Ensuring Wise Technology Investments on the Journey to a Paperless National Health ServiceOctober 2013

Abstract Health Secretary Jeremy Hunt has called for a paperless National Health Service (NHS) by 2018. To achieve that state, local NHS trusts should act now to reduce their use of paper and improve the gathering and use of electronic data. Before embarking on technology upgrades or purchases, however,

the organisations should conduct a full assessment of current paper and digital application use and rationalise and optimise their processes. Only then can they accurately identify their need for technology investment. In this white paper, the author lays out a step-by-step-plan for this process.

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Introduction......................................................................................................................................3

A step-by-step plan for assessment, rationalisation and optimisation ............................... 4

Step One: Assess current state, people and process ............................................................. 4

Step Two: Assess current state, technology and tools........................................................... 4

Step Three: Define a clear, systematic action plan ................................................................. 4

Step Four: Rationalise and optimise current processes and applications...........................5

Step Five: Realise the full potential of current assets ..............................................................5

Step Six: Assess the need for investment ...................................................................................5

Summary ...........................................................................................................................................5

Table of contents

Written by:

Mary Cooper RGN MBA

Professional Services Practice Leader

Dell

Karen Branz

Healthcare Services Writer/Editor

Dell

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To achieve a paperless state, NHS trusts must understand and optimise current processes to make the most of their IT investments.

National Health Service vision: Paperless by 2018At the start of 2013, Health Secretary Jeremy Hunt set out a vision for a paperless NHS by 2018. Through better use of technology, Hunt believes NHS will be able to improve the patient experience and ensure that accurate, up-to-date information is available at the point of care.

Hunt identified key objectives for achieving this vision:

• By March 2015, everyone who wishes will have online access to their health records currently held by their general practitioner (GP).

• Universal adoption of email GP referrals instead of paper letters when referring a patient to hospital.

• Clear plans to enable secure linking of electronic health and care records — wherever they are held — to create as complete a record as possible.

• Clear plans for those records to be accessible at any point in the health and social care arena where patients have given consent.

• By April 2018, digital information to be fully available across NHS and social care services, barring any individual opt-outs.

Those who work in or closely with the NHS are aware of the challenges that the NHS will face in achieving the

last of these objectives. Furthermore, the health secretary does not seek to define “paperless” in an NHS context or prescribe the process of how the vision can be achieved. This lack of specificity presents an opportunity for NHS organisations to think innovatively and use the goal of paperless operations to drive process change, underpinned by the necessary technologies and policies.

The need for immediate IT investment appears to be pressing when you consider both the paperless directive and the Caldicott 2 report on patient information sharing and security published in April 2013. However, with minimal technology investments, it is possible for NHS organisations to make significant progress toward achieving paperless ways of working over a five-year period. By rationalising and optimising existing systems, a trust can create an organisation that is not only predominantly paperless but also agile in its ability to engage staff, treat patients and integrate across the health economy.

This process will also allow the trust to extract the full potential of the organisation’s current technology assets, and give the organisation the time and information necessary to make critical investment decisions wisely. It will also ensure that the move toward a paperless and agile organisation is carefully managed and engages all stakeholders.

Assess, rationalise and optimise paper and digital systems

before making technology investments.

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A step-by-step plan for assessment, rationalisation and optimisation NHS-wide programmes, such as Transforming Community Services, have changed the shape of many NHS trusts. Because of this, all trust constituents must agree on an appropriate process for becoming paperless and agile.

Furthermore, the organisation must not conduct the initiative without involving other key stakeholders in the health economy if there is to be any chance of providing information across health and social care.

Finally, a step-by-step process of assessment, rationalisation and optimisation of paper processes and digital applications will allow the trust to clearly identify where technology investments will offer the most benefit for the funds expended.

Step One: Assess current state, people and processDo not underestimate the need to fully explore the current state. First, focus on the people and process components of the ”as-is”. The outcome needs to ensure that the trust is aware of how paper is used, how data is captured on paper forms and the interactions between paper and the patient pathway.

Identify representative clinical services and follow the patient journey through them to ensure the assessment process covers significant portions of trust operations.

To be effective, the assessment will need to provide a full understanding of the patient paper supply chain, the current policies and procedures that exist for paper use and a detailed taxonomy of paper forms. Conducting these activities will identify areas of data and effort duplication that the trust can swiftly act upon.

Step Two: Assess current state, technology and tools To use the full potential of available technical capacity the trust must identify

what and how electronic data and information is being captured. This is especially pertinent if the organisation has recently been through a merger.

First, create a definitive inventory of all custom off-the-shelf applications (COTS) and bespoke applications. Conducting an audit like this does not have to be hard: automated tools that harvest licence details and usage information over time are available, and IT departments should already have lists of installed assets. If these are not available, or are not up-to-date, then getting this insight now is a priority.

Once the organisation has inventoried the applications, it can create a detailed electronic data taxonomy and map the results to the paper forms taxonomy, highlighting duplication and latent capacity for data items.

Concurrently, the organisation should also identify all electronic interfaces in use and where, for example, there is dormant HL7 capability. This analysis will highlight where electronic messaging can replace paper-based messaging, further reducing duplication and increasing efficiency.

The organisation should also assess current printing practices and current printing infrastructure, including management of stock and storage.

Step Three: Define a clear, systematic action planOnce the current state is fully assessed and analysed, the organisation will be ready to define the journey toward a paperless state.

At this point the trust can create a baseline of the benefits of moving toward a paperless state and define what needs to be done to create an appropriate future state that uses the full potential of current assets.

The plan should include improvements to be made, costs and the timescale needed to reach future state.

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By creating a clear and systematic action plan for rationalisation and optimisation, the organisation can ensure that it focuses on its top priorities.

Step Four: Rationalise and optimise current processes and applicationsThe detailed current state analysis will have identified the areas of duplication and non-value-add between paper and technology. The process of rationalising paper and IT will align the people, processes and technology to achieve the best patient care with the least amount of paper use. This will then optimise technology usage and may result in decommissioning redundant applications. Be sure to consider the effects of contract cancellations and service level agreements in the application reduction process.

Optimisation of available application and technical capacity will require planning, communication, facilitated user involvement and change management.

Step Five: Realise the full potential of current assetsThe future state can now become business as usual, accompanied by a refresh of the organisation’s standard operating procedures. Due to the detailed analysis conducted at the start of the initiative, the organisation will be able determine if the anticipated benefits have been realised. Sustaining the benefits will require sustaining the improved processes and system usage, so take steps to ensure that the new operating procedures are fully adopted across the trust.

At this point the organisation can make a detailed case for IT investment. If paper usage remains high and the agility of the organisation low, the areas for investment will be obvious.

Step Six: Assess the need for investmentThe reality of going paperless cannot be achieved in isolation and neither can the decisions on the types of technology in which to invest. A truly agile and paperless organisation will require the people and technology infrastructure to support the new ways of working. Therefore any decision on investment must facilitate employee and patient choice in how and where care is provided.

In the assessment of the need for new technology investment, identify the remaining use of paper and determine the options available for further paper reductions. Then create a business case for making investments, including a detailed analysis of the return on investment and the timescale for achieving the return.

Only after developing a deep understanding of how the organisation functions with paper can it develop an accurate approach for digital functions. The technology investments will then enable and enhance the process rather than define the process itself.

SummaryAny approach adopted by an NHS organisation toward a paperless and agile business must ensure that the change is appropriately managed, including the allocation of sufficient time and skills in achieving the vision. The organisation should aim to realise the full potential of current people, process and technology and make certain that it has the ability to make future investments knowledgeably and decisively.

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