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NHS ROTHERHAM

Rotherham NHS IT Strategy 2010 - 2015

Final Version 5.0

Date: 8th April 2010

Author: Andrew Clayton

Owner: Robin Carlisle

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Approvals This document requires the following approvals.

Name Signature Title Date of Issue

Version

Andy Buck Chief Executive 19/04/10 V5.0

Revision History Date of this revision: 19/04/2010 Date of Next revision: 01/04/2015

Revision date Previous revision date

Summary of Changes Version

01/02/2010 NA First draft V1.0

03//02/2010 01/02/2010 Second draft: revised structure and additional content

V2.0

17/02/2010 03/02/2010 Third draft: further revised structure, new content, additional sections added

V3.0

18/02/2010 17/02/2010 Added content to section 3.10. Errors revised V3.1

19/02/2010 18/02/2010 Added additional content to section 3.10. Formatting standardised

V3.2

05/03/2010 19/02/2010 Additional content added to the RDaSH sections V3.3

11/03/2010 05/03/2010 Executive summary added V4.0

24/03/2010 11/03/2010 Content added to section4.8.1 to reflect planned RCHS telehealth project

V4.1

31/03/2010 24/03/2010 Statement added re accessibility of the IT Strategy

V4.2

08/04/2010 31/03/2010 RFT content added, programme plan added, indicative financial plan added, sections on Integrated Identity Management and SystmOne V3 added, typing errors corrected

V5.0

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Rotherham NHS IT Strategy 2010 – 2015 Contents:

1. Executive Summary 5 2. Introduction and Context 8 3. Current IT Services in NHS Rotherham 9

4. NHS Rotherham IT Strategy 11

4.1 Clinical Data Quality and Safety 11

4.2 Information Governance 13

4.3 System Interoperability 14

4.4 GP Systems Rationalisation 15

4.5 Information to Support Community Management and Commissioning 16

4.6 Developing the Use of InterQual 18

4.7 IT Infrastructure and the NHS Infrastructure Maturity Model 19

4.8 Supporting QIPP - Across the Healthcare System 19

4.8.1 Use of telehealth and telecare 19

4.8.2 Hospice telehealth system 21

4.8.3 Windows Desktop Automation 22

4.8.4 Community Staff Digital Pen Project 23

4.8.5 Choose and Book Optimisation 23

4.8.6 Home Working 24

4.8.7 Remote Working 25

4.8.8 PACS Optimisation 26

4.9 Supporting QIPP – IT Initiatives 26

4.9.1 Review and rationalise existing IT Services 26

4.9.2 Shared Informatics Services 27

4.9.3 NHS Mail Adoption 28

4.9.4 N3 VOIP Implementation 29

4.9.5 ePEX System Decommission 29

4.10 Delivering National Initiatives 31

4.10.1 SystmOne Out Of Hours 31

4.10.2 SystmOne Walk In Centre 32

4.10.3 SystmOne Community Hospital 32

4.10.4 Electronic Prescribing Service Phase 2 33

4.10.5 Summary Care Record 34

4.10.6 Pseudonymisation Implementation Programme 35

4.10.7 Map of Medicine 36

4.10.8 SystmOne Version 3 – Data Sharing Model 36

4.10.9 Integrated Identity Management 37

5. Provider IT Strategies 38

5.1 RFT 38

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5.1.1 Electronic Patient Record 38

5.1.2 Order Comms 39

5.1.3 System Interoperability 39

5.1.4 Delivering the ‘Clinical 5’ 39

5.1.5 Use of SystmOne (A&E/Paediatrics/ Pharmacy) 39

5.1.6 Approach to telehealth/telemedicine 40

5.1.7 NHS Mail Adoption 40

5.1.8 IT Infrastructure and the NHS Infrastructure Maturity Model 40

5.1.9 Information Governance 40

5.2 RDaSH 41

5.2.1 Electronic Patient Record 41

5.2.2 System Interoperability 41

5.2.3 Delivering the ‘Clinical 5’ 41

5.2.4 Use of SystmOne 41

5.2.5 E-consultations 41

5.2.6 NHS Mail Adoption 41

5.2.7 IT Infrastructure and the NHS Infrastructure Maturity Model 42

5.2.8 Information Governance 42

5.2.9 Other Strategic Initiatives in RDaSH 42

6. High Level Programme Plan 43

7. Indicative Costs 2010 -2015 45

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1. Executive Summary

This IT strategy has been developed to support NHS Rotherham in the delivery of the “Adding

Quality and Value” strategic refresh and the associated programme of work to reconfigure the

delivery of health services in Rotherham “Shaping the Future”. The strategy identifies the work that

needs to be carried out across the health community to enable these strategic goals to be achieved.

The main clinical systems that are currently in use or under implementation by NHS Rotherham and its partners are:

General Practices - use a mix of systems predominantly supplied by SystmOne and EMIS but there are also a small number of Vision system users

NHS Rotherham – SystmOne Community

Rotherham Foundation Trust – Meditech

RDaSH – Maracis

RMBC Childrens and Young Peoples Services and Neighbourhoods and Adult Services – SWIFT

It is not the intention of any of the organisations covered in this strategy to move to the Connecting for Health provided Lorenzo system. General Practices using the EMIS LV system will need to migrate to other systems as this product has recently ceased to be developed and will not support new strategic initiatives such as the Electronic Prescription Service. The most significant requirement for information technology arising from the new strategy is the need to seamlessly share patient information across the health community to support the provision of quality clinical care in differing locations at any time of day and to enable healthcare commissioners to be fully informed of the needs of the population. In support of this requirement there are three key priorities for this strategy which are summarised below: GP Systems Rationalisation The General Practices in Rotherham have all been using clinical IT systems to hold their patient records for over a decade. Practices have always been able to choose from a wide range of system suppliers when implementing a clinical system and this has resulted in a number of different systems being used across Rotherham. These traditional GP systems are practice based and only allow information to be shared within the practice. The information held in a patient’s primary care record is an important resource for clinicians working outside of general practice to aid them the delivery of high quality care and therefore it is essential that this information is shared appropriately to support an integrated health care system. New generation General Practice clinical systems are designed to support interoperability with other healthcare systems and to provide access to their data outside of the practice setting. The GP system of choice for the Yorkshire and Humber region is SystmOne, this is a hosted system that is fully integrated with the community system already widely used in Rotherham. Therefore SystmOne will be our preferred clinical system for all primary and community care services. We will work closely with GPs to encourage and support more of them to migrate to SystmOne. We will also ensure that there is an effective interface between SystmOne and the RFT's new electronic patient record system.

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NHS Rotherham will work with GPs to design a package of optimal support to assist all practices that wish to migrate on to SystmOne to ensure that this is done quickly and efficiently with minimal disruption to the practice. System Interoperability System Interoperability is used to connect disparate information systems together to enable information to pass between them. The need to leverage the connectivity between IT systems in different clinical care settings is essential to supporting the plans for “Shaping the Future”. Without effective information sharing between NHS Rotherham and its partners the aims of vertical integration will not be realised. Access to a shared care record showing the detailed patient history will improve the quality of care for patients and enable the patient to move efficiently through the healthcare system and be treated in the most appropriate setting. The reduction in scope of the National Programme for IT presents an urgent need to identify technical solutions that will enable information to be shared at the local level. Work will be carried out with system suppliers to identify solutions to these connectivity issues. Clinicians will be engaged in identifying what information is required to support the delivery of care and how systems will be configured to pass information between each other. Appropriate governance structures and information sharing frameworks will be put in place to ensure that patient information is transferred securely between systems and is only accessible to those with a requirement to view it. Data Warehousing Data warehousing is used to collect information from disparate information systems to enable it to be joined and linked to support operational management and for the purposes of querying and manipulation. Data on the Rotherham population held in General Practice systems and data on children held in the Children’s System are the most comprehensive and detailed sources of information available on the health of the local people. In most cases, however, this information is held separately and is not readily available for sharing. To support the management of services and to enable commissioners to be as fully informed as possible it is essential that this information is gathered together to form a comprehensive population database. NHS Rotherham will work with commissioners and clinicians to identify how this population database should be delivered and what functions it should be used for. We will then work with suppliers to identify a suitable platform to deliver these requirements. The complex governance issues surrounding the sharing of this information will be addressed as an integral part of the programme of work.

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Clinical Data Quality

An over arching requirement to support all of the above priorities is the need to maintain

consistently high quality data in all areas of the health care system.

NHS Rotherham will support data quality initiatives in primary and community care and will seek to

assure data quality across all of our providers.

Supporting QIPP and Delivering the National Programme for IT

As well as the key priorities identified above there are also a range of other initiatives that need to

be delivered to support the NHS in Rotherham in meeting the requirements of the Quality,

Innovation, Productivity and Prevention (QIPP) agenda and to deliver the outstanding elements of

the National Programme for IT.

The aim of the QIPP initiatives will be to introduce quality and efficiency into the delivery and

management of health care through the use of information and digital technologies. Some of these

initiatives will be focussed across the whole healthcare system and in particular there will be a drive

to implement telehealth solutions to support the delivery of health care. Other initiatives will be

focussed internally and will seek to drive efficiencies in the delivery of IT services.

The initiatives relating to the National Programme for IT will focus on the further rollout of

SystmOne to all appropriate areas of the health care system and the delivery of the Summary Care

Record and the Electronic Prescription Service.

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2. Introduction and Context This strategy has been developed to ensure that NHS Rotherham has the IT capabilities to fully support the delivery of its refreshed strategy “Adding Quality and Value” and also of Regional initiatives and national policies. It is written in the context of the change in financial outlook for the NHS and the need for enabling programmes including Information Technology to drive the QIPP agenda to deliver increased Quality, Innovation, Productivity and Prevention. The main focus of this document is the development of the strategic IT initiatives that NHS Rotherham will take forward in support of delivering the objectives of “Adding Quality and Value”, the QIPP agenda and the National Programme for IT. Subsequent sections of this strategy address the strategic direction and intentions of NHS Rotherham’s key providers and detail how their respective IT strategies will support and integrate with that of NHS Rotherham to deliver benefits across the whole healthcare system. This document reports on the current position of IT delivery within NHS Rotherham and summarises progress with delivery of the National Programme for IT before moving on to describe the new initiatives required meet the challenges of the future. The main clinical systems that are currently in use or under implementation by NHS Rotherham and its partners are:

General Practices - use a mix of systems predominantly supplied by SystmOne and EMIS but there are also a small number of Vision system users

NHS Rotherham – SystmOne Community

Rotherham Foundation Trust – Meditech

RDaSH – Maracis

RMBC Childrens and Young Peoples Services and Neighbourhoods and Adult Services – SWIFT

It is not the intention of any of the organisations covered in this strategy to move to the Connecting for Health provided Lorenzo system. General Practices using the EMIS LV system will need to migrate to other systems as this product has recently ceased to be developed and will not support new strategic initiatives such as the Electronic Prescription Service.

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3. Current IT Services in Rotherham

IT Services in Rotherham are currently provided by organisation based IT departments within Rotherham Foundation Trust, RDaSH, RMBC and NHS Rotherham. The NHS Rotherham IT department also provides IT services to RCHS and all of the General Practices in Rotherham. Section four of this strategy looks in detail at the strategic initiatives that will be lead by NHS Rotherham. The sections which follow on from that look at the contribution that the IT strategies of Rotherham Foundation Trust, and RDaSH will make to the overall delivery of IT services for the Rotherham healthcare system. The “Adding Quality and Value” strategy will require changes to the structure of organisations across the health community. In response to these changes it may be necessary to change the form of IT services from those detailed above and a later section of this strategy details an approach to reviewing IT and Information Services. However the focus of this strategy is the functions that must be delivered across the health community to achieve our strategic objectives. NHS Rotherham IT Services: NHS Rotherham currently delivers its IT Services through an in-house IT department that forms part of the Directorate of Intelligence and Performance. The IT Department is managed by the Head of IT and Deputy Head of IT. Service is delivered by the six teams listed below:

IT Customer Services

IT Infrastructure

IT Application Development

IT Projects

Information Governance

IT Education, Training and Development The IT Department delivers services to NHS Rotherham, Rotherham Community Health Service and all the General Practices in Rotherham. It provides IT infrastructure and support in premises across the borough of Rotherham, including in some Local Authority premises where NHS staff are located there. NHS Rotherham has invested significantly in its IT Infrastructure since 2006 and has implemented:

Virtual servers to replace traditional application servers

A fully mirrored Storage Area Network

A managed WAN across the Rotherham borough

Secure remote access to the network from mobile and fixed telephone extensions

Secure wireless networks at key facilities As at January 2010 NHS Rotherham had delivered the following elements of the National Programme for IT:

Adopted the regional LSP (Local Service Provider) Community system across all of its community services

Adopted the regional LSP Child Health system

Migrated eighteen of its forty one General Practices onto the regional LSP GP System

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Rolled out GP2GP records transfer to all GPs

Deployed EPS Phase one across all pharmacies and General Practices

Implemented a Registration Authority for access to CfH hosted applications

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4. NHS Rotherham IT Strategy The following sections detail the strategic initiatives that will be led by NHS Rotherham. The scope of this document does not include finance, intelligence, performance or the Intranet/Internet. This strategy is aligned to the operating plan and sets the strategic direction for IT services over the next five years, with an emphasis on delivery over the next three years through to 2013. A high level programme plan and indicative costs for the duration of the strategy are provided in sections six and seven of this document. NHS Rotherham will ensure when delivering this strategy that information and new technology is equally accessible across vulnerable groups. At the point of implementation of each project a full Equality Impact Assessment will be carried out and this will be subject to regular monitoring. NHS Rotherham’s partners will also be required to share evidence that they have carried out Equality Impact Assessments on their developments

4.1 Clinical Data Quality and Safety

Why is Data Quality important? High quality data underpins informed and hence good patient care and safety. In February 2008 the Audit Commission published a discussion paper, In the Know – using information to make better decisions, which sets out their overarching framework:

“Good quality data which is collected, captured and stored in the right way, should then be turned into fit-for-purpose information which is well analysed, relevant and right for the context….and used to inform good quality decisions which improve outcomes for local people. “

It advocates that if data and information is used smarter and more effectively, better decisions which improve the lives of local people can be made. It defines good quality data as:

“ the raw material – the statistics, facts, numbers and records which can then be organised and analysed into information which answers a specific need.

The quality of this raw material matters because, if you have poor data, anything that’s based on this becomes unreliable. Being confident in your data means that:

It is reliable, accurate and trustworthy.

Legal and security obligations are met.

Robust supporting information systems are in place.

The right systems, processes and skills are in place to support sharing of data with other departments and organisations.”

Rotherham is now in position to build on benefits realised by the data quality programme introduced to improve electronic record keeping across GP practices during 2002, and reap benefits from the electronic record keeping system it has deployed within community services since January 2007. This facilitates PCT level reporting and the provision of statistics on the health of the local community and current trends. The GP programme has supported QOF,

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National, Local and Direct Enhanced Services (NES, LES and DES), progress towards introduction of the summary care record and paper light working. Prescribing information is now easily available to identify trends and cost savings by swapping branded to generic, identify patients missing from chronic disease registers and highlight any unsafe prescribing. The introduction of the electronic prescribing service will further reduce data quality issues bringing the relationship between pharmacies and GP’s closer and advocating that patients use a nominated pharmacy. Safeguarding of patients is enabled by the use of flags, warnings and alerts, audits, shareable information and tools to identify where data is either incorrect or missing to name but a few examples. Continuity of care is one of the main benefits of a shareable record which contains complete, accurate, relevant, accessible (by multiple users at any place at any time) and timely information. Test results can be transferred directly from labs electronically, reducing the risk of inaccuracies and loss of information and enabling timely decisions to be made about a patients care and treatment. All these factors contribute to more efficient and effective care of patients resulting in better outcomes which can be reported on. Rich reliable clinical data forms the basis for sound dependable intelligence upon which to base decisions and streamline services to benefit patient outcomes and offer cost efficiencies. It is therefore, important to support the Better Health, Better Lives, 6 major efficiency programmes and other programmes of work. Where are we now? GP Practices The data quality programme in NHS Rotherham was first launched to support GP practices during 2002. Over the years benefits for patients, practices and commissioners have become apparent, particularly upon the introduction of the new GMS Contract and since the purchase of an audit tool to interrogate the systems holding the data. There are currently 41 GP practices within Rotherham which are supported by the data quality programme with mixed levels of engagement. 25 are approved as paperlight and 20 of these have achieved data accreditation status. Across the Yorkshire and Humber area NHS Rotherham is benchmarked as average for data accreditation. 27 practices are engaged and actively working on the data quality programme, however the other 14 have limited involvement. Community Services During 2007 the integrated electronic patient record was introduced within community services and the data quality programme was expanded to support this. Rotherham Community Health Services has in excess of 46 community units which have gone live with an electronic patient record. The introduction of a single record has highlighted the need to bring community data quality up to the standard of the GP records. The quality of the electronic patient record has not been assured by the organisation and much work is required to get this up to an agreed standard. Due to the rapid roll out program of the new system, data quality has been provided by means of templates designed and built by the Data Quality Specialists in conjunction with relevant clinicians and then approved at the Clinical Care Records Committee. This process sufficed for the roll out but has recently been reviewed due to problems with resourcing, lack of engagement and approval bottle necks. NHS Rotherham

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During the early stages of the GP data quality programme implementation, NHS Rotherham purchased an audit tool to extract data from GP practices. All GP practices in Rotherham have now signed up to use the tool “QUEST”. It has been developed from initially running a quarterly audit on practice data for key health information required by the PCT and also requested by GP’s, to a data extraction tool to aid the retinopathy recall service, and various other NHS Rotherham initiatives such as extraction of data regarding performance for DES’s and LES’s such as the CVD enhanced service. Awareness has been raised regarding the data quality team and they are usually invited to participate in groups and committees driving forward key NHS Rotherham initiatives. What do we want to achieve It is the corporate strategy to fully deploy an electronic shared record within the Rotherham community and GP services. This strategy is well under way with community services already live on a single system and 18 GP’s surgeries with a further 3 scheduled to go live this year. The aim of the data quality programme is to facilitate excellent quality data across GP and community services so it fits together seamlessly as a single record and to continue to support practices on other systems to improve data to the accredited standard. The ultimate aim is to pass on the knowledge and skills to hand over responsibility for data quality to services and additionally to develop knowledge within the commissioner arm to understand how we should do this. In order to satisfy ourselves and other stakeholders of the quality of our data we will need to manage this by ensuring the following:

The governance of data quality

Policies and procedures in place for data recording and reporting

Systems and processes in place to secure data quality

Knowledge, skills and capacity of staff to achieve the data quality objectives

Arrangements and controls in place for the use of data What are the options? The options are:-

Carry on supporting as currently

Develop a plan to engage teams and train and support data quality within services and pass responsibility over in a phased approach

Leave services to improve data quality themselves Next steps

Develop a data quality academy consisting of a blended learning approach and support for nominated data quality leads within service. Pass responsibility over to services in a phased approach.

Support practices in the migration to the single system

Support practices to achieve a 100% paperlight target in support of the summary care record deployment by August 2011

4.2 Information Governance

NHS Rotherham will continue to manage its Information Governance capabilities through an annual programme focussed on the requirements of the Information Governance Toolkit. The

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Information Governance Steering Group will oversee the delivery of and assessment against this programme and will be responsible for ensuring that appropriate policies and strategies are in place to support effective Information Governance practice.

4.3 System Interoperability

Background System integration is used to interface disparate information systems together and pass information between them. It can be achieved in several ways commonly through direct interfaces between systems or through intermediate systems called integration engines. The interface engine that is provided and promoted by the Yorkshire and Humber Strategic Health Authority in called Ensemble. Where are we now None of the main information systems currently used in the Rotherham health community are interfaced together. Work on the Common Assessment Framework has looked at the possibility of integration between health and social care systems but no work has been carried out to deliver this. What do we want to achieve Delivery of the “Adding Quality and Value” strategy will require systems to be integrated together to provide the necessary flow of information between different levels of the health and social care system. Therefore it is our objective that systems integration will be achieved between the key information systems of NHS Rotherham, The Rotherham Foundation Trust and RMBC. Initially it is expected that this will be integration between NHS Rotherham’s instance of SystmOne Community, TRFT’s Electronic Patient Record System Meditech and RMBC’s Social Care System SWIFT. Other systems will be integrated as the need becomes apparent. What are the options At this stage there are the options to either wait for the outcomes of work ongoing centrally in the NHS around integration with SystmOne or to immediately pursue integration between systems using a locally designed technical solution. These two options are outlined below. SHAs are currently in discussion with the LSP and CfH relating to integration from SystmOne and this may also be provided within the Total Contract Value (TCV). If this is the case, then the SystmOne messaging set would be developed and would come free as part of the system. NHS Rotherham would not need to do anything further with their system. TRFT would need Ensemble (and they already have it) to integrate to their Meditech system. In addition, NE Lincolnshire are piloting links between SystmOne and the Swift Social Care system, and again this interface would be provided free in SystmOne.

If the option to pursue integration locally is adopted then the Y&H SHA will fund a development licence for the Ensemble integration engine. This allows NHS organisations to train staff up and

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develop interfaces/integration not funded by CfH. It is difficult at this stage to judge if NHS Rotherham needs this immediately. However, if there is an identified need the SHA will fund it. Another possibility may be to take the product now in case those discussions with the LSP and CfH don’t progress quickly enough. The SHA provides £50k and this buys the Ensemble development licence, the first year maintenance and support for the development licence, two places on a five day training course and a contribution to buy a server. The Trust then picks up maintenance and support from year 2 (approx £8.1k) so this is the only recurring cost to the trust. The SHA advise us that we may want to wait before we commit to the Ensemble product, but that it may be worth expressing interest pending current discussions on the Interoperability Tool Kit. Next steps The next steps are:

Establish a project that will define the information that needs to be shared across systems with representation from across the health community

Express interest in Ensemble with the Y&H SHA

Determine when the outcomes of the Interoperability Toolkit programme and the CAF Demonstrator pilots will be available and take a community wide decision on whether to proceed with local interfaces or not 4.4 GP Systems Rationalisation

Background General Practices have traditionally used standalone systems to support their clinical practice and hold the records of their patients. While these systems have been very effective for the practices their standalone nature has been a barrier to the sharing of information that could be of great benefit to patients when available to the wider health community and they have not supported the integration of information with community workers allied to the practice. Under the Connecting for Health Programme the LSP began to offer the hosted GP clinical system SystmOne. This system holds information in a data centre connected to the NHS network which makes it possible for the data to be shared and used by appropriate people outside of the patients practice. This system also has an integrated community solution, allowing the practice and community health workers to share a common record. Since the release of SystmOne the other major GP clinical system provider used in Rotherham, EMIS, have developed a centralised system called EMIS Web. Where are we now Currently of the forty one General Practices in Rotherham:

eighteen are using SystmOne

nineteen are using EMIS LV

one is using EMIS PCS

three are using Vision What do we want to achieve

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The mixed economy of clinical systems we currently have is restrictive when trying to develop and deploy consistent solutions for information sharing across the local health community. Other local health communities have demonstrated the clinical safety benefits and efficiencies that can be delivered when a detailed local care record is held in a manner that allows it to be shared appropriately across the healthcare system. Therefore our objective is to have a single primary care system, which is integrated to the community system and holds a shared primary/community care health record, in use in every General Practice in Rotherham by 2013. What are the options? The options to achieve our objective are:

Migrate the twenty-three General Practices not currently using SystmOne on to the system

Review in detail the EMIS Web product to Identify if it can offer the level of integration and availability that is required. If this is a suitable solution, migrate all General Practices and community services on to the system

Next steps The next steps towards achieving our stated objective are:

Work is already progressing to review the EMIS Web product and compare and assess the two product options with a view to selecting the most suitable one for the Rotherham health community. The outcome of this work will be shared with the Professional Executive for their endorsement

An event demonstrating the potential benefits of SystmOne to members of General Practice took place in March 2010

NHS Rotherham will actively promote their chosen preferred system and work with General Practices, the PE and the LMC to generate commitment to it

A scheduled program of migrations will take place between 2009 -2012 to ensure that each Practice receives the full support necessary for a smooth transition between systems

NHS Rotherham will lead on programmes of work to maximise the benefits of a single system and shared care records across the health community 4.5 Information to Support Community Management and Commissioning

Background To enable effective service planning and the commissioning of services programme managers need to be supported by information generated across the healthcare system, which is gathered, analysed and presented in a timely and meaningful way. Where are we now NHS Rotherham currently receives some data from primary care and secondary care though this is not always complete or at the level of detail required to effectively inform commissioners.

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Primary care data is drawn from GP systems using the Quest query tool to support a number of different initiatives. Each initiative requires a specific query to be written by a third party and cannot be easily amended. Secondary care information comes in the form of SUS data and other specific data sets submitted by acute providers. The information held by NHS Rotherham is in a number of disparate databases. What do we want to achieve NHS Rotherham needs access to all the information that is necessary to aid them in their vision of delivering World Class Commissioning. To do this they will need to develop the sources of information that they receive from both primary and secondary care providers and will need to invest in an effective tool to gather, analyse and present this information. What are the options GP data is an essential source of information for a commissioning organisation as it relates to virtually the whole population. An overarching data warehouse solution that combines the population data across all of the Rotherham General Practices could be used to provide:

Admission risk stratification

Support for health screening programmes

GP referral data

Prescribing data

Practice Based Commissioning dashboards

Support the implementation of Common Assessments

Integration of GP data with InterQual data

Clinical effectiveness and audit data

Data quality reviews

Performance data for World Class Commissioning

In addition to GP data it has been identified that more information to support service planning is required from acute providers particularly to support the programmes for long-term conditions and emergency care. Initially more information in the following areas is required:

Unscheduled admissions for ambulatory care sensitive disorders

Stroke including re-admission data

Falls

Care home liaison

Community matrons

A&E

Hospital discharge There are a number of commercial data warehouse products in the healthcare market each with their own particular strengths and weaknesses in terms of what information sources they can connect to and gather information from and the care programmes that they have developed solutions to support. NHS Rotherham will assess the market for these before moving to a formal procurement exercise when a clear proposal has been developed.

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Next steps

Assess the market for data warehouse solutions

Draw together a project with input from IT, Intelligence, Programme Management, Contracting and PBC to develop a specification for the data warehouse solution

Work with Providers to develop an understanding and agreement of the new data sets required to support Commissioners

Address the Information Governance issues associated with the data warehouse

Determine a funding source for the data warehouse, potentially from savings from cessation of RCHS systems

Carry out a procurement exercise to select a suitable data warehouse solution 4.6 Developing the Use of InterQual

Background InterQual is a evidence based clinical decision support tool that provides assistance in determining when and how individual patients progress through the continuum of care. Where are we now The InterQual tool is used to conduct patient reviews in TRFT and RCHS though the two organisations use the tool in very different ways. TRFT has case managers employed specifically to undertake reviews whereas the reviews in RCHS are undertaken by staff in clinical roles as an addition to their general work. So far the focus of reviews in both organisations has been mainly in an audit capacity to review historical episodes of care to generate data for planning services and care provision. What do we want to achieve In order to deliver the expected efficiencies from vertical integration of nursing services set out in “Adding Quality and Value” it will be necessary to use a tool in real time which supports the transfer of patients through the healthcare system. Therefore our objective is to establish how the InterQual tool can be used during patient contact to support effective patient care at all levels of the care continuum. This will include identifying how to use the tool outside of care premises and in the home. Next steps The next steps are to:

Gain a greater understanding of the InterQual product and how it is implemented and used in established integrated care services

Establish the issues encountered when using the tool in practice

Assess the possible ways of delivering the tool for use outside of a care premises

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4.7 IT Infrastructure and the NHS Infrastructure Maturity Model

Background The NIMM (NHS Infrastructure Maturity Model) has been developed by Connecting for Health in association with Microsoft to enable organisations to self-assess their IT Infrastructure maturity against a specific NHS designed model. This NIMM is based on successful and recognised existing models developed by the likes of Gartner and Microsoft. The NIMM is also linked to the NHS EWA (Enterprise Wide Agreement) which the NHS holds with Microsoft for the provision of software and licensing. Certain types of advanced software can only be accessed when the organisation reaches level four of the NIMM. It also forms part of the SHA assurance model and is being closely monitored. Where are we now A self assessment against the NIMM was carried out during December 09 which found that most areas scored a level 3 out of a possible 4 and some areas were not applicable. What do we want to achieve It is the recommendation of both the SHA and CfH that level four is achieved by all organisations wherever possible. This will allow the SHA and CfH to standardise changes to working practices and procedures and allow the organisation to access Enterprise class licenses which unlock many of the advanced features available in the software already in use. Next steps Due to the size of the NIMM (73 controls over 13 areas), two or three particular areas will be concentrated on during 2010/11 to ensure a level 4 is achieved/achievable with subsequent areas being looked at in future years. It is expected that level 4 is achieved across all areas applicable to NHSR by 2012/13. The project will be managed by the IT Infrastructure Manager with support from the server and network technicians and should involve very little, if any capital or revenue costs. This is due to the amount of investment in the NHSR IT infrastructure in recent years. The majority of the work required will be in the form of documentation and re-structuring of the existing infrastructure.

4.8 Supporting QIPP – Across the Health System

4.8.1 Use of telehealth and telecare

Background The NHS Operating Framework 2009-2010 sets out that all NHS organisations should consider how they will deploy digital technologies to improve services for citizens and patients and improve working practices over the course of the next twenty four months.

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There is a widely supported view that the use of digital technologies in the NHS particularly in the field of telehealth can deliver significant improvements to patient care and aid in prevention while at the same time delivering system efficiencies and driving down costs. Where are we now At present most NHS telehealth projects are in the demonstrator stage being co-ordinated at national or regional level. The Rotherham health community has not been involved in these demonstrator projects, but completed a pilot of community telehealth monitors in 2008 across patients with COPD and Heart Failure The pilot showed qualitative benefits but was too small to evidence quantitative benefits such as a reduction in admissions and clinician time. A local telehealth project initiated by Rotherham Hospice is in the planning stages and this is detailed in the following section of this strategy. The equipment used during the 2008 pilot is still available and a proposal is being progressed to utilise it for a joint Breathing Space and Community Matron project. To support this, RCHS has recently invested in a web based triage system that will allow wider multi disciplinary access to patient results. What do we want to achieve NHS Rotherham will actively seek to develop and deploy telehealth and telecare solutions that support its objective of delivering the best quality services for its patients. What are the options A major barrier to the implementation of telehealth has been the costs involved in the initial setup and delivery of possible systems, a lack of clear technology standards and the difficulties with testing and evaluating models of telehealth care. In response to this the Y&H SHA has established a regional telehealth programme called the “T Health Programme”. This programme aims to leverage the scale of Y&H NHS to develop telehealth systems in the three “modes” detailed below:

Tele-consulting: using teleconferencing and diagnostic equipment such as digital stethoscopes to bring health care to virtually any patient, anywhere, anytime without the need for any travel for either the clinician or the patient

Tele-monitoring: enabling patients who need to monitored or reviewed at frequent intervals to be safely managed in their own homes without the need for expensive and inconvenient hospital stays

Tele-education: enabling staff to receive relevant training and patients to receive relevant education to support the management of their own illness

NHS Rotherham will review the outcomes of national whole system demonstrator projects and work with the Y&H SHA T Health Programme to identify the best opportunities for telehealth deployment in the local healthcare system Next steps

Move forward with the proposed telehealth solution for Rotherham Hospice

Move forward with the proposal to utilise the existing telehealth monitors in a joint project between Breathing Space and Community Matrons

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Review the outcomes of the demonstrator project for e-consultations and determine how this could be deployed locally for diabetes care

Continue to review ongoing evidence from other areas including Whole System Demonstrator sites to identify opportunities to utilise telehealth in Rotherham

4.8.2 Hospice telehealth system

Background As part of its transformational initiative for end of life care, NHS Rotherham has a target of reducing hospital deaths by 100 per year. Telehealth is seen as an enabler to achieve this target, and as such the hospice has submitted a bid for funding to the NHS Yorkshire and the Humber Regional Innovation Fund (RIF) for financial support to initially deliver a pilot video conferencing solution. This solution will offer both clinical and emotional support to terminal end of life care patients and their families/carers. Scope The solution will initially consist of a pilot of six homes being linked back to the hospice. Upon successful completion of the pilot, the plan is to rollout the solution to an additional twenty five homes. The technology requirements are for a two-way video link via a set-top box solution to enable an interactive consultation to take place utilising two-way bandwidth. Progress To Date Costs and suppliers for the solution have been sourced, Saville’s AV will supply the equipment and technical expertise and Digital Region will provide the bandwidth. A proof of concept will take place in April 2010 utilising the hospice and the hospice manager’s home broadband connection. This will prove the technology and provide an insight into how the solution will operate and what can be expected in terms of visual and audio quality. Outcome Improvements It is expected that the Telehealth solution will help the hospice to achieve the following quality and efficiency gains:

Improved choice for the home as a place of care/death

Improved experience of the patient/family

Reduction and avoidance of unnecessary admissions to hospital

Reduction in staff lone-working out of hours

Provision of a more personalised service to patients/carers through the use of a visual image in addition to telephone communication

Next Steps Should a positive outcome from the innovation bid be achieved, the first steps of the project would commence in April 2010 as follows:

Purchase seven sets of equipment (one for the base and six for patient/family use).

Identify a project manager

Set-up a steering group to implement, steer and evaluate the project

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4.8.3 Windows Desktop Automation

Background PC’s are used extensively by staff in NHSR. Most PC users will find that some of their work involved repetitive tasks on PC’s, or may be aware that their IT applications can provide them with additional useful functionality but they don’t have the time to fully use it. Robotics technology can be used to solve this problem by automating repetitive tasks on PC’s. Where are we now We are currently in the process of automating the download and processing of SystmOne monthly activity reports, utilising the .AWL tool from NDL. Currently these reports take a member of staff 1 full day of processing per month due to the navigation through several screens, report generation, downloading to MS-Excel, editing in MS-Excel then importing to MS-Access. The process is repeated over 44 times during the day for different units on SystmOne. The automated version is almost completed and is expected to reduce processing time from 1 day to less than 1 hour. What do we want to achieve We see huge potential for this “robotics” technology. The technology can “read” the screen and apply logic to “decide” what actions to perform. The technology will work on any application which runs on a Windows PC. Potentially this technology could be used throughout the organisation to:

Reduce the amount of time it takes staff to carry out repetitive tasks on PC’s.

Improve data quality by reducing potential human input error.

Automate data quality testing between IT systems which would have previously been too time consuming and laborious for staff to do.

Fully exploit our existing investment in IT applications by utilising more functionality through automated processes.

Enable better integration between different IT applications. What are the options Currently the IT Development Team are assisting the RCHS Information Department with the initial pilot of the system. We are currently looking into the option of testing out the technology within the IT department and ensuring IT Development staff are trained to build, test and support the automation process. We will then look at the options of carrying out further pilots in other departments. Next steps

Complete the pilot for the RCHS Information Department

2 x IT staff to receive training

Carry out further pilot projects within the IT.

Identify further potential pilot projects

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4.8.4 Community Staff Digital Pen Project

Background There are some types of clinical recording of data which for various reasons are not quickly replicated on SystmOne, the IT system used in Rotherham as its main patient electronic record. For example, services which use special clinical “symbols” as a form of short hand recording could not do so and had instead to write, longhand, very extensive descriptive notes. This was so time consuming that fewer patients were being seen. The use of digital pens and associated stationery has been viewed as a possible solution. Where are we now In association with the company Ubisys, a pilot has been undertaken in the physiotherapy and speech and language therapy services to use the pen technology. In brief, the consultation is written on to the special pixellised stationery with the digital pen which captures what is written. When docked, the pen sends its information electronically to a secure area of the network. The resultant files are then forwarded on to SystmOne, authenticated by the user and finally attached as an image within the patient record. Evidence so far is that this method has freed up time for extra patient appointments. What do we want to achieve Further time savings for clinical staff, providing the solution is cost effective. Further streamlining of the solution so that a more seamless transition from pen to SystmOne is achieved. What are the options

Continue the trialling currently in place

Extend to other areas Next steps Awareness of the possibilities of this functionality is being extended throughout the Yorkshire And The Humber (YaTH) Strategic Health Authority in an attempt to gain extra support for its development and adoption, and possibly attract resource from this area. Further trialling is planned in the Health Visiting Unit, using a section of the children’s Red Book. Should this prove successful, further time saving possibilities in clinical areas should be identified and, if feasible, introduced.

4.8.5 Choose and Book Optimisation

Background Choose and Book Provider functionality has been available to community based services since 2006, allowing patients and GPs a greater and more instant range of choice when planning the first outpatient attendance.

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Where are we now Ear Care, Orthopaedic Triaging, Podiatry, Male Sterilisation, and Podiatric Surgery have benefited from this functionality using the legacy system ePEX-3 since 2006. As this system has now been largely replaced by SystmOne, a programme of work is currently in place to re-direct these services on to the new system. The aim is to achieve this by summer 2010. What do we want to achieve Roll out of additional services to SystmOne. These are GPwSI (including Vasectomy, Dermatology, Minor Surgery, and Community Geriatrician), Contraception and Sexual Health, Tissue Viability, Cardiac Rehabilitation, Heart Failure, Continence, and the Wheelchair Service. What are the options There is no technical restriction to providing the deployment of the new services. The resources required are principally training and set up/configuration. Next steps Agree with commissioners a planned roll out.

4.8.6 Home Working

Background A solution was required to allow users to have access to work files from outside of the confines of the NHSR offices including email. Where are we now NHSR IT Services have implemented a home working solution allowing staff to use an NHSR laptop for connectivity back to the Trust. This utilises an NHS provided security token for connection via a VPN (Virtual Private Network) on to N3. Once connection is established and the user verified using two-factor authentication, a Terminal Server at the Trust allows authenticated users access to a network environment not dissimilar to the one they would have access to if actually sat within Trust premises. The advantages of this are:

Allows end users to work from anywhere there is a connection (wireless or wired)

Allows end users with 3G/GPRS connections to work from anywhere

Allows end users full access to the files and folders normally only available at work

Allows end users full access to email and Intranet

Allows the trust to consider home working as a viable alternative to providing desk space

Allows users who are unable to attend the workplace through illness or injury the ability to carry on working

Allows users to connect to work in the event on severe inclement weather

Allows the IT Technical team to remotely connect and diagnose/fix network issues

Very little cost to the Trust (Laptop and a small monthly connection charge)

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Connection to NHS only internet sites including TPP SystmOne What do we want to achieve Ideally, rather than supplying users with NHSR equipment which is not only an additional cost but could potentially go missing and requires additional administration by the department in order to keep track of equipment, it would be useful to extend the access to the users home PC/Laptop Next steps NHSR IT is also currently undertaking a trial using a third party supplied appliance to allow the end user to use their own equipment (home PC/Laptop) thus negating the need to provide and NHSR Laptop. This project is being managed by the IT Infrastructure Manager with the assistance of the Server and Systems Specialist. It is expected this solution will be in place by 06/10. There is only a small annual maintenance figure attached to this project as the equipment is already in place. A policy is currently being developed which will define the Home Working solution procedures and protocols with the co-operation of the Human Resources department.

4.8.7 Remote Working

Background 3G technology enabled laptop and tablet PC’s have become available over the last few years. This gives much better performance of Clinical and Admin applications whilst staff are working mobile away from their usual desk or base. Where are we now In support of the SystmOne community rollout approximately 400 Dell laptops equipped with 3G cards have been deployed to RCHS staff. This has proved invaluable in supporting live access to the detailed care record and to allow contemporaneous data entry by clinical staff. What do we want to achieve The 3G devices would be more useful if they could run a greater range of applications and offer more of the features of a normal Windows desktop computer. Ways of achieving this should be investigated. This should enable wider adoption across the workforce as part of the home working and mobile workforce agendas as office space is becoming ever more precious. In addition this would save travelling time, and make a contribution to the green and sustainability agenda’s by reducing staff costs and eliminating unnecessary journeys . What are the options As a baseline the organisation should continually monitor that mobile devices are well used. When it is found that a device is poorly used Budget holders should re-address the case of need, and either emphasise why mobile input is needed, or in other cases arrange to re-deploy them .

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Next steps NHSR needs to develop organisational policies to normalise this new way of working as a matter of urgency. Efforts can then move on to investigating and evaluating further functionality and options, in order to maximise value for money.

4.8.8 PACS Optimisation

Background Further to the initial rollout of Acute Hospital based PACS there are further plans to extend the functionality into use in Community settings nationally. These plans have yet to appear in any concrete form. Locally within the Rotherham LHC we have national PACS within RFT, and CareUK operating their own system within the RCHC. Where are we now In advance of any national project we have established manual methods of routing images from one provider to the other. In addition some Staff based in Community units have viewing stations or browser based software to access the image stores. What do we want to achieve In advance of any national solution there is still scope to improve image and information flow’s locally. In particular there should be scope to automate the sending of textual radiology reports to the requesting GP or Clinician – this is usually the most pertinent output, and demands much less complex infrastructure than remote image viewing. What are the options We can wait for a full blown national Community PACS, which seems increasingly unlikely to materialise in the current climate, or continue to liaise with our local imaging partners and clinicians to improve local workflow. Next steps NHSR IT to broker discussions between interested parties regarding local requirements and to continue to work on individual mini projects as requested by the commissioning team.

4.9 Supporting QIPP – IT Initiatives

4.9.1 Review and rationalise existing IT Services

As part of the overall QIPP agenda it will be necessary to review existing IT Service provision to check that value for money is being achieved and efficiencies attained. The Head of IT will lead a programme of work to review the IT Service over the following areas:

Use of temporary staffing

Utilization of the back office infrastructure (hardware, software and networks)

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Review of procurement arrangements and existing providers

Review and rationalisation of existing support and maintenance contracts

Review of telephony service provision

Review of telecomms providers

Investigation of the benefits of unified communications (fixed telephony/mobile)

Review NHS Enterprise Wide Agreements to determine any further efficiencies can be gained from them

Establish options for savings on power and paper through applied controls to desktop computers

4.9.2 Shared Informatics Services

Background Shared services for back office functions including informatics are viewed as a potential way to create efficiencies and save money. The models for IT service integration are varied and range from national and regional solutions through to integration of IT services at the level of the local health community. Integration can be vertical through a market, horizontal across a sector or composite cross both. The Y&H SHA have commissioned a major piece of work to review the possible models for IT service integration and are expected to make recommendations on how the formation of shared services should be approached. Where are we now Currently all of the services in the Rotherham local health community (commissioner, providers and the local authority) host their own IT Services. What do we want to achieve Our objective is to identify the best model for the provision of IT services for Rotherham following the service reconfiguration required to deliver the “Adding Quality and Value” strategy. The model should deliver optimal IT services to the constituent organisations in the most efficient manner. What are the options The large number of possible models presents many possible options. The most likely options to consider are:

Doing nothing and retaining local IT services

Form a Rotherham IT service that provides all or part of the informatics services to all or some members of the local health community

Join some or all of the existing IT services to the shared service established through the recommendations of the Y&H SHA

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Next steps Until the organisational structure required to deliver the “Adding Quality and Value“ strategy has been agreed it will not be possible to identify the best shape of IT services for Rotherham as form should follow function. The Rotherham health community will need to review and reflect upon the recommendations for shared IT services put forward by the Y&H SHA when these are released and make a decision as to how these recommendations will be actioned.

4.9.3 NHS Mail Adoption

Background NHS Mail is the secure email and directory service available to all NHS staff. It was migrated to a Microsoft Exchange platform at the end of 2008 with actual account migration being completed throughout 2009. The service is maintained by Cable and Wireless through an NHS contract and is available from an Internet connection regardless of where the user is (N3 connectivity is not required) and the service has been provided as an alternative to using local email systems. The service offers a lot of the functions available under local email services and uses the same client (Microsoft Outlook). Although there are some noticeable restrictions on mailbox size limits, the service does offer some advantages such as mail to mobile messaging (texting) and secure email from NHS Mail to NHS Mail accounts. There are also some secure connections to other governmental organisations such as the Police and Councils, providing these organisations have signed up to use these services. Where are we now NHSR has a local email service based on Microsoft Exchange and Outlook which has been recently upgraded and does not rely on an external connection for local email (within NHSR). This is widely used by all NHSR staff for secure email between each other and the GP Practices. There is also a secure link between NHSR and the Rotherham Foundation Trust enabling NHSR and GP staff to securely email users on the Hospital email system. The system is also widely used throughout the organisation for calendaring purposes including room bookings. What do we want to achieve Although widely used for messaging, there are several applications that are used throughout the NHS such as Microsoft SharePoint (document sharing) and Office Communication Server (OCS, links voice to email) which NHSR does not currently use but has looked at with a view to incorporating the added features of these into the current environment. These would not be available to NHSR if a move to NHS Mail was undertaken.

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Next steps The NHS is urging people to consider using NHS Mail as an alternative to using local email systems so our next step is to compare the two offerings side by side and propose which solution to use for the future. Of course this decision may get made for the organisation if use of the NHS Mail system becomes mandatory. For now, due to the fact that the NHSR system is both current and stable, there is no urgency to consider migration to the national system.

4.9.4 N3 VOIP Implementation

Background N3 is the NHS Internet service provided to all NHS (and some private) organisations. N3 VOIP is the centrally managed Telephony (Voice over IP) service that is being offered by BT (who provide N3) as an alternative to using locally managed systems. Where are we now NHSR along with the Rotherham Foundation Trust installed a replacement telephony system approximately 4 years ago (the two organisations share a common telephony system). This system is based on VOIP and uses the wired computer cabling in the various buildings for connectivity. What do we want to achieve Although the NHSR Service currently deliver and maintain the VOIP service, this service is only available to buildings directly cabled back to NHSR. Although not physically impossible, NHSR could not guarantee the quality of a VOIP service delivered to other users over N3. Providing a quality VOIP service whilst reducing cost, are key when considering any other provider service. Next steps N3 VOIP services do not need to be considered as a replacement for the current system unless a radical change in the NHSR infrastructure takes place. They could however be considered as an alternative for other sites wanting to migrate from older telephony systems such as GP Practices.

4.9.5 ePEX System Decommission

Background The clinical IT system prior to the introduction of the Connecting for Health chosen offering (SystmOne), known as ePEX-3, still exists and is used by some clinical staff. Full decommission of this system is desirable as it represents a considerable financial drain on resources (c. £25000 per quarter) for increasingly diminishing return.

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Where are we now The majority of clinical services have now fully transferred from ePEX-3 to SystmOne and use this on a daily basis, although ePEX-3 is still available to them as a look-up tool for old information. There are three key areas which remain “active” on ePEX-3:

Bed Management services

Choose and Book (C&B) outpatient clinics

Contraception and Sexual Health (CASH) services This is because SystmOne has hitherto been unable to provide the functionality to accommodate these services to an acceptable standard. However, developments within the system to meet these standards have now been met.

Bed Management functionality is available as part of national contract for Palliative Units of SystmOne (for Rotherham, this is the Hospice and Breathing Space) and for other Units, Community Hospital functionality is available but at commercial rates (for Rotherham, this is the PLD Unit).

C&B has now trialled in Rotherham and a migration programme of those services using ePEX-3 as C&B “Provider” services to SystmOne is now rolling out with a view to all these services being transferred by summer 2010. The only current obstacle is with the Orthopaedic Triaging Service which currently enjoys additional C&B “Referrer” status which is not supported by the present Choose and Book model.

CASH service will be transferred to SystmOne after the deployment of Release 3 Data Sharing Model which improves the existing sharing model and allows sensitive data entered onto the unit to remain confidential.

What do we want to achieve It is desirable to migrate all these services to SystmOne as soon as is practicable. Following this, ePEX-3 can be decommissioned and a previously constructed archive tool of the ePEX-3 data can be deployed as an alternative, look-up only option for staff wishing to look at old clinical data. What are the options

Bed Management: Take Palliative Unit functionality as soon as possible (this is currently in trial phase – no firm date set for wider roll out to Trusts).

Bed Management: Purchase Community Hospital functionality for the PLD Unit (available now)

Bed Management: Look at developing an in-house tool for meeting national reporting requirements relating to bed management whilst maintaining usability at service level (likely to be extremely labour intensive and does not meet strategic aims or clinical integration aims)

C&B: This programme of work is in place and ongoing.

CASH: Migrate the service once full Data Sharing Model is in place in Rotherham. Next steps

Bed management: take forward the roll out for Palliative Units as soon as possible.

Bed Management: explore the viability of taking Community Hospital functionality for PLD.

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C&B: continue the roll out programme.

CASH: Explore in depth what levels of confidentiality are possible within the new Data Sharing model. 4.10 Delivering National Initiatives

This section details the programmes of work that will be carried out to deliver the remaining elements of the rescaled NPfIT. This section assumes that the SystmOne will be fully adopted by NPfIT as a strategic solution and a full alternative to the Lorenzo system. The deployment of SystmOne is a single solution to allow sharing of patient information amongst clinicians within Rotherham General Practice, community and Out of Hours environments which supports the “Adding Quality and Value” strategy. Having a single solution will support the first class primary care services objective by allowing high quality information within the primary care setting to be accessible to health care staff across the patient’s care pathway.

4.10.1 SystmOne Out Of Hours

Background The SystmOne Out of Hours (OOH) module brings potentially great benefits to the Rotherham LHC by allowing the sharing of TPP GP and community records with the OOH service. This will allow safer care, and reduce the need for onward referral or admission to other providers by enabling the OOH practitioners to see a full medical history for their callers, including prescribing history, allergies and reactions. Where are we now The OOH unit currently use the Adastra system in support of their service. This has poor integration with the rest of the community regarding lookup of existing records. Consequently Doctors working out of hours will always err on the side of caution and send patients to their registered GP the following day, or on to A&E if the condition is acute. What do we want to achieve A full implementation of the OOH module will allow the realisation of the benefits described above. Currently all of the Community records, and half of GP records will be immediately visible to the service. As further GP’s migrate to SystmOne they too will benefit from less referrals from the OOH service. What are the options Implement this module to get the benefits of the shared record, if we fail to implement we risk further inappropriate admissions. Next steps

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A project to implement the OOH module has been instigated, and official authority to proceed is being requested from the local Service provider via the Strategic Health Authority. It is hoped to go live in the OOH unit during June 2010.

4.10.2 SystmOne Walk In Centre

In April 2009 Care UK opened the new Walk-in-Centre at Rotherham Community Health Centre. The Walk-In-Centre is located within the same premises for the CareUK GP Practice, Chantry Bridge Medical Centre. The computer system used within the Walk-In-Centre is Adastra and the GP practice system is SystmOne. The Walk-In-Centre is scheduled to transfer onto SystmOne during March 2010. Training is planned for February and March for the CareUK staff by the local training team to support the transfer. The benefits of moving onto SystmOne will allow staff at the Walk-In-Centre to register patients through the Spine which will ensure that demographic information including NHS numbers of patients is captured correctly. With the patients consent, information will also be available to clinical staff that has been recorded from Child Health, community settings and the GP practice information (if the patient is registered with a SystmOne GP) which will better support the management of walk-in patients care.

4.10.3 SystmOne Community Hospital

Background The SystmOne Community and palliative care modules have been rolled out extensively to the provider units across Rotherham. There are however a few area’s of functionality that have been weak and resulted in continued use of legacy system’s or workarounds. Primarily these gaps are around 18 week Referral To Treatment tracking, bed management and CDS/MDS production. Where are we now In 2009 TPP announced that the Community Hospital module would be launched and encompass the features described above. Consequently this option was seen by both Commissioner and provider as promising enough to warrant investigation. In the meantime the existing palliative care and Community modules have been enhanced and now offer some of the functionality. What do we want to achieve Ultimately SystmOne should deliver us sufficient functionality to satisfy end users and commissioners across all Community care settings. We aim to exploit this to stick to our ethos of a single detailed care record shared across the community. Sustained use of legacy and workarounds dilutes the effectiveness of this approach. What are the options 1. Continue use of legacy systems and SystmOne – this has a significant revenue cost and may

be unsustainable medium term.

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2. Discontinue legacy systems and employ workarounds where conventional SystmOne is insufficient – this may be labour intensive.

3. Discontinue legacy systems and obtain the SystmOne community module – this has a revenue cost and there is doubt that the module is yet fit for purpose.

Next steps Investigation into the capabilities of the individual SystmOne modules. The output from which should be a documented gap analysis of the various approaches to inform the commissioner of the relative merits and justify any expenditure required. Subject to this a decision will be needed from NHSR on what option to take.

4.10.4 Electronic Prescribing Service Phase 2

Background The Electronic Prescription Service (EPS) is a project within the scope of the National Programme for IT (NPfIT). The EPS will allow prescriptions generated by GPs and other prescribers to be transferred electronically between prescribers, dispensers and the reimbursement agency, currently the Prescription Pricing Division (PPD). EPS Release 2 will see the electronic digital signing and transmission of prescriptions, and the electronic reimbursement process from PPD to the dispensers. There are five high level business process areas of EPS Release 2; Patient Nomination, Electronic Signing of Prescriptions, Electronic Cancellation of Prescriptions, Electronic Repeat Dispensing and Electronic Prescription Reimbursements Endorsements. In time, with EPS Release 2 the paper FP10 prescription will be phased out as much as possible with the majority of prescriptions being sent to dispensers electronically. Where are we now NHS Rotherham has already established EPS Release 2 project board and project manager to support the implementation. Pharmacies and practices have been upgraded to Release 1 functionality allowing them to test the infrastructure. Pharmacy and GP System suppliers will be upgrading their systems during 2010/11 to incorporate the latest release. Testing of some of these systems has taken place and it is expected that some pharmacy and GP practices will be available from early 2010. What do we want to achieve All pharmacies and GP practices are able to use the EPS Release 2 functionality by 2011. What are the options This is a National Programme for IT initiative that will be performance managed by the Strategic Health Authority. Next steps Several key milestones will need to be achieved to deploy EPS Release 2 to the timescales proposed.

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A draft Nomination Policy will be required by the end of February 2010.

All pharmacists and dispensing staff will need to be issued with Smartcards to enable them to use the Release 2 functionality.

NHS Rotherham will need to apply for Digital Signatures from the Department of Health in order for GP and other prescribing staff to digitally sign prescriptions.

A business continuity guidance document will need to be written to support pharmacies using the new software and Smartcards.

A process will need to be established to arrange for the ordering and distribution of dispensing tokens.

A pilot site will need to be agreed and a full implementation plan to incorporate all GP and pharmacies.

4.10.5 Summary Care Record

Background The Summary Care Record is a major element of the NPfIT, and allows patients to choose to have a Summary Care Record, which will be available to authorised health care professionals treating them anywhere in the NHS in England. Where are we now NHSR has just launched a formal project to implement this system. We have moved quickly in order to bid for central funding of the mass mailout to all Rotherham residents aged 16+ years which forms an essential pre-requisite before commencing to load the summary records onto the central spine repository. This is achieved by copying sections of the patient record from the GP system where they currently reside. Currently not all Practice systems are ready to perform this upload but are scheduled to be upgraded by May 2010. What do we want to achieve We would like to upload summary records for all residents who agree (typically 99.5% in area’s who have already gone live) within two years. Once the mailout has been successfully completed the next stage is to ensure that the records of residents who consent to share the SCR their records are of a sufficient quality to be uploaded. What are the options If we win the bid for National funding, we aim to do the mailout in late April. If we fail in our bid for funding we will reschedule to a time as and when funds are available (potentially £91k). In either case the letter to residents will only have rough timescales as the detail of the rollout will depend on practice readiness. Next steps Several key milestones will need to be achieved to deploy Summary Care Record these are:

Patient letter completed by March 2010

Mailout to all patients during April 2010

General practices are data accredited or paperlight

Concept Training has taken place

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Patient information uploaded to spine from December 2010 through to August 2011

SCR deployed to healthcare services

4.10.6 Pseudonymisation Implementation Programme

Background The 2009/10 IM&T Guidance within the 2009/10 Operating Framework - Informatics Planning (page 20), informed NHS organisations that they should prepare to implement pseudonymisation and initially required plans by June 2009. This deadline has since been changed to October 2009. It is NHS policy that patient level data should not contain personal identifiers, including the NHS Number, when it is used for purposes other than the direct care of patients. It is important that organisations commissioning and providing NHS care develop and implement plans for the use of data, which has either been anonymised or in which identifiers have been replaced with pseudonyms. This should cover all patient level data which is not used for direct care purposes and in particular NHS wide data which is extracted or received from the Secondary Uses Service. Where are we now A Project Manager has been appointed to implement the project and a project plan has been completed. The project plan has twelve remaining distinct requirements which have been allocated to named individuals to complete and will be monitored through the project team. What do we want to achieve

NHS Rotherham to be compliant with the data protection Act 1998 and to meet the requirements of the Information Governance Toolkit regarding pseudonymisation. What are the options This initiative is from the Department of Health and is not optional. Next steps Ensure that relevant staff are aware of and trained to be able to use anonymised or pseudonymised data by April 2011. Ensure changes are made to existing systems, processes, historic data and access control mechanisms in order to facilitate the use of pseudonymised data in place of patient identifiable data. Use the latest Information Governance Toolkit to assist in implementation and assessment of compliance with policy. Additionally ensure that organisations from which care is commissioned comply in the use of pseudonymised data for purposes other than the direct care of patients.

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4.10.7 Map of Medicine Background Map of Medicine is an evidence-based patient journey for common and important conditions - a sat nav overview that can be shared across all care settings. The Map is a web-based tool that can help drive clinical consensus to improve quality and safety in any healthcare organisation. Where are we now The Map of Medicine software has been deployed at every GP SystmOne deployment. However, no training has been provided for the use of Map of Medicine and no localized Rotherham pathways have been written. What do we want to achieve NHS Rotherham will ensure that Map of Medicine is considered as a tool for optimising knowledge of care pathways to health clinicians within Rotherham and developing local care pathways. Next Steps

The Map of Medicine tool will be considered for use across all care settings in Rotherham. If it is found to add value NHS Rotherham would adopt the management of the Rotherham instance on behalf of the health community

The InterQual tool will be considered for use as a clinical decision tool across all care settings

The Isabel diagnosis decision support system will piloted in Rotherham in the general practice setting and reviewed against Map of Medicine

4.10.8 SystmOne Version 3 – Data Sharing Model Background In the current version of TPP SystmOne Release2, clinical staff are able to control how patient

information is shared i.e. they can control what is shared and who it is shared with. Information

is currently shared between users, units and organisations. These decisions to share patient

information are generally made without patient consultation. Proprietary confidentiality

controls in the current release provide functionality for clinical staff to protect the

confidentiality of patient records. However, the current release does not support mechanisms

for patients to limit how their confidential information is shared. It is law and policy to provide

individual patients rather than clinicians with powers to limit how their confidential information

is shared and this has influenced the design decisions for Release 3 of TPP SystmOne.

TPP SystmOne Release 3.01 introduces new facilities which will enable patient choices on

information sharing to be recorded and applied. There are two types of choices to limit

information sharing, each of which is described below:

Patient consent/dissent to NHS CRS information sharing; and

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Privacy markers, enabling patients to restrict access to certain parts of their records. Where are we now NHS Rotherham has been unable to progress with the upgrade to Release 3 of SystmOne due to issues found from PCT pilot sites. What do we want to achieve NHS Rotherham would like to implement the enhanced data sharing model when it is available to enable sharing of patient information between GPs and community staff. Next Steps

Complete the readiness assessment

Convene a Project Board

Complete a roll-out plan

4.10.9 Integrated Identity Management

Background From April 2008 new NHS Employment Check Standards were required of the NHS as part of the annual health check. Similarly, robust identity checks (using the same identity management standards) are carried out by an NHS Organisations Registration Authority (RA) to verify an individual’s identity before allowing access to NHS Care Records Service (NHS CRS) applications. Combining these two parallel activities into a single Integrated Identity Management process could deliver some efficiency savings within the organisation. Where are we now NHS Rotherham are unable to proceed with the Integrated Identity Management programme whilst organisational changes have been agreed as this may determine what strategy it would like to employ when looking at Integration. What do we want to achieve NHS Rotherham will review the efficiency savings that could be delivered by integrating ESR and RA processes and implement these changes as soon as possible. Next Steps

Set-up project board and team to support the implementation of IIM

Enable ESR NHS CRS Smartcard access for users of ESR

Review where HR And RA processes could be integrated

Create Position Based Access Controls for staff using Smartcards

Implement the new registration software which will allow electronic forms and digital signatures.

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5 Provider IT Strategies 5.1 RFT

5.1.1 Electronic Patient Record

One of the key priorities for RFT is the implementation of an integrated Electronic Patient Record System. To this end RFT has contracted Filetek to implement the latest version of Meditech EPR solution (V6). The EPR will be implemented in two phases and will be completed by the end of 2011. The first phase will deliver functionalities into the following areas: Phase One – Dec. 2010

PAS

A&E

Maternity & Child Health

Theatres

Assessments – Outpatient and Inpatient

Discharge Summary incorporating TTO’s

Outpatient Prescribing

Interfaces (e.g. Choose and Book, path, rad, and other departmental systems)

Critical Care

Order Communications and Results Reporting

o Pathology

o Radiology

Clinical Correspondence

Statutory and Management Reporting

Document Management and Scanning

Clinical Decision Support

SNOMED CT

Phase Two - Dec. 2011

Inpatient Prescribing

Medication Administration

Care Plans

Integrated Care Pathways

Radiology Information System

Departmental Systems e.g.

o Cardiology

o Endoscopy

o Audiology

o Cancer

o GUM

Interfaces

o Direct Patient Booking Access

o SMS Texting

o Links to clinical monitoring devices

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The EPR will enable RFT to deliver the key corporate objectives, by improving patient safety and enhancing patient experience in many different ways. It will also enable the trust to improve its efficiency in delivering health care services. The EPR is implemented as a major change programme and at the heart of the implementation is a process redesign phase the purpose of which is to examine and redesign the main clinical areas in the trust and then configure the system to support the new clinical processes and ways of working. The EPR programme implementation is benefits focused and the trust has in place an effective Benefits Management Strategy and plan to realise the intended benefits from this investment. A robust Governance arrangement is in place now with the EPR board chaired by the Trust Chief Executive and reports to the Hospital of Tomorrow Board that is designing the future of service provision at RFT.

5.1.2 Order Comms

Order communications has many elements. Currently all GP practices and hospital clinicians can access pathology results electronically. The second phase of Order communication has started by piloting electronic requesting of tests and the viewing of results that has not been requested by primary care. This will be rolled out during this year to the great majority of practices. The final phase of OC is the implementation of EPR phase one that will enable the hospital clinicians to electronically requests test, and expanding this service to include other procedures such as radiology tests.

5.1.3 System Interoperability

Rotherham Foundation Trust is leading the region in the use and the full exploitation of integration technology through the use of CfH integration engine “Ensamble”. Furthermore the EPR system will support any HL7 messages to facilitate the sharing of information between different health care providers.

5.1.4 Delivering the ‘Clinical 5’

The clinical 5 include: PAS integrated to other systems and sophisticated reporting, order comms and diagnostic reporting, letters with coding, scheduling, e-prescribing. The PAS is already in place with demographic links to key systems. Reporting is provided through a third party data warehouse system. Order comms and reporting is in place for primary care but electronic test requesting is being rolled out this year. The production of letters with diagnostic and procedure coding (where applicable) are able to be provided via the current PAS. E-prescribing will be available from the EPR implementation.

5.1.5 Use of SystmOne (A&E/Paediatrics/ Pharmacy)

SystmOne is viewed as the strategic system for primary and community work. To this end the trust is working closely with the system one provider and NHS Rotherham to explore ways to

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enhance the use of this system and to interface it to other clinical systems such as the EPR. The trust believes that SystmOne should be made available in the first instance in the following departments, A&E, Paediatrics and Pharmacy. The trust is currently discussing with the SHA issues relating to the use of the system by hospitals, the licensing and contracting arrangement.

5.1.6 Approach to telehealth/telemedicine

The trust believes that there are great opportunities to improve patient care through the use of Telehealth/telemedicine in certain areas. The trust is working with NHS Rotherham to explore and prioritise the key initiatives that need to be initiated in this area.

5.1.7 NHS Mail Adoption

RFT believes that NHS mail is the strategic solution going forward, however the trust view that the solution must be very stable and reliable before RFT migrate to it. Mail services are critical services to the organisation and the trust will continually evaluate the timescale to migrate to NHSmail.

5.1.8 IT Infrastructure and the NHS Infrastructure Maturity Model

The trust has developed an infrastructure strategy that has transformed IT services in the Trust. So far the following has been completed:

Re-wiring the entire hospital to Cat 5e standard

Install a full wireless network in the hospital

Create a second computer centre and re-fresh the technologies in the old computer centre

Implement VMware technology to improve the management and the utilisation of the IT back end.

The implementation of wireless access to the trust email and network

The use of encryption to mobile devices The final areas of the infrastructure strategy will be completed by August 2010 and will include

The move to full central storage

Email Archiving

Exchange Upgrade to 2010

The upgrade of all old PC to minimum standards to support the EPR implementation

5.1.9 Information Governance

The trust has in place an Information Governance Steering group that is chaired by the Medical Guardian who is also the Caldicott Guardian. The trust uses the IG Toolkit to assess progress against the key standards within the tool.

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5.2 RDaSH

5.2.1 Electronic Patient Record RDaSH uses Maracis as a complete Clinical and Administrative package for Mental Health services. Currently this is being rolled out to Substance Misuse services throughout the Trust although within the Rotherham area it is already the main system in use. Discussions are ongoing regarding use of SystmOne by certain services within the Trust although funding is currently an issue together with project management and training requirements. There would also be a requirement to integrate/share data between SystmOne with Maracis in some form.

5.2.2 System Interoperability

The Trust Network and Server Manager is currently meeting with Technical representatives from other Trusts across the Rotherham area to discuss system interoperability although these discussions are at an early stage as yet.

5.2.3 Delivering the ‘Clinical 5’

Currently Patient Administration is provided using the Maracis system which is built on up to date technology and is potentially capable of integration with other systems dependant on agreement of the other system providers and appropriate resourcing. Sophisticated reporting is achieved through the use of a data warehouse which currently links directly to the clinical system and has the potential to link widely to a range of other systems.

Order comms are provided through use of the Acute Trusts systems. Discussions are underway to provide a direct order comms service from RDaSH's main clinical system.

Standard discharge letters are available through the current clinical system

As the majority of Trust services are provided from the community bed scheduling has not been seen as a priority

E-prescribing is an aspiration as the pharmacy company currently linked to the Trust does not have this facility at the current time

5.2.4 Use of SystmOne

RDaSH are investigating the use of SystmOne particularly in respect of Psychological Therapies and Learning Disabilities services, however funding issues have currently curtailed the discussions.

5.2.5 E-consultations

A project to develop e-clinics within the Psychological Therapies services is taking place in the North Lincs area of the Trust. It is possible that if successful, this project may be expanded to other areas of the Trust.

5.2.6 NHS Mail Adoption

As is the case with NHSR, RDaSH have a modern e-mail server and infrastructure. When this needs to be replaced, consideration will be given to moving to NHS mail although at the present time this is not seen as fit for purpose due to the lack of storage capabilities and the inability to encrypt mail which is being sent outside the NHS Mail system.

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5.2.7 IT Infrastructure and the NHS Infrastructure Maturity Model Funding has been allocated during the current financial year to provide a project manager who

is undertaking an exercise to provide a plan for the implementation of ITIL principles across the

RDaSH IT Services. Additionally a piece of work is being undertaken to measure the Trust

against the NIMM standards that have been defined to date and provide action plans to bring

scores up to a minimum of level 3 across these standards.

5.2.8 Information Governance

Information Governance is provided by a trained IG Manager and supported by an Informatics

Security Specialist. The Trust is on track to achieve an overall Green rating of 80% for the IG

Toolkit submission at March 2010. Action plans are in place to consistently improve scores year

on year although definitional changes have resulted in a slight decrease in the score from 2009.

All Trust staff receive IG training at induction and as an integral part of clinical system training.

However limited resourcing has meant that yearly IG updates for all staff are not possible.

5.2.9 Other Strategic Initiatives in RDaSH

Additionally RDasH are:

Currently implementing a data warehouse for the Trust which will develop over time to provide comprehensive dashboards and reporting for the Business divisions.

Taking part in work to develop a currency for Mental Health PbR.

Consistently improving network infrastructure and disaster recovery routines. Implementing VOIP technology across the Rotherham areas of the Trust.

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6. High Level Programme Plan

Description Project

Lead

Period

2010/11 2011/12 2012/13 2013/14 2014/15

Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4

Clinical Data Quality and Safety Bet Rudge

System Interoperability Andrew Clayton

GP Systems Rationalisation Andrew Clayton

Information to support community management and commissioning

Andrew Clayton

Developing the use of Intequal Andrew Clayton

IT Infrastracture and the NHS Infrastructure Maturity Model

Derek Stowe

Use of Telehealth and telecare Andrew Clayton

Hospice teleheath system Alan Meloy

Windows Desktop Automation David Rees

Community Nursing Digital Pen Project

Peter Clarkson

Choose and Book Optimisation Peter Clarkson

Home Working Derek Stowe

Remote Working Derek Stowe

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PACS Optimisation Alan Meloy

Review and rationalise existing IT Services

Andrew Clayton

Shared Informatics Services Andrew Clayton

NHS Mail Adoption Derek Stowe

N3 VOIP Implementation Derek Stowe

ePEX System Decommission Peter Clarkson

SystmOne Out of Hours Wendy Lawrence

SystmOne Walk-In Centre Wendy Lawrence

SystmOne Community Hospital Alan Meloy

Electronic Prescribing Service Release 2

Wendy Lawrence

Summary Care Record Wendy Lawrence

SystmOne Version 3 Wendy Lawrence

Pseudonymisation Implementation Programme

Wendy Lawrence

Map of Medicine Wendy Lawrence

Integrated Identity Management Wendy Lawrence

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7. Indicative Costs 2010 – 2015 All cost shown are in £, 000’s

Description

Period

2010/11 2011/12 2012/13 2013/14 2014/15

Rec £

Non-Rec £

Cap £

Rec £

Non-Rec £

Cap £

Rec £

Non-Rec £

Cap £

Rec £

Non-Rec £

Cap £

Rec £

Non-Rec £

Cap £ Comments

STRATEGIC PRIORITIES

System Interoperability 0 0 0 8 0 0 0 0 0 0 0 0 0 0 0

Costs based on the assumption that interfaces to Meditech, Maracis and Swift will be provided by the suppliers at no additional cost. Recurrent revenue funding in existing budgets.

GP Systems Rationalisation 11 73 131 11 73 132 0 0 0 0 0 0 0 0 0 Capital funding will be subject to a capital bid

Information to support community management and commissioning 20 100 0 0 0 0 0 0 0 0 0 0 0 0 0

Recurrent revenue funding in existing budgets

SystmOne Out of Hours 14 60 0 0 0 0 0 0 0 0 0 0 0 0 0

Recurrent revenue funding in existing budgets

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ASPIRATIONAL DEVELOPMENTS

Clinical Data Quality and Safety 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

Developing the use of Intequal 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

IT Infrastracture and the NHS Infrastructure Maturity Model 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

Use of Telehealth and telecare 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

Telehealth will be delivered as part of the vertical integration of services

Hospice teleheath system 0 15 39 0 21 95 13 0 0 0 0 0 0 0 0

Windows Desktop Automation 6 0 0 0 0 0 0 0 0 0 0 0 0 0 0

Community Nursing Digital Pen Project 48 0 244 0 0 0 0 0 0 0 0 0 0 0 0

Choose and Book Optimisation 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

Home Working 4 0 0 0 0 0 0 0 0 0 0 0 0 0 0

Remote Working 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

PACS Optimisation 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

Review and rationalise existing IT Services 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

Shared Informatics Services 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

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NHS Mail Adoption 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

N3 VOIP Implementation 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

ePEX System Decommission 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

SystmOne Walk-In Centre 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

SystmOne Community Hospital 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

Provided in CfH contract from April 2011

Electronic Prescribing Service Release 2 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0

Additional monies to supplement NHSR controlled stationary budget

Summary Care Record 0 5 0 0 0 0 0 0 0 0 0 0 0 0 0

SystmOne Version 3 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

Pseudonymisation Implementation Programme 0 10 0 0 0 0 0 0 0 0 0 0 0 0 0

To support Calisto upgrade

Map of Medicine 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

Integrated Identity Management 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

Total 104 264 415 19 94 227 13 0 0 0 0 0 0 0 0 Additional recurrent per year

104

19

13

0

0

Total non-recurrent per year (capital+non-recurrent revenue)

679

321

0

0

0

Total per year

783

340

13

0

0