Service Transformation through new technology: Yorkshire Imaging Collaborative Update

Transcription

1 Service Transformation through new technology: Yorkshire Imaging Collaborative Update Dr Nicholas Spencer, Consultant Radiologist, Mid Yorkshire Hospitals NHS Trust Clinical Lead, YIC Digital Imaging, Manchester, July 12 th.

2 Looking Back Pre-PACS Piles of Films Waiting Lists for CT and MRI 3-6 months Proprietary Workstations for CT and MRI Teleradiology and Report into RIS ISDN Return to work for emergencies and weeks on call, 1 in 4 PACS Transition Massive culture change, unifying force in multisite Trust

3 Present Cultures and Challenges PACS everywhere Teleradiology and Outsourcing Capacity Pressures Need for immediate imaging and reports Various amounts of utilisation of radiographer reporting Order Comms, EPR and MDT s for communication

4 Solutions System Change/New Ways of Working STP s Shared Services between institutions 7 day services Multi-professional Workforce Technological Innovations AI, CAD Performance Management (GIRFT and NHSI)

5 What might the future look like? Fewer boundaries System inter-operability Imaging provided in hospitals and in communities Care record joined up between primary and hospital sectors, with imaging integrated Patient will manage, access and control their own data

6 YIC Purpose Multi-factorial, from PACS re-procurement & financial savings, through to service transformation and image sharing Drive for delivery Conceived during national PACS programme exit planning (Regional PACS Strategy Group), supported by Y&TH throughout and then hosted by HSCIC in later stages Limitations in current solutions, Challenges of Image Transfer/Sharing

7 Originally 9 member trusts Barnsley FT left post-procurement Expansion will be provisioned in model 7

8 YIC mission statement Provide a proven, affordable enterprise imaging management solution for the Yorkshire and Humber region, which as a minimum replaces existing radiology PACS and which may also include RIS and/or other imaging solutions. The solution will enable the transformation of service delivery - enhancing care and the patient experience. o Deliver a best value strategic imaging solution o Enable service transformation o Improve patient experience

9 YIC Team Programme Manager NHS Supply Chain (Local base in East Leeds) PACS Manager lead Clinical lead All accountable to Programme Board

10 YIC Programme Board All Trusts represented, with quoracy rules articulated Multi-professional; Clinical (radiologists, radiographers, PACS team), Service Managers and Clinical Directors IT, technical, management and Executive Supplies, including procurement experts Project managers

11 YIC Initial Project Vision Build an Outcome Requirements Document for use by NHSSC, who will invite Suppliers ( On Framework ) to Express an Interest in bidding for this award; deliver initial shortlist Construct an OBS fit for Purpose to capture current and future needs of an imaging solution, both for archive and display, as well as to facilitate improved care, seamless pathways, and other service transformation. Use this to select a suitable provider Deliver the solution across the Collaborative, minimising BAU disruption, and embed the transformation objective

12 YIC Procurement 1 Phase 1 completed by December 2015 Phase 2 completed, under budget, at end of March suppliers bid against Outcome Requirements Document with high level Questions 7 shortlisted Incumbent Supplier Dialogue throughout, due to variations in current contract structure, Infrastructure and Application risks in member organisations

13 YIC Procurement 2 Shortlisted Supplier Event on April/16 System Demonstrations, and Structured Supplier Presentations with Q&A New revised Budget to manage project Progressed into extensive and detailed solution development with single supplier Contract Negotiations, Single template, extensive review and evolution Supplier contract with each Individual Organisation Standard Menu Pricing

14 YIC Procurement 3 Trusts developed their business cases individually supported by the programme management. Open Discussions between DoF s Oversight of WYAAT Feeding into STP during its development Management of relationships and contact between organisations and supplier Commencement of Implementation planning and Transformation design and proposals

15 YIC Implementation Phased over 2 years, Planning between Trusts and Supplier, with YIC Programme Team support Baseline position Data Volumes Infrastructures Need for Inter-operability Complexity analysis Implementation

16 YIC Transformation Challenge in some areas Some sub-speciality teams aware and up for it Trainee experience Contractual arrangements ON CALL arrangements Peer to peer support and challenge Scanning technique, and equipment differences How can we transact?

17 Review Established in Sep 2015 & formal Programme in Dec 2015 Objectives o Enable service transformation o Improved patient experience o Best value strategic imaging solution Joint procurement of an enterprise imaging solution for 9 Trusts Three work streams 1 Procurement 2 3 Implementation Transformation Focus shifting from technology to transformation 17

18 1 2 3 Procurement Implementation Transformation Procurement Implementation Transformation Status Replace post-cfh contracts and enable transformation with a unified solution Average 23% saving in support charges totalling 730k per annum 5 full business cases approved 2 contract signed (+ 3 close to signature) Progressing to Implementation Implementation started NLGHFT started Jan 2017 Implementation programme being re-planned due to business case delays Agree revised plan - Apr 2017 Progress sharing architecture options assessment - May

19 1 2 3 Procurement Implementation Transformation Status 2 Transformation Team established Benefits plan developed WYAAT Chief Executives direction Review full spectrum of opportunities from collaborative arrangements through shared service venture Phase/scale from easier to harder Six Transformation Opportunities identified 1. Supporting MDTs 2. Capacity Optimisation 3. Supporting Patient Flow 4. Developing a Flexible Workforce 5. Improving the Supporting Infrastructure 6. Organisational Benefits High-level analysis completed to establish foundations of Case for Change Detailed analysis service-by-service in progress 19

20 1 2 3 Procurement Implementation Transformation Transformation Aims Sharing workforce and achieving economies of scale Standardising protocols and pathways to reduce variation Improving communication and working relationships across the region to benefit patient care Defining the future workforce of where the gaps lie regionally (workforce planning) Improving recruitment and retention in the region by offering high quality services, a strong culture of teamwork and innovative development opportunities Sharing learning to trigger continuous improvement and innovation in the region 20

21 1 2 3 Procurement Implementation Transformation Working Principles 1. Equality and inclusivity of all Trusts 2. Clinically led 3. Collaborative decision making 4. Mutual respect and trust 5. Transparent, inclusive and constructive communications 6. Work with and to learn from others and share good practice, including Cancer Alliance 7. Compromise for the greater good of the Collaborative 8. Make the best use of resources 9. Collaboration outcomes will deliver value for money 21

22 Whole Value Chain Right Request managing and optimising demand using clinical decision support Right Acquisition improved equipment utilisation Right Report efficient use of reporter resources Right Collaboration efficient, virtual working across all resources Right Environment pathway management 22

23 1 2 3 Procurement Implementation Transformation Clinical Model Options 1. Status Quo Maintain the status quo with Member Trusts delivering services independently 2. Collaborative Working All or some Member Trusts delivering services with standardisation of working practices and collaboration across. No additional technology enabler needed 3. Collaborative Working Tech-enabled As for 2. but images and information shared across Member Trusts for more responsive clinical decision making and capacity planning. Additional enabling technology needed. 4. Clustered Services All or some Member Trusts grouped into clusters, with each cluster operating as a single service for that patch. Additional enabling technology needed. 5. Rationalised Services Services rationalised service-by-service across all or some Member Trusts. Additional enabling technology needed. 6. Single Y-IC Service One service for the region. Additional enabling technology needed. 7. Hybrid Hybrid of any of the above. Additional enabling technology needed. 23

24 1 2 3 Procurement Implementation Transformation Supporting Technical Options 1. Independent technology solutions Each Trust maintains independent technology, supported by Enterprise Imaging and Xero platforms for shared access 2. Independent technology solutions with shared reporting workflow Each Trust maintains independent technology, supported by Enterprise Imaging and Xero with shared workflow solution to enable visibility and response to reporting requests and backlogs 3. Independent technology solutions with shared reporting workflow and Vendor Neutral Archive (VNA) As 2. above but with a shared medical imaging and document archive that can be accessed by all Trusts 4. Clustered technology solutions Each Trust in a cluster sharing a single technology, supported by Enterprise Imaging and Xero platforms for shared access 5. Clustered technology solutions with VNA As 4. above but with a shared imaging and document archive that can be accessed by all Trusts in the cluster. 6. Single Instance Solution All Trusts use a single Radiology Information System enabling workflow management, supported by a single shared workflow solution to link and share images and reporting requests and reports providing full visibility and management of the demand and capacity for reporting radiology across the region. 24

25 Summary Procurement complete with savings in annual support for all Trusts Implementation in progress, but delays from business cases approvals There is a clear benefit to collaboration to address current and impending constraints Phased approach starting with a collaborative model, building on Procurement Robust options appraisal in progress with detailed data Not all data requested has been received and further data may be needed Costs, benefits, dis-benefits and risks to be updated Consideration to be given to explore full service transformation beyond scope of Radiologists working Other Value Chain opportunities; e.g. efficient use of scanners, pathway redesign Consolidation of imaging archives 25

26 THANK YOU Vision and Big Tent Team YIC remains engaged across multiple STP footprints WYAAT and Working Together Project Phasing and where we are now? Next steps Any Questions?