Report to: Board of Directors (Public) Report author: Mr ... · Directorate of Finance, ICT & Estates Page 5 of 53 Digital Healthcare ICT Strategy – version 1.0 1.0 EXECUTIVE SUMMARY

Report to: Board of Directors (Public)

Paper number: 4.1

Report for: Decision

Date: 30 March 2017

Report author: Mr David Jackland, Associate Director of ICT

Report of: Mr David Wragg, Director of Finance

FoI status: Report can be made public

Strategic priorities supported:

Early and effective intervention / Helping people to live well / Research and innovation

Cultural pillars supported:

We value each other / We are empowered / We keep things simple / We are connected

Title: Digital Healthcare Information Communications Technology Strategy

Executive Summary

This document is the Digital Healthcare Information Communications & Technology Strategy for Camden and Islington NHS Foundation Trust (C&I) and describes an ambitious process to deliver this over the next five financial years (2017 – 2022) in order to address the strategic and clinical objectives.

This is the first Digital Healthcare Strategy produced by C&I which demonstrates that its core purpose is to support the delivery of the Clinical Strategy and the role information and digital technology will play in the process of improved population health outcomes for the people of Camden and Islington over the next five years. The Executive leadership and Board members recognise the important role ICT will play in ensuring success of C&I integrated care, and outcomes based commissioning goals.

The Strategy cannot be seen in isolation as digital technology plays a key part in Information Governance, Performance, Contracting, Information & Business Intelligence, Clinical Care, Estates & Facilities Management and Business Planning. This strategy is, therefore, closely linked with other strategies to ensure integration with all aspects of the C&I business activities.

Better use of digital technologies will help C&I to achieve efficiencies and improve operational productivity and performance, such as those identified in Lord Carter of Coles report (2016). ICT should no longer be seen or viewed as a ‘back-office’ function as it now underpins the means to provide a critical modern healthcare service. In the event that core infrastructure or information systems should become unavailable then C&I would struggle to deliver a safe and effective service to our Service Users.

Digital technology has the capability to contribute to service redesign and with the development of new models of care. This will be required in order to address the challenges that are now facing C&I and the wider NHS.

The purpose of the Strategy is to restate C&I vision, aims and objectives and to ensure that ICT has the capacity to align with the clinical and business needs of C&I through the following:

To deliver systems and information that support those needs;

Agile enough to meet the evolving needs of C&I and the wider NHS; and

To meet the needs and expectations of our stakeholders including staff, Service Users, commissioners and the wider health community that we serve.

To enable the strategy seven key strategic pillars have been outlined in order to address the vision, aims and objectives of C&I, these are as follows:

Integrated Electronic Patient Record;

Adding value for Service Users & Clinicians;

Enhanced productivity through innovation;

Agile working across all settings;

Empowered and engaged Service Users;

Supporting care outside hospital; and

Joined-up care.

In order to achieve these targets, objectives and benefits as set out in the National / local strategies as well as the Digital Roadmaps by 2020, C&I will have to rapidly put into place the foundations of this strategy. The programme of work within Section seven of this document establishes which key developments will be required to address this.

The Digital Development Committee (DDC) has been established with the responsibility for steering, governing and performance managing the digital work programme. The DDC will be directly accountable to the Resources Committee.

In conclusion, the strategy aims to set the direction for the programme of change and demonstrates how C&I can provide clinical services and leadership through the provision of a digitally enabled and technologically ambitious healthcare service, for the benefit of our Service Users, staff and partners.

Recommendation to the Board

The Board of Directors is requested to:

APPROVE the enclosed strategy sufficient for its recognition as a Board strategy for the purpose of the St Pancras Outline Business Case but subject to wider consultation and agreement within the FTE and a refined document to be submitted aligned by the Full Business Case submission in the autumn of 2017.

Risk Implications

All potential risks are register on the Corporate and the ICT Department risk registers.

Finance Implications

This will be addressed through business case(s) and Capital bids.

Equality and Diversity Impact / Single Equalities Assessment

N/A

Camden and Islington NHS Foundation Trust

Directorate of Finance, ICT & Estates Page 1 of 53 Digital Healthcare ICT Strategy – version 1.0

Digital Healthcare

Information Communications Technology

Strategy



Digital Healthcare Information Communications Technology Strategy

DOCUMENT CONTROL SHEET

Document Change History:

Version Number:

Date: Author: Summary of changes:

1.0 20/03/17 David Jackland – Associate Director of ICT

Version 1 for Board approval



DOCUMENT CONTROL SHEET ..................................................................................................... 2

1.0 EXECUTIVE SUMMARY ..................................................................................................... 5

2.0 INTRODUCTION ................................................................................................................ 7

2.1 WHO WE ARE. ............................................................................................................................. 7

2.2 PURPOSE OF THIS DOCUMENT. ........................................................................................................ 7

2.2.1 WHAT DO WE MEAN BY DIGITAL HEALTHCARE ICT? ........................................................................ 8

2.3 PROCESS USED FOR THE DEVELOPMENT OF THIS STRATEGY. .................................................................. 9

3.0 STRATEGIC CONTEXT ....................................................................................................... 10

3.1. NATIONAL CONTEXT. ...................................................................................................................... 10

3.1.1. THE FIVE YEAR FORWARD VIEW (FYFV) AND THE ROLE OF ICT. ......................................................... 10

3.2. IMPLEMENTING THE FIVE YEAR FORWARD VIEW – LOCAL DIGITAL ROADMAPS. ......................................... 12

3.2.1. LOCAL DIGITAL ROADMAPS. ......................................................................................................... 12

3.2.2 THE NATIONAL INFORMATION BOARD (NIB). .............................................................................. 13

3.2.3 OUTCOME BASED COMMISSIONING (OBC) ................................................................................. 16

3.2.3 INTEGRATED CARE AND POPULATION HEALTH ............................................................................... 17

3.3 LOCAL CONTEXT - THE VISION AND STRATEGIC AIMS OF C&I .............................................................. 18

4.0 DIGITAL HEALTHCARE ICT STRATEGY ............................................................................... 20

4.1 DIGITAL HEALTHCARE ICT VISION, AIM AND OBJECTIVES. ................................................................... 20

4.2 ENABLING THE DELIVERY OF OUR STRATEGIC AIMS. ........................................................................... 22

4.2.1 TRANSFORMING HEALTHCARE. .................................................................................................. 22

4.2.2 WORKING WITH OUR PARTNERS ................................................................................................ 23

5.0 THE CASE FOR CHANGE ................................................................................................... 24

5.1 OUR REQUIREMENTS. ................................................................................................................. 24

5.2 REQUIRED DIGITAL ICT ASSESSMENTS TO BE PERFORMED. ................................................................. 25

5.3 ESTATES ................................................................................................................................... 28

5.3 RISKS ....................................................................................................................................... 28

6.0 REQUIREMENTS TO ACTION – OUR STRATEGY. ................................................................ 29

6.1 OUR STRATEGY OBJECTIVES. ........................................................................................................ 30

6.2 SEVEN UNDERLYING PILLARS. ........................................................................................................ 31

7.0 OUR PROGRAMMES OF WORK ........................................................................................ 36

7.1 OUR PROGRAMMES OF WORK. .................................................................................................... 36

7.1.2 AN ELECTRONIC PATIENT RECORD (EPR) PROGRAMME. ................................................................ 36

7.1.3 A SERVICE USER ACCESS PROGRAMME / SERVICE USER PORTAL. ..................................................... 36

7.1.4 AN INTEROPERABILITY PROGRAMME. ......................................................................................... 37

7.1.5 A BUSINESS INTELLIGENCE PROGRAMME. .................................................................................... 37



7.1.6 AN AGILE WORKING PROGRAMME. ........................................................................................... 39

7.1.7 AN ICT MODERNISATION PROGRAMME. ..................................................................................... 39

8.0 HOW WILL WE DELIVER THESE PROGRAMMES? .............................................................. 40

8.1 PURPOSE OF DIGITAL DEVELOPMENT COMMITTEE (DDC). ................................................................ 40

8.2 A NEW ICT SERVICE ................................................................................................................... 42

8.3 A NEW INFORMATION GOVERNANCE SERVICE .................................................................................. 42

9.0 ENABLERS OF CHANGE .................................................................................................... 43

9.1 BEING CLINICALLY LED: ............................................................................................................... 43

9.2 A LEARNING ORGANISATION: ....................................................................................................... 43

9.3 MAINTAINING SERVICE USER FOCUS: ............................................................................................. 43

9.4 A NEW PROGRAMME MANAGEMENT OFFICE: ................................................................................. 43

9.5 A REFRESHED ICT SERVICE: .......................................................................................................... 43

9.6 A RENEWED FOCUS ON DATA QUALITY: ........................................................................................... 44

9.7 A CLEAR PERFORMANCE MANAGEMENT FRAMEWORK ON INFORMATION GOVERNANCE: ........................... 44

10.0 INTENDED MEASUREABLE BENEFITS OF THIS STRATEGY ............................................... 45

10.1 SAFER AND MORE EFFECTIVE CARE ............................................................................................ 45

10.2 MORE RESPONSIVE AND EFFICIENT SERVICE. ................................................................................ 46

10.3 EQUITABLE & SERVICE USER CENTRIC CARE. ................................................................................ 47

10.4 A NEW INFORMATION CULTURE SUPPORTED BY RESILIENT AND MODERN IT INFRASTRUCTURE AND SUPPORT

BY AN EFFECTIVE AND EFFICIENT ICT DEPARTMENT FOCUSED ON SERVICE DELIVERY. .......................................... 48

11.0 CRITICAL SUCCESS FACTORS ......................................................................................... 49

11.1 FUNDING ASSUMPTIONS .......................................................................................................... 49

11.2 WORKFORCE ......................................................................................................................... 49

11.3 ENGAGEMENT, TRANSFORMATION & GOVERNANCE ...................................................................... 50

12.0 TAKING THIS STRATEGY FORWARD… ............................................................................ 51

APPENDIX A – ICT STRATEGIC ROAD MAP ................................................................................. 52

APPENDIX B - FROM VISION TO REALITY: STRATEGY AT A GLANCE ............................................ 53



1.0 EXECUTIVE SUMMARY

This document is the Digital Healthcare Information Communications & Technology

Strategy for Camden and Islington NHS Foundation Trust (C&I) and describes an

ambitious process to deliver this over the next five financial years (2017 – 2022) in order to

address the strategic and clinical objectives.

This is the first Digital Healthcare Strategy produced by C&I which demonstrates that its

core purpose is to support the delivery of the Clinical Strategy and the role information and

digital technology will play in the process of improved population health outcomes for the

people of Camden and Islington over the next five years. The Executive leadership and

Board members recognise the important role ICT will play in ensuring success of C&I

integrated care, and outcomes based commissioning goals.

The Strategy cannot be seen in isolation as digital technology plays a key part in

Information Governance, Performance, Contracting, Information & Business Intelligence,

Clinical Care, Estates & Facilities Management and Business Planning. This strategy is,

therefore, closely linked with other strategies to ensure integration with all aspects of the

C&I business activities.

Better use of digital technologies will help C&I to achieve efficiencies and improve

operational productivity and performance, such as those identified in Lord Carter of Coles

report (2016). ICT should no longer be seen or viewed as a ‗back-office‘ function as it now

underpins the means to provide a critical modern healthcare service. In the event that core

infrastructure or information systems should become unavailable then C&I would struggle

to deliver a safe and effective service to our Service Users. Digital technology has the

capability to contribute to service redesign and with the development of new models of

care. This will be required in order to address the challenges that are now facing C&I and

the wider NHS.

The purpose of the Strategy is to restate C&I vision, aims and objectives and to ensure

that ICT has the capacity to align with the clinical and business needs of C&I through the

following;

To deliver systems and information that support those needs,

Agile enough to meet the evolving needs of C&I and the wider NHS and

To meet the needs and expectations of our stakeholders including staff, Service

Users, commissioners and the wider health community that we serve.



To enable the strategy seven key strategic pillars have been outlined in order to address

the vision, aims and objectives of C&I, these are as follows:

Integrated Electronic Patient Record

Adding value for Service Users & Clinicians

Enhanced productivity through innovation

Agile working across all settings

Empowered and engaged Service Users

Supporting care outside hospital

Joined-up care

In order to achieve these targets, objectives and benefits as set out in the National / local

strategies as well as the Digital Roadmaps by 2020, C&I will have to rapidly put into place

the foundations of this strategy. The programme of work within Section seven of this

document establishes which key developments will be required to address this.

The Digital Development Committee (DDC) has been established with the responsibility for

steering, governing and performance managing the digital work programme. The DDC will

be directly accountable to the Resources Committee.

In conclusion, the strategy aims to set the direction for the programme of change and

demonstrates how C&I can provide clinical services and leadership through the provision

of a digitally enabled and technologically ambitious healthcare service, for the benefit of

our Service Users, staff and partners.



2.0 INTRODUCTION

2.1 WHO WE ARE.

Camden and Islington NHS Foundation Trust (hereafter referred to as C&I) provides high

quality, safe and innovative care to our Service Users within the community or in hospital.

C&I provide services for adults of working age and older who have learning difficulties in

the London area. These clinical services are delivered in the majority to residents in the

London Boroughs of Camden and Islington. C&I provision of care also includes substance

misuse within Westminster, and a substance misuse and psychological therapies service

to people living in Kingston.

C&I services are split into five divisions. This makes it easy for Service Users and GPs to

access the right sort of care. Our five divisions are:

Acute

Recovery and Rehabilitation

Services for Ageing and Mental Health

Substance Misuse Services

Community Mental Health

2.2 PURPOSE OF THIS DOCUMENT.

This document sets out C&I high-level vision for the future of the Digital Healthcare

Information Communications Technology (ICT) Strategy within the organisation and

through working in partnership with our key stakeholders to enable health and social care

across Camden and Islington for the next five years. It identifies the strategic objectives to

be achieved in order to fulfil that vision. The document will also form the base to develop

the new Digital Roadmap for the organisation and to fulfil both the North Central London

(NCL) and NHS England requirements.

The vision of this new strategy illustrates how digital technology can act as an enabler to

transform change in service delivery over the next five years. Therefore this strategy in

turn will form a key part of the overall organisation‘s strategy, its operational plans and

most importantly of all the Clinical Strategy.

The target audience for the document therefore includes all key stakeholders.



2.2.1 WHAT DO WE MEAN BY DIGITAL HEALTHCARE ICT?

The digital revolution is developing at pace across the world and this includes the area of

healthcare delivery. The means of capturing, recording and delivering electronic

information is changing the way and manner that the public expect its current and future

healthcare provision.

Technology is moving to a completely new era of delivery; over the next few years there

will be dramatic changes in which technology as we currently are aware of and understand

will slowly transcendence into the Cloud1. The provision of healthcare is part of this new

era where data recorded in Electronic Health Records through devices such as mobile

devices, social media and other sources will work with data streaming into cloud-based

data stores from all NHS organisations.

However as we rush to become more digital it is important to understand ―what does digital

really mean?‖ The term ―Digital Technologies‖ is used to describe the use of digital

resources to effectively find, analyse, communicate, and use information in a digital

context.

Globalisation and technological change are two key features that are changing and

shaping our lives. To participate in a future knowledge healthcare society we will need to

be able to; adapt to change, research, experiment, think critically, work creatively, plan,

self-assess, use feedback, as well as project management tools to enable us to

communicate ideas in a creative and critical way.

For some, it‘s simply about technology (IT hardware) however digital is about a set of

technologies (analytics, data, mobile, cloud, social etc.) that connects devices with

applications. An example is to think of a mobile phone, which is a device that by itself can

only perform limited functions. However through applying applications this device can now

become a smart phone which can extract your location, contacts, time and place as well

as connecting to others resources in real time across the internet.

For others, digital is a new way of engaging with Service Users and for others still it

represents an entirely new way of providing clinical healthcare / business. It should be

stressed that none of these definitions is necessarily incorrect, however with such diverse

perspectives this may cause confusion which in turn could result in piecemeal initiatives or

misguided efforts that lead to missed opportunities or false starts.

1 Cloud computing is a type of Internet-based computing that provides shared computer processing resources and data

to computers and other devices on demand. It is a model for enabling ubiquitous, on-demand access to a shared pool of

configurable computing resources (e.g., computer networks, servers, storage, applications and services).



To ensure C&I remains as a leading provider of healthcare it will be crucial that the

organisation is closely attuned to our Service Users needs and how future healthcare

provision will be developed through the evolving digital technology. That means

understanding how Service Users behaviours and their expectations are developing inside

and outside the business, as well as outside our sector.

2.3 PROCESS USED FOR THE DEVELOPMENT OF THIS STRATEGY.

The strategy has been produced based on the following inputs:

National policy and guidance in relation to Digital Healthcare ICT.

C&I Clinical Strategy.

Strategic documentation produced by the North Central London – Sustainability and

Transformation Plan (STP).

Interviews conducted with stakeholders.

The process used for the development of this strategy has been to review and analyse all

of the above and to then extract their key themes which will then form the basis of this

strategy. This can be summarised in the diagram below:

DetermineCurrent ICT

environment

DetermineCurrent ICTcapability

Analyse Gap

IdentifyStrategicchoices

Actionplanning

Personalised Health & Care 2020(6 Themes)

C&I Clinical Strategy(10 Themes)

North Central LondonLocal Digital Road Map

(5 Themes)

C&I ICT Digital Strategy

ICT capability

GA

P

Integrated Electronic Patient Record

Adding value for Service Users & Clinicians

Enhanced productivity through innovation


Empowered & engaged Service Users

Supporting care outside hospital

Joined up care

ICT Programmes of works

Digital Strategy(7 Pillars)

A detailed programme of works as stated within Section 7 and in Appendix A will be further

developed and supported by internal business cases for the attention of the Digital

Development Committee.



3.0 STRATEGIC CONTEXT

This section describes the context in which C&I operates and identifies the key strategic

drivers at a National, Regional and local level.

3.1. NATIONAL CONTEXT.

3.1.1. THE FIVE YEAR FORWARD VIEW (FYFV) AND THE ROLE OF ICT.

In October 2014, NHS England produced the Five Year Forward View (FYFV). This sets

out a clear view of the challenges ahead, why change is needed, and what change might

look like. It outlines a vision to address the challenges facing the NHS, and to drive better

Service User outcomes.

The estimated £30 billion gap in NHS funding predicted to appear by 2020-21 could be

closed completely if the health service develops new, more efficient care models. Digital

and information technology is a key enabler to deliver this transformed future for the

benefit of every Service Users, carer, citizen and professional.

The Five Year Forward View states that the biggest challenges the NHS are facing

remains:

1. Changes in Service User health needs and personal preferences;

2. Changes in treatments, technology and care delivery and the need to provide care

that is genuinely co-ordinated around what people need and want; and

3. Continued decline in funding.

Some key themes that need to be addressed to overcome these challenges are outlined

below:

Quality – Recent reports into quality of NHS care have all called for a truly Service User

focussed culture, greater transparency and more rigorous management of standards. The

FYFV continues the focus on quality stating that NHS organisations must narrow the gap

between the best and the worst whilst raising the bar for all.

Prevention - As populations are living longer with more chronic health conditions,

communities must work toward reducing causes of preventable illness such as obesity and

lifestyle risks. Organisations must successfully incentivise and support healthier

behaviours then we can prevent ill health and increasing demands on healthcare. The

FYFV focuses on targeted prevention, supporting a healthier workforce and working

across healthcare partners to enable local, democratic leadership.



Service Users and Communities- The FYFV builds on the Government‘s vision of an

NHS that puts Service Users and the public first, where ―no decision about me, without

me‖ is the norm. It states that Service Users must have more access to their healthcare

information, increased control over the care that is provided to them, and more support in

managing their own health. The wider community, including carers, third party sector and

citizens, also play a vital role and must be engaged in new ways to support the challenges

ahead.

New models of care - Over the next 5 years and beyond the NHS will increasingly need

to flex its traditional care boundaries to support truly integrated, Service User centred care.

The FYFV defines its own view of what healthcare should look like over the next 5 years

and introduces new organisational types and care models.

Leadership and Workforce - Radical change, can only be achieved with the leadership

and people to make it happen. Greater support is needed to help mobilise leaders and

workforces to work differently, develop the newly needed skills, values, behaviours and

numbers to deliver the improvements needed.

Efficiency and Productivity - The NHS needs to make savings of £20> billion with an

additional £30 billion required by 2021. It has been estimated that funding growth will

remain at 1.2% per annum, which will be half of what is needed to fund future services.

With the Better Care Fund shifting a significant amount of NHS funding to Social Care the

financial future of the NHS will become increasingly challenging. Greater efficiency and

productivity is key to delivering the NHS vision for the future as demand increases and

funding decreases.

Health innovation - The FYFV highlights the need for health innovation in relation to

research, personalised care and accelerated innovation in ways of delivering clinical care

such as apps and telemedicine.

ICT – The FYFV focuses heavily on the importance of ICT in achieving the required

changes the NHS has to make. It talks of a National focus on key systems that will

provide the ‗electronic glue‘ to enable different parts of the NHS to work better together.

Key elements include:

Comprehensive transparency of performance data.

Expanding set of NHS accredited health apps to support digital inclusion.

Fully interoperable Electronic Health Records / Portal continuing the move towards

paperless.

Appointments and prescriptions online.

Better audit of data.

Increased focus on technology including smart phones and

Support to build capacity and help those unwilling or unable to use technology.



3.2. IMPLEMENTING THE FIVE YEAR FORWARD VIEW – LOCAL DIGITAL ROADMAPS.

3.2.1. LOCAL DIGITAL ROADMAPS.

The National Information Board (NIB) Framework for Action calls for CCGs to produce

digital roadmaps outlining how their local health and care economies will achieve the

ambition of being paper-free at the point of care by 2020. CCGs will be required to submit

their plans as part of the annual Clinical Commissioning Group planning process.

Commissioners have been asked to take a lead on coordinating and collaborating with

their neighbouring providers to dissolve the artificial barriers between care settings, and

between healthcare professionals.

The local digital roadmaps will provide a means for the CCG to communicate plans to local

stakeholders and inform local service transformation, commissioning and investment

strategies. C&I is part of the North Central London (NCL) – Local Digital Roadmap

footprint and NCL has identified five digital themes to underpin the vision and ambition

which are as follows:-

1. Digitally activated population: We will provide our citizens with the ability to

transact with healthcare services digitally, giving them access to their personal

health and care information and equipping them with tools which enable them to

actively manage their own health and wellbeing.

2. Connected care: We will create and share care records and plans that can be

shared across health and care systems seamlessly to enable integrated care

delivery across organisations.

3. Insights driven health system: We will use data collected at the point of care to

identify populations at risk, to monitor the effectiveness of interventions on Service

Users with established disease and deliver whole systems intelligence so the needs

of our entire population can be predicted and met.

4. Digitally enabled workforce: We will support our providers to move away from

paper to fully digital care processes and provide infrastructure which enables our

care professionals to work and communicate effectively, anywhere at any time.

5. Sustainable Care: We will improve efficiency and productivity through

consolidation of digital services, applications and projects.



3.2.2 THE NATIONAL INFORMATION BOARD (NIB).

What we need to do.

The NIB have set out the framework required to enable substantial change to be made in

the way the NHS can change the way services are delivered to maximise the benefits of

technology and information. In overview they state:

‘Better use of data and technology has the power to improve health, transforming

the quality and reducing the cost of health and care services. It can give Service

Users and citizens more control over their health and wellbeing, empower carers,

reduce the administrative burden for care professionals, and support the

development of new medicines and treatments.

In other parts of our lives, we see the benefits of technology: in the way we book

our travel and holidays, manage our bank accounts and utility bills, buy groceries,

connect and communicate with our friends and family. Digital technologies are

changing the way we do things, improving the accountability of services, reducing

their cost, giving us new means of transacting and participating. This is more than

an information revolution: it puts people first, giving us more control and more

transparency’

The NIB sets out a framework for collective action, and it is expected that the requirements

set out will be included as contractual requirements on providers in the future. Details of

some of these requirements which are relevant to this C&I are summarised below:

a) Proposals to enable me to make the right health and care choices.

From March 2018 all individuals will be enabled to view their care records and to

record their own comments and preferences on their record, with access through

multiple routes including NHS Choices.

All citizens to have a single point of access to all transaction services, including

booking appointments and online repeat prescriptions for all care services, and to

consolidate NHS e-Referrals, appointment booking and repeat prescription ordering

with NHS Choices, as a basis for providing a single, common portal for all care

providers and Service Users.

The NIB will set up a task and finish group with clinical and civil society leaders on

the regulation, accreditation and kite-marking of technology and data enabled

services, including apps, digital services and associated mobile devices. The NIB

will support the development, diffusion and adoption of low-cost high-efficacy apps

with a particular priority on mental health services, for example for cognitive

behavioural therapy.

The NHS Digital will publish the roadmap and the standards that care organisations

will need to meet in order to be able to access core transaction systems, including

Spine and NHS e-Referrals.



The NIB will oversee the launch of a national experiment to give Service Users a

personalised, mobile care record which they control and can edit but which is also

available in real time to their clinicians.

b) Proposals for giving care professionals the data they need.

All Service Users and care records will be digital, real-time and interoperable by

2020. By 2018 clinicians in primary, urgent and emergency care and other key

transitions of care contexts will be operating without needing to use paper records.

NHS England will support National and local commissioners to develop roadmaps

for the introduction of interoperable digital records and services by providers –

including in specialised and primary care – which commissioners and providers will

publish.

The NIB endorses the move to adopt a single clinical terminology – SNOMED CT –

to support direct management of care, and will actively collaborate to ensure that all

primary care systems adopt SNOMED CT.

c) Proposals for ensuring that information is used to improve the quality of care.

The Digital Maturity Index will be a census of digital progress developed by NHS

England alongside the NHS Digital work on burden reduction. This tool will track

increases in the effective use of information technology, digital data and services,

and the consequent reduction in clinical bureaucracy. From March 2016 and

onwards it will be taken into consideration by the Care Quality Commission (CQC)

as part of their inspection regime and by Health Education England (HEE) with

regard to training accreditation.

The NIB will work to drive up adoption and optimisation of mobile technologies that

enable healthcare professionals, Service Users and carers to collaborate effectively

in the organisation, delivery and evaluation of care in community and home care

settings.

NHS Digital, CQC, NHSi and NHS Trust Development Authority (NHS TDA) will

publish data quality standards for all NHS care a provider, including the progressive

improvement in the timeliness, accuracy and completeness with which data is

entered into electronic records and made accessible to carers and Service Users.

The CQC will from April 2016 take performance against these data quality

standards into consideration, as part of its regulatory regime.

The Secretary of State for Health and NHS Digital will publish enhanced data

security standards and requirements for all publicly funded providers of care.

DH will develop proposals to further strengthen the role, responsibilities and

functions of senior information risk owners and information asset owners in the

health and care system.



NHS Digital will re-launch a new Information Governance Toolkit to reflect

enhanced information governance and data security requirements; this will be

called General Data Protection Regulation (GDPR).

d) Proposals for bringing forward life-saving treatments and supporting innovation

and growth.

NHS England and DH will set up a working group with Genomics England, NHS

Digital and other relevant scientific bodies to ensure that the NHS is capable of

supporting the future agenda on genomics and molecular pathology datasets at

scale, building on the current programme to sequence 100,000 whole human

genomes.

Technology Funds and any new ones will be invested in innovative solutions, to

support existing service providers to implement significant service change and to

stimulate new offerings that enable integration and care co-ordination between

services, where individual citizens and carers through access to information are

enabled active partners in their health and care.

e) Proposals for supporting care professionals to make the best use of data and

technology

HEE working with NHS Digital, will introduce a new knowledge and skills framework

for all levels of the health, care and social care workforce to embrace information,

data and technology in the context of a rapidly changing digital environment.

DH, in consultation with the NIB, will develop proposals for national investment in

the digital development of the care system. This work will draw on the experience of

the Technology Fund, and will take a broader perspective across all sectors within

the care system. It will inform wider decisions about health funding in the next

spending review.



3.2.3 OUTCOME BASED COMMISSIONING (OBC)

In answer to many of the challenges outlined above, commissioners are taking the

opportunity to improve local health and care systems by developing new and innovative

commissioning partnerships to support integrated care. Commissioners are moving away

from traditional commissioning models towards an outcome based commissioning

approach.

Traditional commissioning tends to focus on processes such as payment for activity or

organisational performance. With outcome based commissioning, health and care

services are paid for based on achieving outcomes that are important to Service Users.

OBC is interested in net productivity based on outcomes in relation to the resources used -

an approach which aligns with the FYFV‘s focus on efficiency gains. The King‘s fund

paper, Commissioning and Contracting for Integrated Care identifies some of the more

common contractual outcomes including:

Service User experience and satisfaction with services.

Early detection and intervention, to support people to recover and stay well.

Supporting people to manage their condition, and increasing Service User

involvement in decision making.

Improved Service User outcomes (including survival rates).

Reducing emergency admissions to hospital.

Delivery of co-ordinated and Service User-centred care, demonstrating joined-up

working

Effective information-sharing, including use of technology

It is clear from these examples that ICT will play a significant part in supporting

organisations to achieve OBC. Identifying the supporting data elements and technology

platforms will need to play a key part in contract negotiations and redesign of services. The

high level implications of OBC for ICT are:

pooling of population, Service User, service and finance data to measure outcomes

and report against contracts

health intelligence platforms to support the detection and early intervention of illness

technology to support data collection across the continuum of care

data sharing to support co-ordination of Service User centred care

business intelligence platforms to support benchmarking, data analysis, reporting

and predictive modelling and

innovative technology to engage and empower Service Users.



3.2.3 INTEGRATED CARE AND POPULATION HEALTH

Integrated care has become a central theme to health service reform in recent years due

to the changing burden of disease and decreasing health and social care budgets outlined

above. Integration of services through policy initiatives such as amendments to the Health

and Social Care Bill, and the establishment of the Better Care Fund, have made some

progress towards coordinating care of older people and those with complex needs.

Integrated care has seen benefits such as allowing people to live independently in their

own home, and reducing use of hospital services. However, these efforts have not yet

extended to the broader health of local populations.

Population health aims to achieve a wider co-ordination across a geographical population.

It requires partnerships across many sectors to integrate investments and policies in order

to improve the health of a total population.

Access to traditional health and services plays an important part in the health of a

population; however evidence indicates that it is not as important as lifestyle, the influence

of the local environment and the wider determinants of health. With population health,

accountability is spread across the community and not just within the boundaries of health

and care services.

The paper, Population Health Systems – Going Beyond Integrated Care, (The Kings Fund,

February 2015) sees integrated care as part of a broader shift to population health and

cites evidence such as the large and avoidable differences in health outcomes between

social groups, increase in co-morbidity increasing with deprivation, and the clear link

between morbidities and lifestyle.

A number of countries outside the UK have begun to make this shift from integrated care

to population health and these all share similarities:

At the macro level organisations work together across systems to improve health

outcomes across a whole population. Specific interventions target the most

deprived group. In contrast integrated care models tend to target frequent Service

Users.

At the meso level people with similar needs are grouped together and services and

interventions are tailored accordingly. This requires population segmentation and

risk stratification to identify the needs of different groups, and systems within

systems to focus on the various groups.

At the micro level, population health systems deliver a range of interventions

aimed at improving the health of individuals and involve a range of varied services.

This includes integrated health records to co-ordinate peoples care services and

―scaled up‖ primary care services to co-ordinate effectively with other services.



3.3 LOCAL CONTEXT - THE VISION AND STRATEGIC AIMS OF C&I

This Strategy supports the vision of C&I in that people who use C&I services will have the

best possible prospect of recovery within the resources we have available. This vision is

underpinned by three strategic aims:

Early and effective intervention

Helping people to live well

Research and innovation

The three strategic aims will focus on where we know we can make the most impact and

benefit the greatest number of people.

Our first priority is early and effective intervention - the gap between rich and poor in

Camden and Islington is very wide with people who are well-off getting lots of good advice

about how to manage their health and, as a result, enjoying long and healthy lives. We

need to provide that level of advice and service to everyone – regardless of their income or

current state of health. Resources are limited, so we need to empower people to make the

small changes – such as stopping smoking - that will make huge differences in the long

term

Helping people to live well - our second priority - is about joining up care so that we give

people the best chance of getting better. We know that currently lots of our services are

in silos. As people, we are not separated into boxes but have a range of issues in our

lives that interact. We therefore need to have our health care, our mental care and our

social care integrated as one. That means people with mental health problems also

getting information about debt, housing, and their physical health. Developing better

integrated services is something we are working really hard to achieve.

Our Integrated Practice Unit for Psychosis is a fantastic example of this and is already

showing great, early results. It works by shifting the focus to the needs of the Service

User, to care for both their mental and their physical health.

Last, but definitely not least, is our third priority – research and innovation. Our

partnership with University College London has made us second only to Harvard in the

world. Currently, 25 of our staff are leading 45 research projects and we want to expand

this further. Translating our research into better care has to be at the heart of everything

we do. It is proven that high quality research staff raises the standard of care across the

board and that is something C&I wants to champion.



Our staff and our values are central to the realisation of our vision and our strategic

objectives. Our values are part of our core behaviour and all C&I staff are expected to

demonstrate our values and associated behaviour standards as illustrated in our four

culture pillars below:

We value each other - This involves supporting each other‘s well-being and

development.

We are empowered - This means taking action and responsibility to do

what is best for your services and team.

We keep things simple - This means cutting out bureaucracy when it adds

nothing.

We are connected - This means working collaboratively across services

and organisations, rather than in silos.



4.0 DIGITAL HEALTHCARE ICT STRATEGY

This Strategy outlines a high level strategic plan for the next five years to enable a sound

fit for purpose Digital Healthcare ICT delivery. C&I Clinical Strategy lies at the centre of its

ambitions to achieve fit for purpose clinical systems supported by a strong ICT

environment which in turn will then enable the sharing of clinical information seamlessly

via interoperability.

Key Messages:

ICT is a key enabler to help achieve the clinical and business outcomes.

Technology will support the delivery of the Integrated Care.

This strategy is core to the delivery of the long term aims.

High quality, consistent Service User experience will be aided by the best use of

technology.

Information should be collected once and shared appropriately – avoiding

unnecessary repetition and inconvenience for both Service Users and our staff.

4.1 DIGITAL HEALTHCARE ICT VISION, AIM AND OBJECTIVES.

This strategy apart from taking into account all of the requirements contained within the

strategic context section will also then complement the outcomes, vision and aims of C&I

Clinical Strategy which have been defined as follows:-

The core outcomes of the strategy are:

To strengthen and further develop mental health and substance misuse services

provided within primary care and community settings.

To maintain specialist care-pathways based on clinical need.

To strengthen the focus on recovery, resilience and independence.



C&I is committed to using digital tools and techniques to improve its clinical delivery. We

will apply these at each stage of the clinical services delivery in order to support our

Service users, to seek feedback, to explain our clinical decisions and to then evaluate their

effectiveness. As such C&I will continue to expand upon and improve the technology used

to deliver and enable our clinical services so that we can achieve the overarching 10 key

themes we have identified which are:

1. Co-production of treatment and support

2. Recovery-orientated treatment and support

3. Evidence-based interventions

4. Outcomes that matter to service users

5. Integration with other services and physical healthcare

6. Prevention

7. Drugs and alcohol

8. Equality and diversity

9. Quality improvement

10. Research

As part of our commitment to deliver excellent, modern healthcare we plan to use ICT to

achieve our organisational Vision, Aims and Objectives, which are outlined in the diagram

below:

VISION

AIMS

“To maximise health and wellbeing in our community”

Research & Innovation

(Deliver excellent healthcare)

Helping people to live well

(Build partnerships to achieve more together)

Early & Effective Intervention

(Connect with local communitiesto be locally effective)

OBJECTIVES

Trust Vision, Aims and Objectives

“I want staff to have more conversations with me to get to know me and understand me better so that my plan is about me not just my illness”

Deliver safe services for Service Users, Carers and

families

Achieve the best pPossible holistic

outcomes for people

Achieve an excellent

Service User and staff experience in

the delivery of healthcare

Engage our staff and

support them achieving their full

potential

Ensure our services are

commerciallysound



4.2 ENABLING THE DELIVERY OF OUR STRATEGIC AIMS.

The intention of this Strategy is to enable the delivery of C&I long term aims as described

below:

1. Deliver excellent healthcare: We will implement new, clinical systems to ensure

information supports our ability to consistently deliver the highest standards of

healthcare.

2. Build Partnerships: We share a common ambition with our commissioner which is

to put in place clinical systems that will give us the ability to share information

across providers and therefore create a seamless health economy in both Camden

and Islington and within NCL, providing truly integrated care to our Service Users.

We see the NCL Digital Roadmap as a key future method to achieve information

sharing and where advantageous infrastructure sharing.

3. Connect with our communities: Over the next five years we will need to ensure

we can deliver our services where Service Users need us, often in their own homes,

and provide our Service Users with access to their own health information via the

internet ―Service User portals‖ so they can become empowered to take control of

their own healthcare. Through new mobile or ‗agile‘ working, combined with

investing in telemedicine, our clinicians will have to access Service User information

to support care at home.

4.2.1 TRANSFORMING HEALTHCARE.

By its very nature ICT is an enabler of modernisation and improvement within healthcare in

the 21st Century – helping C&I to achieve its clinical and business outcomes and ensuring

a high quality, consistent Service User experience through the best use of technology.

High quality, timely and accessible information is vital to the delivery of safe, prompt and

appropriate care and ICT clearly has a key role in making this happen. Where systems are

not fit for purpose they will be removed and replaced with more appropriate systems, in

order to encourage confidence and trust in our services.

ICT can be a major driver for initiating transformation within the organisation and if

correctly managed will create business advantage and enhance the effectiveness of our

services. There is a need to take a tactical, pragmatic investment approach in the medium

term, investing where there is a sound business justification to do so – that is where the

consequent efficiencies and/or improvements in clinical or business effectiveness create a

compelling investment case. This will be underpinned by sound information governance

practices. We will learn from the past and not repeat mistakes where systems or hardware

have not been owned or tailored to the needs of users.



4.2.2 WORKING WITH OUR PARTNERS

This ICT Strategy should not, and will not, sit in isolation from our partners. We have

strong established links with the Clinical Commissioning Group (CCG), Secondary Care

providers, Councils and other key stakeholders with whom we share many common

ambitions to join up services to benefit our communities. Information sharing is core to

many of these relationships at an operational level and we are committed to developing

common work programmes as necessary.

In particular we have in place a number of joint operational ICT programme initiatives with

our CCG‘s and NCL colleagues where agreement is now in place to work together to direct

and support the ICT programmes. This strategy is therefore aligned to take into account

the requirements of C&I whilst also trying to address the overall aims and goals of the

CCG‘s and NCL.

Through this strategy we will continually seek the engagement and involvement of

clinicians, Service Users, support staff and partners in order to develop systems to meet

their needs and provide information that improve clinical outcomes.



5.0 THE CASE FOR CHANGE

5.1 OUR REQUIREMENTS.

In order to have the means and capability to deliver the stated Strategic Context C&I

needs to conduct a thorough review and assessment of its current ICT capability. This

needs to cover ICT services such as Information, Information Governance and IT in terms

of architecture and infrastructure as at present these areas will not be able to meet modern

clinical or business needs. Some of the main areas which defined the case for change are

as follows:

The functions and roles of the ICT Department need to be clarified and brought into

align with most NHS ICT Departments in order to achieve a unified structure. At

present there is confusion within the roles of Business Intelligence, Information,

Business Performance and Data Quality.

Our IT server architecture is not fit for purpose and our Data Network and

Telephony requires urgent updating in order to ensure that the threat of Cyber

Security2 can be addressed.

We have no 3rd party support / maintenance contracts in place for our IT

environment or infrastructure.

We have no out of hours support for any of our clinical, business systems or ICT

provision.

Audits already conducted for the provision ICT have stated limited assurance in

terms of the quality, resilience and sustainability.

C&I still has a limited amount of clinical systems which do not integrate into the

Data Warehouse and therefore cannot share their data. The risk of this is that C&I

is not able to capture all of its clinical information / activity.

We do not have sufficient real time clinical information supporting decision making

at the point of care in order to support the practice based teams and to develop

care-pathways models (as defined within C&I Clinical Strategy). The solution to

achieve this will be through the Clinical Portal in order to support multi-disciplinary

teams.

Service Users are not able to access their own information concerning their care.

Issues with the current paper Medical Health Records combined with no means to

digitise any paper records towards an Electronic Document Management System

(EDMS).

2 Cyber security is the technologies, process and practices designed to protect networks, computers, programs and data

from attack, damage or unauthorised access. This requires coordinate efforts through the ICT Dept. to include the

elements of application, Information, network security, disaster recover, business continuity planning and user training.



5.2 REQUIRED DIGITAL ICT ASSESSMENTS TO BE PERFORMED.

In order to assess the above to ensure C&I has an ICT environment that is adequately

able to support any further innovation or modernisation of C&I‘s services we will start to

use tools, such as the Digital Maturity Assessment3 (DMA), the Informatics Capability

Maturity Model (ICMM)4 and the National Infrastructure Maturity Model5 (NIMM).

These maturity models are designed to assist NHS ICT Departments to carry out an

objective assessment of their IT infrastructure and Informatics (to determine how

developed / capable specific ICT services are mature or not) and to identify areas which

require improvements.

―The Digital Maturity Assessment measures the extent to which healthcare services in

England are supported by the effective use of digital technology. It will help identify key

strengths and gaps in healthcare providers‘ provision of digital services at the point of care

and offer an initial view of the current ‗baseline‘ position across the country‖ (The forward

View into action: Paper-free at the Point of Care – Completing the Digital Maturity Self-

assessment – November 2015). The three areas it covers are as follows:-

Readiness: covering strategic alignment, leadership, resourcing, governance and

information governance

Capabilities: covering records, assessments and plans, transfers of care, orders

and results management, medicines management and optimisation, remote and

assistive care, asset and resource optimisation and standards

Infrastructure: covering areas such as Wi-Fi, mobile devices, single-sign on and

business continuity.

In the 2016 assessment C&I position (although there is no league position) regarding the

three above areas is as follows:-

3 https://www.england.nhs.uk/digitaltechnology/info-revolution/maturity-index/

4 http://content.digital.nhs.uk/article/4931/Informatics-Capability-Maturity-Model-ICMM

5 https://digital.nhs.uk/NHS-infrastructure-maturity-model

https://www.england.nhs.uk/digitaltechnology/info-revolution/maturity-index/

http://content.digital.nhs.uk/article/4931/Informatics-Capability-Maturity-Model-ICMM

https://digital.nhs.uk/NHS-infrastructure-maturity-model



NHS Digital Maturity (self ) Assessment:- as of 2016.

% = C&I mark Overall National Position,

ALL NHS C&Is

(229 C&Is)

National Mental Health

C&Is

(57 C&Is)

All C&Is within Greater

London

(38 C&Is)

All Mental Health C&Is

within Greater London

(10 C&Is)

Readiness – 78% Joint 22nd Joint 12th Joint 10th Joint 3rd

Capabilities – 53% Joint 22nd 5th 7th 2nd

Infrastructure – 80% Joint 9th Joint 8th Joint 7th 4th

The above figures exclude Ambulance Services.



The Informatics Capability Maturity Model will be used to assess how capable or mature

C&I is from an informatics perspective through the five capability dimensions, the diagram

below demonstrates that C&I requires a major review. The outcome of these assessments

and maturity models will then form part of a Digital ICT action plan which will then be

monitored and managed through the Digital Development Committee.

Managing information

“Information anarchy” Fragmented, incomplete,

inconsistent information Duplication of effort

Information regarded as a strategic asset

Agile information environment enabling strategic agility

Using business Intelligence

Basic reporting and analysis High manual effort required Reporting for historical

purposes

Predictive analytics Full embedded BI within processes,

systems and workflow

Using information technology

Products focussed decisions Standalone products Minimal change to business

process

Innovation through IT Needs led investment Transformation of processes and

services

Aligning business & informatics

Informatics is isolated Viewed as a “cost” No informatics involvement in

business planning

Informatics regarded as a valued asset Board level representation Fully integrated planning

Managing change

Weak change leadership Reactive approach to managing

change High levels of resistance

Change led by the business Senior sponsorship Robust governance Managed benefits

LEVEL 1 LEVEL 5Five Capablity dimensions



5.3 ESTATES

C&I estates portfolio is large, spread out across both Camden & Islington and in most

cases the estate requires improvement. This is further complicated in that there has been

little understanding as to how the estates strategy could help to improve efficiency and

move more care out of hospitals.

With the rapid pace of change in medicine and digital technology this means that it is very

difficult to future-proof large-scale investments in estates and, once built, there are very

few mechanisms for these assets to be changed. Through exploit new technologies C&I

has the opportunity now to consider the following benefits:-

To reduce the overall size and cost of the estate and improve the efficiency with

which it is used.

Improve the appropriateness and quality of the environment for Service Users and

staff.

Develop much more environmentally sustainable buildings and services.

Create collateral for new sources of finance.

Generate income from property rather than create one-off windfalls from sales.

5.3 RISKS

Failure to maintain the estate and its infrastructure to the standards required will result in

an inability to deliver clinical services and objectives. IT issues affecting the ability to

respond to new service requirements or reconfiguration requirements are identified as one

of the origins of this risk.

There are also a number of significant individual risks identified on the Corporate Risk

Register which this strategy will seek to address. Failure to implement the strategy in full or

in part will require alternative mitigation of these risks.

The implementation of the Digital Strategy will reduce the level of information and

technology risk to which C&I is exposed too.



6.0 REQUIREMENTS TO ACTION – OUR STRATEGY.

Key messages:

We have a clear vision for ICT and how it will contribute to the operational plans in

future.

We have identified clear objectives that deliver our vision for ICT.

We have identified programmes of work to achieve these objectives.

The current structure of the ICT Department requires to be defined into a unified

structure which incorporates IT, Information, Business Intelligence, Information

Governance and Medical Health Records.

We need to learn from previous informatics projects and ensure we have the right

skills, resources and structures to deliver with the minimum of bureaucracy–

running an effective implementation programme.

We must not lose sight of ‗the Service User‘ in the delivery phase and allow the

programme to become technology led.

We have identified key benefits, aligned to the operational plans that will ensure the

outcomes achieved by this strategy.

Our Vision

‘Ensure our healthcare services are supported by excellent, high quality

clinical and business information which is timely, accurate and tailored to

requirements.’

To provide high quality services we need to exploit the power of electronic information to

help ensure that Service Users get the right care, involving the right clinicians, at the right

time, to deliver the right outcomes. It is therefore as much about transforming traditional,

outmoded paper driven administrative and clinical processes as it is about technology.

This ICT Strategy is intended to enable improvements in Service User safety, outcomes

and experience through timely access to accurate information.



6.1 OUR STRATEGY OBJECTIVES.

Informed by our principles and requirements, our vision has been translated into the

following key strategic objectives:

To transform the way in which we deliver our services;

Through the use of technology and data improve the quality and delivery of health care so

that tailored information follows the Service Users on their healthcare journey where ever

possible – both within the community and in hospital.

To improve the effectiveness of our services with care delivered in partnership with

our Service Users;

To develop closer relationships with Service Users by ensuring that at each consultation

there is comprehensive information concerning their conditions available. This will be

achieved through sharing information with GPs and other key stakeholders. C&I will work

in partnership to develop and provide a Service User Portal.

To deliver reliable business intelligence through new technologies;

Ensuring there is a single overview of our Service Users information and where high

standards of Information Governance are achieved through the application of good quality

information, this will then drive all aspects of service delivery. This will then support

effective management where reporting is simply a by-product of good clinical, business

and administrative information.

To implement new technologies to support service delivery regardless of location;

Recognising the challenges of establishing interoperable systems which support effective

data sharing this will make the best use of technology to enable agile working which is a

key priority for clinical staff. This will enable more Service Users to be treated in the most

appropriate location; help to rationalise the estate; save money on travel / wasted journeys

and enable more Service Users to be treated as clinicians will not need to return to their

base as often.

To implement a resilient and robust ICT environment;

The Board recognises and understands in today‘s provision of modern healthcare the

strategic importance of ICT assets and that these must be protected, maintained and

managed. This will require having in place an effective and efficient ICT Department who

have the capability and skills to maintain the environment and infrastructure in order to

provide reliable clinical services to staff and Service Users.



6.2 SEVEN UNDERLYING PILLARS.

By consulting widely with key stakeholders both internally and externally we have identified

seven underlying “pillars‖ that have guided the development of this strategy which

underpin our requirements. These are:

Adding value for Service

Users & clinicians

Enhanced productivity

through innovation


Empowered and engaged Service Users

Supporting care outside

hospital

Joined up care

Integrated Electronic

Patient Records

An integrated electronic Service User record: the need for information

The first step towards improving Service User care is to understand what is really taking

place now in terms of outcomes, experience and safety. Good information is vital to

achieving this. C&I needs to ensure information is focussed on what matters and is

collected once and shared appropriately – avoiding unnecessary repetition and

inconvenience for Service Users and staff thereby making clinical services more efficient

and effective. Information must be seen as a key enabler for more streamlined, efficient

and higher quality services.

In 2012, the NHS ―Power of Information Strategy‖ focussed on the need to join up service

delivery by joining up information for Service Users, their carers, clinicians, managers and

other care professionals. It also recognised the principle that ‗joined up‘ information

doesn‘t require one ‗big‘ system. It identified that information technology is always

advancing and the big lesson learnt from the National Programme for IT (NPfIT) was that

in reality ‗big‘ national solutions are difficult to implement quickly and successfully and can

inhibit local flexibility and innovation.



Joined up Care: Delivering Modern Healthcare

We have hundreds of ‗contacts‘ with Service Users using a variety of staff across multiple

locations in Greater London. In each case we need to capture and record vital information

to provide effective care. Making these records and other useful information available

electronically will make the provision of care more informed, safer and independent of

where the Service User makes contact with our services.

C&I is often one of many providers who are involved in a Service User care and it is

important that the information that supports the overall care process of; referral, diagnosis,

treatment and discharge is timely, relevant and accessible regardless of the provider.

Currently, within C&I we still have a number of independent silo of clinical recording

systems. This strategy is committed to removing these information silos, moving away

from paper records wherever possible and ‗joining up‘ information flows through smarter

use of interoperability technology to provide information seamlessly and securely

alongside the Service User journey.

In the next decade, the health and social care system will have to contend with an ageing

population, increasing numbers of people with complex long-term conditions, budget

constraints, increasingly sophisticated treatments and rising expectations of what health

and care services should deliver.

An integrated approach aims to meet these challenges through better co-ordination of

health and social care services, reducing the fragmentation or duplication of care. C&I

have ambitious plans to remove unnecessary and artificial boundaries between our

services and ensure Service Users are provided with seamless care C&I new Clinical

Strategy demonstrates this. We are seeking to transform our service offer to be more

integrated, efficient and effective.

To make this a reality what is required is the ability to combine high quality information

together in a detailed ‗live‘ overview of a Service Users care across multiple services and

providers – this will be achieved through systems known as an Electronic Health Record &

Portals.

Although a single system would be one technical solution, in reality this is not desirable or

achievable in our complex health economy. Instead we need to procure modern

interoperable systems which support the sharing of clinically rich & well-structured

information.



Supporting care outside hospital: To help people stay ‘closer to home’.

One of C&I on-going priorities is working with health and social care partners to reduce

avoidable contact with Service Users and keep Service Users ―closer to home‖.

This concept is also a CQUIN target6 which also aligns well with the NHS ‗Digital First‘

initiative; the means to achieve this will be through this strategy.

To deliver this priority there is a requirement for good communication systems across all

areas of care and amongst all relevant service providers with joined up information

systems to support the provision of clinical care.

For the future will require the need to consider where technology can better support the

self-management of long term conditions and new ways to manage complex conditions in

the community through initiatives such as tele medicine and clinical mobile apps.

Empowered and engaged Service Users: Supporting Service Users to manage their

Health and Healthcare.

Whether our Service Users obtain their care through direct contact or remotely, Service

Users should receive ―personalised care‖ supported by access to their personal health

information.

Our Service Users rightly expect healthcare to keep pace with other services (i.e.

commercial providers) which provide access to information anytime, anywhere. Laptops,

mobile phones and other mobile devices have become as much a part of society culture

as television. As the Internet and mobile technology become ever more prevalent, it is

reasonable to expect that these technologies should play an integral role in the ability to

obtain and provide personalised healthcare.

There is a need to create an information revolution for Service Users - to support self-

care and promote ‗health literacy‘ - giving Service Users and their carers much more

information about their conditions and signposting for help and support. Technology is not

the total solution but it can play a big part in providing relevant and tailored information to

Service Users that will then allow them to take control of their own care needs.

By 2020, the Government has directed that Service Users should have much closer

involvement in their care, and this will be achieved partly, by ―enabling' Service Users to

access their records‖ to summary information about their care record.

6 The Commissioning for Quality and Innovation (CQUINs) payments framework encourages care providers

to share and continually improve how care is delivered and to achieve transparency and overall improvement

in healthcare.



Enhance Innovation through Productivity: Efficient and Effective Services.

With the impact of NHS financial pressures on the future provision of care C&I will need to

plan now to determine how to deliver care with increasing limited resources over the next 5

years. This will mean delivering both clinical and business services in the most efficient

manner possible. To assist in these pressures C&I will consider using technology

innovatively to modernise and simplify services – taking out unnecessary steps in service

delivery which either delay or detract from service provision.

With the advancements in medicine and surgery, alongside ICT and technological

innovations mean that there is a wealth of ideas and efficiencies that could potentially be

implemented to reduce costs overall and in turn support C&I to become more sustainable.

As a healthcare provider C&I core need for information is to support clinical care.

However, as a business C&I needs to use this information more widely and more

intelligently to inform on decisions of how, where and why we provide the services we do.

The ability to gather and analysis good intelligence is compromised as currently

information services, performance reporting and business intelligence capabilities each

require significant extension and improvement in order to support the delivery of Corporate

objectives. Management information often needs to be gathered through a mixture of

manual and electronic processes and is both time consuming and unsatisfactory. The

information gathered through the Electronic Patient Record system needs to be aligned to

service quality (outcomes, safety and experience) to provide a more realistic

understanding of activity against performance and to then provide real time reporting.

Moving forward we need information which allows us to:

Do predictive analysis across the board to support business decisions.

Ensure all staff has access to intelligent data / information that helps them to work

more effectively.

Ensure business intelligence is fully embedded within processes, systems

workflows and is easily extracted.

Ensure our internal information teams can provide an excellent, responsive service

where changing requirements are easily handled for new services or business

functions. This will give us the ability to provide information to support contracting /

commissioning more effectively.



Agile working across all care settings: Taking care to where our Service Users need

us.

C&I is committed to taking clinical services to our Service Users wherever possible to

minimise disruption and impact on Service Users. To do this C&I requires access to

administrative and clinical information regardless of where we make contact with our

Service Users. This will mean having timely, reliable access to Service User information

regardless of location and the connectivity challenges that this may cause. By doing so

this will also help to rationalise the estate and save money on travel and wasted journeys,

as well as enable more Service Users to be treated with clinicians not needing to return to

their base as often.

Adding Value for Service Users and Clinicians: Making a Difference.

We need to build confidence in the role technology can play in delivering excellent

services. Both Service Users and clinicians need to understand and see that technology is

genuinely making a difference to the quality of services that can be provided.

Technology will provide part of the answer but equally as important will be how C&I

combines and extracts the clinical benefits of these new technological capabilities, such as

the implementation of the new Electronic Patient Record with other non-technical

improvements such new operating procedures, process improvements and sharing

information across health providers.

Technology can be the catalyst, but to make a difference and realise the transformation in

healthcare that C&I wishes to aspire too, there will be a need to have a ‗total system‘

approach to transformation.



7.0 OUR PROGRAMMES OF WORK

7.1 OUR PROGRAMMES OF WORK.

To achieve the vision and objectives the following programmes of works have been

developed. These programmes are likely to evolve and change as C&I define its

requirements and deliver solutions and will require the ICT Department to develop each

requirement through an individual business case. However initially these programmes will

include the following main topics:

7.1.2 AN ELECTRONIC PATIENT RECORD (EPR) PROGRAMME.

C&I will continue to enhance and develop the Electronic Patient Record system. Ideally

this will be a single system across all our service areas but more importantly it will provide

appropriate and tailored administrative, clinical and performance information and

functionality to deliver excellent modern healthcare. The EPR will be platform to develop

all C&I information environments such as the Data Warehouse and Portals.

7.1.3 A SERVICE USER ACCESS PROGRAMME / SERVICE USER PORTAL.

C&I will consider how to deliver a Service User Portal7 this will be achieved through

working in partnership with our CCG‘s partners. This will provide Service User access to

their own clinical information which in turn will support the means to consider future

telemedicine capability. This will be achieved through the following:

A business case to consider the options and benefits for investing in a single

Service User Portal through working in partnership with both our CCG‘s and within

the NCL.

To consider a work programme to facilitate the engagement of Service Users in

order to build the Portal to provide access for Service Users to their own health

information.

7 A Service User portal is a secure online website that gives Service Users convenient 24-hour access to personal

health information from anywhere with an Internet connection. Using a secure username and password, Service Users

will be able to view their own health information.



7.1.4 AN INTEROPERABILITY PROGRAMME.

The EPR will provide the basis to share clinical summaries, referral and discharge

information and alerts with other care providers to work towards a combined Electronic

Health Record (EHR)8 and Portal. To do this C&I will co-ordinate a series of

interoperability projects across the health economy to enable the necessary capability to

share information seamlessly with our partners. The programme will work with clinicians

to realise the benefits of this technology to improve clinical and administrative practice and

remove the current paper based information sharing. The programme will deliver projects

to:

Create the capability to share administrative referral and discharge information.

Implement via an integration engine a tailorable electronic health record derived

from multiple systems and healthcare providers. Tailorable clinical views will be

available in core clinical systems to provide clinicians real time information on

diagnosis, treatment, medication and administrative information.

Implement messaging technology to share safeguarding or clinical alert information

across service providers. E.g. A&E visits by Service Users being shared between

both organisations.

This system ‗integration‘ and ability to share information proactively will support our wider

work to make Service User care seamless.

7.1.5 A BUSINESS INTELLIGENCE PROGRAMME.

C&I will further develop the Data Warehouse9 in order to assist in the provision of

integrated clinical information and management reporting.

C&I current information services, performance reporting and business intelligence

capabilities each require significant extension and improvement in order to support

delivery of C&I corporate objectives. Data Quality still remains both an issue and a risk

within C&I. The provision of a robust and comprehensive business intelligence and data

warehouse solution has long been recognised as a key priority in enabling C&I to meet

mandatory reporting requirements and to achieve the required performance

improvements, service reconfiguration and financial stability

8 An EPR contains the standard medical and clinical data gathered in a single C&I. EHR go beyond the data collected of

a single C&I and includes a more comprehensive Service User history. For example, EHRs are designed to contain and

share information from all providers involved in a Service Users care. EHR data can be created, managed, and consulted

by authorised providers and staff from across more than one health care organisation. Unlike EPRs, EHRs also allow a

Service User‘s health record to move with them—to other health care providers.

9 A data warehouse are central repositories of integrated data from one or more disparate sources and is a system used

for reporting and data analysis, and is considered a core component of business intelligence.



There is significant scope for a more sophisticated approach to Business Intelligence and

performance reporting, with a much greater focus on data driven insight enabling evidence

based decision making, predictive modelling and proactive performance management.

The Business Intelligence programme will seek to address these challenges through a

series of themed work streams that will ensure we have the supporting technologies to

extract, analyse and report ‗real time‘ and retrospectively so that C&I has in place a ―single

source / version of the truth‖.

The programme will include:

To conduct an Information Maturity audit which will take into account the issues of

Data Quality and standards for data capture and coding.

Data warehouse solution architecture based on recognised industry best practice

methodologies for schema design and storage, which will enable automated data

processing and deliver timely access to information.

Defined business logic layer with data definitions and standards to ensure

consistently accurate and ―single version of the truth‖ reporting.

Integration and triangulation of key data sets across activity, finance, workforce and

quality domains.

Self-service reporting for all managers and clinicians to access key information

through sophisticated, yet intuitive, reporting tools and dashboards.

Analysis solutions to enable predictive planning as well as retrospective

performance reporting.

An information culture which promotes data driven decision making with a skilled

and enabled workforce.

In addition to addressing the challenges of information maturity the Business Intelligence

programme will also deliver a significant step change in the way in which information

management and reporting is delivered to key stakeholders and customers, through a fully

automated solution utilising easy to use self-service reporting tools for managers and

clinicians.

There is an urgent and critical business requirement to enable executives and senior

managers to become self-sufficient in access and proficient in use of management

information. C&I executive, operational managers and clinical leadership all require timely

access to key performance information, and be confident that this can be analysed by

Division, Specialty, Ward and Clinician without requiring specialist technical skills to do so.

The Business Intelligence programme must deliver a significant step change in the way in

which performance information management is delivered to key stakeholders and

colleagues, through automation of relevant and standardised reporting.



7.1.6 AN AGILE WORKING PROGRAMME.

97% of C&I Service Users are treated and supported in the community this programme will

ensure access to our electronic systems wherever our staff and Service Users need this.

Healthcare needs to be provided in a variety of settings – from care homes, to people‘s

own living rooms – and our staff need supporting technologies which give them the access

they need to information regardless of their location. To achieve this we will deliver

projects to:

Define, market test and procure for staff appropriate hardware that can support

remote working and provide reliable access to core systems.

Feasibility test handheld mobile devices to access clinical and administrative

information to provide care in people‘s home and other remote locations and

implementation where appropriate.

Work with partners to provide seamless connectivity via wired or wireless ‗guest

access‘.

Work with our clinical system supplier(s), to ensure clinical systems can be

accessed remotely.

7.1.7 AN ICT MODERNISATION PROGRAMME.

This programme will deliver a new, modernised ICT service through the following projects:

A review of ICT service provision both within C&I and beyond with interested NHS

and non NHS partners to improve the robustness and effectiveness of current

support, networks, hardware and software provision. We will consider delivery

options such as shared services, outsourcing and hosted services.

Subject to the review, we will deliver a project to define and then procure and

implement a new ICT services.

We will review networks and associated infrastructure to ensure they can support

appropriate speeds for voice, image and video communications, whilst remaining

secure and resilient for our services.

The review will take into account the assessment maturity models as defined within

section 5.2.



8.0 HOW WILL WE DELIVER THESE PROGRAMMES?

8.1 PURPOSE OF DIGITAL DEVELOPMENT COMMITTEE (DDC).

In order to support the introduction of the ICT modernisation programme it is essential that

process and governance arrangements are in place. C&I have already recognised the

importance of establishing a dedicated committee to provide the monitoring and

management this is the Digital Development Committee (DDC) as shown below:

Camden & Islington NHS Foundation Trust Board

Information Governance Committee

Digital Development Committee Governance structure

Digital Development Committee

Resources Committee

Estates & Capital Planning Committee

Audit and Risk Committee

Working relationship

Working relationship

Foundation Trust Executive (FTE)



The primary role of the Digital Development Committee is to ensure that C&I investments

in ICT to generate business value, deliver its clinical needs and mitigate the risks that are

associated with ICT. The Committee will focus specifically on ICT, in terms of digital

development, software, hardware, applications / systems, projects and procurement, as

well the performance and risk management. The Committee will set the direction, plan

and provide the following:-

Develop and ratify the Digital ICT Strategy and plans that ensure the cost effective

application and management of all ICT systems and resources within C&I.

To address and develop the National Information Board (NIB) requirements. This is

a new body set up by the Department of Health to bring together organisations from

across the NHS, public health, clinical science, social care, local government and

public representatives. In November 2014, the NIB published a Framework for

action ―Personalised Health and Social Care 2020‖ to support the implementation of

the ―Five Year Forward View‖.

To ensure the Digital ICT Strategy reflects the needs and requirements of both C&I

Clinical and Operational Strategy.

To manage and monitor the ICT Capital programme.

Review current and future technologies to identify opportunities to increase the

efficiency of ICT resources.

Monitor and evaluate ICT projects and achievements against the ICT Strategic plan.

Provide advice and assurance to the Resources Committee, Foundation Trust

Executive (FTE) and Board that the all ICT related systems and applications are fit

for purpose, and make recommendations for mitigation and improvement where

they are not.



8.2 A NEW ICT SERVICE

C&I will consider various options to create a new, fit for purpose ICT support service. This

is likely to be through a mixture of in house management and external suppliers / 3rd party

(out sourcing) to provide a hybrid solution. This will also include the investigating the

potential to explore share services with other NHS and non-NHS partners within Greater

London and in the North Central London – Sustainability and Transformation Plan (STP).

The economic advantages of in-house provision of IT are now outweighed in some areas

by the benefits of commercially supplied services. These commercial suppliers have the

capacity and capability to deliver better service quality than what could be achieved in-

house. C&I will be able to secure its investment through linking payment to delivering

quality services. However, to manage this new IT infrastructure it will be essential that C&I

maintain its knowledge through in house IT strategic management. Outsourcing elements

of IT service provision would ensure rigorous business critical capabilities such as

information protection, disaster recovery and business continuity.

The next steps will be to clarify the current financial expenditure and market test - drafting

business cases that demonstrate the benefits of investment. This will require detailed

analysis and rigorous scrutiny on financial, technical and HR issues.

8.3 A NEW INFORMATION GOVERNANCE SERVICE

Information Governance (IG) underpins all areas of this strategy; however C&I currently

lacks the capability to address the full IG agenda as there is no permanent structure /

resources available, this requires to be addressed. As IG moves towards the new General

Data Protection Regulation (GDPR)10 process it will be essential that C&I has in place a

dedicated team to complete the annual GDPR assessment and to provide innovative

solutions to this agenda with a view to streamlining business processes which will:

Promote the IG agenda ensuring that it is embedded throughout C&I to Divisional

level.

Build a positive reputation with internal and external clients by providing sound

advice and an efficient reliable service regarding all IG matters.

Ensure all policies and procedures are informed by our ‗lessons learnt‘ around IG.

Ensure we embed national policy and requirements taking every opportunity to

drive the culture change needed to support excellent IG.

10 The General Data Protection Regulation (GDPR) (Regulation (EU) 2016/679) is a regulation by which the European

Parliament, the European Council and the European Commission intend to strengthen and unify data protection for

individuals within the European Union (EU). It also addresses export of personal data outside the EU. The primary

objectives of the GDPR are to give citizens back the control of their personal data and to simplify the regulatory

environment for international business by unifying the regulation within the EU.[1] When the GDPR takes effect it will

replace the data protection directive (officially Directive 95/46/EC)[2]



9.0 ENABLERS OF CHANGE

There are a number of enablers which will assist in delivering these programmes of work

and this strategy these include the following:

9.1 BEING CLINICALLY LED:

C&I will continue to involve clinicians and Service Users in the development and

tailoring of technology in order to support the provision of healthcare. Technology is

an enabler of better healthcare but we must ensure it meets our stated

requirements. We will utilise and support clinical leaders to shape and deliver this

strategy.

9.2 A LEARNING ORGANISATION:

C&I will learn from previous failures and successes around implementing ICT

projects and ensure we have the right skills, resources and structures to deliver this

strategy with the minimum of bureaucracy but with the maximum efficiency. This

can be addressed through the involvement of clinicians in the specification and roll-

out of this strategy and purposeful evaluation of benefits realisation as we progress.

9.3 MAINTAINING SERVICE USER FOCUS:

A Service Users ability to make informed choices around care is intrinsic to the

success of this strategy and we must not lose sight of ‗the Service User‘ in the

delivery phase and allow the programme to become technology led. We will involve

Service Users in the delivery of the programme.

9.4 A NEW PROGRAMME MANAGEMENT OFFICE:

The ICT Department has recognised the need to invest in project manager (s) who

are skilled in project methodologies in order to then assist in implementing the

programme of works as defined within the strategy. Creating this new capacity and

skillset is vital if the strategy is to be delivered with the necessary capabilities within

agreed timescale, budget and quality expectations.

9.5 A REFRESHED ICT SERVICE:

C&I will require a new and fit for purpose ICT Service which can meet the

requirements of the organisation and support in the delivery of this strategy. C&I

will need a service which will gain the trust and confidence of staff in moving

towards a new era where it will be even more important to have reliable systems

and hardware and IT support which is responsive, easy to access and resolves as

many issues as possible at first point of contact.



9.6 A RENEWED FOCUS ON DATA QUALITY:

Culturally, many clinicians believe that poor data quality is compromising the

credibility of information. Poor data quality can negate all efforts to improve

information management and systems. The strategy will break the cycle where

poor data leads to poor information which in turn leads to clinical information

systems lacking credibility which inevitably leads to apathy inputting data in the first

place.

Clinical leaders, in partnership with the ICT Department will build confidence in the

vision of an information based culture within C&I – ensuring through on-going

engagement that systems really work for clinicians and allow them to record

information in a way that makes sense to them. Systems will work hard for people,

rather than people working hard for systems and feeling they are just ‗feeding a

beast‘ needlessly.

9.7 A CLEAR PERFORMANCE MANAGEMENT FRAMEWORK ON INFORMATION GOVERNANCE:

We will ensure that C&I can demonstrate that it can be trusted to maintain the

confidentiality and security of personal information by helping individuals to practice

good information governance and be consistent in the way they handle personal

and corporate information.



10.0 INTENDED MEASUREABLE BENEFITS OF THIS STRATEGY

When investing in technology C&I will be clear on what the benefits will be. C&I will also

need to be clear on the ‗future state‘ we are heading towards – what will success look like

and how will it make a positive difference to clinical services? This section describes the

future state to be achieved through this strategy.

The measurable benefits of this ICT Strategy can be summarised as follows:

Safer and more effective care.

More responsive and efficient service.

Equitable & Service User Centric care.

A new information culture supported by resilient and modern IT infrastructure

and support by an effective and efficient ICT Department focused on service

delivery.

10.1 SAFER AND MORE EFFECTIVE CARE

Service User Story: Ethel, Highgate.

Ethel presented to her GP that she was feeling suicidal and reporting the experience of a

voice inside her head telling her to harm herself. She was referred to and seen by the

Crisis Team, who in turn referred her to the psychotherapy service and she was offered an

initial consultation a few weeks down the line.

Ethel‘s GP discussed her at a practice meeting where several members of the practice-

based team were present. The practice-based team were able to access C&I – EPR

Carenotes system remotely to view her care plan and in turn share more fully the Crisis

Team intervention with the GP.

With the introduction of Carenotes for the practice-based team this now provides the final

piece of the jigsaw. Each care provider (GP, Consultant & C&I staff) now has access to

Ethel complete clinical records and through sharing of this vital information including any

admissions to hospital or referrals are able to take this into consideration when providing

the care Ethel needs. All of this clinical information can now be viewed through the Clinical

Portals.

By having modern, electronic clinical records C&I clinicians can make safer and faster

diagnoses which will now be based on a better understanding of Service Users history and

current health status. Also with this ability to have all clinical information now in one place

comes the potential to bring together data for audit and improvement processes. This will

reduce the variability in the provision of care by having clinical systems based around

agreed standard operating procedures, protocols, pathways of care and the application of

clinical guidelines and best practice.



By having a single record this reduces the risk of any mismatch of Service User records or

the losing of paper records. Also with the ability to access a composite ‗detailed‘ care

record, generated through interoperability across healthcare providers with the Service

User consent C&I staff can now access essential medical information which can potentially

be life-saving.

Advances in telemedicine will also be exploited to support the delivery of care closer to

home, improving clinical services with the aim that C&I most vulnerable Service Users can

receive tailored care and where a number of agencies are involved in providing this care it

will be possible to share information more effectively to actively support any changes to

that care.

10.2 MORE RESPONSIVE AND EFFICIENT SERVICE.

Administrator’s Story: Mary, Trust HQ:

Services for Ageing & Mental Health (SAMH) previously had a mixture of paper and

electronic systems to record clinical information which were supported by a range of

means of collecting performance data – from spread sheets to databases – and analysis

tools. Mary had to spend significant time re-recording information for reporting purposes

which was both time consuming and frustrating. With the introduction of new clinical

systems important clinical and administrative information is captured in a structured way

which is capable of being used for reporting purposes removing the need for Mary to

undertake this manually. This means Mary‘s time is now focussed on supporting the new

improved referral process for the service which is reducing waiting times and, with

improved information sharing across healthcare providers, means less misrouted referrals

so Service Users get the right treatment faster.

With modern clinical systems, telemedicine and Service User access to their records

comes improved communication and the ability to share key information between

clinicians, Service Users and carers within the health sector and across partner agencies -

saving valuable time previously lost through paper processes and numerous meetings.

C&I will also avoid duplication of effort through repeated data collection and recording –

new clinical systems will remove the need to capture information once for Service User

care and again for reporting purposes. This will in turn reduce the administration burden

faced in services and by using the principle of ‗record once and use many times‘ to free up

more time for Service User care and reduce costs. It will make care processes more

streamlined with enhanced booking systems, faster electronic test results and improved

communication between services.

In future information for performance analysis will be generated as a ―by product‖ of clinical

and administrative processes. Information on Service User journeys will be provided with

a Service User centric rather than condition based approach, to facilitate the care of

Service Users with multiple long-term conditions and/or complex care needs.



10.3 EQUITABLE & SERVICE USER CENTRIC CARE.

Clinician’s Story: Joanne a Practice –Based Team, Camden:

Michael, a 24 year old man, was referred by his GP for a diagnostic assessment. He was

seen within the Assessment Team by a psychiatry trainee doctor, who discussed the case

with the Consultant Psychiatrist in supervision. The impression was in keeping with bipolar

affective disorder, but further clarification was needed to confirm the diagnosis and to

formulate an initial management plan. Given the Service User was registered at one of the

GP practices covered by Joanne; the Consultant was able to arrange to see him the

following week. This gave the team the opportunity to revisit aspects of his history and

clarify the diagnosis in an environment he was more familiar with, and at greater

convenience to him.

Being co-located in a GP practice, the team was able to share information with the GP

face-to-face and together they thought about how to implement a provisional management

plan, including further investigations arranged by the GP practice. In the past Joanne had

to use paper records to capture her work with Service Users. If Joanne had to request the

Service User paper record from administration this would often take days to arrive.

With the introduction of the EPR for this service, Joanne can see at a glance a Service

User record of medications, and problems and within Camden CCG area and through

consent access the wider GP record too. Through the Clinical Portal CIDR11 this clinically

rich information now supports Joanne in providing Service Users with the best advice and

guidance on their needs and keeps track of the outcomes to other healthcare providers. It

also avoids asking repetitive questions of Service Users in understand the most basic

information relating to their care. With access to a laptop or I pad, Joanne can update the

record within the Service User home and access wider public health information.

This set up has allowed Michael to feel that the intervention has been more personalised,

with a strong network of support that includes his GP and with contact that is local for him.

Michael has since written to say that he is feeling very well supported and understood by

the Consultant and the team involved and says; Thank you so much!....I think the service

is a wonderful asset to the mental health community‘

11 Camden Integrated Digital Record – a local borough project to combine and share all Health & Social

Care data with all NHS data into one unified source.



There will be less need for Service Users to repeat information, thereby improving

confidence in service efficiency and demonstrating seamless service across both this C&I

and its partner health providers. Service Users will be supported in exercising their rights

to access their health records and be involved in verifying and amending if appropriate.

Service Users and carers will have improved access to up to date information about their

condition or about a procedure they may have to undergo, encouraging greater

involvement in maintaining and improving their own health. Information will enable care to

be more targeted where appropriate – to create equity in outcomes.

10.4 A NEW INFORMATION CULTURE SUPPORTED BY RESILIENT AND MODERN IT INFRASTRUCTURE AND SUPPORT BY AN EFFECTIVE AND EFFICIENT ICT DEPARTMENT FOCUSED ON SERVICE DELIVERY.

Corporate Services, St Pancras:

Information systems provide a backbone to clinical performance management and

business control. The outcomes, safety and experience of C&I services is monitored from

these systems, without the need for paper data collections. Reports are available at the

frontline and corporately in real time. Business decisions are made based on data that is

quality assured through effective audit. Staff‘s supervision is supported by good quality

information on their performance, productivity, and outcomes and staff are less isolated

from the organisation in delivering effective services.

In future Services will be defined and driven by good quality information which staff can

rely upon for all kinds of management and clinical decision making. High quality, timely

and accessible information will be the ‗norm‘ not an aspiration.

Where technology has received poor publicity in the past when Service User identifiable

information has been ‗lost‘ or misplaced there will be a renewed confidence that modern IT

systems are the safest, most secure means to capture, handle, store, share (with consent)

and update sensitive information. The new ICT service will provide a customer focussed

service which is responsive, proactive and tailored to the new environment where

technology is intrinsic to healthcare.



11.0 CRITICAL SUCCESS FACTORS

There are a number of important Critical Success Factors required to successfully realise

the Vision, Strategic Objectives and Programme deliverables.

11.1 FUNDING ASSUMPTIONS

Delivering the ICT Strategy will require substantial financial investment therefore all

strategic investments will need to be subjected to appropriate business cases, with internal

approvals formally managed in accordance within delegated limits. The following have

been identified as possible means to contribute towards the financial requirements:

Internal capital programme resources: During the first 3 years of this strategy the

ICT Capital programme has been allocated £1.3m from the overall Capital &

Estates Programme. Where funding requirements cannot be accommodated within

available allocations then strategic capital funding may be sourced via the NHS

Trust Development Authority.

Internal C&I requirements: Directives / Departments: All requirements must be

through formal business cases which must address purpose, case for change and

the benefits realisation / efficiency gains in terms of resources; this must take

account of any ICT input. It is acknowledged that such cases must be (at least)

revenue neutral, including taking account of capital charges and depreciation.

Managed service options will also be explored within all applicable value for money

and affordability appraisals.

External funds: There are 3 current external funding sources, (a) local

commissioners, (b) NHS England through individual bidding competitions, e.g.

Safer Wards, Safer Hospitals, and (c) research monies, both national and

international. All will be investigated so every funding opportunity is utilised.

11.2 WORKFORCE

It is imperative that delivery of this strategy will require prominent clinical leadership, as

well as active involvement from networks of well informed and representative multi-

disciplinary clinical subject matter experts (SMEs), suitably immersed in each of the

strategic projects. Crucially, this needs dedicated time for project workload, albeit balanced

against clinical commitments.

For all ‗strategic‘ projects it must be considered a pre-requisite to ensure that clinical

implementation and SME lead roles are sufficiently resourced, as well as having confirmed

backfill arrangements.

Whilst this is equally true for ICT functions, the greater challenge within ICT is to

increasingly shift to resourcing these projects via staff from within our substantive teams,

so retaining knowledge and skills within the teams and reducing current reliance on costly

contractors.



It is the firm intent of the ICT senior management team to introduce local Graduate and

Apprenticeship schemes, supported by HR and developed in partnership with local

education organisations. This ‗grow our own‘ principle is seen as a vital enabler for a

sustainable ICT workforce plan, and has been seen to work extremely well in the past in

areas such as ICT Support and Clinical Coding.

It is also important that all ICT functions are sufficiently developed such that they are

recognised as ‗business partners‘ to the clinical and corporate service teams.

With regards to developing the level of ICT and Informatics skills for wider groups of staff,

there are two main areas of focus:

ICT technical skills (all staff groups). This will be supported through periodic ‗IT

support clinics‘ held in individual departments and community sites, as well as via

self-help tutorials and other knowledge base material available via C&I intranet.

Information Analysis skills for staff within operational teams including managers and

clinicians. Local training content will need to be developed in conjunction with C&I

Performance and Planning leads, to develop the analytics and information

manipulation skills of managers at all levels.

11.3 ENGAGEMENT, TRANSFORMATION & GOVERNANCE

Recruitment to the key role of Chief Clinical Information Officer (CCIO) is a further

essential activity. The CCIO will be expected to provide senior clinical leadership and

direction in representing clinical staff to ensure the safe and efficient design, deployment

and use of ICT to deliver improvements in the quality and outcomes of care.

Working with the senior ICT team and through the ICT governance structure, the CCIO will

champion the development of a clinically appropriate information culture across the

organisation. The CCIO will be a key member of the Digital Development Committee

(DDC) and will support with the developing a network of informatics champions and

subject matter experts within the clinical and nursing professional groups.

It is equally important that the DDC is acknowledged to be truly representative of the

Clinical Divisions and staff groups within the multi-disciplinary clinical workforce. Whilst

currently this is reflected in the Terms of Reference, levels of attendance are inconsistent.

An effective engagement strategy will be conducted initial communications activities will

accompany the launch of the Strategy and will thereafter be maintained through the DDC.

All constituent programmes and projects will be managed in accordance with formal

methodology and programme/project managers will be required to monitor delivery of

benefits realisation targets (outcomes) as well as defined project deliverables.



12.0 TAKING THIS STRATEGY FORWARD…

ICT has the potential to revolutionise healthcare over the next decade and C&I wants to

shape and drive this revolution to the benefit of its Service Users, staff and commissioners.

C&I is committed to aligning the future investment plans with the new ICT strategic

objectives and to working in partnership through joint initiatives with our CCG‘s and NCL

colleagues.

This strategy will form an integral part of the transformation and modernisation plans and

the Board is committed to making ICT investment a key priority going forward. To this aim

the Board will allocate both capital and revenue investments over the next five years

towards the ICT agenda in order to ensure the means are in place to provide modern

healthcare service provisions which truly meet the needs of people in Camden and

Islington.

Recognising the increasing clinical dependency on availability of ICT we believe that better

use of technology will, of course, just be one part of this journey. However technology is

an important enabler of change alongside investment in people, better processes,

improved buildings and better use of information to drive clinical decision making. This

Strategy defines the key building blocks to provide ICT services wherever and whenever

they are needed – freeing us up from slow paper driven processes which tied us to bases

and locations which did not always work for our Service Users or staff.

Through the approval of this ICT business case the revolution starts here…



APPENDIX A – ICT STRATEGIC ROAD MAP

ICT Strategic Roadmap Key

Version - 1.0 Not Started

Status - draft In Progress

Date Last Updated -16th February 2017 Complete

2018/19 2019/20 2020/21 2021/22

Provision of robust infrastructure and ICT support

•Develop the data and network, both wired and wireless

•Develop the Voice Over IP (telephony) system

•Virtualise systems into the cloud where possible

•Improve Cyber security systems to protect the Trust against attacks and data breaches

•Improve data backups

•Provide ITIL v3 training for all ICT staff to standardise processes

•Seek ISO standards accreditation

Utilising ICT to improve integration and quality of health care

•Agree vision and outcomes with stakeholders

•Further develop the EPR system

•Explore improved connectivity between the EPR and new clinical systems

•Create a forum for managers and clinicians to agree data sharing and measurement

Sharing of patient information across provider organisations

•Explore integration with social care and other partners

•Agree data sets for sharing information

•Provide input into the delivery of the NCL LDR

•Evaluate options for sharing patient records

Technology to promote wellness and engage and empower service users

•Identify service user engagement and telehealth solutions and strategies

•Work with clinicians to understand the needs of service users

•Evaluate and implement a Population Health Management system

•Evaluate and develop service user self-assessment, monitoring, and communication apps

Business Intelligence to understand population needs, and manage contracts

•Explore Geographical Information Systems GIS

•Develop additional clinical & performance dashboards

•Understand and address barriers to accessing centralised primary care data

•Implement a Performance Management system

•Develop new commissioning arrangements into all systems

•Develop clinical coding

•Update BI tools to improve agility and output (i.e. real time dashboards)

Optimise, standardise and integrate software to support clinical knowledge and

decision making

•Produce an audit of software licences and usage

•Develop structures to support clinical software purchasing

•Explore and implement decision support systems

Improving the satisfaction and productivity of the workforce through information

•Implement Electronic Document Management

•Develop the Intranet & Internet websites

•E- learning

•Improve access to business tools to improve productivity and efficiency

Agile Workforce

•Produce a standard mobile device policy

•Evaluate and implement Single Sign on

•Migrate to a hosted email solution with secure email

•Implement Unified Communications and collaboration tools

•Expand Mobile working

HIGH LEVEL PROJECTS STATUS2017/18

YEAR



APPENDIX B - FROM VISION TO REALITY: STRATEGY AT A GLANCE

ICT VISION OBJECTIVES

“Ensure our healthcare services are supported by excellent, high quality clinical and business information which is timely, accurate and tailored to

requirements

”

Develop and implement an integrated Electronic Patient Record for our Service Users across our C&I and beyond.

Provide Service User access (Service Users Portal) to their own health information.

Deliver reliable Business Intelligence process.

Implement new technologies to support services regardless of location.

Implement a resilient ICT infrastructure.

Clinical led not technology led

A learning organisation

Maintaining Service User focus

A new Programme Management Office

A clear performance management framework on Information Governance

A renewed focus on data quality

A refreshed ICT service

ENABLERS

Electronic Health Record & Portal programme Providing clinical system(s) as the basis for a detailed care record.

Interoperability programmeconnecting systems across the health economy to support information flow and integration.

Service User access programmetechnologies to support telemedicine and access to Service Users own information

Business Intelligence programmetechnologies to extract, analyse and report on clinical and administrative information.

ICT modernisation programmeto define, market test and procure ICT services.

PROGRAMMES

Agile working programmeensuring access to systems regardless of location.

PROGRAMMES

Safer and more effective care

More responsive and efficient service

Equitable & Service User centric care

A new information culture supported by resilient and modern IT infrastructure

FROM VISION TO REALITY: STRATEGY AT A GLANCE

Documents

Report to: Board of Directors (Public) Report author: Mr ... · Directorate of Finance, ICT & Estates Page 5 of 53 Digital Healthcare ICT Strategy – version 1.0 1.0 EXECUTIVE SUMMARY