The Local Digital Roadmap for Warrington - … Papers/The Local... · Web viewThis document is the Local Digital Roadmap for Warrington and is the third step in the 3-part process

The Local Digital Roadmap for Warrington

Our Vision

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Glossary of Terms:

Term / Abbreviation What it stands for

CCG Clinical Commissioning Group

CIO Chief Information Officer

CCIO Chief Clinical Information Officer

CEO Chief Executive Officer

CSU Commissioning Support Unit

DCO Director of Commissioning Operations (NHS England)

DH Department of Health

EPaCCs Electronic Palliative Care Coordination System

ePMA Electronic Prescribing and Medications Administration

EPR Electronic Patient Record

HSCIC Health and Social Care Information Centre

LDR Local Digital Roadmap

LDS Local Delivery System

LSP Local Service Provider

MIG Medical Interoperability Gateway

NWAS North West Ambulance Service

PF@POC Paper-free at the Point of Care

RoI Return on Investment

RTT Requirement to Treat

SIRO Senior Information Risk Owner

SRO Senior Responsible Officer

STP Sustainability and Transformation Plan

VFM Value For Money



ContentsIntroduction.........................................................................................................................................................7

1. National and Local Strategic Contexts..........................................................................................................8

1.1 The national challenges for health and care services..........................................................................8

1.2 The national response to these challenges.........................................................................................8

1.3 The local challenges for health and care services.............................................................................10

1.4 The local response to these challenges.............................................................................................10

2 Local Digital Roadmap Development and Footprint..................................................................................14

2.1 Warrington – scope and scale...........................................................................................................14

2.2 The Cheshire and Merseyside STP and Local Digital Roadmaps........................................................15

2.3 Local Delivery Systems and Devolution.............................................................................................17

3 The Vision for Digitally Enabled Transformation........................................................................................19

3.1 The Vision..........................................................................................................................................19

3.2 The Impact.........................................................................................................................................20

4 The Baseline Position.................................................................................................................................21

4.1 The Warrington Digital Landscape....................................................................................................21

4.2 Other key achievements to date.......................................................................................................23

4.3 Current Initiatives..............................................................................................................................25

4.4 Rate Limiting Factors.........................................................................................................................31

4.5 Digital Maturity Self-assessment.......................................................................................................31

5 Readiness...................................................................................................................................................33

5.1 Leadership, Governance and Clinician and Care Professionals Engagement....................................33

5.2 Approach to Change Management...................................................................................................34

5.3 Approach to Benefits Management and Realisation.........................................................................35

5.4 Approach to Local Investment...........................................................................................................37

5.5 The 2016/17 Programme Structure..................................................................................................38

5.6 Using Resources Effectively...............................................................................................................39

6 Capability Deployment...............................................................................................................................40

6.1 Paper-free at the Point of Care.........................................................................................................40

6.2 The Capability Deployment Schedule................................................................................................41

7 Universal Capabilities Delivery Plan...........................................................................................................46

8 Information Sharing...................................................................................................................................47

9 Standards...................................................................................................................................................50



9.1 NHS Number......................................................................................................................................50

9.2 SNOMED............................................................................................................................................50

9.3 GS1 Standards Compliance................................................................................................................50

10 Infrastructure.........................................................................................................................................51

10.1 Current state and plans.....................................................................................................................51

10.2 Future state.......................................................................................................................................52

11 Minimising Risks Arising From Technology............................................................................................54

FiguresFigure 1 - Warrington Health and Wellbeing Board ‘Our Vision’ infographic....................................................11Figure 2 - Warrington Health and Wellbeing Board Transformation Programmes illustration.........................13Figure 3 - Map illustrating LDR footprints in relation to the wider STP.............................................................15Figure 4 - The Digital Vision for Warrington.......................................................................................................19Figure 5 - The Digital Programmes in Warrington..............................................................................................25Figure 6 - Warrington Care Record Transformation Alignment.........................................................................27Figure 7 - Digital Maturity Self-assessment Theme Level Indicators.................................................................32Figure 8 - Digital Maturity Self-assessment Section Level Indicators.................................................................32Figure 9 - Digital Maturity Trajectory for the 7 PF@POC Capabilities................................................................32Figure 10 - The Warrington LDR governance arrangements..............................................................................33Figure 11 - The Benefits Lifecycle.......................................................................................................................36Figure 12 - Warrington Shared Infrastructure Blueprint....................................................................................52



IntroductionThis document is the Local Digital Roadmap for Warrington and is the third step in the 3-part process to articulate the baseline, vision and plans for delivering technology enabled change across the Warrington health and care system over the next 3-5 years. It demonstrates how technology will be harnessed to accelerate change as well how the Paper-free at the Point of Care by 2020 target will be achieved.

There are five major organisations involved in commissioning and providing health and care services in Warrington, these are:

NHS Warrington Clinical Commissioning Group Warrington Borough Council Warrington and Halton NHS Hospitals Foundation Trust Bridgewater Community Healthcare NHS Foundation Trust 5 Boroughs Partnership NHS Foundation Trust

In responding to the significant national and local challenges facing NHS and Local Authority commissioners and providers, this document provides a narrative description of how technology will enable transformational change across the Warrington-wide health and care system and demonstrates that:

There is strong leadership in place across Warrington’s health and care system and a significant degree of collaboration and partnership working between organisations at an operational level

Clinicians and care professionals are engaged and providing leadership to the system-wide transformational change programmes

There are robust, system-wide governance arrangements in place, driven by the Health and Wellbeing Board

Each of the five main constituent organisations has implemented, or is in the process of implementing, modern, fit-for-purpose IT solutions. These are the building blocks for the Local Digital Roadmap and aligned with organisational IM&T Strategies

Another major foundation for the Local Digital Roadmap is a single, shared solution for clinicians to order pathology and radiology tests and receive results, itself part of a wider solution supporting order communications and results reporting across the region

There is a commitment to the procurement and implementation of an information-sharing platform across the health and care community – the Warrington Care Record – and a plan in place to deliver it. This programme is now driving the local interoperability agenda and will build on what has been delivered to date in the interoperability space

The IT Infrastructure and Information Governance delivery programmes that underpin the Warrington Care Record and other IT enabled change initiatives are making good progress

This is how in Warrington we will ensure we Become Investment Ready.



1. National and Local Strategic Contexts

1.1 The national challenges for health and care servicesPublished in October 2014, the Five Year Forward View identified three significant challenges facing health and care provision in all industrialised nations’ health systems. These were:

Changes in patients’ health needs and personal preferences. Long term health conditions -rather than illnesses susceptible to a one-off cure -now take 70% of the health service budget. At the same time many (but not all) people wish to be more informed and involved with their own care, challenging the traditional divide between patients and professionals, and offering opportunities for better health through increased prevention and supported self-care.

Changes in treatments, technologies and care delivery. Technology is transforming our ability to predict, diagnose and treat disease. New treatments are coming on stream. And we know, both from examples within the NHS and internationally, that there are better ways of organising care, breaking out of the artificial boundaries between hospitals and primary care, between health and social care, between generalists and specialists—all of which get in the way of care that is genuinely coordinated around what people need and want.

Changes in health services funding growth. Given the after-effects of the global recession, most western countries will continue to experience budget pressures over the next few years, and it is implausible to think that over this period NHS spending growth could return to the 6%-7% real annual increases seen in the first decade of this century.

It goes on to say that if they remained unchecked at a fundamental level, they would inevitably lead to three widening gaps:

The health and wellbeing gap: if the nation fails to get serious about prevention then recent progress in healthy life expectancies will stall, health inequalities will widen, and our ability to fund beneficial new treatments will be crowded-out by the need to spend billions of pounds on wholly avoidable illness.

The care and quality gap: unless we reshape care delivery, harness technology, and drive down variations in quality and safety of care, then patients’ changing needs will go unmet, people will be harmed who should have been cured, and unacceptable variations in outcomes will persist.

The funding and efficiency gap: if we fail to match reasonable funding levels with wide-ranging and sometimes controversial system efficiencies, the result will be some combination of worse services, fewer staff, deficits, and restrictions on new treatments.

1.2 The national response to these challengesIn responding to these challenges, the Five Year Forward View sets out a number of strategies and measures designed to ensure that the NHS remains sustainable in the longer term. These include strategies for:



A more engaged relationship with patients, carers and citizens in order to promote wellbeing and prevent ill-health

Introducing new models of care and managing systems and networks of care, not just organisations Making out-of-hospital care a much larger part of what the NHS does Integrating systems around the patient

In addition to these strategies, six approaches are set out that have been designed to aid delivery. These are:

1. Backing diverse solutions and local leadership2. Creating aligned national NHS leadership3. Supporting a modern workforce4. Exploiting the information revolution5. Accelerating useful health innovation6. Driving efficiency and productive investment

Warrington is part of the wider Cheshire and Merseyside Sustainability and Transformation Plan (STP) and has been working closely with the STP team on the STP-level return in general and specifically on the Digital Section of that return from a Local Digital Roadmap perspective. This is covered in more detail in Section 2.2 of this document.



1.3 The local challenges for health and care servicesIn addition to the national health and care challenges set out above, that impact Warrington just as much as they do elsewhere across the country, there are a number of specific local variations and inequalities that demand local action, including1:

By 2030, it is predicted the over 65 population in Warrington will have increased by nearly 60% from 2010 levels, increasing the burden on future health and care service provision

Life expectancy is slightly lower than the average for England (there are also some significant inequalities in life expectancy within Warrington between the most and least deprived areas)

Smoking related deaths are significantly worse in Warrington than in most other parts of the country Consumption of alcohol to unsafe levels has increased slightly, and does not follow the usual pattern

of deprivation, in that the least deprived areas have the highest proportion of people drinking to unsafe levels

Alcohol related hospital admissions amongst those aged under 18 years are higher in Warrington‐ than the average for England. Rates are substantially higher in the most deprived areas of the borough, and the gap appears to be widening

The prevalence of obesity is increasing locally. Whilst the increase is relatively small, this is in contrast to the national picture (which has plateaued) and rates are very high amongst certain population groups, for example, middle aged men‐

The rate of new cancers in Warrington is higher than the national average for England The rate of hospital admissions due to substance misuse amongst young people aged 15 to 24 years

in Warrington is also significantly higher than the average for England Rates of unplanned or emergency admissions to hospital amongst the over 65’s are significantly

higher than the average for England Ischaemic Heart Disease (IHD) is the biggest contributor locally to the comparatively higher rates of

CVD deaths: IHD death rates consistently exceed the average for England by over 20% Quality of life, as measured by healthy life expectancy, is also poorer for older people in Warrington,

compared with the average for England

1.4 The local response to these challengesIn response to the long term national and local health and care challenges, the Warrington Health and Wellbeing Board has set out a vision and strategy2 that, in practice will mean:

People are the focus of delivery, regardless of the organisations providing or commissioning Outcomes for people take priority over output or process targets and measures Frequent users of public services are encouraged to make better choices and contribute to their

communities through the development of services designed to encourage and facilitate responsible behaviour

Multi-agency provision of services, across sectors, are the norm, service silos and duplication are eliminated

Technology will transform our ability to predict need, provide advice and deliver service

To continue to support local people effectively and efficiently, and access new opportunities for even better services, a number of guiding principles have been agreed locally. They must underpin all health and wellbeing work in Warrington to realise success for the health and wellbeing strategy. They provide a ‘check’ 1 https://www.warrington.gov.uk/download/downloads/id/8771/2013-14_jsna_summary.pdf 2 http://www.warringtontogether.co.uk/media/1017/health-and-wellbeing-2015-18-low-res.pdf


http://www.warringtontogether.co.uk/media/1017/health-and-wellbeing-2015-18-low-res.pdf

https://www.warrington.gov.uk/download/downloads/id/8771/2013-14_jsna_summary.pdf


by which local commissioning plans can be developed, considered and commented on, in order to ensure that they align with the aims and vision of this strategy.

These principles are:

Tackling inequalities Promoting prevention Providing care closer to home and enabling self-care Strengthening communications and improving engagement Personal responsibility Ensuring consistent safe and quality care Investing in integration Promoting safety and improved quality of life Providing high quality integrated services

Under the Health and Wellbeing Board “Together we…” branding, the following infographic has been developed to illustrate the future vision for health and care service provision across Warrington:

FIGURE 1 - WARRINGTON HEALTH AND WELLBEING BOARD ‘OUR VISION’ INFOGRAPHIC

In delivery terms, 3 transformation programmes have been established (illustrated in Figure 2 below):



Starting well: there is a strong body of evidence that emphasises the importance of health and wellbeing in childhood and before birth, with long-term benefits of ensuring that all children have access to the best start in life. If we are to improve the health and wellbeing of our population further and more quickly we have to focus on the key issues in the early stages of life. Key outcomes identified:

Healthier start in early years, including achieving school readiness Less children living in relative poverty Narrow the gap in educational outcomes Reduce risky behaviours Improved levels of emotional wellbeing

Living Well: adults form a large segment of our population. Choices and behaviours during adulthood can have profound impacts on people’s health and wellbeing for the rest of their lives and one of the main challenges in adulthood include the preventing of chronic illness later in life. This will be achieved by early intervention and prevention. Key outcomes identified:

People will live longer and healthier lives by reducing gaps in life expectancy between our disadvantaged groups and communities and the rest of Warrington (improved lifestyle choices) and improving outcomes for those with cancer and cardio-vascular disease

Improve health and wellbeing in our workforce Improved levels of mental health Reduced levels of unsafe alcohol consumption Early intervention and prevention of ill health Redesign of our care and support services

Ageing Well: in Warrington 16% of people are aged over 65 years which is in line with the England average however our over 65 population is expected to grow by a much higher percentage than the England average by 2030. The likelihood of the common long term conditions (e.g. cancer, heart disease, hypertension, stroke, respiratory disease, diabetes) all increase with age. The rise of other health issues such as visual impairment, mental ill health and physical disabilities also increase with age and all have a significant impact on people’s independence and need for care and support. By promoting health in our populations we can delay and/or prevent their need for treatment services. This will also support people in their desire to remain independent and to lead full and active lives in older age. Key outcomes identified:

Services which promote health, independence and wellbeing and develop community capacity to reduce loneliness and reliance

Care which is more preventative, personalised and anticipatory Care received by the right person, in the right place, at the right time



FIGURE 2 - WARRINGTON HEALTH AND WELLBEING BOARD TRANSFORMATION PROGRAMMES ILLUSTRATION

The outcome from delivering the vision will be:

Improved healthy life expectancy A reduction in inequalities Fewer people experiencing social deprivation An increase in preventative services which support people to tackle issues before they become

problems More sustainable services which have been designed around current and future needs of local

people More ownership and involvement from citizens in the design, delivery and evaluation of services Our population receiving the right services, at the right time, in the right place

This will be achieved by transforming our public services to ensure that people are the focus of delivery, regardless of organisations providing or commissioning, and that there is a rebalancing of focus from expensive specialist services to universal effective preventative ones.

The ability to harness technology in order to accelerate change is recognised as one of the critical enablers to delivering these transformation programmes. This Local Digital Roadmap has been through a collaborative development and review process with the full participation of all of the above-named organisations and sets out how this will be achieved.



2 Local Digital Roadmap Development and Footprint

2.1 Warrington – scope and scaleThis Local Digital Roadmap (LDR) covers the Warrington footprint which is served by five main health and care commissioning and provider organisations. These organisations are:

NHS Warrington Clinical Commissioning Group Warrington Borough Council Warrington and Halton NHS Hospitals Foundation Trust Bridgewater Community Healthcare NHS Foundation Trust 5 Boroughs Partnership NHS Foundation Trust3

Warrington has a population size of 212,000 and is bordered by Cheshire, Merseyside and Greater Manchester.

In addition to these five organisations, North West Ambulance Service (NWAS) and a number of Third Sector organisations including St Rocco’s Hospice (a registered charity), make up a significant part of the health and care landscape. Added to this and to complete the picture, Warrington has:

31 dental practices 14 opticians 48 pharmacies 19 nursing homes 14 residential homes

2.2 The Cheshire and Merseyside STP and Local Digital RoadmapsWarrington is part of the wider Cheshire and Merseyside Sustainability and Transformation Plan (STP) footprint. 40 commissioning and provider organisations (12 of which are CCGs) are included in the Cheshire and Merseyside STP which serves a population size of 2.4 million. Under the umbrella of the Cheshire and Merseyside STP, 4 LDR submissions are being made:

Merseyside Eastern, South and West Cheshire and Vale Royal Wirral Warrington

This is shown diagrammatically below:

3 Whilst the 5 Boroughs Partnership NHS Foundation Trust is one of the five main partner organisations that make up Warrington’s health and care system, their substantive LDR submission is being made under the Merseyside Local Digital Roadmap and so is not included here



FIGURE 3 - MAP ILLUSTRATING LDR FOOTPRINTS IN RELATION TO THE WIDER STP

As will be reflected in the Cheshire and Merseyside STP submission under the Digital Section, at an STP level we have a strong track record of digital achievements including advanced shared care records programmes, European leaders in assistive technology adoption, population health management, high penetration of NHS number across health and social care, a single radiology system and national pioneers in citizen identity and verification management.

Working together as an STP, we have also agreed three digital ambitions that have an associated scope and set of outcomes. These are shown below:


https://www.england.nhs.uk/digitaltechnology/wp-content/uploads/sites/31/2016/03/cheshire-mersey-map.png


Digital Ambitions Scope That Means

1. Digitally Empowered Individuals

Enable people to utilise digital technologies to manage own care

Enabling people to take control and work in partnership in relation to their health and wellbeing

Ensuring digital inclusion for all

Digital skills for workforce & citizens

Individuals interacting with their care services digitally through a ‘digital no wrong door’ and a ‘personalised front door’

Patients can access online services using their choice of device and app to manage their care

Use assistive technology to manage their care and interact with professionals

Access information about their own health and conditions to support them to self-care

Single approach to citizen identity

2. Connected Health and Social Care Economies

Ensure that information is available to the right people, in the right place, at the right time

Improve quality, safety and patient experience by eliminating paper processes and records that cause inefficiency and delays in care resulting in organisations operating paper free at the point of care

Reduce fragmentation & duplication

Eradicate unwarranted variation

Support a technologically enabled workforce to fully benefit from digital solutions

Enhancing care and quality, whilst ensuring greater system efficiency

Every health and social care practitioner will have the ability to directly access the information they need, in near real time, wherever it is held, digitally on a 24x7 basis

We will have further consolidated and rationalised our Electronic Patient Record systems in and out of hospitals

We will have structured, digital clinical records across all providers in the pathways of care

Our workforce will be digitally skilled with the appropriate technology and culture to enable rather than disable effective working through technology

3. Exploiting the Digital Revolution

Move towards ‘intelligence led healthcare’ by utilising advanced analytics, greater industrial partnership and engaging Information Governance as a structure for safe development rather than a blockage to progress

Build on the work of the North West Coast Genomic Medicine Centre to embed and normalise genomic medicine into heath and care services

A direction towards intelligence led services allowing care to be delivered in the most efficient and effective manner

Closer working relationships with academia and industry to take advantage of new, cutting edge innovation and expertise

Exploitation of population health capabilities





To deliver our digital ambitions there are a range of programmes within each LDR, the below are themes demonstrating how we will achieve them with some cross cutting areas:

1. A set of Digital Principles

2. Information Sharing / Governance Framework

3. Digital Maturity of all Health and Social Care Providers (including Primary Care Digital Transformation)

4. Rationalisation of systems in and out of hospital

5. Interoperability between systems

6. Upscaling of Assistive Technology

7. Advanced Analytics / Population Health

8. Consolidated infrastructure at LDR level and connectivity between LDRs where clinical services overlap

2.3 Local Delivery Systems and Devolution2.3.1 Local Delivery SystemsIn relation to Local Delivery Systems (LDSs), there are three being formed under the Cheshire and Merseyside STP. From a CCG perspective these are:

North Mersey (Knowsley, Liverpool and South Sefton CCGs) The Alliance (Halton, Southport and Formby, St Helens and Warrington CCGs) Cheshire and Wirral (Eastern, South Cheshire, Vale Royal, West Cheshire and Wirral CCGs)

In terms of The Alliance LDS digital transformation and from an acute provider perspective, The Alliance LDS covers three acute trusts namely, Warrington and Halton Hospitals NHS Foundation Trust, St Helens and Knowsley Teaching Hospitals NHS Trust and Southport and Ormskirk Hospital NHS Trust. These three organisations have formed an Informatics Steering Group, the objectives of which are:

Digital Transformation to enable the 3 organisations to be clinically and financially sustainable Align to the wider LDR strategy and submissions for the participating Trusts Align to the Cheshire and Merseyside STP digital vision

Three LDS digital ambitions have been identified, along with scope and outcomes for each. The LDS digital ambitions are:

Digital Self Care Digital Access at the Point of Care Exploiting the Digital Roadmap

2.3.2 DevolutionIn devolution terms across England, the emerging picture is that of a combined local authority covering Warrington and Cheshire with an elected mayor and significant devolved funding. However the scope



currently does not extend to health and all proposals in relation to devolution are subject to public consultation.

This configuration means Warrington points two ways – north for Acute services, south for Primary Care, Social Care and Commissioning. To this end our Warrington plans enable sharing across other STP digital solutions.



3 The Vision for Digitally Enabled Transformation

3.1 The VisionIn order to address the three national challenges of closing the health and wellbeing gap, closing the care and quality gap, and closing the finance and efficiency gap, Warrington’s vision for digitally enabled transformation echoes the Health and Wellbeing Board vision (set out in Section 1.4) and will be brought together through the creation of the Warrington Care Record – the digital exchange platform for Warrington (see Section 4.3.3).

This is aligned with the wider STP digital approach (set out in Section 2.2), and the four elements (Lots) of the Warrington Care Record can be directly mapped to the 4 key areas that the local vision encompasses:

Paper-free at the Point of Care (Lots 1 and 2) Digitally enabled self-care (Lot 4) Real-time data analytics at the point of care (Lots 1 and 2) Whole systems intelligence to support population health management and effective commissioning,

clinical surveillance and research (Lot 3)

An infographic has been developed to illustrate the vision for digitally enabled transformation for Warrington:



FIGURE 4 - THE DIGITAL VISION FOR WARRINGTON

The Warrington Delivery Programme to realise this vision is expanded in Section 4.3 and this programme is aligned to the national capabilities in Section 6.

3.2 The Impact Child

Ideal state

Oliver is a 6 year old boy who has epilepsy. Oliver’s mother is the main carer and Oliver spends time at his grandparents who help his mother when she needs a break. One weekend night Oliver is found unresponsive in bed whilst at his grandparents and is taken into hospital after the paramedic has issued the rescue drugs. He has recently been seen by his GP who has been treating Oliver’s medication with a view to reducing the amount in line with specialist advice. Oliver’s mother had previously provided consent for AED staff at Hospital to see vital information including care plans and medication contained within his Warrington Care Record. This enabled the care team to manage Oliver’s presenting symptoms in a timelier manner, whilst mitigating any possible clinical risks by restarting medications which had been withdrawn from Oliver’s treatment plan. There was no contact with a specialist. Oliver avoided a stay in hospital and returned to his grandparents that night.

What actually happened

One weekend night Oliver is found unresponsive in bed whilst at his grandparents and is taken into hospital after the paramedic has issued the rescue drugs.



The AED staff had no idea about Oliver’s past medication history and tried in vain to contact Oliver’s specialist for advice. After discussion with the Children’s center in Manchester Oliver restarted medication previously withdrawn due to reactions. These reactions were not documented in Oliver’s electronic record on either site. Oliver was admitted over the weekend and Oliver’s mother was contacted and returned home from holiday to oversee the organisation of his care.

Adult

John has hypertension and visits his GP twice a year for observation. His GP, as part of the neighbourhood initiative, enables video consultations and digital workflow across all services, supported by process change, and utilising shared patient data and patient-captured data from in-home devices. Rollout of the enabling Warrington Care Record platform and the single Warrington infrastructure allows patients with hypertension patients, with direct digital access to Primary Care, releasing the traditional Primary Care capacity. The platform is based on open standards and supports multi-agency care through shared patient records and workflow management.

John, using the technology to track and share aspects of his physical health, sets himself the goal of increasing his physical activity. Small changes such as walking instead of taking the car, using the stairs instead of the escalator made him feel much healthier. The GP tracks this using the Warrington Care Record.

The solution enables the clinician/care provider to monitor trends in the patient’s condition, and give appropriate advice/guidance via email or high definition video conferencing within the infrastructure platform. This in turn alleviates the need for trips to the surgery, freeing up patient appointments (approx. 1,200 appointments in one practice of the 26 in the CCG), and related over-stretched resources for the care provider team.



4 The Baseline Position

4.1 The Warrington Digital LandscapeEach organisation has its own plans in place to introduce or develop its own internal electronic patient records. These are aligned to organisational IM&T strategies, which are themselves linked to business plans and objectives.

NHS Warrington CCG/Primary Care – building on the existing GP systems e.g. rolling out Summary Care Record and mobile working. This includes Warrington Health Plus, who during 2014 and 2015 delivered local neighbourhood services across Warrington together through telemedicine and risk stratification as part of the Prime Ministers Challenge Fund.

Warrington Borough Council – replacing existing systems in the Families and Wellbeing Directorate with a single electronic client record system, Mosaic from Servelec Corelogic

Warrington and Halton NHS Hospitals Foundation Trust – recently implemented Lorenzo under the Local Service Provider (LSP) Agreement

Bridgewater Community Healthcare NHS Foundation Trust – rolling out TPP SystmOne 5 Boroughs Partnership NHS FT – rolling out Servelec Rio

4.1.1 NHS Warrington CCG/Primary CareThe CCG shares its strategic Director of Informatics Services with Warrington and Halton Hospitals NHS Foundation Trust, however its Practices receive support services from the Midlands and Lancashire Commissioning Support Unit (CSU).

20 of the 26 GP Practices use TPP SystmOne (in common with Bridgewater Community Healthcare NHS Foundation Trust, local Hospice and the Out of Hours service). Of the remaining six Practices, five use EMIS Web and one INPS Vision. The CSU has implemented the MIG (via Bridgewater) to support the exchange of information with these 6 Practices, for example discharge documents from the Acute Trust. The roll out of the Summary Care Record is virtually complete and the community Electronic Prescribing Programme is being accelerated. Mobile working is being rolled out with TPP SystmOne.

4.1.2 Warrington Borough CouncilThe Families and Wellbeing Directorate currently holds client data largely on electronic systems but is in the process of implementing an electronic client record system (Mosaic from Corelogic) that will replace its current adults’ and children’s social care systems. By the end of this year it will have a new work flow based electronic social care assessment and review system for all of its clients that is also integrated with for example payments and charging. This is due to go live in October 2016 and will use the NHS Number as the unique identifier. The new system will realise significant benefits in terms of process and the potential to better integrate services, improved access to and portability of records, and the ability to meet the requirements of the Care Act.



4.1.3 Warrington and Halton NHS Hospitals Foundation TrustThe Hospitals’ informatics service provides support to all its service areas via a range of inter-connected or freestanding systems, from a number of different suppliers.

The Trust’s medical records are now part-way towards a digital patient record and hence there is a mixed economy of digital and paper-based files for each patient. Inactive paper records are stored off site and there is considerable movement of records between the Warrington and Halton sites using courier services. There are many problems with these arrangements, particularly limited (and no mandatory) training in case note handling and administration, poor use of tracking facilities and unstructured off-site storage.

The Trust has invested in some of the infrastructure necessary to support electronic records and clinical support tools, including more mobile working. It also has a number of pilot initiatives underway to create elements of an electronic patient record (EPR) or to develop electronic communications with other organisations. Examples of this include an electronic document management system creating a scanned record of historical case-notes, the development of electronic records and workflow via Portals in A&E and Outpatients and the electronic communication of certain discharge documents.

Its main focus has been the successful completion of its implementation of a core EPR system (the Lorenzo system) that replaced systems that were nearing the end of their lives and it provides the facilities to replace paper by electronic patient records. This will bring major benefits to the Trust internally and also create the opportunity to share information with other organisations.

The Trust has a range of other informatics priorities, such as:

Real-time patient workflow/ADT Better support for peripatetic staff e.g. giving community midwives real time access to appointment

scheduling Automated/speedier discharges e.g. better advance planning of TTOs with pharmacy Reducing 30-day readmissions through targeting patients at risk i.e. supporting better post-discharge

care and improving levels of patient self-management Electronic prescribing and medicines management (including better connectivity to GP systems) The standardisation of diagnostic test ordering and the introduction of community-wide orders and

results

4.1.4 Bridgewater Community Healthcare NHS Foundation TrustThe Trust has rolled out TPP SystmOne - which is also used by the majority of Warrington GPs - to create a single electronic clinical record for all its patients. It expects to achieve 75% coverage of its clinical services within the next year but this will depend on changes to service delivery processes to fully embrace the implications of mobile working/technology.

The majority of patient records in the Warrington locality are currently held on paper-based systems, which are separate held for each service. The TPP PAS functionality has replaced all the legacy iPM and Childhealth systems. Some teams are now starting to go live with TPP using fully templated EPR functionality and an online/offline mobile PC based mobile application.

Bridgewater has made a significant investment in mobile devices, with associated support and training for clinical staff. At the same time the Trust has a number of other informatics issues such as:

The rationalisation of shared IT infrastructure such as wide-area networks The establishment of single sign on facilities for all clinical staff



Improvements to VFM The extension of telehealth services from the current pilots The roll out the ICE Orders/Results system

The Greater Manchester data exchange hub is used for the electronic communication of some discharge documents from a range of services.

The MIG is being used in Warrington for sharing between Out of Hours services and non-SystmOne GP Practices and on a wider footprint to share GP datasets and EPaCCs data into a range of services.

4.1.5 5 Boroughs Partnership NHS Foundation TrustThe Trust’s aims are that all service users will have a comprehensive electronic record that is accurate and accessible at any time and from anywhere, to support efficient, safe and collaborative health care. To achieve this, it has replaced its PAS (iPM) and two other partial electronic record systems with RiO – a single Trust-wide electronic clinical, demographic and administrative system. This major undertaking has involved significant changes to ways of working in all parts of the Trust.

The RiO EPR will support improvements in the clinical quality, safety and cost effectiveness of its front line services. It will also improve data quality and resilience and facilitate the more effective and extensive use of clinical pathways, across multiple services. Patients will eventually have only an electronic record, which will be available whenever needed and as such will also offer significant opportunities for communicating or sharing patient information with other organisations.

4.2 Other key achievements to date There is a single, shared solution for clinicians in primary and secondary to order pathology and radiology

tests and receive test results. This is itself part of a wider solution supporting order communications and results reporting across the region.

There is a single Picture Archiving and Communications System (PACS) solution in use to support Radiology services across Cheshire and Merseyside meaning it is possible to share radiology images across organisations and reducing the need for radiology examinations to be repeated on an organisational basis

The national Summary Care Record is in regular use in a number of Acute and Community settings across Warrington

The national Electronic Prescription Service (EPSr2) has been deployed to 100% of Warrington’s GP Practices and 60% of repeat prescriptions use the EPS service

Acute outpatient services (managed in Lorenzo) are available to be booked through the national e-Referral Service (e-RS) and the Accenda referral gateway service (paired with the e-RS) is deployed to 100% of GP Practices for referrals to be made

Warrington care home telehealth presence Risk stratification within some neighbourhoods to manage patients with long term conditions The 5 Boroughs Partnership implementation of IAPTus to support delivery of early intervention

psychological therapies The 5 Boroughs Partnership implementation of RiO workflow is configured to generate alerts in situ and

via email or SMS as necessary



The 5 Boroughs Partnership ‘Patient Status at a Glance’ (PSAAG) tool implemented to facilitate rapid discharge

The 5 Boroughs Partnership Ward management system implemented to prompt for tasks and overdue actions

The 5 Boroughs Partnership Psychiatric Assessment Service provided from the Warrington Hospital site is fully digital with referrals to the service being made via the Warrington-wide order communications and results reporting system and all clinical noting being completed on the Acute EPR Lorenzo

Structured, electronic clinical noting is now common practice using Lorenzo in areas of the Acute Trust The Medical Interoperability Gateway (MIG) for non-TPP GP systems and integration for TPP systems is

deployed across all GP practices Inpatient & Day Case Electronic Discharge Summaries from Acute Trust to GPs are compliant with the

Academy of Medical Royal College headings standards A self-check-in and triage system integrated with Lorenzo is in use within Warrington Hospitals

Emergency Department The Acute Trust runs a monthly ‘Facebook the midwife’ session so that expectant mothers can message

the midwifery team with questions about their maternity care and childbirth Specialist medicine multi-disciplinary teams are using teleconferencing to support end of life care

planning Shared network infrastructure and WiFi to create a Warrington Community of Interest Network (COIN)

and connection to wider Lancashire COINs to allow staff connectivity to roam from site to site



4.3 Current InitiativesAs illustrated below in Figure 6 below, under the revised governance arrangements, there are currently three active Warrington wide digital programmes working to the IT Partnership Board (Warrington Care Record, Information Sharing Programme and Infrastructure) and two local provider initiatives (Medicine Management and Digital Providers) to achieve the ultimate aim of Citizen and Patient access to digital services and records.

FIGURE 5 - THE DIGITAL PROGRAMMES IN WARRINGTON

The IT Infrastructure Programme; the Better Information Sharing Programme; and the Warrington Care Record Programme shown above fit within the overall Health and Social Care digital programme. Each of these supports multi-disciplinary working by health and care professionals working across the constituent Warrington partner organisations and they are critical enablers of the new ways of working outside of local providers. Whilst significant progress has been made to date in all three programmes, no one organisation is able to fund the projects and further system wide funding is required for each in order to progress them across Warrington from their respective current positions and to complete their delivery.

4.3.1 IT Infrastructure ProgrammeUnder the IT Infrastructure Programme there are three Warrington-wide work streams:

1. Active Directory: the immediate aim for this is for Warrington and Halton Hospitals to become part of the broader Midlands and Lancashire Commissioning Support Unit (CSU) Active Directory ‘Forest’ (Bridgewater and Warrington CCG are already part of this). This will enable health professionals to log



on to devices at locations other than their ‘home’ location and access securely the same systems and services they would access within their own organisations. With the design phase completed, implementation will require migration from existing services to the new wider Active Directory service. Migration options are being considered and may need the support of a third party migration service to complete the work. This would require additional funding.

2. Network Infrastructure: this will see the joining up of organisational WiFi networks across Warrington, enabling health and care workers with mobile devices to connect to WiFi networks in health and care settings other than their ‘home’ organisation. This will mean health and care staff have access to the local and national online services they need to carry out their day to day tasks regardless of which provider organisation they are physically working in, without having to work in ‘offline’ mode. Again, Midlands and Lancashire CSU are progressing this work in collaboration with the other constituent organisations and CCG funding for this work is in place. Bridgewater already federate the NWSIS WiFi service across the locality and its wider operating areas.

3. Unified Communications: this is dependent on work streams 1 and 2 and will see the introduction of instant messaging, voice and video service capability (e.g. cisco jabber, Skype for business, etc.) across Warrington. This will enable seamless communications channels for health and care workers across organisational boundaries. Currently in conceptual design phase, no delivery plan or funding is in place for this work.

4.3.2 Better Information Sharing ProgrammeThe Better Information Sharing Programme sits in the Information Governance space and is the result of the CCG Select Committee Inquiry (SCI) into the Sharing of Patient/Service User Information. Completed in Spring 2015, the completion of the SCI is also now referred to as Stage 1 of the Better Information Sharing Programme. There were 8 recommendations resulting from the SCI, 6 of which were converted into enabler projects making up the Better Information Sharing Programme and these are critical enablers of the Warrington-wide IT Partnership Programme.

The 6 projects are:

1. Privacy and Consent2. Communications and Relationships with Patients/Service Users3. Culture, Confidence and Willingness4. Information Governance5. Information Capture and Sharing6. IT Systems, Interoperability and Security

The remaining 2 recommendations were ‘Managing Changes and Improvements’ and ‘Sharing beyond Non-statutory or non-Health and Social Care Organisations’ and these are being dealt with separately.

Whilst the PID for Stage 3 of the Better Information Sharing Programme has been approved, there is no funding in place to continue the work required and therefore this programme is currently on hold.

See Section 8 for further detail on work to date and how this programme is being taken forward.



4.3.3 Warrington Care Record – providing a Warrington Digital HubFocused around local citizens, the Health and Care Community have invested in procuring a single, shared information platform. A core group of health and care, operational and IM&T staff from the constituent organisations has been actively involved in progressing the Warrington Care Record programme to date, having worked through the Strategic Outline Case (completed in August 2014) and Outline Business Case (completed in September 2015) stages.

This platform will provide a digital hub across Warrington and serve the wider STP footprint based on open APIs to strengthen the system integration options. The functionality will join our record to support the Warrington Health and Wellbeing Board Transformation Programmes as shown diagrammatically below:

FIGURE 6 - WARRINGTON CARE RECORD TRANSFORMATION ALIGNMENT

The Outline Business Case was presented to the Health and Wellbeing Board in January 2016 and a procurement project is underway. This will culminate with an identified preferred supplier and a completed Full Business Case (FBC). The finalised FBC will be presented to the appropriate governance bodies for endorsement in each organisation prior to its presentation at the Warrington-wide governance fora (set out in Section 5.1) for final approval (the investment decision).

The approach to procurement is Lot-based and encompasses 4 Lots. The rationale behind this is three-fold. Firstly, the Lots reflect a sense of logical progression with Lot 1 meeting the data sharing technology platform requirements in order to establish the data sharing culture in the shortest possible timescales. Lot 1 will provide the base on which to build additional capability (Lots 2 – 4) that meets the specific needs of Warrington’s citizens and the health and care community in the new ways of collaborative working on health and care provision across organisational boundaries. Secondly, the Lot-based approach can be seen as an enabler allowing the participating organisations to ensure they are only investing in the Lot based systems and services that have been specified to meet the care community’s requirements, and to get the best value from the best products and services that are currently available. Thirdly, the care community considers that the specified Lot based approach will maximise Potential Provider competition within each Lot.



In summary, the Lots are:

Lot 1: A data sharing technology platform with front end user interface and back-end interfaces to core organisational and national systems; a health and care community-wide citizen index (using the NHS number as the unique identifier); consent to share management controls; role based access controls; simple citizen access; secure access from mobile and desktop devices across multiple device operating systems; and end-user access audit reporting. This will be underpinned by openAPIs to allow further integration into local systems

Lot 2: Capturing additional data by health and care professionals using eForms that are created and based on pathways of care; supporting workflow and rules based decision-making; and the creation of care correspondence.

Lot 3: Population health functionality utilising data warehouse capability and analytics tools, in order to help identify the particular health and care needs of the Warrington population (including risk stratification across health and care), using data from the care community’s main source systems.

Lot 4: Developing citizen access to include personal data from ‘apps’ and monitoring/measurement devices i.e. the more ‘innovative’ end of the procurement. Whilst these are optional requirements for the purposes of the procurement in that they are not reflected in the care community’s Potential Provider budget for the procurement, the care community’s intends to procure this functionality either from a successful Lot 1-3 Potential Provider or from a successful Lot 4 Potential Provider. The care community recognises that some of the Lot 4 functionality in question is relatively niche and specialist in nature and that solutions to satisfy some of these requirements may be ‘in development’ or, indeed, may not yet exist. It also recognises that the successful Lot 4 Potential Provider will only be in a position to propose how best to develop its Lot 4 solution until it fully understands the nature of the successful Lot 1-3 solutions. Accordingly, the PQQ response document questions in respect of Lot 4 focus on generic appraoches as opposed to focusing on specific solution issues.

The 4 procurement Lots can be mapped directly to the 4 outline areas for LDR vision for digitally enabled transformation as stated in Section 3 above. The mappings are:

Paper-free at the Point of Care (Lots 1 and 2) Digitally enabled self-care (Lot 4) Real-time data analytics at the point of care (Lots 1 and 2) Whole systems intelligence to support population health management and effective commissioning,

clinical surveillance and research (Lot 3)

The Lot 1 technology required to underpin the data-sharing platform will have the following characteristics in order to provide clinicians and carers with real-time access to key source data that resides within the relevant source systems:

Unified, secure access – single sign-on capability with users required to authenticate only once per user session

Integration — the real-time connection of data from multiple back-end source systems into new front-end components with an integrated navigation between these components

Customisation — users can customise the look and feel of their environment based on attributes of the user and metadata of the available content



Personalisation — where customisation is in the hands of the user, personalisation is embedded within the solution and is primarily about matching content with the user. Based on a user profile, personalisation uses rules to match the "services", or content, to the specific user

Access control — the ability for the platform to limit the content and services users have access to in order to make it appropriate for their role

Citizen search — the ability to search for content based on the citizens NHS Number Omni channel enablement — present content optimally on all channels and devices Audit — track and monitor user behaviour (such as navigation, clicks, downloads, page exits and

such) and generate reports for audit purposes

In order to create the Warrington Care Record, the following source systems will be drawn on to create the digital hub:

GP – SystmOne from TPP and the MIG for GP practices using EMIS Acute – Lorenzo from CSC Community – SystmOne from TPP Mental Health – RiO from Servelec Healthcare Care Services – Mosaic from Servelec Corelogic National transaction systems – Personal Demographics Service, Summary Care Record, Child

Protection Information Sharing

The key benefits of the investment in the Warrington Care Record will include:

Joint teams, e.g. common assessment teams being able to access the same source of information, thereby speeding up assessments, reducing costs and improving consistency of approach (and patient experience)

Better/safer services resulting from the automatic communication of information between the different services dealing with a patient

A reduction in wasted time e.g. unnecessary visits, tests and phone calls chasing up missing information

Reductions in inappropriate referrals between services due to fuller information being available at the point of diagnosis or treatment/management decisions

The ability for separate services to work on common treatment plans or pathways e.g. End of Life pathways, thus saving time through avoiding gaps or overlaps in services and improving patient experiences

Saving time and increasing opportunities to deliver services more flexibly if the latest information about a patient is available in community settings or patients’ homes

Reducing the movement/loss/unavailability of current patient records and the costs of handling them

Reducing readmissions though fuller information being available pre-referral or to support patients post-discharge in the community

The ability to plug the Warrington Care Record data exchange platform into other data exchange platforms under the STP footprint

See also Appendix 4 - Warrington LDR Information Sharing Approach.

4.3.4 Digital ProvidersHigh quality Local Provider electronic patient records are key to our digital programme.

Warrington and Halton NHS Foundation Trust serves the population of Warrington and their strategic aim is to continue to digitise the patient notes, either through extending the use of Lorenzo as an ePR or building the ability to scan the paper legacy which exists. This scanning software will also have to provide capability



to allow The STP ‘Alliance’ group of hospital providers the access to newly created Lorenzo digital notes and legacy Warrington paper records. Eventually ‘The Alliance’ plan is for a common EPR for all Adult Acute services, seamlessly linked with Children’s acute services, Community based services and social care within Mersey but this is beyond the life of this roadmap. Digitalisation of the Acute has been seen over the last 3 years as a key enabler for providing safe, efficient, flexible, patient-centered and cost effective care and significant local investment has made this a reality.

Further to this, Lorenzo now delivers new functionality such as clinical decision support, patient alerts, clinically coded documentation determined at the point of data entry, real time reporting, and patient record sharing with Primary Care through the Summary Care Record. The plan is to extend this use of the Summary Care Record through the MIG and into the Warrington Care Record.

In our community settings, we have consolidated onto a single system supplier (TPP) across a significant part of the footprint area. Our strategic aim is to build on this further over the next three years to drive up digital maturity in out of hospital based care and provide further foundations to deliver high quality patient care. This single system is also the majority system used in Primary Care.

This approach within our hospitals and community will not only enable the levels of digital maturity in our economy to thrive but it will deliver the level of service transformation articulated through our STP and LDS plans and support our digital ambition to truly exploit the digital revolution.

Within Mental Health, 5 Boroughs continue to rollout RiO with the plan to reduce variation in the delivery of care.

Social Care will go-live with new system to allow use of the NHS Number as a primary enabler to join up the ability for providers to contribute to our digital programme.

Significant local investment in Change Management is resulting in reducing the variation of clinical delivery and already increasing the handover of care between organisations.

4.3.5 EPaCCsAn Electronic Palliative Care Co-ordination System (EPaCCs) project has been set up to ensure that end-of-life preferences can be captured and shared across organisations and services:

EPaCCs data items will be captured by a range of health and care professionals (either electronically or on paper) and will be stored in GP systems

Warrington CCG originally purchased the MIG to share data for the non-TPP practices (6 of 26) but for GP data only, the CCG have purchased the EPaCCs MIG module for all the Warrington practices including the TPP practices so in terms of how EPaCCs data is shared, it will be available for all patients and all 26 practices to all providers via the MIG

4.3.6 Medicines ManagementOur aim for e-prescribing between GP practices and community pharmacies are for all prescriptions to be sent digitally using the national Electronic Prescribing Service (EPS) system.



Our ambitions for e-prescribing within the acute setting has already started with medicine reconciliation on admission being cross-checked with Primary Care information stored on the Spine. We then prescribe the TTO medicines on discharge and send this through to Primary Care as part of the digital Discharge Summary. Over time we expect the Warrington Care Record to share the in hospital medication history with all providers so to complete this we will implement Lorenzo Electronic Prescribing and Medications Administration (ePMA) over the next few years.

4.3.7 Complex Dependency ProgrammeThe Cheshire-wide Complex Dependency Programme is a council-lead transformation programme aimed at providing improved and integrated social care services for families and individuals with complex care needs, across a number of organisational boundaries. Social workers, housing, education and police are among the intended users of the information system which will support this programme, which is anticipated to support approximately 35,000 citizens across Cheshire. The IT element of this programme is currently in a procurement phase, and at the time of writing is executing the final evaluation activities as part of the Invitation to Tender (ITT) stage.

The specific nature of this transformation programme, coupled with the wider footprint, means that it is intending to link to a significantly higher number of source systems across a much broader set of public sector agencies than the Warrington Care Record. It consequently has a significantly different set of requirements and outcomes that it is aspiring to meet. More information on the Complex Dependency Programme can be found at http://www.candwleadersboard.org.uk/what-we-do/complex-dependency-programme.

4.4 Rate Limiting Factors Funding – the availability of sufficient funding for the development of a shared care record, against

the backdrop of increasing financial challenges across the whole community Capability and Capacity – the ability of each organisation to resource the project, especially when

they have major internal EPR Projects underway Public Support – the support of the public for a programme to share clinical records across

organisational boundaries, particularly if any major national programmes such as a reactivation of the Care.Data Programme are undergoing consultation with the public

4.5 Digital Maturity Self-assessmentThe Digital Maturity Self-assessment applies to three of the five health and care organisations in Warrington, namely:

Warrington and Halton NHS Hospitals Foundation Trust (WHH) Bridgewater Community Healthcare NHS Foundation Trust 5 Boroughs Partnership NHS Foundation Trust (5BP)

The summary returns including the Capability Deployment Trajectory for all three are below.



Digital Maturity Self-assessment 2015/16 – Theme Level Indicators

FIGURE 7 - DIGITAL MATURITY SELF-ASSESSMENT THEME LEVEL INDICATORS

Digital Maturity Self-assessment 2015/16 – Section Level Indicators

FIGURE 8 - DIGITAL MATURITY SELF-ASSESSMENT SECTION LEVEL INDICATORS

Capability groupBaseline score

(Feb 16)Target

(end 16/17)Target

(end 17/18)Target

(end 18/19)Records, assessments and plans 47.0 60.3 74.3 82.7Transfers of care 39.7 61.7 76.3 84.7Orders and results management 56.7 61.3 72.7 78.0Medicines management and optimisation 22.0 22.0 56.3 78.3Decision support 27.7 34.3 45.7 62.3Remote care 16.7 20.0 34.0 46.7Asset and resource optimisation 23.3 30.0 51.7 63.3

Average scores across providers

0.0

10.0

20.0

30.0

40.0

50.0

60.0

70.0

80.0

90.0

Baseline score(Feb 16)

Target(end 16/17)

Target(end 17/18)

Target(end 18/19)

Aver

age

scor

es a

cros

s pro

vide

rs

Records, assessments andplans

Transfers of care

Orders and resultsmanagement

Medicines management andoptimisation

Decision support

Remote care

Asset and resourceoptimisation

FIGURE 9 - DIGITAL MATURITY TRAJECTORY FOR THE 7 PF@POC CAPABILITIES

See Appendix 2 for the Capability Deployment Trajectory.



5 Readiness

5.1 Leadership, Governance and Clinician and Care Professionals Engagement

In addition to individual leadership within organisations, results available in the Digital Maturity Self-assessments, a robust governance exists across Warrington in relation to digital development for Warrington’s health and care transformation plans, this has been simplified for illustration purposes below.

FIGURE 10 - THE WARRINGTON LDR GOVERNANCE ARRANGEMENTS

Each of the healthcare organisations has an appointed Chief Clinical Information Officer (CCIO) who is engaged with the Warrington digital transformation programme and providing the clinical leadership and drive required. In turn they are engaging with their health and care colleagues within their own organisations to take forward any organisation-level issues and actions.

The organisations Chief Clinical Information Officers (CCIOs), Senior Information Risk Owners (SIROs) and Caldicott Guardians are listed below.

Name Organisation RolePaul Sherry Warrington and Halton Hospitals CCIODiane Mathews Warrington and Halton Hospitals Deputy CCIOEllis Clarke Warrington and Halton Hospitals Nursing CCIOJason DaCosta Warrington and Halton Hospitals SIROProfessor Simon Constable Warrington and Halton Hospitals Caldicott GuardianMich Tomonaga Warrington CCG CCIO



Nick Armstrong Warrington CCG SIROLynton Green Warrington Borough Council SIROSteve Peddie Warrington Borough Council Caldicott GuardianKaren Slade Bridgewater CCIO/Caldicott GuardianGareth Davies Bridgewater SIROSukru Ercan 5 Boroughs Partnership CCIOGail Briers 5 Boroughs Partnership SIROLouise Sell 5 Boroughs Partnership Caldicott Guardian

5.2 Approach to Change ManagementThe vision for Warrington is for an advanced integrated clinical and administrative digital hub that will service care processes across the Warrington borough and extend into the wider STP footprint from early 2017.

Procured through 4 Lots the digital hub will facilitate the integration of clinical and administrative functions, increase patient choice and improve overall quality of care. Organisational change will be supported by a Change Management team which significantly improves the amount of clinical engagement, the quality of implementation and process change.

The Warrington Care Record digital hub will be far more than an upgrade to existing systems. Accompanied by positive organisational change, engagement and change resources we will be able to significantly identify the service improvement opportunities in line with the transformational strategic direction. This work has already started and forms the business case for the digital hub. As a group of organisations we will promote efficient use of resources across the health communities of the STP by providing increased visibility of patients, carers and citizens needs so bringing greater coordination of services.

5.2.1 Purpose of business changeThe purpose of business change is to give an overview of the capabilities of the digital hub and show stakeholders, either citizens, staff or our leaders how successful deployment will help achieve the NHS vision of integrated health and wellbeing services. The business change service will help organisations and citizens understand the fit of our technology against current NHS policy and initiatives by:

Detailing the innovative new capabilities of the digital services such as Patient Health Records and highlight a number of key service improvements which when used in conjunction with IT deployment will achieve NHS wider organisational change objectives

Describe the approach for successful deployment of the technology and highlight the likely challenges (people, process and technology) facing deployment and suggest mitigations to ensure smooth transition

Describe the tools, collateral and support on offer which will be developed by the Business Change Team to assist the citizens to successfully implement the changes to improve care and support for carers



5.2.2 Approach to Business ChangeThe release of open digital enabled system will require varying degrees of organisational change depending upon the age of the organisations IT platforms.

The largest challenge facing successful use is to train, educate and most importantly convince all users of the system of the benefits of fully utilising the improved system and adopting the new ways of working.

The implementation of the digital hub will be rolled-out using an incremental approach with multiple projects in line with the lot based procurement. The approach is designed to make the most of the opportunities for this release whilst taking account of the likely challenges before, during and after each project.

To achieve the most benefit from the digital hub, local Primary Care neighbourhood communities will want to plan their local programmes of IT-enabled change and decide what change needs to happen before, during, and after the deployment of the new IT capability.

5.2.3 The Business Change TeamThe successful roll out of software, use of the new systems and in particular utilisation of extended capabilities will require a large degree of business change across the healthcare community.

The Business Change Team (BCT) is a central team within the Design, Build and Test function of the digital hub and will be responsible for developing the approach and deliverables to aid successful uptake of solutions.

The team will be resourced as outlined in our Warrington Care Record Outline Business Case with a business change lead, benefits lead and stakeholder engagement lead embedded in the project team.

5.3 Approach to Benefits Management and RealisationThrough the development of the Warrington Care Record Strategic outline Case (SOC) and Outline Business Case (OBC), a benefits log has been developed into an initial set of quantifiable and non-quantifiable benefits and then classified as:

Cash-Releasing – financial returns that can be legitimately put back in the budget, e.g. Staff costs Non Cash-Releasing – financial returns that are put back into the system e.g. Clinical time saved that

can be put into other areas such as developing a new system or clinic Societal – a benefit to the patient or staff that cannot be quantified in financial terms e.g. improved

clinical interventions for a patient or improved work life balance for staff

This will be further developed for the Full Business Case in order that the investment decision can be made, based on fully developed and robust metrics.

The same approach will be adopted for all digital projects and programmes, in line with the process illustrated below (process starts at Identify).



FIGURE 11 - THE BENEFITS LIFECYCLE

Once implemented, benefits will be pro-actively tracked and managed throughout the LDR lifecycle. Benefits will be reported through the Benefits Realisation Plan which will also show how they will be measured and realised, and the schedule of when this will take place. In addition, it also show appropriate milestones when benefits reviews will be carried out to ensure the project benefits delivery remains on track. This will be supported by a Benefits Tracker tool which outlines on a month by month basis progress for each benefit against its planned target.

This list will be regularly reviewed and updated to ensure that all benefits arising as a result of the programme are captured and reported through the governance described above and aligned to the wider Warrington programme.

5.4 Approach to Local InvestmentA set of investment objectives for the development of a shared Warrington Care Record, were developed during the business case development process from an analysis of the key elements of the overall Health and Wellbeing Board’s Transformation Programme and the main strategic aims of the Warrington organisations.

The investment objectives are:

5.4.1 Outcomes and experiences Achieving patient perceptions of single (and best possible) services being provided Whole person approach Better enablement of self-management and self-care

5.4.2 Commissioning Joined up commissioning Proactive commissioning/analysis/risk stratification Measurement of effects of commissioning programmes



Development of Public health information/planning

5.4.3 VFM/Cost Reduction Overall reductions in costs More effective use of resources

5.4.4 Pathway – based services Increasingly seamless services Proactive management of certain conditions/patient groups e.g. LTC or older people End of life services

5.4.5 More Appropriate Care Reducing unplanned care Increasing selection of most appropriate services Effective/appropriate prescribing/reducing costs Reducing variations in primary care

5.4.6 Safety Reducing clinical risk caused by the lack of information on citizens at the point of care More appropriate/joined up prescribing

5.4.7 Settings Supporting care in citizens’ homes and other settings More self-sufficiency possible

5.4.8 Service Redesign Citizen-centred care is the overall driving principle Continuous service evaluation and redesign possible

5.4.9 Quality of Care Better access to Mental Health services Better coordination of Mental Health, physical and social care services Equity, accessibility and choice



5.5 The 2016/17 Programme Structure5.5.1 Project Management To achieve paper free, each project outlined in Section 6 will be governed and managed in accordance with Projects in a Controlled Environment (PRINCE2) best practice, as already used by all five organisations.

A Project Manager is already in place along with some initial PMO support. Section 5.6 sets out the additional resources that will be needed to plan and deliver the project, and to realise the changes and benefits that are the ultimate aims of this development. These include the project, technical and training etc staff needed for the 2-year period of implementation, and the change and benefits staff needed to help Warrington’s health and social care services exploit the potential of shared records over the 5 –year life of the project.

In addition a Senior Responsible Owner (SRO) has already been identified – Andy Davies, NHS Warrington CCG Chief Clinical Officer.

Rollout will be Primary Care led and broken into individual neighbourhoods.

5.5.2 GovernanceAs already indicated, each project is to be managed as an integral part of the programme that is already in place to transform the way in which health and social care services are delivered across Warrington. A joint IMT Partnership Board is already in place to oversee the delivery of all IT related issues for this programme as shown earlier in Figure 10.

A PRINCE project board comprises of:

Senior business role (to represent the organisational interests) Senior user role (to represent the end users’ interests) Senior technical role (to represent technical issues, including supply-side)

In addition best practice suggests that it should include:

The SRO Commissioners’ interests Stakeholder interests

Many of these roles are already represented on the current Board, but a number of changes to its membership will inevitably be needed to meet all these requirements. As the project involves five organisations, an early decision will be needed as to whether each organisation needs to supply a representative for all 3 PRINCE roles or whether some roles may be combined. The former approach would mean the Board would comprise a minimum of 24 people - 6 x 3 PRINCE roles, plus SRO, Supplier, Procurement Adviser and it is suggested, the Warrington Transformation Director, together with the Project Director and PMO representative. This would be a challenging number of people to function as a Project Board, carrying out the functions of:



Approval of the project aims, plans, phasing and contingency arrangements Approval of regular highlight reports and the authorisation of and major deviations from plan Authorisation of the start and completion of each phase Ensuring that the necessary resources are committed to the project Resolution of any conflicts within the project Oversight of the resolution of any problems with any external bodies Authorisation of the implementation of any contingency plans and resources Reporting on progress against plans to the Transformation Board The management of Risks and of the Programme Assurance process Ensuring the delivery of all contractual obligations – by the Supplier and by the five Warrington

organisations, for the duration of the project Ensuring the formal closure of the Project

5.6 Using Resources EffectivelyNHS Warrington CCG will focus resources on funding the people and technology to deliver the Warrington Digital Programme so the efficiency and service improvement that result in paper free, are realised. These resources include

Access to BCF funding to resource a Programme Manager to oversee the projects of Better Information Sharing Programme. Each of these projects will be resourced from existing provider resources backed off by CQUIN monies to enable participation. E.G. communications will consist of the provider communication teams working together led by the Programme Manager.

Build project team costs including change and training into the Warrington Care Record project business case, with transformational project support from the Warrington CCG PMO office.

Access Primary Care capital to ensure public and staff WiFi access across all Primary Care sites so enabling the Warrington Single Infrastructure.

Local provision for Digital Providers is expected to be found by each provider funded either through BAU activity & CQUIN investment, National Driving Digital Maturity Investment Fund and the Estates and Technology Transformation Fund.

NHS Warrington CCG will actively pursue collaboration across a broader programme set within The Alliance LDS and Cheshire Devolution, we will endeavour to utilise and support the delivery of transformational change programmes through strategic alignment. Such programmes are vanguards, Connected Health Cities, 100,000 Genomes Project, Northern Health Sciences Alliance and PACS.



6 Capability Deployment

6.1 Paper-free at the Point of Care NHS Warrington CCG as the lead commissioner for each provider organisation over the last three years has worked closely with providers, supporting investment proposals through our Director of IM&T to provide assurance both that plans are deliverable and aligned with the principles of the Warrington Digital Vision and the Warrington Digital Programmes.

To achieve these plans we continue to invest in CQUIN initiatives and create the pressure for change. Implementation of the capabilities improves Warrington’s digital maturity and the planned trajectory against each of these capabilities is shown in Section 4.5.

Our plans will drive up our levels of digital maturity and achieve paper free are outlined below mapped with the capabilities we expect to achieve by delivering the Warrington Digital Programmes. How these 7 Paper-free at the Point of Care (PF@POC) capabilities map to our Digital Programme and also the STP Digital Ambitions (see Section 2.2) is shown in the tables below (see also Appendix 1 for the Capability Deployment Schedule and See Appendix 2 for the Capability Deployment Trajectory).



6.2 The Capability Deployment Schedule6.2.1 Records, Assessments and Plans

Who What Year Capability groupWarrington Programme 16/17 Status

Alignment with STP Digital Ambition

Bridgewater, 5BP, WHH EPaCCS 16/17 Records, assessments and plans

Digital Providers

Project Implementation ongoing


Bridgewater, 5BP, WHH Rollout of local ePRs 16/17 Records, assessments and plans

Digital Providers



Community Pharmacy

Use of the Summary Care Record 16/17 Records, assessments and plans

Digital Providers



Primary Care

Extend use of Map of Medicine and localise for Warrington 16/17 Records, assessments and plans

Digital Providers



Primary Care, Bridgewater

Standardise Templates in TPP 17/18 Records, assessments and plans

Digital Providers

Project Scope Starting


Primary Care Standardise SNOMED 17/18 Records, assessments and plansDigital Providers



WHH, Primary Care, Bridgewater, 5BP

Complex, dependant family information shared across Cheshire 17/18 Records, assessments and plans

Digital Providers



NWAS, WHHTriage Ambulance Patients at Handover 17/18 Records, assessments and plans

Digital Providers



Warrington Citizens

Patient access to online assessments, records and plans 18/19 Records, assessments and plans

Warrington Care Record

Procurement Underway


WHH, Social Care

Electronic Document Management System 18/19 Records, assessments and plans

Digital Providers



Bridgewater, 5BP, WHH, Social, Primary Care Document Sharing 18/19 Records, assessments and plans

Warrington Care Record





6.2.2 Transfers of Care



WHH, Primary Care

Electronic Discharge Summaries 16/17 Transfers of care

Digital Providers

Project Complete


Primary Care Maximise GP2GP transfer 16/17 Transfers of careDigital Providers

Project Implementation Ongoing


WHH, Primary Care, Social Care

Digital Single Assessment to facilitate faster transfer from Wards 16/17 Transfers of care

Digital Providers



Primary Care, WHH Uplift in e-Referral Usage 17/18 Transfers of care

Digital Providers




Complex, dependant family information shared across Cheshire 17/18 Transfers of care

Digital Providers



WHH, Primary Care

Structured forms in ICE to support transfer of care 17/18 Transfers of care

Digital Providers



Social, Primary Care

e-Referral through to Social Care 18/19 Transfers of care

Warrington Care Record - Lot 2



Bridgewater, Primary Care

e-Referral through to Community Services 18/19 Transfers of care




WHH, Primary Care, Social Care, Bridgewater, 5BP

Unify Messaging through Warrington Care Record 18/19 Transfers of care




WHH, Bridgewater

Electronic Discharge Summaries from Acute to Community 18/19 Transfers of care




WHH, Social

Electronic Discharge Summaries and other documentation from Acute to Social Care 18/19 Transfers of care




WHH, 5BP

Electronic Discharge Summaries and other documentation from Acute to Mental Health 18/19 Transfers of care






6.2.3 Orders and Results Management



WHH, Bridgewater, Primary Care, 5BP

Use of ICE to request and review diagnostic tests across all providers 16/17 Orders and results management

Digital Providers



WHH

Cardiology Imaging and Orders incorporated into ICE and PACS 17/18 Orders and results management

Digital Providers



WHH, Bridgewater, Primary Care, 5BP PACS reprocurement 18/19 Orders and results management

Digital Providers Not Started


WHH, Primary Care, Social Care, Bridgewater, 5BP

All results from all providers available 18/19 Orders and results management




6.2.4 Medicines Management and Optimisation



WHHMedicines and allergies reconciliation from Spine 16/17 Medicines management and optimisation

Medicines Management

Project Optimisation Ongoing


WHHAll anti-cancer treatments are prescribed electronically 16/17 Medicines management and optimisation




WHH

In-Patient Prescribing to complete Medicine and TTO prescribing 17/18 Medicines management and optimisation




Primary Care Bi-directional Spine updates 17/18 Medicines management and optimisationMedicines Management Not Started


WHH, Community Pharmacy

Community Pharmacies dispense Acute stay TTOs 17/18 Medicines management and optimisation




WHH, Primary Care, Social, Bridgewater, 5BP

All medication history available electronically 18/19 Medicines management and optimisation






6.2.5 Decision Support



Primary Care

Maximise the use of Primary Care protocols and concepts embedded in clinical systems 16/17 Decision support

Digital Providers



Primary CareMap of Medicine for Peads, Ortho, Gastro, Cardiology 16/17 Decision support

Digital Providers



Primary Care/WHH

Warrington Referral Gateway pathways expanded 16/17 Decision support

Digital Providers



BridgewaterIntegrated CP-IS in OOH Service 16/17 Decision support

Digital Providers



WHHClinical observations and alerts in Lorenzo 17/18 Decision support

Digital Providers




Child Protection Information included in national summary record 17/18 Decision support

Digital Providers



WHH, Primary Care, Bridgewater, 5BP, Social

Complex, dependant family information shared across Cheshire 17/18 Decision support

Digital Providers




Use of Warrington Care Record to flag patients and support decision making 18/19 Decision support





Risk Stratification beyond Primary Care 18/19 Decision support






6.2.6 Remote Care



Primary Care, Care Homes

Telehealth deployment around neighbourhoods 16/17 Remote care

Digital Providers



BridgewaterRemote access to records using TTP Mobile 16/17 Remote care

Digital Providers



Primary Care, Warrington Citizens

Read code access to Primary Care records for patients 16/17 Remote care

Digital Providers



WHH

MiCheckIn Remote outpatient checking in apps and feedback 16/17 Remote care

Digital Providers



WHHMobile access to Lorenzo records using Direct Connect 16/17 Remote care

Digital Providers



5BP

Silver Cloud - use of digital access for mental health services 17/18 Remote care

Digital Providers



WHH, Primary Care, 5BP, Bridgewater, Council, Citizens

Assistive home technology to increase patient adoption across disease pathways 18/19 Remote care




WHH, Primary Care, 5BP, Bridgewater, Council, Citizens

Virtual Consultations with patients 18/19 Remote care




6.2.7 Asset and Resource Optimisation



CouncilRollout of NHS Number as the unique identifier 16/17 Asset and resource optimisation

Digital Providers



WHHe-Rostering and nursing safe care rota 16/17 Asset and resource optimisation

Digital Providers



WHHUse of e-Whiteboard to manage patient status 16/17 Asset and resource optimisation

Digital Providers



WHH, Primary Care, Bridgewater, 5BP Unified Directory of Services 16/17 Asset and resource optimisation

Digital Providers



5BPData Warehouse Implementation 16/17 Asset and resource optimisation

Digital Providers



WHH Patient flow tracking 17/18 Asset and resource optimisationDigital Providers



WHH, Bridgwater, 5BP

Location of clinical assets tracked and 3GS standard implemented 18/19 Asset and resource optimisation

Digital Providers

Project Scopting Underway


WHH, Primary Care, Bridgewater, 5BP, Council, Citizens Digital Home Care tracking 18/19 Asset and resource optimisation






7 Universal Capabilities Delivery PlanIn summary Warrington either already meets or plans to meet the 10 universal capabilities:

Professionals across care settings can access GP-held information on GP-prescribed medications, patient allergies and adverse reactions. Warrington are already meeting this capability through use of the Spine.

Clinicians in urgent and emergency care settings can access key GP-held information for those patients previously identified by GPs as most likely to present (in U&EC). Warrington are already meeting this capability through use of the Spine and TPP access in Urgent and Emergency Care Settings.

Patients can access their GP record, the plan is to provide read code access through Primary Care systems and then full care record access through Warrington Care Record Lot 4.

GPs can refer electronically to secondary care is already happening through e-Referral with more specialities coming on line as the rollout of Warrington Referral Gateway continues.

GPs receive timely electronic discharge summaries from secondary care is already happening with discharge summaries target being 80% of discharges and mandatory Royal College fields populated with optional fields where there is data available. We will continue to agree with Emergency Medicine what headings should be incorporated in an eDischarge but it is likely that the requirements will be based upon the AoMRC requirements with ED related additions.

Social care receive timely electronic Assessment, Discharge and Withdrawal Notices from acute care is happening as part of the e-Single Assessment Form accessed on all Wards through Lorenzo e-whiteboards.

Clinicians in unscheduled care settings can access child protection information with social care professionals notified accordingly is planned via the Spine.

Professionals across care settings made aware of end-of-life preference information via EPaCCs. GPs and community pharmacists can utilise electronic prescriptions through the rollout of EPS. Patients can book appointments and order repeat prescriptions from their GP practice through the

rollout of Primary Care Patient Access and the Warrington Care Record Lot 4.

See Appendix 3 for the Universal Capability Delivery Plan.



8 Information SharingA significant amount of work and progress has been made to date on enabling information sharing both across, and beyond, Warrington. This includes the creation of a Warrington Information Sharing Toolkit that was formally approved for use on 30 June 2014. Further information on this can be found on the Warrington Information Sharing Hub http://www.warringtontogether.co.uk/intelligence-and-data/information-sharing/

The Better Information Sharing Programme summarised in Section 4.3.2 has a number of strategic and programme drivers. These are:

8.1.1 Strategic DriversThe benefits from this programme will support the following strategic drivers:

1. Greater move towards integration2. Whole person approach3. Safety of care4. Improving patient/service user experiences 5. Improving the efficiency and effectiveness of direct care provision thereby reducing the overall cost of

health and social care provision6. NHS National Conditions (Better Care Fund) which requires the NHS Number as the primary personal

identifier across health and social care

8.1.2 Programme DriversAlthough the vast majority of care professionals want to share provided they can be assured it is safe, there are a number of reasons currently cited by some care professionals for not doing so. Patients/service users also expect care professionals to share safely and appropriately and their requirements are not being met. Finally, organisations require all its employees to work efficiently and effectively together and variable levels of information sharing impedes the free flow of information. So the drivers for this programme include:

1. Patients/service users expect all care professionals to share their data safely and appropriately for the purpose of diagnosis and treatment. They generally want all their relevant medical conditions taken into account and shared on a need to know basis.

2. Benefits and risks of data sharing are not clearly understood. 3. Lack of understanding of Information Governance which is often seen as a barrier.4. Lack of understanding of how and what to share (what can and cannot be legally shared). It is

consequently safer and easier not to share - a ‘culture of anxiety’ as expressed in the Caldicott Reviews. Concerns about, for example, possible sanctions, inadequate data safeguards, when implicit or explicit consent should be used

5. Lack of resources and time within consultations (GPs) to inform the patient, gain and record their consent and set their sharing preferences. Furthermore, patients are often not sufficiently informed to make the decision and a small minority require significant time from care professionals to provide this information and respond to their concerns and queries.

6. Culture or custom and practice.


http://www.warringtontogether.co.uk/intelligence-and-data/information-sharing/


7. Concerns that patients/service users will withhold sensitive but important information to health professionals if they believe their privacy may be breached.

8. Wider fears around security and confidentiality. 9. IT systems not interoperating which is hampering timely information flow between organisations. Note

that, conversely, benefits expected from current cross-community IT plans will be reduced if information is not flowing across boundaries.

10. Lack of a primary personal identifier. It is accepted by all that this is the NHS Number but Social Care systems do not consistently record it and some NHS organisations use it but have a local number as the primary identifier.

11. Variable data quality – deemed safer not to share rather than share potentially misleading information.12. A lack of a simple overall sharing agreement or consistent protocols to aid staff when making decisions

to share or not share patient/service user information to aid care.

Caldicott states that sharing should be practiced wherever it is in the best interests of patients and should happen unless there is a good reason not to. The GMC and other national professional guidelines state that there is a duty to share and recommend data sharing as good practice. They endorse the seventh information sharing principle given in the second Caldicott Review: that “the duty to share information can be as important as the duty to protect patient confidentiality” and state that “health and social care professionals should have the confidence to share information in the best interests of the patients…”

In summary, addressing the above issues will reduce the risk to integrated care and see improvements in the quality of care and the efficiency of the care process, reduce anxiety and confusion among care professionals and service users and reduce the risk to benefits that can be realised from the IT Infrastructure investment.

8.1.3 Benefits Summary A summary of the major benefits for the six projects comprising the overall programme is given below. Benefits will be reviewed, quantified and time-scaled in conjunction with Benefits Owners during the early months of Stage 3. An overall Benefits Plan will need to be signed off by each organisation and used by the Integrated IT Partnership Board to monitor progress and delivery.

Project 1 - Privacy and Consent

a. Increased sharing of GP information in particular - more care professional confidence and clarity around consent will result in more patients being asked to share and/or the increased use of implicit consent (especially by GPs), where agreed, will obviate the need to ask.

b. SystmOne users (of the enhanced Data Sharing Model) will find it easier to share and other care professionals (eg OOH GPs, Emergency Physicians) will be able to access SystmOne held information

Project 2 – Communications and Relationships

a. More informed patients will allow a more effective relationship with their care professionals and will reduce the time required by care professionals to seek consent.

b. Improved patient experience as patients will be more comfortable knowing that their information is being held securely

c. GPs will spend less time handling patients’ queries



Project 3 – Culture, Confidence and Willingness

a. The majority of GPs and other care professionals will understand and trust all aspects of information sharing and will be confident that sharing is safe, legal and will not expose them to sanctions or litigation.

b. Responses to GPs and other care professionals who have concerns or queries will be quick, simple and clear.

Project 4 – Information Governance

a. Information Governance rules and guidance will be simpler to understand and applyb. IG will be seen as supporting health and social carec. Use of IG will be built into commissioning contracts and into job contractsd. IG staff will work together as a virtual team or strong cohesive network to ensure the resources are

used flexible across Warringtone. GPs and other care professionals will be indemnified or fully insured against accidental harm caused

by the use of shared data.

Project 5 – Information Capture and Sharing

a. Care professionals will have clinically relevant data available at the point of needb. Data quality will be acceptable; NHS Number will be used as the primary person identifierc. Safe, legal information sharing will be practised throughout Warrington facilitated by an Information

Assurance Contract, Information Sharing Framework (including Privacy Impact Agreements and organisation-level sharing agreements) which will have senior care professional and management signed off to demonstrate that appropriate policies, guidance, processes, tools, safeguards, roles, skills and knowledge are in place.

d. Improved sharing will improve efficiency and deliver cost improvements

Project 6 – IT systems, interoperability and security

a. Safe, secure, efficient and effective information sharing will be supported by the Warrington Care Record and organisational systems.

b. The capture, flow and quality of data needed to deliver good quality care will be improved by the new processes initiated by the Better Information Sharing and Integrated IT programmes.

See also Appendix 4 - Warrington LDR Information Sharing Approach.



9 Standards

9.1 NHS NumberAcross Warrington NHS organisations the current adoption of the NHS number as the primary identify for patients under the care of health providers is universal. Health organisations have adopted and adhere to the requirements as set out in the ISB0149-01 (ISN 32/2008) & ISB0149-02 information standard boards (http://webarchive.nationalarchives.gov.uk/+/http://www.isb.nhs.uk/library/dscn/dscn2008/dataset/322008.pdf )

Within Social Care, regular spine batch tracing of adults services records is currently undertaken in to ensure that a high percentage of clients NHS numbers are known to social care.

During 2016/17 the new Social Care system will connect directly to the Spine to ensure all citizens demographic information is regularly traced against PDS to ensure full compliance.

9.2 SNOMEDWithin Warrington and Halton NHS Foundation Trust, the adoption of SNOMED CT is in place as the single common terminology in all in patient care settings using Lorenzo for diagnosis, past medical history and available for use within procedures. The Emergency Department is using SNOMED CT already for diagnosis and treatments.

The Warrington Care Record plans to support SNOMED vocabulary. SNOMED CT will be a fundamental requirement.

9.3 GS1 Standards ComplianceGS1 standards incorporated within barcodes and RFID technologies are increasingly used to provide improved patient safety, deliver greater regulatory compliance and drive operational efficiencies. The GS1 compliance table below shows Warrington and Halton NHS Foundation Trust’s current baseline state in relation to GS1 standards, and highlights future plans to further deploy and develop the use of this technology. Primary Care and Social Care organisations are out of scope for the GS1 standards compliance.

GS1 Compliance

Provider Baseline Plans

Warrington and Halton NHS Foundation Trust

The trust is in the process of planning the implementation of the GS1 standard

Expect full compliance by 18/19

Bridgewater Community Healthcare NHS Foundation Trust

No current requirementReview as part of future development plans

5 Boroughs Partnership NHS Foundation Trust

Not used No plans currently


http://webarchive.nationalarchives.gov.uk/+/http://www.isb.nhs.uk/library/dscn/dscn2008/dataset/322008.pdf

http://webarchive.nationalarchives.gov.uk/+/http://www.isb.nhs.uk/library/dscn/dscn2008/dataset/322008.pdf




10 Infrastructure

10.1 Current state and plansOur vision for IT and infrastructure is to provide a best in class data network and connected services and connect to the surrounding Community of Interest Network (COIN). The infrastructure will be focused on connecting both the patient and the clinician to everything from anywhere. Over the last 3 years across Warrington Primary Care, CCG and Hospital Provider the desktop rollout replaces static desktops with Windows tablets. Over 1,000 machines were deployed last year to truly mobilise the workforce.

Warrington’s Server and Network infrastructure must therefore be capable of supporting current and future requirements and ensure that care of patients and service users is not compromised. Our current plans include joining up our separate resilient and highly available networks and offering single Warrington Community of Interest Network (COIN) for citizen access to WiFi from one network across Social and Health buildings.

Our vision for infrastructure is that it needs to enable, rather than disable our front line staff and our citizens.

By joining up our server infrastructure across Warrington to the Lancashire COIN, we will ensure we can:

Access all appropriate clinical and corporate systems relevant to their role from any NHS or Social Care building across Merseyside using secure corporate Wi-Fi across Lancashire

Access all appropriate clinical and corporate systems relevant to their role from a none work setting e.g. patients or staff members home

Utilise secure end to end communication methods, such email, shared calendars across the whole Merseyside workforce (NHS Mail2)

Access a range of services such as common unified communication platform, enabling video conferencing, instant messaging and flexible telephony solutions through our common Cisco and NHS Mail platforms.

Not only will our infrastructure be required to deliver information in a secure and accessible way, but it must also provide the ability to interact via consumer devices and ‘wearables’. The Warrington COIN will allow devices such as Fitbit, jawbone and the Apple Watch when coupled with a smartphone to become the primary method of generating and interacting with online health data. Therefore, a modern and accessible NHS must be capable of interacting with and utilising these devices and the data they produce when our service users wish to do so, providing them with the capability of monitoring their own health. Our new homes will be digital ready and able to provide this information across Warrington.



10.2 Future state

FIGURE 12 - WARRINGTON SHARED INFRASTRUCTURE BLUEPRINT

The table below identifies a number of key schemes we will deliver to achieve this future state:

Initiative Description

Enhanced mobile access solutions Continue rollout of Direct Access to existing scalable mobile access solutions which already provide a first class user experience

Shared Wi-Fi Access Connecting local access controllers to enable all Health and Social Care staff to connect to corporate WiFi from all Health and Social Care locations across Warrington

Consolidated and strategically situated data centres By 2020 we plan to move to state of the art energy efficient data centres, across The Alliance and the council.

Common mobile/agile working devices Providing enhanced user experience through state of the art consumer devices enabled for the corporate environment, whilst maximising economies of scale through economy wide



purchasing

Common Unified Communications platform Providing innovative means of communication for both staff and patients through the use of collaboration tools such as instant messaging and video conferencing via NHS Mail 2, skype and our common Cisco platform

Shared Active Directory Providing the ability to logon to any machine independent of organisational ownership of hardware and access corporate/clinical resources as we connect to the Lancashire Domain bringing Warrington Primary Care, Bridgewater and the Hospital together.

Shared Corporate e-mail system Adoption of a common and secure email solution across Merseyside, such as NHS Mail 2 allowing the sharing of calendars

Joining Telephony Systems Exploring the provision of shared/joined telephony solutions across Merseyside, achieving efficiencies through free calling between organisations, whilst providing the facility to access calls from multiple locations

Connectivity to wider North West Coast initiatives Ensuring the economy is interconnected with neighbouring economies across the North West Coast

Online Citizen Identity Enabling a secure method for patients and public to securely access health and social care services online



11 Minimising Risks Arising From TechnologyRisks Mitigations

1. Finance

Sufficient local funding isn’t available (particularly ongoing revenue support)

Discussions are ongoing amongst the Directors of Finance to explore external funding and reinvesting benefits to fund implementations.

2. Benefits

Benefits don’t get delivered as planned (particularly cost savings)

The application of the Cranfield benefits management approach and the establishment of benefits owners.

3. Governance and Transformation

The project doesn’t get properly embedded in the Transformation Programme but is regarded as an IT initiative

Fully engage delivery groups/staff in deciding on priorities for sharing at all stages.

Providers can’t give appropriate priority to this Project due to of their participation in other projects within and outside Warrington

Agreement on roles and commitments will be subject to sign off by the Health Summit

Commissioners will place pressure for change and participation through contract

Agreement decisions to coincide with organisational planning cycles to allow signup

4. Stakeholders

Clinicians and care providers are not engaged effectively

Current CCIOs are engaged and this project will utilise the additional clinical leadership approaches of the Transformation Programme and will provide extra resources to strengthen them

5. Data Sharing

All IG issues are unable to be resolved Ensure that the data sharing forum is addressing these issues from start and that the IG and Caldicott leads of each organisation are actively involved. Completion of the Better Information Sharing Programme – see Section 8

6. Data Management

Responsibility for the data (and therefore its Each organisation will be responsible for its own



management) held in any joint system is unable to be agreed

data. Standards for data capture and transfer will be established at outset. Lead person responsible for data and technical architecture. SIROs involved in signing off individual data extractions.

Agreed levels of data quality are not achieved Mandatory training for all users of major systems to be introduced in every organisation that wants to have access to shared data

7. Technical

IT infrastructure is not in place to allow fast and mobile access to shared data

The project board will ensure that there is a dedicated work stream for this issue

8. IT services

Individual organisational priorities and situations change over time

Inevitable! Monitor progress regularly and take early decisions to switch priorities if this is appropriate course of action

Each of the Warrington health and care commissioning and provider organisations has in place robust processes for managing risk that is enshrined in formal local governance arrangements. Similarly, a robust risk management process is operating for the health and care transformational programmes that are underway across Warrington, in line with the formal governance arrangements that are in place (see Section 5.1).

Risks associated with the Warrington Local Digital Roadmap will be managed both via the existing individual organisations and the cross economy programme governance arrangements as outlined above.


Documents

The Local Digital Roadmap for Warrington - … Papers/The Local... · Web viewThis document is the Local Digital Roadmap for Warrington and is the third step in the 3-part process