EDM). EDM supports both the reduction of paper and storage as well as providing electronic access to historical/archived records. The implications of this need to be understood fully and the review of EPR options should further consider the role EDM needs to play in the Trust s move to a full Electronic Patient Record. In order to reduce the reliance on paper and the consequential impact of processing, storing and retrieving it, the implementation of an electronic document management system (EDMS) is a desirable component a digital care record strategy. It is proposed that the business case for is revisited in parallel to the development of the EPR business case to enable the trust to move to a paper light operation. The emphasis should be on the limiting the need to store newly created paper records in a physical form rather than the elimination of the existing archive. This will reduce the need to back scan records, that in all probability will never be needed. Instead records should be scanned on demand and reviewed in a digital form. Community Services EPR Delivery The establishment of an EPR to support community services using the Allscripts application is complicated by the requirement of the application for an always on connection to the Allscripts database. This is difficult, if not impossible to achieve using current mobile telephony services. The Trust will review solutions form leading community system suppliers and integrate the preferred solution into the EPR to provide a comprehensive EPR covering both hospital and community care. Procurement Route Since the original Digital Trust Business Case was compiled the SBS Framework for procuring EPR solutions has been developed. The Trust played a pivotal role in its development and it has recently been used by a number of Trusts to successfully procure the Allscripts application in relatively short timescales this included South Manchester University NHS Foundation Trust. The SBS framework provides for mini tender and direct to award. The benefit of using the SBS framework to procure is that it provides a quick and relatively low cost route to procurement. This also reduces the risk legal challenge which complicated the use of the existing Salford or 18 P a g e

20 Wigan contracts. It is therefore proposed that the SBS framework is used to procure the Allscripts application and that a direct award is made. The diagram below sets out the proposed path to the selection, procurement and implementation of an EPR for Bolton NHS Foundation Trust and progression towards a Shared Care Record for the North West Sector of Manchester. SBS Procurement Framework Implement Bolton NHS Foundation Trust EPR Integrate with WWL and Salford EPR to provide a Digital Shared Care Record Allscripts - Locally Hosted EPR This strategy provides the quickest route to the implementation of an EPR for the Trust which supports shared care across organisation in the North West Sector using a common clinical care record and the provides the Trust with the capability to exploit the use of technology to provide innovative solutions to the delivery of care. Implement eobs Maximise use of existing icm Merge Acute and Community PAS Implement Business Intelligence Strategy Implement Bolton Hosted EPR Build the workforce to support EPR and IT Strategy Delivery Establish and Information Culture Key Consideration Electronic Patient Record An integrated Electronic Patient Record that supports the delivery of safe, efficient clinical care that positively impacts patient outcome and experience is integral to enabling the Trust to participate in both national and local initiatives. High quality and reliable data will enable better patient outcomes and more effective management of resources. 19 P a g e

21 5.4 Informatics Strategy Forward View Bolton NHS Foundation Trust Infrastructure Due to historical under-investment in Informatics the Trust infrastructure was totally inadequate for business as usual let alone any future Informatics plans. As previously mentioned, in July 2014, the Trust commissioned Deloitte to create a business case for Monitor and the Department of Health to facilitate funding the infrastructure burning platforms that had been identified. Burning platform areas were defined as areas of Informatics that needed upgrading and that are essential for running the hospital. The report categorised the areas that needed focus into three categories: Category A - Burning platform and like for like replacement needed; Category B - Burning platform with options for replacement; Category C - Investment required but not considered a burning platform. The Trust took the full replacement option, category A, to Monitor and the DoH, the funding for this was granted. The following Infrastructure areas to be considered: Datacentres Currently the organisation has scalable, resilient and secure data centres through continued development and review and this needs to be continued Using our current true vendor agnostic software defined datacentre (SDS) two or more datacentres should be off site and fully replicated. Needs to be scalable resilient and secure Review options for shared datacentre services across the GM or local trust controlled WAN attached datacentres. Networking There was a large investment in 2011 and this needs to be reviewed to ensure a warrantied environment ensuring security and to support other projects such as unified communications. In 2016 the network needs to be reviewed to ensure it is suitable for EPR, EDMS and Unified Communications. Wireless Wireless should be expanded into the community and we should federate to neighbouring organisations to allow seamless connectivity to the trust infrastructure. Mobile workers can connect to desktops regardless of location. Wireless should be scalable to incorporate wireless Unified Communications, medical devices and public access without affecting core services. Infrastructure Telemedicine and mobile working should be expanded to homes to provide the same level of experience as working within the trust environment. Including secure diagnostic quality imaging. Core infrastructure: development / Migration to a new active directory forest design to include a new local domain optimised for federated and shared services. Desktop Moving to the latest version of the desktop operating system (as of this document windows 10) to support the latest technologies. We are also looking at open source desktops, general office applications including cloud based offerings such as Office 365. A continued development of secure and resilient desktops. 20 P a g e

22 Expand the already established virtual desktop infrastructure An upgrade to the on premise Exchange to support unified communications. Expand the desktop infrastructure to offer federated integrated desktops to external NHS organisations. Providing a Shared workspace and document sharing environment for collaborative working. Security A continued overarching security programme that covers all aspects of the infrastructure. Given the fast paced development this needs to be left generic and everything will be appraised and brought to attention as required. A continued programme of external auditing and reviews (penetration testing) to ensure compliance and integrity. A regular review of backup hardware and software infrastructure (including disaster recovery planning) to ensure the infrastructure meeting organisation /departmental recovery time objectives (RTO) and recovery point objectives (RPO) Expansion of backup practices to meet new IG backup and recovery policy guidelines. Regular reviews of , Firewall and Desktop Security due to constant threats. Evaluation and investment in implementation of active Data Loss Protection (DLP) including and external gateways. Servers and Storage Continue to refresh and develop to deliver a resilient and secure infrastructure to support the 5 year strategy as detailed in this document. We will look at the feasibility of hybrid cloud computing for resources for ad-hoc projects. A proactive monitoring system linked to a digital service desk to pre-empt issues and provide detailed reporting to the board on service delivery. Environmental Constantly reviewing the most cost effective solutions taking into account environmental considerations. Continue looking for efficiencies on power, cooling and emissions from servers, storage, network, desktops and datacentres. Digital Dictation A digital dictation and voice recognition system that integrates into the trusts EPR and unified communications to allow increased efficiencies in reporting and remote working. IT Unified Communications Instant messaging, multi user video conferencing and patient liaison teleconferencing. An accredited ISO system. Support Services To support EDMS, EPR and general infrastructure we need to provide adequate resourcing to support 24 hour service delivery within IT services. Key Consideration Infrastructure The vision and strategic objectives for informatics can only be obtained through a robust, resilient and future proofed infrastructure. Without funding to replace the burning platform all other Informatics investments are unlikely to be successfully implemented. The inability to fully 21 implement P a g e solutions will also impact any benefits and transformation programmes associated with solution implementations.

23 5.5 Informatics Strategy Forward View Bolton NHS Foundation Trust Shared Services In response to national digital objectives, NHS Trusts are required to obtain higher levels of digital maturity whilst often responding to cuts in funding within Informatics departments. Informatics delivers an essential service to the Trust but this service, above most others, must not only be value for money, but responsive, flexible, robust and adaptable whilst delivering solid business as usual services. Three methods of service delivery are available to the Trust; In House continue to deliver the Trust s Informatics using an In-House team. Outsourced commission the delivery of the Trust s Informatics services from an industry IT specialist. Shared Service working with other local healthcare providers create a single team across the local organisations that can deliver Informatics services across the local economy. Each of these approaches has its own merits and draw backs as described in the table below: Approach Quality of Service Flexibility Cost In - House With a historically underfunded team it will prove increasingly difficult to respond to nation digital objectives in an agile way. The skill sets currently present within the team will need to be expanded and improved to allow for continued digital development. An In-House service will provide closer links to the business, with an understanding of the Trust s objectives. An In-House service can provide a great deal of flexibility in responding to the Trust s requirements. With the current staffing and investment levels it may prove difficult to be truly responsive and flexible to change. This option is likely to cost the least of the three in the long run. However due to historical under funding the Trust will be required to substantially invest in the current service delivery team in order to improve current BAU practices and give the service the ability to respond effectively to large scale implementations in line with national objectives. Out Sourced Outsourcing the Trust s informatics delivery service would provide the highest quality with industrial standards of service delivery being utilised to retrieve, host and process data and systems. This approach is likely to give the least amount of flexibility to the Trust through the likelihood of lengthy contracts and little ability to change or adapt services in a responsive agile way. This option is likely to be the most expensive of the three. Shared Service A Shared Service model would utilise the Trusts current health care partners and peers to create a good A Shared Service model would prove more flexible than an out sourced model. This option is likely to sit in the middle of the other two in terms of costs, however it 22 P a g e

24 quality service through an NHS sensitive culture. It would create a team which covers all key skills and rids the service of single points of failure through the sharing and accessibility of knowledge and expertise. This approach also enables career structure development and effective up skilling programmes. This approach also provides the Trust with the ability to develop services in line with each other, raising the bar for all. would prove the most cost effective in terms of the value for money, service provided and flexibility offered through this economy of scales approach. In order to make a Shared Services Agreement successful it is important that the Trust engages fully and is active in the definition of the Service Level Agreements. It is also imperative that the service is governed by clear and transparent policies on accountability, escalation procedures, prioritisation, investment and costs. The GM Devolution agreement and subsequent strategic plan, Taking Charge of our Health and Social Care sets out the ambition for Health and Social Care provision over the next five years in Greater Manchester. The wider ambition of Greater Manchester is to become a financially selfsustaining city region and the reform of Health and Social Care will provide a significant contribution towards this. The GM strategic plan is focused on five key areas one of which is the standardisation of clinical support and back office services. At a strategic level the consideration of shared back office services is considered an accepted part of business strategy and a necessary part of driving efficiencies across the health and social care economy in GM. The devolution agenda does however provide us with the opportunity to go further than simply pooling and sharing resources, it allows and enables us to think differently, considering new organisational forms and potential collaborations across new parts of the public sector we hadn t previously considered. There is currently significant opportunity to assess Services reduce duplication across IM&T and drive efficiencies through collaboration and consolidation. It is inevitable that as individual organisations look for increasingly efficient mechanisms for providing services within a decreasing financial envelope some will look to external providers. Taking this approach on and organisations by organisation basis misses the opportunity to take advantage of scale and drive reduced costs. Collaboration will enable participating organisations to drive efficiencies, share costs and ensure consistency in levels of current provision. Standardisation of infrastructure and joint models of working could enable participating organisations to potentially reduce reliance on external providers and outsourcing, which would potentially have higher associated overall cost. In addition a collaborative approach would enable future proofing through scale and the retention of specialist skills and experiences across the collective workforce. Moving to a joint IM&T service could be undertaken in a phased approach whereby specific services and assets are on boarded individually. This would allow for testing and management of risk but will inevitably reach a critical point at which transformation to a new organisation could be significantly scaled. A detailed understanding of the right services to be part of a new organisation would need to be considered and planned in a systematic way. As part of this clear deliverables would need to be 23 P a g e

25 established to ensure standards under the new organisation are at least as good if not better than current provision. Accepting that each individual organisation currently performs differently across the range of IM&T services this will mean a minimum of lifting performance in each service area to the current best performing of the participating organisation. Key Consideration Shared Services A Shared Service model is a cost effective way forward for the Trust to continue developing its digital maturity with an improved, flexible service delivery approach which meets both local and national objectives. The Trust will need to ensure that any Shared Service agreement is subject to the appropriate governance procedures and SLAs 5.6 Telemedicine Telemedicine is the use of communication and information technologies to deliver clinical care where the individuals involved are not at the same location. They can either be two healthcare professionals or a healthcare professional and a patient. Telehealth includes this definition, and also covers telecommunication to deliver non-clinical services such as research and health education promotion. Telemedicine can be split into three main categories: store-and-forward, remote monitoring, and interactive telemedicine. Store-and-forward telemedicine involves transmitting medical data from a patient to a doctor for assessment at a later time; remote monitoring uses devices to monitor patients in a non-medical setting; and interactive telemedicine uses technology such as videoconferencing and telephones for real-time remote communication. Telehealth technology is now also widely available and has been successfully implemented in numerous care settings including a number of North West organisations. Connecting patients in their home to clinicians through video technology has been proven to drastically reduce hospital admissions, cut on travel expenses, provided care quicker and more efficiently for patients who are not able to travel easily, and has greatly improved the end of life care of patients who have trialled this approach at NHS Trusts. During the lifetime of this strategy, the Trust will review opportunities to utilise to facilitate telehealth. The first stage is to complete a Telemedicine review that engages clinicians and stakeholders to understand the needs and benefits that Telemedicine can bring. This review will include the exploration and trialling of appropriate telehealth technologies before a full implementation plan is created. Key Consideration Telemedicine Telehealth solutions enable care to be provided in locations that best suit the patient and reduces unnecessary travel. These solutions enable self-management and enhanced health ownership for patients and their families. These developments rely on a strong infrastructure but can produce cost savings and work efficiency gains across the clinical departments. 5.7 Community Integration Acute and Community As a result of the community integration in 2011, the Trust Informatics team has had to flex its approach from a customer base that is mainly fixed at the hospital site to one that is far more mobile. In addition, the Informatics team is now a combination of two existing teams. While work 24 P a g e

26 has commenced to ensure team integration and parity of service for the acute and community teams, it is recognised that more work is needed to ensure both the acute and community teams receive the same level of service. Healthier Together Outside of the Trust there is a regional Greater Manchester review of services. The process, called Healthier Together is currently in progress. The review aims to provide solutions for facing the increasing demands placed on the NHS across Greater Manchester. With multiple failing organisations the region has decided that no change is no longer an option, and therefore the programme is looking at how to shape the services across the region to: Improve the waiting times in GPs and A&Es; Centralise specialist hospital care onto specific sites so that appropriate expertise are available all of the time; Create one coordinated system so that all of the organisations and facilities involved in patients care offer high quality care and an excellent patient experience. Greater Manchester Devolution Agreement The recent devolution agreement between the government and Greater Manchester emphasises the urgency for reform that is required to meet budgetary, health and social pressures, as outlined in the FYFV. As a result of the agreement, a Memorandum of Understanding (MoU) has been drafted between all local authority members of the Association of Greater Manchester Authorities (AGMA); all Greater Manchester CCGs; and NHS England. The purpose of the MoU is to ensure the greatest and fastest possible improvement to the health and wellbeing of the 2.8 million citizens of Greater Manchester (GM). It sets out a more integrated approach to utilising the 6bn of health and care resources allocated for 2015/16. It also highlights the transformation changes and collaborative working that will be required to deliver services across the city. The MoU recognises that integrated health and social care services; along with a digitally integrated health economy is vital to improving efficiencies and health of the GM population. With two large community integration programmes initiated it is imperative that the local healthcare economy seek to harmonise the infrastructure across healthcare providers, creating a seamless transition between solutions. The output of this should include synchronicity of contact and the ability to access information when required, where ever it is required. Mobile working as described in section 5.15 below will also play a vital role in enabling this new healthcare model. The most important challenge currently facing local healthcare providers is the absence of a shared patient record. To enable new community wide models of healthcare delivery it is important that a single electronic patient record is available to healthcare providers across the local economy. There are three options for achieving this objective: Local Acute EPRs are extended into community services. Procure a specialist communications system which would interface with the current systems across the local healthcare economy. Utilise portal technologies to create an integration platform across current systems. To create a successful shared record it is important the Trust fully engages in the community integration programmes above. A wider piece of market engagement involving all local health care providers will need to be undertaken to fully understand the requirements of this initiative. 25 P a g e

27 Key Consideration Community Integration The Trust will need to remain open, flexible and fully engaged with community integration initiatives and take an active role in market research and requirements gathering to enable a successful shared record approach. 5.8 Unified Communications Unified Communications (UC) is the integration of real-time digital communication services such as instant messaging, presence information, voice telephony (including IP telephony), video conferencing, data sharing (including web connected electronic whiteboards interactive whiteboards), call control and speech recognition with non-real-time communication services such as unified messaging (integrated voic , , SMS and fax). UC is not necessarily a single product, but a set of products that provides a consistent unified user-interface and user-experience across multiple devices and media-types: Unified messaging focuses on allowing users to access voice, , fax and other mixed media from a single mailbox independent of the access device. This creates one source of inbound contact rather than having to check multiple locations; Multimedia services (MMS) include messages of mixed media types such as video, sound clips, and pictures, and include communication via short message services (SMS). MMS supports the ability to interact with staff and patients in ways other than paper and letters; Collaboration and interaction systems focus on applications such as calendaring, scheduling, workflow, integrated voice response, and other enterprise applications that help individuals and workgroups communicate efficiently. Working in this way helps patients to have more control over their scheduling and also enables staff to be more responsive to inbound care needs; Real-time and near real-time communications systems focus on fundamental communication between individuals using applications or systems such as conferencing, instant messaging, traditional and next-generation private branch exchanges (PBX), and paging. This could be for both staff and patient interactions; Transactional and informational systems focus on providing access to m-commerce, e- commerce, voice web-browsing and other enterprise applications. The ambition for the Trust is to provide a convenient, flexible infrastructure that supports communication of all types, tying together a range of technologies to suit the needs of the individual user. This will include the need for supporting the use of users own personal devices where appropriate (Bring your own device - BYOD). Another key area is the ability to use Skype for business to aid cross area working while reducing travel. Currently telephony and mobile data is the responsibility of estates but will move to Informatics, to enable the development of a unified communications strategy. This is becoming increasingly important for the business, a Trust wide telephony/unified communications review is needed to understand the Trust s requirements and best location for these services going forward. Key Consideration Unified Communications An assessment of the current ability of the infrastructure to support unified communications technologies will be required. An approach to Bring your own device will need to be defined which must include extensive governance parameters. 26 P a g e

28 5.9 Skill Development For true change to be delivered staff need to be able to confidently use the enabling technologies. As a result, the delivery of the strategy should be supported by a review of staff skills and capability to understand the gap between the current skills and the skills needed for a more information, communication and technology enabled Trust of the future. This will provide a training needs analysis which will inform a rolling training programme to ensure all staff are Informatics literate and confident. This will help increase both efficiency and optimisation for both current and future systems and technology. To enable this skills development initiative the Trust will need to review its current training capacity and reinvest in this area to enable Trust wide change programmes to be successful. It is recognised that for true change to be delivered staff need to be able to confidently use the enabling technologies. As a result, the delivery of the strategy should be supported by a review of staff skills and capability to understand the gap between the current skills and the skills needed for a more information, communication and technology enabled Trust of the future. This will provide training needs analysis which will inform a rolling training programme to ensure all staff are Informatics literate and confident. This will help increase both efficiency and optimisation for both current and future systems and technology. To enable this skills development initiative the Trust will need to review its current training capacity and reinvest in this area to enable Trust wide change programmes to be successful. As part of the Trust financial recovery process the IT training resource was significantly reduced and IT Training moved from traditional face-to-face delivery to almost 100% E-Learning delivery. This approach, whilst enabling staff to undertake training at a time and place of their choosing, it has found to be unsuitable for complex IT systems. It has also been difficult to keep the pace of E- Learning package development in line with the rapidly changing software being adopted. It is therefore proposed that the E-Training provision is reviewed and that a blended approach is adopted that provides opportunities for staff to choose the approach to learning that best suits them. This will require an increase in the size of the IT Training Team so that the capacity to deliver training can be increased. Opportunities to minimise the cost of this will be explored such as shared approach to EPR training Key Consideration Skill Development That the E-Training provision is reviewed, that a blended approach is adopted that provides opportunities for staff to choose the approach to learning that best suits them. An increase in the size of the IT Training Team is required so that the capacity to deliver training can be increased Mobile Working Mobile working is the ability to work anywhere, irrespective of place and time, enabling staff to access and update information and communicate on the go. Mobile working provides clinicians with the means to manage their time and workload better. They can communicate more freely with colleagues and patients, and have the flexibility to work in the office, in the community or at home. The same technology can also be used by patients and visitors to access their medical records. There is increasing demand throughout the Trust for improved support for mobile working. Mobile working ranges from remote working in the community, mobility within the hospital, a managed 27 P a g e

29 approach to the proliferation of tablet devices and the unification of voice and data communications. A Trust wide strategy will be developed for supporting mobile working which addresses the aspects mentioned above and ensuring any investment is maximised. Key will be the ability for devices to support current and new clinical systems and applications. The strategy will also need to tackle the organisational changes that are required to operate this technology safely and cost-effectively, and to maximise the benefits gained. The strategy needs to be developed in collaboration with other key business areas such as estates and HR as these areas are integral to a mobile strategy. Mobile working to enable effective community nursing is part of the government s Digital First initiative. Integral to creating a successful mobile working culture are devices, connection speeds and usability which is in line with user s experience of personal technologies. As part of the mobile working strategy, an action plan for supporting mobile working including tackling organisational change, a review of the mobile data currently held in estates and maximising the benefits gained will be addressed. Development of policies for Bring your own device to support mobility will be key ensuring adequate security e.g. Air watch is in place to protect the organisation. Key Consideration Mobile Working Mobile working is often considered an improvement both in cost savings but also in staff productivity and morale. It is important that a mobile working strategy is firmly in place with consideration of Bring your own device (BYOD) as described above Health Innovations Once the Trust has fully robust infrastructure, systems and processes it will focus on the development and use of innovative health technology. This will include areas such as health applications, wearables, open source technology, whole population health data and outcomes and patient led innovations. One of the first health innovations the Trust would benefit greatly from, is access to a Vendor Neutral Archive (VNA). This medical imaging technology stores clinical documents and images in a standard format with a standard interface, such that they can be accessed in a vendor-neutral manner by other systems. This would greatly contribute towards the community integration programmes. This will be driven by the GM Collaborative Imaging Procurement Project, which sets out to procure a GM wide PACS /VNA Solution. As the strategy develops the IT team and CCIOs will keep up to date with the latest healthcare technologies making sure the strategy and stabilisation of infrastructure has the flexibility to support the future. Key Considerations Health Innovations It is vital that any decisions made in relation to ICT with regards to the strategy, improvements and procurements considers and has the ability to enable health innovations that will be standard technology in the future. 28 P a g e

30 5.12 Business Intelligence Our aim is to enable decision-makers, in particular Executive Directors, clinicians and managers, to make better decisions by providing them with actionable information. In order to achieve this we need to transform our Information function from a department that produces reports into a Business Intelligence team which adds value to data. Decision-makers need to be able to find the information that they want quickly. This will be achieved through the delivery of self-service, personalised reporting, delivered directly to the desktop, whereby the user will be presented with the most useful and relevant information that they need to do their job whilst making it easy to find other information. There will be an emphasis on predictive reporting in order that action can be taken to resolve a potential problem before it happens rather than reacting after the event. We will deliver near real-time reporting in order to provide a current-state picture of the organisation and therefore facilitate early intervention as issues arise. We will extend the use of benchmarking to provide context to our performance, especially in relation to mortality reduction and other quality metrics. Reporting systems, however sophisticated, are only one part of the solution. Decision-makers also need access to experts who are able to interpret, evaluate and explain data trends and anomalies and provide recommendations for action. We will recruit and develop Business Intelligence Specialists who will provide these skills to Divisions as part of a multi-disciplinary partnership which includes clinicians, managers and specialists form other functions (HR, Finance, Governance etc). We want to be recognised as a centre of excellence for business intelligence, providing exemplary customer service and staff development, so that we can attract the brightest and best talent. Our Business Intelligence Strategy is set out in Appendix D 5.13 Delivering the Strategy The success of delivering this Informatics Strategy rests on the Trust s ability to create robust and adaptable foundations on which to build innovation. The delivery of a solid infrastructure depends largely on the Trust s ability to secure the funding to replace the burning platform. The infrastructure will enable the Trust to move forward to join community health care initiatives and lead in the potential for the delivery of the Trust s Informatics services through a Shared Service model. 29 P a g e

31 Summary of Key Considerations - Strategic Objectives Both the national and local contexts have numerous implications for Informatics; the Trust must consider what is possible over the next 5 years in relation to: Paperless 2018/2020 Electronic Document Management Electronic Patient Record Community Integration Shared Patient Records In response to the stakeholder engagement and strategy process the following actions have been highlighted: Further development of the CCIO roles are required Rationalisation of the Trust s current IT systems Enable a better user experience through the reduction of signing in and out Improve WiFi provisions to enable mobile working Continue to build a solid relationship with the Business, through the use of the CCIOs Resolution of the disconnect between acute and community through the implementation of a shared record and integration of information Improved investment in Informatics resources to counter the historical under investment Implementation of an EPR Complete the burning platform replacement programme Take a leading role in the initiation and governance of a shared service programme across the local healthcare economy Conduct market research into current Telehealth technologies and ensure infrastructure improvements are sufficiently future proofed to allow use of these technologies. Take a leading role in the provision of a shared record initiative through market engagement and requirement gathering Conduct an assessment of the current ability of the infrastructure to support unified communications Definition of the Trust s mobile working strategy including the approach to bring your own device. Implement the Business Intelligence Strategy Ensure robust information governance practice. 30 P a g e

32 6 NHS England has reiterated that radical change is needed to move the NHS forward. This is the same message for people in Informatics. To move forward, the Informatics team must: work to create standardisation of processes, datasets, platforms and interfaces; understand that IT must be delivered alongside fundamental business change; build from a place of security and Trust; deliver transparency; take a collaborative approach to developing and delivering services; Create services that have been defined by services users, carers and professionals not services driven by technology. The following section covers the supporting areas that are needed to deliver a successful Informatics strategy. 6.1 Approaches and Methodology To deliver the strategy the following industry standard approaches will be implemented across all Informatics programmes and projects. Programme Management - Managing Successful Programmes (MSP) is a structured, flexible framework that allows the management and control of all activities involved in managing a programme. MSP is the de facto standard used for managing programmes in the NHS. Project Management - PRINCE2 has been adopted as the in-house standard for project management and key staff have received training and mentoring in project management techniques. All projects have a Project Board with a sponsor and clinical engagement. A recent audit confirmed that this implementation is robust. Service Management - ITIL is the most widely accepted approach to IT service management in the world. ITIL provides a cohesive set of best practice, drawn from the public and private sectors internationally. Information Governance- Information is a vital asset for the Trust, supporting both day to day clinical operations and the effective management of services and resources. Therefore it is essential that all Trust information is managed effectively within a robust governance framework. In addition the Trust has a statutory responsibility to patients, public and NHS staff to ensure that it has effective processes, policies and people in place to deliver its objectives in relation to holding and processing of information in a confidential, reliable and available manner. The Trust requires accurate, timely and relevant information to enable it to deliver the highest quality health care and to operate effectively as an organisation. It is the responsibility of all staff to ensure that information is accurate and up to date and that it is used proactively in its business. Having accurate relevant information available at the time and place where it is needed, is critical in all areas of the Trust s business and plays a key part in corporate and clinical governance, strategic risk, and service planning and performance management. Effective Information Governance will ensure appropriate levels of availability, integrity, confidentiality, non-repudiation and authentication of information and information systems. This confidence is particularly important in the present environment, which is subject to unprecedented levels of malicious activity with intent to compromise information systems. 31 P a g e

33 Key ambitions Informatics Strategy Forward View Bolton NHS Foundation Trust Information is used to drive integrated care within and between organisations, and across the health, care and support sector as a whole; Our electronic care records will progressively become the source for core information used to improve our care, improve services and to inform research, etc. reducing bureaucratic data collections and enabling us to measure quality; Information recorded once, at first contact, and shared securely between those providing care supported by consistent use of information standards that enable data to flow whilst keeping our confidential information safe and secure. Security Management - The Trust intends to gain certification to the ISO/IEC standard in order to achieve: better management of information security risks, now and in the future; increased access to new customers and business partners; demonstration of legal and regulatory compliance; potential for reduced public liability insurance costs; enhanced status and competitive advantage; overall cost savings (reduced errors and re-work). Digital Maturity - Over the five year period of this strategy the Trust aims to achieve top levels of digital maturity. There are currently two key healthcare digital maturity models in use within the UK. The first, the Clinical Digital Maturity Index (CDMI) was developed by EHI Intelligence in partnership with NHS England specifically for NHS Trusts and benchmarks relative maturity against other UK Trusts. The second, HIMMS Electronic Medical Record Adoption Model (EMRAM) model is used widely across the globe and increasingly in the UK. (Appendix C) The Clinical Digital Maturity Index (CDMI) is a benchmarking tool which aims to provide NHS Trusts with a better understanding of how investing in and using information technology can provide benefits. The Index is based on a nine-level electronic patient record rating. Recommended by NHS England, the Trust aims to us this model to support its future journey. HIMSS Analytics Europe has developed a European EMR Adoption Model (EMRAM) based on the model established across the U.S.A. and Canada. It aims to identify the levels of electronic medical record (EMR) capabilities ranging from basic departmental systems through to a paperless EMR environment. The methodology and algorithms automatically score hospitals based on their IT enabled clinical transformation status. The model also allows Trust to compare themselves to peer organisations. This model will also be used to help the Trust in its strategic IT decision making. As demonstrated in Appendix C, Bolton NHS Foundation Trust is in the middle of the pack. Scoring above average for leadership, governance, information governance and transfers of care, but below average for resourcing, records, assessment and plans, decision support and standards. All of which will be improved significantly by the implementation of an Electronic patient record. 6.2 Connection to the Business The only way that Informatics can truly enable an organisation is by having a meaningful, two-way relationship between itself and the business and especially with those at the front line delivering care. This connection enables communication and engagement across the organisation that leads to real, IT-supported business change. The Trust has already implemented the MDT CCIO roles which are proving to be vital in the creating a better connection between Informatics and the business. As these roles are relatively new, they 32 P a g e

34 will continue to be developed to ensure that they are improving how Informatics is discussed and implemented across the Trust and therefore supporting the development of the Informatics strategy. The CCIO roles will help to; Create energy for change; championing and bringing passion to projects creating engagement and excitement for the future IT can help create; Translate the technology into stories of real user experience and patient impact creating understanding and pull towards the future vision; Shape the strategic direction of IT based on the unique view of patient and business needs clinical expertise brings; Improve the experience of IT for both the IT team and the people interacting with it by creating a stronger connected to the business; Build robust connections and networks that support IT to effectively enable transformational change; Make the right decisions based on whole system understanding and well established team processes. As the Trust gets clearer about the journey for Informatics, patient engagement will become increasingly important. The NHS is moving towards more empowered patients, involving patients, carers and general citizens in the design and implementation of information, communication and Informatics. The Informatics team and formally appointed CCIOs and Trust patient advocates will work to establish closer connections to the Trust s patients and service users, gathering information about their needs and their openness to available and future technologies. Where possible existing networks will be used but new channels will be created where necessary. The CCIO s will represent informatics locally, regionally and nationally as appropriate to champion the informatics strategy from a clinician s perspective. 6.3 Change Delivery With such a large degree of change possible for Bolton and the Greater Manchester area, the Trust fully understands the importance of robust change leadership and delivery. Technology can never be optimised and fully support clinical and operational work without the appropriate change resource and funding being identified for each and every IT project. A key part of successful change will be the relationships created between the clinical IT advocates and Informatics but additional resource will always be needed, over and above people s day jobs, to truly realise the benefits of future Informatics projects. It is also vital that the delivery of the strategy is led by the required business processes rather than Informatics dictating what the processes need to be based on the technology or its functionality. Each strategy area needs full engagement with the business leveraging the skills of the CCIOs and the existing Informatics team. For the delivery of this strategy business change skills will be required across areas such as; behavioural and mind set change, stakeholder engagement, creating energy for change, process creation and optimisation, benefits creation and change delivery etc. 33 P a g e

35 7 34 P a g e

36 8 The informatics department has made considerable progress over the last 18 months. However, the Trust and local health economy is now going through a period of unprecedented change and informatics needs to mobilise itself further to support the needs of the Trust, its patients and the wider community. Key to the success of both informatics and the Trust is a robust financial position and therefore decisions need to be made about what can be achieved and when. This strategy clearly set out the focus for the next 5 years and will be supported by a robust operational plan, related business cases and informatics enabled transformational change. 35 P a g e

37 9 Trust WWL Salford Bolton Trust Turnover 262,000, ,479, ,000,000 Revenue spend on IT 13/14 2,888,805 4,874,051 2,383,636 Planned spend 14/15 2,986,450 6,684,644 Not Available % revenue spend on IT 13/ % 1.08% 0.84% % revenue spend on IT 14/ % 1.49% Not Available WTE in IT Refreshed Trust WWL Salford Bolton Trust Turnover 15/16 272,424,000 Not provided 292,541,000 Revenue spend on IT 15/16 5,695,216 6,291,216 2,316,242 Planned spend 16/17 6,143,041 8,400,465 3,491,507 % revenue spend on IT 15/16 2.1% 1.27% 0.79% % revenue spend on IT 16/17 2.1% 1.35% 1.15% WTE in IT Salford - Please note these staff and spends also include the support for hosted bodies including the AHSN, AQUA, adult social care and Haelo as the team are a shared service. As a result the spend on IM&T is a higher percentage than comparable non shared services. 36 P a g e

38 10 Category A Category B Category C ipm PAS Microsoft Licences ORMIS Theatre Man Virtual Desktop Community Services Integration icm Order Comms Firewall, Security and Remote Access Simplified Single Sign On Data Centre Server Refresh Programme Infrastructure for Pathology and Pharmacy Wi-Fi IT Resource. icm Order Comms Firewall, Security & Remote Access Simplified Single SignOn Data Centre Service Refresh Programme Infrastructure for Pathology and Pharmacy Applications Wifi IT Resource Service Deliver These areas are the most important areas that need addressing. Not only are they in critical condition in terms of their inability to support the Trust but they are the foundation for delivering the Informatics vision for the future. Once confirmation of funding has been agreed a detailed infrastructure plan will be created to detail how the above areas will be implemented. The plan is to have all of the burning platform work completed by the end of P a g e

39 11 38 P a g e

40 Digital Maturity Index Bolton NHS Foundation Trust Section Type Score National Average Strategic Alignment Readiness Leadership Readiness Resourcing Readiness Governance Readiness Information Governance Readiness Records, Assessments & Plans Capabilities Transfers Of Care Capabilities Orders & Results Management Capabilities Medicines Management & Optimisation Capabilities Decision Support Capabilities 3 36 Remote & Assistive Care Capabilities Asset & Resource Optimisation Capabilities Standards Capabilities Enabling Infrastructure Enabling Infrastructure Readiness Average Readiness Capabilities Average Capabilities Enabling Infrastructure Average Enabling Infrastructure P a g e

41 Question National (Dataset) 5 Boroughs Partnership NHS Foundation Trust Bolton NHS Foundation Trust Bridgewater Community Healthcare NHS Foundation Trust Central Manchester University Hospitals NHS Foundation Trust Greater Manchester West Mental Health NHS Foundation Trust Manchester Mental Health and Social Care Trust Pennine Acute Hospitals NHS Trust Pennine Care NHS Foundation Trust Salford Royal Hospitals NHS Trust Stockport NHS Foundation Trust Tameside Hospital NHS Foundation Trust University Hospital Of South The Christie NHS Foundation Wrightington, Wigan and Manchester NHS Foundation Trust Leigh NHS Foundation Trust Trust Average Score Score Answer Score Answer Score Answer Score Answer Score Answer Score Answer Score Answer Score Answer Score Answer Score Answer Score Answer Score Answer Score Answer Score Answer Organisation Demographics Strategic Alignment 76% 70% 63% 85% 100% 100% 60% 90% 25% 100% 85% 75% 65% 70% 75% Leadership 77% 90% 100% 70% 100% 75% 80% 95% 20% 100% 90% 85% 75% 65% 80% Resourcing 66% 45% 45% 60% 95% 80% 50% 95% 35% 100% 75% 70% 60% 70% 70% Governance 74% 50% 90% 70% 100% 90% 90% 100% 30% 95% 80% 65% 45% 60% 70% Information Governance 73% 46% 96% 75% 96% 75% 83% 96% 67% 100% 79% 67% 67% 46% 50% Records, Assessments & Plans 44% 37% 16% 64% 58% 62% 56% 59% 20% 94% 60% 53% 40% 18% 32% Transfers Of Care 48% 15% 69% 53% 59% 61% 52% 100% 9% 100% 81% 87% 16% 13% 39% Orders & Results Management 55% 27% 57% 47% 92% 19% 42% 98% 12% 91% 86% 90% 52% 62% 55% Medicines Management & Optimisation 30% 6% 22% 43% 40% 5% 23% 75% 0% 79% 82% 24% 31% 14% 6% Decision Support 36% 11% 3% 61% 72% 47% 11% 31% 19% 83% 28% 58% 25% 17% 6% Remote & Assistive Care 32% 0% 33% 50% 42% 33% 17% 0% 75% 75% 33% 33% 25% 17% 42% Asset & Resource Optimisation 42% 10% 50% 0% 60% 30% 30% 45% 20% 80% 50% 45% 10% 20% 25% Standards 41% 42% 15% 58% 46% 29% 13% 67% 25% 58% 67% 50% 29% 87% 29% Enabling Infrastructure 68% 66% 39% 73% 80% 80% 61% 77% 66% 98% 100% 64% 45% 36% 73% 40 P a g e

42 12 - From Information to Intelligence Business Intelligence Strategy Gary Young

43 Introduction Vision Our aim is to enable decision-makers, in particular Executive Directors, clinicians and managers, to make better decisions by providing them with actionable information. In order to achieve this we need to transform our Information function from a department that produces reports into a Business Intelligence team which adds value to data. Decision-makers need to be able to find the information that they want quickly. This will be achieved through the delivery of self-service, personalised reporting, delivered directly to the desktop, whereby the user will be presented with the most useful and relevant information that they need to do their job whilst making it easy to find other information. There will be an emphasis on predictive reporting in order that action can be taken to resolve a potential problem before it happens rather than reacting after the event. We will deliver near real-time reporting in order to provide a current-state picture of the organisation and therefore facilitate early intervention as issues arise. We will extend the use of benchmarking to provide context to our performance, especially in relation to mortality reduction and other quality metrics. Reporting systems, however sophisticated, are only one part of the solution. Decision-makers also need access to experts who are able to interpret, evaluate and explain data trends and anomalies and provide recommendations for action. We will recruit and develop Business Intelligence Specialists who will provide these skills to Divisions as part of a multidisciplinary partnership which includes clinicians, managers and specialists form other functions (HR, Finance, Governance etc). "In my job I don't have time to go hunting for what I need. I have a link on my desktop that takes me straight to my Divisional dashboard which helps me focus on my key issues. My forecasts let me know if I have a potential problem coming-up so that I have time to do something about it. The live reports alert me in real-time as issues arise which enables me to take earlier corrective action. I don't know how we ever managed without this system." [Ed Honcho, Divisional Director of Operations] We want to be recognised as a centre of excellence for business intelligence, providing exemplary customer service and staff development, so that we can attract the brightest and best talent. Scope The scope of this strategy is limited to the delivery of management business intelligence to decision makers including Executive Directors, Divisional managers and clinicians. Wider considerations, such as the delivery of business intelligence to patients and the general public, are out of scope for this strategy but are addressed in the more wide-ranging Informatics Strategy: 5 Year Forward View This document should be considered a sub-strategy of the Informatics Strategy. Context The Greater Manchester Devolution Agreement, Healthier Together and closer co-operation between Trusts, commissioners and local authorities will require collaboration between all parties in order to facilitate improvements in the local health economy. This may require changes to working practices and information governance protocols and also the development of new methods of reporting as we transition to more pathway-based and outcomes-based models of care.

44 There will inevitably be initiatives to merge back office functions under the assumption that there are significant economies of scale to be made in doing so. Recent evidence from a similar initiative that led to the creation of the GM Commissioning Support Unit, suggests that very few, if any, benefits are likely to be realised through this approach. This strategy assumes therefore that business intelligence services will continue to be delivered by an in-house team in the medium term. Themes Adding Value to Data Self-service Reporting Decision-makers require access to reporting which is: Easy to find Timely Actionable The Trust has implemented a number of different reporting systems over the last few years and this has resulted in users having to look in a number of different places to find what they want. There is no single reporting system that adequately services all needs, each having its own characteristic strengths and weaknesses, and so a multi-system approach is inevitable. We will however reduce the number of systems and make it easier for users to find what they want through the development of a portal which will provide a single point of access (via a desktop icon) to reporting which is personalised to the user's requirements. Historically, most reporting has tended to be retrospective: what happened last month? We need to make data available more quickly, aiming for real-time reporting wherever possible, as this will facilitate early intervention as issues arise. Real-time reporting is not currently possible from our main patient administration systems, LE2 and Lorenzo, however we are able to obtain near real-time data from Extramed and plan to use this to develop reporting to help manage patient flows by combining current bed state with emergency department performance. "First thing each morning I check the refreshed dashboards looking for any issues. If I find something, I drill into the numbers to see if I can work-out what's going on and I speak to the service lead if necessary. I have a huddle meeting each morning with my DDO and her team at which I brief her on what I've found and tell her what I think needs to be done." [Anna Liszt, Business Intelligence Specialist] We intend to provide actionable information to decisionmakers, a key element of this being that reports are predictive so that action can be taken to address an issue before it occurs. We will help decision-makers to focus on the key issues by delivering well-presented, concise, contextualised reporting which fits on a single page or screen wherever possible. We need to make our data more easily accessible, but to do this in a controlled manner so that users get the right answer and we do not have to spend unnecessary time and effort in reconciliation of numbers. We will do this by creating intuitive drag-and-drop or filterable reports, delivered via our portal, which permit access to data without the need to go through a gate-keeper. This should have the effect of reducing simple ad hoc requests, freeing-up time for more useful activities.

45 Business Intelligence Specialists Each Division will have a dedicated Business Intelligence Specialist (similar to the Finance Business Partner role) who will co-ordinate the Divisional workload, supported by the central Business Intelligence team. Spending a significant proportion of their time embedded within their respective Division, the role of the Business Intelligence Specialist is to: Monitor and summarise operational issues Interpret and explain data and reporting Evaluate trends and anomalies Contextualise performance using national, local and peer benchmarks Model capacity and demand scenarios and provide forecasts Recommend appropriate actions The development of these roles is the key mechanism by which Business Intelligence will add value to data and hence transform the service from information to intelligence. Individuals who possess these transformative skills are indemand and come at a premium in the job market. Downward pressure on budgets means that we are likely to need to recruit people with potential and develop their capability inhouse as outlined in the Business Intelligence Skills Framework section below. Enablers We must free-up time to provide the space to develop our Business Intelligence Specialists and key to this is automation of routine reporting. We will undertake a review to identify processes which could either be made more efficient though automation, discontinued or replaced. Our ambition is to be in the top 10% of NHS hospitals as measured by risk adjusted mortality comparison. My reports show me exactly how we are performing compared to our peers and help me focusin on areas where we may be an outlier. This is really powerful information which I can use in my discussions with our consultants to drive improvement. [Dr Lancet, Medical Director] We have undertaken a review of our existing systems and have decided to standardise our processes using a reduced set of technologies. Data Warehouse The current Trust data warehouse is no longer fit-for-purpose and is being replaced by an in-house developed system, Minerva, built using SQL Server. SQL Server is an enterprise-class database platform which is used by most NHS organisations with the necessary skills being readily available in the job market. We have decided to develop a system in-house because of the greater flexibility this gives us and also because it significantly reduces the time and cost to add new functionality, such as bringing-in data from new systems. Integrated Performance Monitoring System The production of performance management reports, for example corporate and Divisional scorecards, is resource-intensive and often data is duplicated leading to the possibility of inconsistency between reports. We will develop an Integrated Performance Monitoring System (IPMS) to streamline the production of performance reports and to ensure that all share the same data: one version of the truth. Reporting Technologies