The Safer Hospitals, Safer Wards Technology Fund Expression of Interest

Transcription

1 The Safer Hospitals, Safer Wards Technology Fund Expression of Interest Applicant Name Applicant Address Is this a joint application? Project Title Key Project Contact Details Project Aim & Description Wrightington, Wigan and Leigh NHS Foundation Trust Wrightington, Wigan and Leigh NHS Foundation Trust Buckingham Row Brick Kiln Lane, Wigan WN1 1XX No Paper Lite Name: Chris Hudsmith (Project Manager) Tel No: Address: Buckingham Row, Brick Kiln Lane, Wigan, WN11XX. Chris.Hudsmith@wwl.nhs.uk Provide a description of your project. Explain what you are seeking to achieve and the expected benefits for patients, clinicians and efficiency (400 words maximum statement) The Paper Lite project will see the entire Outpatients process, including Inpatient cross over managed by digitised data means (applying 80/20 rule for complete paper less). The intention is to implement a technical solution which supports and enhances the working lives of all clinical staff supporting outpatients. The 3 key aspects of the project are: Electronic Medical Document Management: How the system can manage the casenote and other clinical documents, so they can be accessed from a single place, quicker and easier than the paper casenote. Referrals: How clinicians can access and action their referrals electronically, including being notified of new referrals and being able to access the letters on a computer in clinic, Diagnostic reports: How clinicians could access all of their diagnostic reports electronically, including being made aware when new reports are available and being able to sign them off electronically, The Projects key objectives are: 1. Deliver a solution or set of solutions that have a positive impact on patient care, measured in terms of quality and cost; 2. Engage with appropriate stakeholders to define a comprehensive set of functional and non functional requirements; 3. Assess all Pilots existing systems (including local databases and spreadsheets) which do not currently feed into the patient Electronic Patient Record and make their outputs available in the patient

2 record; 4. Deliver print to file integration between the disparate systems used as part of an Outpatient care episode, providing a single Outpatient clinical repository; 5. Digitize all incoming referrals, whether they be received via post, fax, or Choose and Book (CAB) and provide the means to attach these to the patient record in a logical and accessible manner; 6. Deliver functionality so that referrals and diagnostic sign off can be managed electronically via workflow in an efficient and auditable manner without the need for printing and filing; 7. Develop appropriate system and business processes so that digitized Outpatient information is available to clinicians; 8. Develop a solution which can be scaled and expanded to Inpatients; 9. Deliver a solution which meets all patient safety and information governance requirements; 10. Every step taken towards becoming a paper less care provider delivers benefits for both patients and clinicians; the following benefits are by no means exhaustive but give a real feeling of the impact of the project if delivered successfully. Figure 1: Project Benefits Digital/Paperless Roadmap Provide organisation s roadmap to move from paper to paper light to paperless. This should include an indication of the progression that an award of funding would make in terms of scope, scale or speed. (400 words maximum statement) The Paper Lite Project is supported by a wider Strategic Vision which aims for the trust to be Paperless (applying an 80/20 rule) by 2017/2018. The following timescales below give an indicative view of the roll out plan and implementation of the various work streams which support this overarching

3 vision. If successful with this bid for NHS England Funding, the benefits and opportunities would be experientially increased, these include the following tangible measure: 1. Accelerating timescales, i.e e referrals and mobile devices piloted within 2013/14; 2. Seamless Transfer to digital Clinics (by providing the technological solutions); 3. Provide a foundation and system for ALL future paper less and e solutions across the organisation (both clinical and corporate), the benefits of this will be continued to be realise well beyond 2018 and almost indefinitely if the systems is utilised to its full capability; 4. Opportunities for collaboration and shared service; 5. Flag ship project to showcase opportunities and lessons learnt for all other Trust aiming to go paper lite/less, for example Change management strategy and digitised casenote structure and indexation. Project Delivery Approach Provide an outline of the intended approach for delivering the project, confirming if the project is currently in flight (400 word maximum statement) A proposed solution for the Paper Lite project (digitally integrating referrals, diagnostics and outpatients) has been developed and the Paper Lite project is in Flight. With the support of NHS England this approach will allow a much more holistic solution, in that it tackles root causes (i.e the paper based case note) and is scalable to support the wider Trust in becoming Paper Lite and eventually Paper Less in the future. In terms of the process, referrals will either be received electronically or will

4 be scanned (the intention is to minimise where possible the amount of paper referrals received). It is also the intention of the project to include internal referrals. The referral will pass through acceptance and triage processes electronically and will allow for forwarding on or rejection as normal. When the clinician sees the patient, the referral will be available to view in electronic format. Additional information will be captured in clinic by electronic means including dictation, tablets, hand held devices, drawing packages etc. Through the Paper Lite project the acknowledgement and sign off of results will also be electronic, so results will be available to view in follow up clinics. Pi lots and Roll Out The pilots to support delivery and consolidation of the projects have been agreed by the Delivery Group and Senior Stakeholders, these include Gynaecology, and Ophthalmology. The approach will see the 2 pilots work in partnership with one another to design and align business processes, workflows and standardisation of letters and forms, that are future proof and scalable for the roll out of a Trust wide solution. The first of the pilots (Gynaecology) would go live by the end of January Each Pilot will be evaluated prior to the withdrawing of casenotes from clinics and following the final go live of Opthamology. By the end of March 2014 a comprehensive evaluation of the project will be undertaken to make recommendations for roll out. Current Project Status Comprehensive Governance arrangements in place and initial project resources in place; As Is Processes and Business Profiles documented and analysed; Supplier Demo s seen by over 50 clinicians, nurses, managers, secretaries and administration staff; Specification and Business requirements documented; Procurement process underway; To Be Design workshops, including digital casenote structure in place. Sourcing Strategy Provide an outline of the sourcing strategy and suppliers involved (if known) and the likely procurement approach and timescales. (400 word maximum statement) Supporting the findings of a number of site visits we have also held a series of internal demonstrations, which have been formally evaluated by Clinician, business managers, secretaries and other administration staff, these include: 1. PCTI (Docman) Primarily a referrals management solution, but with options to extend to managing other document types. Downside is the limited customisation of the case note view and the need to index every document;

5 2. Ascribe A good document management solution with an excellent range of document import options. Also has intelligent recognition which eases the burden of indexing at the point of capture. Downsides are that it has little ability to manage a composite case note timeline view; 3. Kainos A document management solution with intelligent recognition at import. Downside is the poor case note presentation and the product comes at a premium cost; 4. Hylands Software (Onbase) A good document management solution with a focus on case note management. Good presentation options. Good integration with EPR (Allscripts). Good range of import options and interfaces. 5. C cube A proven case note management solution implemented in a number of NHS Trusts. Flexible user interface and intelligent recognition of key documents which helps overcome problems of misfiles in legacy case notes. Good search facility within the case note. 6. Other A number of other demonstrations have been delivered which offer supporting technologies ie Dell, Samsun and Livescribe (Mobile Devices). The Trust is currently in the middle of two tender processes; one, using the CITHS Cabinet Office OJEU compliant framework, to purchase an integrated Health Information System, with potential providers in final stages of the evaluation process and the second looking to purchase a Electronic Medical Document Management solution from another existing framework. This approach will provide the trust with the flexibility to purchase the most appropriate solution which meets the business requirements but delivers greatest value for money and maximum return on investment. With both procurement processes at an advanced stage, i.e site visit evaluation stage, we would be looking to award contract by the end of October 13. However with this funding stream potentially available, we would delay any decision until any outcome of this bid is made, as if successful it will undoubtedly offer the trust a great opportunity in implementing not only a fit for purpose but future proof solution which would be scalable to suit the long term aspirations of a paperless organisation. Supplier Partner Capability Assessment Provide details on any delivery capability and capacity assessment that has been made regarding the envisaged supplier partner(s) involved (400 words maximum statement) The project and business team, including senior clinicians and business managers have already made a number of site visits to the following organisations to ascertain approach, lessons learnt and the suppliers capability/capacity including: 1. Aintree significant cost savings after closing their medical library following delivery of the C Cube document management system;

6 2. Preston part way through delivery of the Kainos Evolve solution, now ceased delivery of case notes to 20% of clinics; 3. Kings College successfully delivered Docman referral management system leading to reduction in referral receipt to appointment booking time; 4. Salford progressing with Hylands Electronic Document Management System; 5. Liverpool Heart and Chest Live with Hylands Electronic Document Management System. Lessons learnt were collated, that were typical of each of the projects, these included: 1. Clinician buy in from the start and clinicians seen to be leading the project; 2. Implement a well proven EDMS, which can present the patient record back to the clinician in a way that is better to navigate as the paper record; 3. Scan on demand to reduce the clinical risk of not providing case notes to clinics, get acceptance from the clinicians and deliver cash releasing benefits quicker; 4. Centralise or outsource your scanning operation (whether that is back scanning, scan on demand, day forward) to ensure that quality can be managed appropriately; 5. Scan in inpatient documentation which is created on the back of an initial outpatient clinic appointment rather than trying to work around the cross over; 6. Invest in hardware in clinic rooms so clinicians can see multiple documents/systems at one time. The above data gathering and lessons learned exercise has informed the organisation and the key stakeholders into understanding what is required in terms of system delivering to support paper less care provision. The following requirements have been provided via a User Group Workshop held on Friday 19 th July: 1. To provide a digitised version of the case note that is accessible and structure; 2. Standardise and manage the end to end Referral process, including reducing the timescales from receipt of referral to appointment booking; 3. To prioritise urgent results or abnormal results in the clinicians review queue; 4. To sign off diagnostic reports which have been received; 5. To provide work flow to clinician which enables proactive reporting of a patient s status and alerts clinician s regarding next steps; 6. Improve Patient and GP experience. NHS VistA Solution Confirm your interest in being involved in the development and adoption within your organisation of an NHS Open Source IDCR, NHS VistA, that

7 would provide a core platform for digital care records. (YES/NO) Would like to learn more. We wouldn t opt out at this stage but it would need to fit with our current procurement? Strategic Alignment Describe the fit of the project with the organisation s information and IT strategy and the current level of infrastructure and capability (400 words maximum statement) Following the comprehensive spending review of 2010, the NHS is committed to 20billion of annual efficiency savings per annum until While meeting its obligations as part of this national requirement will obviously be a major challenge for the Trust, the efficiencies which it must deliver are acting as an important driver for the Trust to be bold in terms of its future plans for delivering patient care. The Trust must deliver more for less and it is now widely accepted that it will not be able to do this if it maintains a heavily paper based clinical record system. This has led to a number of strategic projects and initiatives which aim to move various clinical processes away from paper and into integrated electronic systems. Reducing the reliance on paper is now a high priority, as outlined in the five year IM&T Strategy There are various technology enabled changes currently being implemented in a number of clinical settings which will significantly reduce the requirement for clinical staff to use paper. These include new IT systems be implemented in Pathology, Intensive Care, Coronary Care and Endoscopy, while a new Health Information System (HIS) is currently being procured to manage Emergency Care attendances, patient administration and prescribing. These initiatives will not deliver a true paperlite environment on their own therefore this has led to the Trust funding a dedicated project to drive the move to becoming paper lite across the organisation. The power of information strategy challenges GPs and organisations to provide patients and carers access to paperless records and share all data with all health care professionals by This project aims to integrate where with GP s systems and process to allow transparent and efficient 2 way paperless communications. To deliver the structural and cultural changes that the organisation requires to achieve sustainable and long lasting benefits for patient care, effective technologies, a paperless shared patient record are sort to support this critical and complex change management project. This investment will enable us to deliver the programme and realise the sustained benefits we aspire to for our patients and clinicians. Improving quality, safety and efficiency as we help patient choose and engage in their

8 care, smooth the flow of the patient through care settings. Aiding health professionals to make informed clinical decisions to provide the best care in the right place at the right time. Total Project Cost Please state the total cost of the project ( k) Electronic Document Management - Year 1 Software & Licenses 421, Hardware and User Interface 10, Interfaces 10, Consultancy (Provider) 120, Implementation (WWL) 310, Maintenance 94, Total 967, Costs over 5 years Year 1 - EDRM & 1st Year 967, Maintenance - Years 2 to 5 379, Implementation (WWL) - Years 2 to 4 296, Total 1,643, All Costs are Exclusive of VAT Total Amount of Funding Requested Please state the total amount of capital funding requested in this application ( k) Funding is sort from NHS England to support the implementation of a Document Management System, including the first year maintenance cost. All other annual maintenance and support costs will be met by WWL Trust. The total amount is 483,887 Financial Breakdown Provide a breakdown of total project costs by year, the profile of the costs split by capital/revenue. This should include the amount of capital sought from the fund per year and the amount of funding provided by the organisation (capital and revenue). Please indicate any known tolerances in the costs and funding model. Include any other funds that have been applied for (or are required for the project s viability) and the status of this funding. Total 2013/ / / / /18 Estimate Capital 483, , , , ,172 Revenue 75,944 75,944 75,944 75,944

9 NHS England (Capital sort) 483, ,887 Total 967, , , , ,116 75,944 All Costs are Exclusive of VAT Other costs that have not been included are costs for Live Scanning and Scan on Demand, these figures have not been included as the options are still to be quantified and will vary considerably. The values of scanning will also vary across each clinical area. Given this all cost incurred from scanning will be secured by WWL NHS Trust. Funding has been secured from the Capital Programme for the amount in the above table. With a significant amount of work already undertaken and successfully completed i.e requirements gathering, processes analysis, specification design, proof of concept implementation (digital pens and mobile tablets) 86,216 has been spent. A contingency budget of 20% has also been secured. Delivery in FY13/14 Details Please state if your project will begin to deliver and incur capital spend from the fund by March 2014: Yes, WWL NHS Trust would look to sign contract by November 2013 (YES/NO) Is this a multiple application? Please indicate if your organisation has made multiple applications to the fund and please rank your applications in priority order, (1st, 2nd, 3rd etc). This priority ranking may be considered if the fund is oversubscribed. Yes, this bid is part of a number of bids from WWL NHS Trust, they are prioritised as: 1. Health Information System 2. Paper Lite 3. Virtualisation 4. Medicines in A&E 5. Tracking System Medical Director Contact Details Name: Dr Umesh Prabhu Tel No: ( ) Umesh.Prabhu@wwl.nhs.uk

10 Finance Director Contact Details Name: Robert Forster Tel No: ( ) Director of Nursing Contact Details Name: Pauline Jones Tel No: ( ) Director of IT/ Informatics Contact Details (or equivalent) Chief Executive Contact Details Name: Stephen Dobson Tel No: ( ) Name: Andrew Foster Tel No: ( ) Chair of the Board Contact Details Name: Les Higgins (Non-Executive Director) Tel No: ( ) Date