This paper aims to provide the Performance Committee with a summary of the IM&T activities and key issues for the directorate.

Transcription

1 IM&T Update for the Performance Committee November Introduction This paper aims to provide the Performance Committee with a summary of the IM&T activities and key issues for the directorate. 2. General The Outline Business Case (OBC) for the procurement of the Electronic Patient Record System was submitted to the IM&T Committee for approval. The OBC concluded that the Trust should not purchase a comprehensive EPR system due to the cost and the inherent risks associated with the option compared to the benefits. The recommendation was to procure a solution that could be delivered in a modular manner. Although this will mean it will take longer for the Trust to provide a full EPR it will make it more affordable and reduce the risks associated with a big bang approach. The IM&T Committee has asked for more details on the costs to keep and maintain the existing system and the cost of going to procurement before making a final decision. The IM&T Committee approved the next set of development priorities for Insight, the Trust s Business Intelligence system. These included Transformation and Trust Key Performance Indicators (KPI) Dashboard, a Nursing KPI dashboard, Service Level Costing and Theatres utilisation information. It also noted the tremendous impact Insight has had on the provision and accessibility of information for day to day operations as well for business planning and strategic decision making. The Trust manager s have cited this as the single most important development in the Trust to help them in carrying out their jobs. A proposal for a new system for recruitment management was approved as long as it can be funded from existing HR budgets. The risk of allowing staff to use un-encrypted UBS sticks was discussed. It was agreed that the current policy should be discussed at the next Executives meeting and changed as required. It was agreed by the IM&T Committee that the Trust would not fully implement the IG Toolkit requirements for Coder refresher training. In taking this stance it would mean that the Trust would not score as highly or even fail for this particular IG Toolkit requirement. 3. Information Governance The IG Steering Group met on 27 th September where the IG options appraisal document, presented to the IM&T Committee and approved by it, was discussed to develop a three year strategy to implement the IG Toolkit requirements. The IG Team are drafting a revised IG Strategy document along with a work plan which will outline the work required for this year. An Information Data Flow Mapping (DFM) exercise incorporating the new IG Toolkit requirements has been initiated. This will include identification and training for the Information Asset owners (IAO s), Information Asset Administrators (IAA s) and their respective staff required to complete the DFM. S. Patel, November 2010 Page 1 of 8

2 4. Information Management All external data submission deadlines have been met. The RNOH has been invited to take part in the Sense Check exercise for the proposed national tariff for next year (2011/12). The IM team have been involved in 2011/2012 Payment by Results (PbR) Tariff sense check and have also developed a tool for the Head of Coding to assist with benchmarking and modelling. A Theatre data quality report has been released on Insight for use by the Theatre staff to identify and correct incomplete theatre data. 5. Clinical Coding 11/12 PbR Tariff Sense Check Overall, the proposed 11/12 tariff results in an income reduction of approximately 1million. The majority of this ( 800k) is due to the reduction of the Specialised Service Top-Up for children from 78% of tariff value to 25%. The RNOH has worked with the Specialised Orthopaedic Alliance to agree a list of desirable modifications to the tariff arrangements. It was presented to the Department of Health Payment by Results Development Team on 9 th November. The Department of Health are aware of the problems for specialised Orthopaedic Trusts and appear to be receptive to suggestions for ways round the problem. However, it is difficult to suggest changes that will: a. Not contradict policy developments, such as the move to Best Practice Tariffs b. Not benefit general Trusts as much as specialised Orthopaedic Trusts c. Give sufficient benefit to ameliorate the losses already identified Table: Changes to inpatient income under Sense Check 11/12 tariff Team Spells in 09/10 S. Patel, November 2010 Page 2 of 8 Sum of income difference Sum of 10/11 IP tariff Sum of 11/12 IP tariff Foot & Ankle ,611 1,531,310 1,411,699 Medical and Rehabilitation , , ,624 Paediatric ,540 3,771,568 3,326,027 Pain Management , , ,107 Peripheral Nerve Injury ,058 2,333,681 1,819,624 Sarcoma and Joint 2470 Reconstruction - 296,109 10,351,413 10,055,304 Spinal Surgical ,611 2,529,056 2,513,446 Upper Limb ,133 3,146,117 3,288,250 Urology , , ,982 Total ,137,091 24,792,152 23,655,061 The figures in the table above are based on 2009/10 activity levels and do not include activity outside Payment by Results which is not affected by national tariff changes, such as: Sarcoma Spinal Cord Injuries

3 the value of ITU/ HDU days the RNOH Market Forces Factor of The overall loss is offset somewhat by a gain (plus 160k) in the income earned for Outpatient attendances. Specialised Orthopaedic Alliance Coding project The SOA wants to develop an information service that will allow the analysis and comparison of coded and costing data of all the SOA member Trusts. The RNOH has bid to run this project as it already has most of the skills and experience necessary and would benefit from the resources that the SOA will commit to this project. 6. Systems Update This section covers progress, upgrades and issues related to systems that are already operational. Highlight reports on new projects are provided separately. 6.1 Patient Administration System (PAS) ics The current servers for the system are the end of their life. Discussions have started with isoft, with whom we have the support and maintenance contract for the PAS to use virtualisation technology rather than physical severs as this is more cost effective, provides more flexibility, is easy to manage and more resilient and provide a low cost mechanism for disaster recovery London Sarcoma Service System (LSS) Work is progressing to enable UCLH clinicians to access the system from UCLH. The progress is slow primarily due the slow response from UCLH IT supplier. 6.3 Intranet (RNOH Web) Work has continued to extend the use of the Intranet: Three new departmental sites have been set up for Training, IT Support and Medical Devices Training. A survey tool to carry out audits has been delivered for the Anaesthetic team. Phase 2 of policies and procedures project to deliver workflow is almost complete and pilot will begin next month. A new Message Board functionality went live at the beginning of November. This has provided a quick and easy communications channel for staff to use for non business activities. This means that All Users functionality has been withdrawn generally and will be only be available via the Communications Department. 6.4 Electronic Imaging Systems - Radiology System (RIS), PACS & Electronic Requesting System (ICE) RIS A new electronic vetting facility has been implemented which will help to ensure that priority requests are highlighted even where the requesting clinician has not selected the correct location (the mechanism used within the system to filter high priority requests). All relevant staff will receive additional training to ensure that any MRI scan requested where the clinical information suggests that the patient has had a previous diagnosis of or has suspected cancer are highlighted as urgent. S. Patel, November 2010 Page 3 of 8

4 7. ICT The Service desk has been very active, completing almost 1600 user requests, whilst making progress on the following projects: PC Management Application (Zenworks) - has been deployed to over 750 desktops. This will provide the IT team with tools to more efficiently manage the roll out of new PCs, the deployment of new software and provide a more cost effective and secure remote access solution as well as automatically compiling a comprehensive software and hardware asset register. Microbiology System - Significant IT resource has been deployed to assist Barnet and Chase Farm to implement a new Microbiology System. Work is underway to resolve post implementation issues. New Service Desk System (Footprints) The implementation for this to manage service calls within the IT Department has been completed. The next phase, to interface with the Procurement Department to streamline all IT purchases has begun. Remote Access System work has begun to implement a new more cost effective remote access system to replace the BT solution currently used Process Improvements A new change control system has been established administered via a Change Advisory Board. This Board will approve all changes to infrastructure. The objective is to instil more professional approach to change management and therefore improve user experience by reducing downtime and change related problems. Service Improvements The team have been upgrading memory on existing PCs to a minimum of 1 GB. This will increase the life of a PC and therefore save on rolling replacement programme. All laptops have been recalled for security and system checks. Service Performance The service desk statistics are summarised below. Received September Closed Closed at first contact October Recieved Closed Closed at first contact* Currently Open Service Requests % % 71 Incidents % % 23 Total % % 94 The Trust currently faces challenges related to the Enterprise Wide Agreements established by Connecting for Health providing Trusts free access to Microsoft, Novell and Oracle software licenses. These agreements will not be renewed and Trusts will have to bear the costs of maintaining and purchasing these licenses in the future. The full cost impact will not be available until we receive confirmation of our free allocation. S. Patel, November 2010 Page 4 of 8

5 APPENDIX A Major Projects Highlight Reports As required, Clinical Safety Officers have been allocated to all clinical projects. However, the IM&T Committee has recommended that clinical safety officers should be allocated to all projects. Project: C-Scribe/C-Store Project Project Manager: Bela Haria Clinical Safety Officer: Andy Goldberg Digital Dictaphone Roll Out Interim outsourcing solution to manage transfer of outgoing and incoming files to/from transcription service is now being used by Soo Kelly. On average around 230 audio files a week are being outsourced about 5% of audios have more than one dictation in them Completed the roll out of Dictaphones to the clinical units. The focus now is on refresher training to ensure that the correct processes are being followed, as well as the assigning of new dictaphones to the new Registrars and SHOs. C-Scribe and C-Store Roll out A fix has been completed to address the issue of C-Scribe crashing and is currently being tested by the project team and by one pilot user to ensure that the solution is robust enough to be rolled out. Completion of training and roll out of Dictaphones to new registrars Recruitment of additional resource Roll out C-Scribe the final solution 1. Poor IT skills amongst secretaries has made the Dictaphone roll out and Pilot roll out of C- Scribe especially challenging Further investment is required in resource to provide extensive support (especially floor walking) and training people in basic IT Skills. Saroj Patel to speak to Jackie Stephen about the possibility of basic IT training or having comprehensive training documentation produced. Project: Corporate Document Library (Phase 2) Project Manager: Jackie Stephen Clinical Safety Officer: Not applicable Reviewed new workflows and tested recent developments Made further recommendations to enhance the workflow which we appreciate will cause the project to slip but we believe it is important that the process is appropriate and robust Delivery of further development from the suppliers Further testing of the process flow 1. That the developments cannot be delivered as required due to technical constraints Close liaison with the developers to ensure effective communication and understanding of requirements S. Patel, November 2010 Page 5 of 8

6 Project: RNOH Insight Project Manager: Bela Haria Clinical Safety Officer: Not applicable Data Warehouse ICS PAS Data has been transferred into the LIVE DATA Warehouse following many months of detailed data validation and we have signed off the Data RIS data load is 60% completed Insight Reporting Key Reports that are reliant on PAS data for the following Phase 1 work streams have been completed Operational Work stream PBR Clinical Coding Executive Information Clinician Work stream Data Quality CW will discuss the on going monitoring process at the next DQ meeting Draft Patient Level Costing/Service Line Reports have been created as part of Phase 2 and have been published on the Insight Portal Detailed data validation of the RadCentre Data load Decision on which feeds to include as part of Phase 2 and beyond Delivery of Prioritised list of Reports 1. Issues with the way data has been extracted and loaded from RadCentre into the Data warehouse continue to arise and has led to the delay in the overall completion of the RadCentre Feed The supplier is investigating these data issues. The RadCentre feed delivery plan has had to be adjusted to reflect this slippage and close monitoring will be necessary to ensure this delivery now remains on track Project: Electronic Requesting for TCIs Project Manager: Gill Coghlan Clinical Safety Officer: Gill Coghlan Mr Skinner has been pilot testing for 4 weeks with no issues Shoulder unit local procedure codes have been uploaded to ICE. The process flows for pre admission have been finalised and all pre admission staff and relevant centralised booking staff have been trained Arrange training for pilot clinicians Commence shoulder unit pilot testing by end of October Commence review of theatre codes by foot and ankle and pain unit 1. Delay in completing the system configuration for the two pilot testers 2. The planned local procedure codes have been changed twice and new codes have had to be imported manually into the ICE 3. Unable to include a second pilot tester due to delay on configuring the local procedure codes Communicate with clinicians to set up meetings and training and then escalate if further issues arise Establish and sign off a final version before uploading the codes to ICE Ensure that the codes are agreed and signed off S. Patel, November 2010 Page 6 of 8

7 Project: PAS Discharge Summaries Project Manager: Colin Waller Clinical Safety Officer: John Skinner/Russell Hawkins Pilot with 4 SHOs completed Training has been given to 6 of the new cohort of SHOs who had not previously at the Trust. Others had previously had ics training and were not booked to attend the normal ics Training. Training will be provided separately to those who haven t attended or been asked to attend The feedback and suggested changes from the pilot have been put to the PAS supplier and they have agreed to make some changes Establish standard phrase requirements from the SHOs Delivery of the functionality to allow and faxing of discharge summaries via NHS Mail A process to upload changes to the drugs database. This is still under discussion and awaits engagement from the Pharmacy system supplier Integration with Clinical Documentation Library Upload of GP Surgery and fax numbers (that have been obtained) 1. Lack of Project Management resource availability More time is being allocated to this project to ensure that the CQUIN targets are met. 2. Integration with Clinical Documentation Library in the document format required and the naming A different solution for this has been proposed and is being progressed convention for the file 3. Non availability of NHS Mail addresses for GP A list is being collated for upload but this covers only a Surgeries 4. Lack of PC equipment on the Wards has been identified as a possible issue small percentage of GPs across the country. Some feedback was provided but nothing about specific areas other than the Coleman Unit where one additional PC was provided (Computer on Wheels) 5. Lack of engagement by SHOs Has been raised at Clinical Governance. The actions were to contact John Skinner and the Senior Surgical Officer to get SHO engagement as the Consultant body has signed up to both the CQUIN and the improvement to the Discharge Summary Project: Electronic Requesting for Orthotics and Therapies Project Manager: Gill Coghlan Clinical Safety Officer: Gill Coghlan Configuration of ICE approved by Therapy Admin Manager. Configuration of ICE in Live for physiotherapy is complete with some minor changes to the original requirement Agreed that a pilot for the requesting process will commence in December before department goes live with etherapies. Arrange a review meeting with Orthotics staff to plan pilot and roll out. Arrange a meeting with Dr Cohen to arrange start of Therapies pilot in December To improve workflows the possibility of an interface between ICE and etherapies is being investigated. A quote for an interface from ICE has been requested. Arrange pilot testing for Physiotherapy requesting Project: Electronic Requesting for Image Import to and Export from PACS S. Patel, November 2010 Page 7 of 8

8 Project Manager: Gill Coghlan Clinical Safety Officer: Gill Coghlan LIVE ICE environment has been configured with request for import and export of PACS images. Training for medical records staff has been complete Sarcoma staff have been trained and commenced pilot testing. Pilot testing has not raised any major issues for either the Sarcoma unit or medical records Joint reconstruction and foot and ankle are now using ICE for image transfer requests. Paediatric pain and 50% of the spinal rehab and spinal surgery department have been trained to use ICE Extend the roll out to PNI and Spinal Consultant s secretaries. Plan the withdrawal of paper requests 1. Some surgeons do not accept a referral until they receive imaging. This makes it impossible to match the imported image to an RNOH record until the patient is registered. 1. Pressures from other projects and the management of other applications has made it difficult to arrange times for training. A meeting will be arranged to discuss possible workflows with individual consultants Endeavour to work around other project priorities to enable the deadlines to be met S. Patel, November 2010 Page 8 of 8