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File reference: GEH 1819 273 IMTStrategy.docx

Delivering for Patients

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Ref: GEH 1819 273 IMTStrategy.docx P2/39

Amendment History:

Version Date Amendment History

1.0 Initial draft

1.1 09 May 2013 Issued for review

1.2 09 May 2013 Insertion of Appendices and formatting

1.6 06 June 2013 Minor revisions and formatting

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Contents

1. Introduction .......................................................................................................................... 5

2. Executive Summary .............................................................................................................. 7

3. The Strategic Vision for IM&T .............................................................................................. 9

3.1 The current IM&T Landscape ....................................................................................................... 9

3.1.1 Network Infrastructure ....................................................................................................... 9

3.1.2 Server and Storage Infrastructure ..................................................................................... 10

3.1.3 Desktop and Printing (including mobile devices) .............................................................. 10

3.1.4 Applications ....................................................................................................................... 11

3.2 The Future Model ...................................................................................................................... 15

4. Drivers for Change .............................................................................................................. 16

4.1 National Context ....................................................................................................................... 16

4.1.1 Equity and Excellence: Liberating the NHS (July 2010) .................................................... 16

4.1.2 Liberating the NHS: An Information Revolution (October 2010) ..................................... 16

4.1.3 Government ICT Strategy (March 2011) ........................................................................... 16

4.1.4 The Information Strategy / The Power of Information (June2012) .................................. 17

4.1.5 NHS Operating Framework (2012/13) .............................................................................. 19

4.1.6 The Clinical 5 Framework .................................................................................................. 20

4.2 The Arden Cluster ...................................................................................................................... 21

4.2.1. Integrated Care ................................................................................................................ 21

4.2.2 Commissioning Intentions – IM&T .................................................................................... 22

4.3 George Eliot Hospital Business and Clinical Strategy ................................................................ 22

4.3.1 Lorenzo Regional Care ....................................................................................................... 22

4.3.2 Securing a Sustainable Future (SSF) .................................................................................. 24

4.3.3 Trust Business Strategy ..................................................................................................... 24

5. Development Road Map ..................................................................................................... 25

5.1 The IT Development Programme .............................................................................................. 25

5.2 ICT infrastructure ...................................................................................................................... 25

5.3 Development Plan ..................................................................................................................... 26

5.3.1 Plan 12 – 15 months .......................................................................................................... 26

5.3.2 Plan 2 – 5 years ................................................................................................................. 26

5.4 Clinical Information and Systems .............................................................................................. 27

5.4.1 Plan 12 – 18 months .......................................................................................................... 27

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5.4.2 Plan 2 – 5 years ................................................................................................................. 28

5.5 T (Technology) QIPP .................................................................................................................. 28

5.5.1 Plan 12 – 18 months .......................................................................................................... 29

5.5.2 Plan 2 – 5 years ................................................................................................................. 29

5.6 Collaboration and Sharing ......................................................................................................... 29

5.6.1 Plan 12 – 18 months .......................................................................................................... 30

5.6.2 Plan 2 – 5 years ................................................................................................................. 30

5.7 Challenges and Risks ................................................................................................................. 30

5.8 Outline Development Plan ........................................................................................................ 31

6. Glossary of Terms ............................................................................................................... 32

7. References .......................................................................................................................... 33

8. Appendices ......................................................................................................................... 34

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1. Introduction

Information Management &Technology (IM&T) needs to be a high quality pro-active and

enabling support service. It should be a ‘utility’ based service, always available on demand and

supporting users in the ways they need to work. Services and information must be available at

the point of care irrespective of location and device.

There is a paradigm shift taking place in the ways that care will be provided for patients. The

DoH’s evolving information strategies, the information confirming review (Caldicott) and more

recently the Francis Report, all clearly signpost that the patient has to be at the very centre of

integrated, information-rich care processes.

The Francis Report [Ref 1] makes this clear with two particular comments:

“The provision of the right information to patients and their families at the

right time is vital”.

and

“Staff need to know sufficient information about the patient to be able to

treat them with humanity, respect and interest.”

The prime objective of this IM&T Strategy is to support this patient centric approach along with

the Trust’s overarching Clinical and Business Strategies and plans. To ensure this, a number of

guiding principles have been adopted to shape the development of this strategy:

Information

Patients’ well-being will be a key focus within the strategy.

Information and technology will be deployed to support Trust staff in delivering high

quality, safe and effective care for patients, 24/7, 365 days a year.

Data Quality will be accurate, complete and timely, compliant with national and

professional standards, including the IG Toolkit.

Patient Information will be captured and recorded at the point of care and there will

be one and only one prime record (EPR).

Technology will be used as a key enabler to support and drive improvements in

service quality and performance.

Technology

Technology will be viewed as enabling, supporting and enabling the delivery of

defined Business and Clinical processes and outcomes.

Technology will be standards based underpinned by interoperability.

Wherever possible energy efficiency will be built into IT equipment and

applications

Will support flexible working:

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Provide information on a technology platform accessible on demand,

independent of device and location;

Provide a secure platform on which to share and collaborate on care

pathways across multiple care settings.

This paper sets out how IM&T will support the Trust’s strategic aspirations and objectives as a

healthcare provider across the Local Health Community (LHC) covering North Warwickshire,

Coventry and Leicestershire and working with our partners and commissioners to provide high

quality joined up care for our patients. The IM&T strategy also considers National developments

around the transformation for Health and Social Care to ‘harness information and new

technologies to achieve higher quality care and improved outcomes for patients and service

users’ [Ref 2].

Our health economy will need to be highly focussed on information, how it is provided, how it is

used to drive forward and improve patient outcomes and how it is shared to join up and

enhance the care provided to, and experience of, the patient. The patient has to be at the very

centre of this new joined up model of care and to do this information needs to be shared and

made available to all those involved in the treatment and care of the patient right across our

LHC.

The IM&T Strategy is not technology driven it is about using technology and information to

enable and encourage the delivery and transformation of health care services, both operational

and clinical, across the Trust. To do this the strategy has four linked development components:

(1) Infrastructure - the core building blocks on which IT and information services are

delivered

(2) Clinical Systems – the applications and technologies that clinical and nursing staff

use to support the delivery of high quality patient care

(3) T QIPP – how we can use the technology to help deliver, quality, innovation,

productivity and performance (QIPP)

(4) Collaboration and Sharing – how we work with our commissioners, partners and

stakeholders to put patients at the heart of their care services.

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2. Executive Summary

This IM&T Strategy sets a four-year framework for transforming the Trust’s ICT infrastructure

and its clinical systems in support of national initiatives and the organisation’s own aspirations to

lead an ‘information culture’ in which patients are put at the centre of all its services.

As citizens, patients and users of care services, the strategy sets out how a new approach to

information and its IT across health and social care can lead to more joined up, safer, better care

for everybody. At the heart of the Trust’s strategy it embraces the national Power of

Information initiatives – most notably the need to have IT systems and processes that record

data once and share it in a controlled and secure manner amongst those providing our care. In

essence the strategy drives integrated care across the Local Health Community (LHC). These

principles are endorsed by the Arden Cluster which has a clear focus on improving outcomes for

patients underpinned by a fully integrated approach to the provision of care.

Section 3 of the document describes the current IM&T landscape and explains significant

successes it already has in terms of clinical systems provision and limited ways in which

information is already shared electronically both between Trust and GP systems. The Trust

already has several years’ experience with interfacing different IT systems: its ability to enhance

Review as its clinical repository, and electronically transfer reports to GPs has been well received

by all care groups. Indeed it’s the success and experience in using these systems that has

facilitated the development of a more comprehensive strategy in which complete Electronic

Patient Records (EPR) will be provided.

EPR solutions cannot be bought, they have to be developed and integrated using best of breed

systems. For the Trust it is fortunate in gaining national support for the implementation of CSC’s

Lorenzo Regional Care (LRC) system – a proven and comprehensive system covering such areas

as Care Management, Emergency Care, Clinical Noting and Documentation, Requesting &

Reporting, Bed Management and so forth. Lorenzo will be integrated with key specialist systems

such as required by diagnostic services (e.g. pathology, radiology, endoscopy, cardiology, vital

signs). The strategy explains how its new Integration Engine (TIE) will facilitate the seamless

interaction between systems so allowing data to be captured once and shared. Sections 4 and 5

explain how the EPR solution will be implemented over a three year period, with the first phase

being brought into productive use during March 2014.

The Strategy also demonstrates its support for the national QIPP initiative and how it embraces

the proactive use of technology. A number of areas are singled out such as real-time bed

capacity monitoring, nurse performance dashboards, and the electronic discharge system.

No modern health organisation can conduct its business without a modern ICT infrastructure.

Information Technology emanates from a rapidly changing and dynamic market sector. New

systems inevitably require better hardware platforms and network infrastructure for it to

operate. All these components have to work together as a whole – within an acute Trust with

24/7 availability – thus requiring special attention to system performance, capacity, and

availability. The need for Disaster Recovery solutions cannot be ignored. Section 3 explains the

current IT landscape and Section 5 provides a development road map to support new

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technologies, including opportunities to provide energy efficiencies, and unified communications

in which data and voice share a common technical infrastructure. For these reasons the

Strategy explains why IT requires continual investment – it’s not just about doing new things.

Whilst the Strategy makes very positive proposals it also identifies a number challenges and

risks. Unless resources are made available the Trust has to be careful it does not over commit.

Inevitably over the period of this strategy prioritisation will need refinement. The full impact of

the implementation of The Health and Social Care Act 2012 and new commissioning processes

may influence in-year priorities. Finally little of this will benefit patients unless significant

clinician stakeholder engagement and clinical ownership is maintained across all aspects of the

IT Programme to ensure that clear patient and clinical outcomes remain the priority.

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3. The Strategic Vision for IM&T

3.1 The current IM&T Landscape

The IM&T landscape within GEH is considered under 4 headings:

(1) Network Infrastructure

(2) Server and Storage Infrastructure

(3) Desktop and Printing (including mobile devices)

(4) Applications

3.1.1 Network Infrastructure

(a) Core Network

As general principles the Trust’s ICT infrastructure has been developed with key

attributes in mid. These are:

Resilience

Reliability

Scalability

Flexibility

The Trust’s network is predominantly CISCO based with two resilient core switches

(6509s) providing links through N3 for external connectivity with a separate 10Mbps

internet link for non N3 traffic.

As part of the collaborative PACS/RIS replacement project with University Hospitals

Coventry and Warwickshire (UHCW) and South Warwickshire Foundation Trust

(SWFT), we are installing a dedicated Community of Interest Network (COIN)

between the three sites to support the secure sharing of images and information.

This will be a network provided by Virgin Media with a minimum of 400Mbps

primary and 10Mbps backup and the intention across the Arden Cluster is that this

network could be further developed to provide a cross LHC network to support

collaboration and sharing.

(b) Distribution and Edge

Routing and switching across the internal network is managed through a series of

Cisco routers and switches using fibre and Cat5/6 cabling. The Trust also uses Solar

Winds to provide real time management of the network and server estate.

(c) Wireless

The Trust deployed a new CISCO wireless network during 2011 which provides both

staff and separate guest wireless access. The wireless network has been configured

to provide full coverage across the main hospital buildings along with full

triangulation to support future deployment of any requirements for Radio Frequency

Identification (RFID).

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(d) Voice over IP (VOIP)

A limited deployment of VOIP will be completed during 2013 with the

implementation of CISCO’s Call Manager to provide a new Switchboard and Contact

Centre capability. Full blown Unified Communications with integrated data & voice

traffic is a consideration within the IT infrastructure plan.

3.1.2 Server and Storage Infrastructure

The core IT infrastructure is split over two separate server rooms on the main hospital

site. These server rooms provide a failover capability across physical locations and this

resilience is further reinforced with key applications and storage running in a full failover

environment for both clinical and non-clinical applications.

Servers

A total of approximately 140 servers.

Currently a mixed estate, predominantly Dell but also HP and IBM hardware.

All new hardware generally comprises Dell with full 3 year support on hardware.

A percentage of the estate is now over 5 years, currently still covered under a

ProbSolv hardware contract.

Key infrastructure domain based services (Integrated Active Directory, DNS,

DHCP, Certificate Services).

Clinical systems and services (A&E Trakker, Review for example)

Storage

New Storage Area Network (SANs) have been rolled out to provide modular disk

capacity on the George Eliot site. Key usage at the moment provisioned to the

new PACS project and the Clinical database cluster.

Future proof solution that allows progression into a potential virtual

environment.

Virtualisation

Server virtualisation offers cost effective service rollout whilst minimising

hardware footprint (reducing cooling, storage and DR requirements). This is

currently being investigated with a view to consolidating the server

infrastructure.

3.1.3 Desktop and Printing (including mobile devices)

The Trust has approximately 1300 desktop and laptop devices using Windows XP and

Office 2003/07. Access to key systems is managed through authenticated single sign on.

Printing is predominantly managed through desktop printers although the vast majority

of these printers are networked. The Trust has recently completed a tender exercise.

The move to a multi-function device (MFD) environment which will provide greater

flexibility with printing along with cost and energy efficiency.

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The Trust has deployed a small number of Apple iPads to support flexible working using

wireless and secure VPN access. However, due to the limitations of the iPad browser

(Safari), the plan is to deploy Windows 8 devices to support mobile and flexible working.

This will start with the deployment of Patientrack (See 5.4).

3.1.4 Applications

The application estate is best split between clinical and non-clinical applications:

Clinical Applications:

Appendix A provides a diagrammatic representation of the main Clinical Systems’ IT estate

and externally hosted IT services as at 2012. Where relevant the diagram also shows where

there are interfaces to provide data flows between respective systems.

The IT architecture includes two key central IT systems which are utilised by most clinical

applications. These are:

(a) Trust Integration Engine – which acts as the data messaging agent and has the

functionality to pass data between systems in a controlled and auditable manner. It

uses a number of ICT messaging standards – several are health specific, others are

standards used in the UK and internationally for IT interoperability. Within the NHS the

strategic standards centre on HL7 V2 & V3, and various UK Government strategic

principles.

During 2013 the Trust’s SeeBeyond JavaCAPS Integration Engine will be replaced by

Orion Health’s Rhapsody integration product.

(b) EPAPI - Enhanced Patient Application PAS Interface. The basic design of the MS SQL

2008 real-time patient repository emanates from the Trust’s PAS supplied by IBA –

covering the period 1999 to 2007. Since this date it has been significantly enhanced to

enrich its dataset to provide a comprehensive patient demographic register, and a table

of patient encounters (such as referrals, admissions, transfers and discharges). The TIE

keeps this up to date on a second by second basis and therefore reflects all PAS

transactions virtually as they occur. It is a prime and fundamental Trust resource for a

number of downstream IT systems, most notably the A&E Trakker and Electronic

Discharge System (EDS).

Specific patient centric applications include:

(c) AuditBase (supplied by Auditdata Ltd) – is essentially a patient administration system

specifically designed for the management patients attending hearing clinics. It includes

a number of modules such as client administration, scheduling, instrument repairs, stock

management, audiometry assessments.

It operates on a MS Server 2003 platform using a Gupta SQL database supplied by the

Unify Corporation. The AuditBase solution is interfaced to audiometry equipment and

has a demographic connection to EPAPI.

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(d) BadgerNet Neonatal (supplied by Clevermed Ltd) – this is a hosted service operated

over N3 from Clevermed’s Data Centre. The system manages care episodes across

individual locations. Care episodes may be joined to form a single patient record view

that can be read by all authorised BadgetNet users associated with individual care

locations.

As at 2012 BadgerNet is not interfaced to any Trust system but has the capability using

HL7 messaging to communicate with a PAS as well as real time medical device

equipment.

(e) Cardiology & Respiratory Unit – (various suppliers such as LoveMedical, Scanmed,

Cardiac Science, GE Healthcare)

The Trust’s CRU has several computer based diagnostic systems used within cardiology

and respiratory function. Currently all reports are paper based, or stored as PDF files on

a shared server folder. This makes report distribution both tedious and very difficult to

facilitate information sharing amongst healthcare professionals. Preliminary discussions

have been held to improve this situation, possibly by using eDocument Manager.

Detailed technical plans require development and resources allocated as may be

considered appropriate.

(f) DAWN AC (supplied by 4S Information Systems Ltd) – is an anticoagulation system used

by the CWPS specifically for George Eliot Hospital registered patients. It is particularly

tailored to managing large anticoagulation clinics. It provides decision support from

patient induction, maintenance, and ongoing management of anticoagulation patients.

Currently the system is operated in standalone mode; however CWPS has expressed

interest in linking into the Trust’s eDocument Manager system and thereby having to

capability to distribute reports to Review and electronically to GPs.

(g) DAWN RH (supplied by 4S Information Systems Ltd) – is hosted by UHCW using a

common database for all Rheumatology patients across the two Trusts. It is interfaced

to Ultra to receive patient pathology reports. As well as providing case management

functionality, a particular strength is its ability to optimise drug utilisations and recall

dates by rapidly assessing disease activity.

(h) Dendrite (supplied by Dendrite Clinical Systems Ltd) – is a user configurable clinical

database system which has been developed for use with a number of clinical specialties.

At George Eliot Hospital it has been specifically purchased to support Stroke and

Oncology services (and their specialist reporting requirements) and TIA/stroke patients.

The system is linked to EPAPI for demographic information.

(i) Documentum – used in conjunction with TaskSpace and Captiva. The software suite

provides an EDM solution for the digitisation of conventional paper based documents

(case notes). The repository uses Documentum, the user interface TaskSpace, and

Captiva for scanning documents.

The system has piloted with Maternity, A&E, and Physiotherapy specialties. It has an

interface to EPAPI, but the very basic nature of the interface and its lack of any ability to

track changes in patient demographic data has resulted in a system which needs

significant attention in terms of database structure, interface design, and user interface.

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During 2012/13 the Trust has commissioned a review of EDM and is seeking options to

improve the current system.

(j) eDocument Manager (Trust developed system) – used for the electronic capture of

clinical documentation prior to submission of documents to Review and EDT Hub. The

system employs configurable metadata to identify the type of document, the speciality,

the patient encounter it refers, and the recipient of the document – typically a GP.

eDocument Manager was originally conceived to provide a low cost solution for the

Trust to meet CQUIN targets associated with the distribution of clinical documents to

GPs. As at 2012 it manages the following document classes:

OP clinical letters generated by IPM across 19 specialities

Mosaiq clinical documents for oncology and haematology patients

Provisional plans have also been developed to link other disciplines such as:

Ophthalmology documents from the Newmedica hosted system

DAWN AC anticoagulation reports

Unisoft endoscopy reports

Cardio-Respiratory diagnostic reports

Whilst eDocument Manager has been very successful it is important to recognise that a

number of clinical specialties do not have the capability to electronically transfer

diagnostic reports for sharing on Review or any other Trust IT system; in essence such

systems are considered ‘islands of information’ – a situation which is subsequently

addressed within this four year IM&T Strategy.

(k) EDT Hub (supplied by PCTi) – is a document capture system specifically tailored to the

PCTi Docman EDM as used by all GP Practices across Coventry and Warwickshire. The

Trust has therefore developed interfaces to use this system to receive reports from

eDocument Manager and EDS for forward transfer to Practices. Technically the

software is modelled on the NHS ITK standard.

Whilst EDT Hub works well it is not compliant with Leicestershire GP Practices which do

not use Docman. During 2013 the West Leicester CCG has requested the Leicestershire

Health Informatics Service to develop collaborative plans for extending the Trust’s

electronic document distribution services to Leicestershire Practices.

(l) Electronic Discharge System (EDS) – is an in-house developed system which provides

the capability to record inpatient clinical information including the production of a

discharge summary inclusive of TTO medication details. The drive to implement this

interim solution was precipitated by national contracting arrangements to ensure that

all GPs receive inpatient summaries within 48 hours of each discharge. The outputs

from EDS are captured by EDT Hub and Keystone – the latter system is used to transfer

IP summaries to Leicestershire Practices using the BT DTS service. EDS obtains patient

encounter details from EPAPI.

(m) ICNet (supplied by ICNet International) – is a commercial infection surveillance system.

It is a real-time, evidence based solution designed to provide optimal support to

improving infection prevention activities within healthcare settings. At George Eliot

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Hospital it is interfaced to EPAPI and to GE Ultra for the receipt of patient microbiology

information.

The system user base is quite small, mainly limited to Infection Control Nursing

personnel.

(n) Review (supplied by Indigo4 Systems Limited) – is the main clinical repository for

pathology, radiology, clinical letters, and IP discharge summaries. In essence it is the

work horse used by virtually every speciality within the Trust. It has a user base of over

one thousand spread across primary and secondary care settings.

The system was brought into service in 2005 and therefore now provides rich clinical

histories. The system is interfaced to Keystone which forwards clinical reports required

by GPs. All GP Practices can receive electronic pathology reports, and the majority can

also receive radiology reports.

The critical nature, the system is deemed to be the most important clinical system

within the Trust, has warranted investment to provide multi-node resilient clustered

servers to ensure as close as possible 24/7 availability.

(o) Indigo4 Keystone (supplied by Indigo4 Systems Limited) – is the main DTS message

routing system used for CDS submissions and the day to day distribution of clinical

reports to GP Practices. It is capable of managing a number of data sets of various

technical standards including EDIFACT, HL7 V2.3, ASTM 1238, XML, SUS CDS XML V6,

Kettering XML.

(p) JAC Pharmacy (supplied by JAC Computer Services Ltd) – is the Trust’s medicines

management system. It provides clinical and administrative support to prescribers,

pharmacists and nurses. Functionality includes drug ordering, stock control, dispensing,

labelling and clinical decision support.

The system has an HL7 ADT interface to provide most recent patient demographic

information. The interface is currently slaved off the legacy Sunquest pathology system

but will be migrated to the Trust’s Rhapsody Integration Engine during 2013.

(q) Mosaiq Oncology (UHCW hosted service, supplied by Elekta). UHCW hosts oncology

services and Mosaiq is their main IT system which, for George Eliot Hospital, provides

support to general oncology and chemotherapy services.

UHCW has provided ADT and pathology interfaces to Mosaiq. At the George Eliot

Hospital there is a capability to receive clinical documents into eDocument Manager for

transfers to Review and GP Practices via EDT Hub.

(r) Pathology Ultra & Sunquest Systems (CWPS services, systems supplied by GE Medical

Systems and Sunquest Information Systems) - the main system is the Ultra Laboratory

Information Management System which is due to be replaced during 2013/14. This

system covers most disciplines, that is biochemistry, haematology, microbiology,

histopathology and cytology. Sunquest primarily supports transfusion medicine. Both

systems are interfaced to Indigo4 clinical systems.

(s) Proton Renal (UHCW hosted service, supplied by Clinical Computing UK Ltd) – used by

UHCW nephrologists when undertaking clinical sessions at George Eliot Hospital. The

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system is specifically adapted for the special requirements of managing nephrology

patients.

UHCW has used this system for many years. It has interfaces to the Ultra pathology

system and receives PAS ADT information.

(t) Radiology+ Soliton & Insignia PACS (Radiology+ hosted by UHCW, supplied by Soliton IT

Limited, and Insignia Medical Systems) – these systems have replaced the HSS CRIS and

GE centricity PACS systems supplied to the Trust under the National Programme for IT

(NPfIT).

The Radiology and RIS is hosted by UHCW and has interfaces to PAS and individual Trust

PACS servers at UHCW, George Eliot Hospital and South Warwick Hospitals. At George

Eliot Hospital Radiology and reports are forwarded to Review and Keystone.

(u) Unisoft Endoscopy (Unisoft Medical Systems) – is a specialist GI administration, clinical

and reporting system deployed within the Trust’s Day Procedures Unit. It has interfaces

to facilitate digital image capture providing seamless integration into endoscopic

reporting tools. The system also has an interface link to EPAPI for demographic

registrations and updates.

The system can only produce paper based reports, however it is anticipated this

situation will be rectified using a document interface thus providing their wider

availability using Review and electronic transfers to GPs using EDT Hub.

3.2 The Future Model

The Future fully integrated model for the Application estate is represented in the schematic

at Appendix A. This application environment will be fully interoperable, with all systems

capable of connecting and sharing data with each other. The prime Clinical System will be

Lorenzo Regional Care (LRC), which will capture, and join up patient related information to

deliver a complete and contextual Electronic Patient Record (EPR), available to all clinical

staff providing patient care.

At the centre of this Application model is the Trust Integration Engine (TIE) which will deliver

seamless interoperability between systems and information, within the Trust as well as

external systems.

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4. Drivers for Change

4.1 National Context

4.1.1 Equity and Excellence: Liberating the NHS (July 2010)

The NHS landscape was re-defined with General Practitioners seen as the commissioners

of care within a regulated framework of competition between providers. Patients will be

empowered through an ‘information revolution’ where they can make educated

decisions and informed choices about their own care. Some of the key changes include

[Ref 3]:

GP consortia to be introduced to have a far greater role in commissioning

within the NHS bringing primary care closer to patients with a stronger focus

on prevention.

The improvement of health care outcomes for all with the aim of driving up

quality, promoting equity and excellence across all services.

Prioritise the need to reform the culture of the NHS to allow for a more

efficient and effective healthcare system with a £20 billion savings plan.

A key underlying theme with the emphasis around innovation and the value of

technology.

4.1.2 Liberating the NHS: An Information Revolution (October 2010)

Equity and Excellence initiative [Ref 4] introduced a number of key drivers for change:

Improved health outcomes through empowerment of patients to make

informed choices, for which patients would need accessible information to be

able to take control of their own health and wellbeing

Improved communication between care professionals and service users

supported by enhanced presentation and more accessible formats to avoid any

exclusions

Confidence in healthcare information by way of a “whole person approach”

backed up by validity, security, quality and accuracy of patient data along with

the technology systems used to manage and deliver this information in a way

to support informed decision making

Empowerment and decision making where seen as important for patients to

learn and take responsibility for their own health.

4.1.3 Government ICT Strategy (March 2011)

The Government published [Ref 5] four strategies covering G-Cloud, End User Devices,

ICT Capability and Greening Government ICT. These were some of the building blocks to

enable radical transformation of ICT to create a more productive, flexible workforce that

delivers digital public services but in a much more cost effective way.

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The development of a referenced architecture and a standards based approach to

underpin the aims of the ICT strategy would enable flexible, reusable and interoperable

solutions to be designed and deployed. The strategy went on to define seven challenges

currently afflicting public sector IT:

Projects tend to be too big, leading to greater risk and complexity and limiting

the range of suppliers who can complete.

Departments, agencies and public bodies too rarely reuse and adapt systems

which are available “off the shelf” or have already been developed in other

parts of Government.

Infrastructure is insufficiently integrated, resulting in inefficiency and over

capacity.

Procurement timescales are far too long and costly, reducing the number of

potential suppliers and there is too little attention at senior levels to the

implementation of big ICT projects and programmes.

Reduce the carbon footprint of IT by 35% over five years.

Move away from “Big Bang Solutions” delivered by the same large suppliers to

a greater number of smaller agile projects.

Enable interoperable ICT by using common and open standards, creating cross-

government standards on Application Programme Interfaces (API’s) developing

a quality assurance “kite mark” and in so doing help to open up new innovative

services from a diverse range of providers.

4.1.4 The Information Strategy / The Power of Information (June2012)

This Strategy [Ref 6] sets out to deliver a vision rather than a formal deployment process

which was felt needed to be managed locally. The key elements of the Strategy are:

Information to be used to drive integrated care across the entire health and

social care sector with the information seen as a health and care service in its

own right for everyone to use and benefit from (this would help to reduce

inequalities).

A fundamental change in culture whereby health and care professionals

recognise that information in a patients care is information about the

individual which should be readily accessible to them.

Information should be recorded once and shared securely between those

providing care, supported by consistent use of information standards that

enable safe and secure sharing.

Patients electronic care records become the source for core information used

to improve care and improve services, reducing bureaucracy in data collections

and enabling quality to be measured.

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A culture of transparency, where access to high quality evidence based

information about services is readily accessible to all.

An information led culture where all health and care professionals take

responsibility for recording, sharing and using information to improve care.

Greater use of modern technology to make health and care services more

convenient, accessible and efficient.

Organisations should have a Chief Clinical Information Officer at Board Level.

Joined up systems supported by common technical and data standards will be

key to driving integration and sharing between NHS, Public Health and Social

Care, focussing absolutely on the individuals health and care needs.

Getting the right information to the right people at the right time in a form

that they can understand and use will help individuals take control of their

own care with more shared decision making and better more informed

choices.

Information must be used to drive better health care and support, to improve

our experience, quality and outcomes of Health and Care Services, putting

people truly at the heart of care.

Establishes a 10 year framework for transforming information and new

technologies to achieve higher quality care and improved outcomes for

patients and service users.

There has to be an absolute focus on Information, how it is provided, shared

and used to drive forward clear outcomes. In effect we need ‘an Information

led culture’ that supports the culture of ‘No Decision About Me, Without Me’.

The Strategy defines a number of key outcomes that are relevant to Acute providers:

(1) To interact with Health and Social Care services on-line through for example,

letters and appointment bookings.

(2) Patients having electronic access to their own care records, including Summary

Care Record (SCR) by 2015.

(3) Joined up/integrated clinical information, for example EPR, Clinical Portal.

(4) Information Standards underpinned by use of the NHS number.

(5) Data capture at point of care.

(6) More information available on the quality and performance of Health Care

Services.

(7) Innovations using technology.

_______________________________________________________________________________________________


Underpinning these outcomes is a clear requirement around adopting a standards based

approach to systems and information such that systems must be interoperable.

The Strategy considered where we are currently. There is no single overall record of our

entire Health and Care history with separately held electronic and paper records across

multiple care settings. Over 25% of all adults have a smart phone and 23% use their

smart phone for on-line surfing. Three quarters of UK homes have broadband

connectivity but we cannot afford to take count of the fact that one quarter of homes

still do not have this broadband access.

Information must be seen as being core to the Business of Health and Care. Investment

in Information Systems will be a core part of delivering a high quality, cost effective

integrated Health and Care Service.

Information and IT need to work for clinicians and care professionals and different

systems across multiple care settings must connect.

The Strategy also describes a number of changes that should be evident in the new ways

of working:

All correspondence about patients and service users to be transferred

electronically in a coded and structured format including:

Referrals

Discharge summaries

Medication details

Assessments

Secure electronic links should be used to transfer information.

The wider use of innovative alternatives to face to face contact in Health and Care

should be encouraged.

Increase the use of mobile technologies for professional viewing and recording of

information.

Patients and service users should be allowed to participate in their own health

care.

Existing patient health records should be made electronic and accessible to

patients on-line.

4.1.5 NHS Operating Framework (2012/13)

The NHS Operating Framework [Ref 7] sets out the National Business and Planning

priorities. There are four key themes for all NHS organisations:

(1) Putting Patients at the centre of the decision making in preparing for an

outcomes focus to service delivery, whilst improving dignity and meeting

essential standards of care.

_______________________________________________________________________________________________


(2) Completion of the transition of the new system – Clinical Commissioning Groups

(CCGs). Foundation Trust pipeline, Health and Well-being Boards and use of Any

Qualified Providers (AQP).

(3) Delivering the Quality and Productivity challenge (QIPP).

(4) Maintain a grip on service and financial performance, particularly around the 18

weeks right to treatment.

The quality of care for older people is set to be a high priority across the NHS and this

has particular relevance for GEH given our local population demographics. As care

decisions are increasingly taken locally, the requirement will be for all organisations to

ensure that service delivery is integrated utilising IM&T systems and technology across

Primary, Secondary and Social Care.

The NHS Operating Framework is to act as the catalyst for driving quality improvements

and outcome measurement and this will include the greater introduction of Telehealth

and Telecare, a focus on emergency admissions and re-admissions, patient surveys and

complaints, improving access to services.

Local clinical decision making will enable and reinforce the ‘Choice’ agenda and there

will be an Information Strategy for Health and Social Care:

To give better patient access to records.

To support information and outcomes.

To support integrated care through enabling the sharing of information between

organisations.

To allow for better use of aggregated information.

There is also a defined financial efficiency requirement of 4% per Trust whilst

maintaining a surplus operating position. Three new CQUIN goals have been set:

improving the diagnosis of dementia in hospital, incentivise the use of NHS safety

thermometers, the ability to make CQIN recurrent where funding is used to achieve a

higher standard of quality with IM&T enabling as necessary.

4.1.6 The Clinical 5 Framework

Technology advances in healthcare are to say the least rapid and it can be useful to use a

framework to assess, plan and deliver technology. One such framework is ‘The Western

European Maturity Model’ [Ref 8] which uses 5 stages to describe the evolution of

healthcare in IT in hospitals.

The table below links this to the strategic Clinical 5 Systems that hospitals should be

aspiring to implement:

_______________________________________________________________________________________________


Stage 5 Digital virtual enterprise Hospitals have fully automated their business and clinical functions supported by a robust clinical data repository (CDR), complemented by business and clinical intelligence tools. Clinical reach is being extended beyond the institution using Telemedicine and remote patient monitoring, plus participation in regional information sharing initiatives

Stage 4 Digital Hospital Once the core clinical information systems are fully implemented, hospitals will begin to implement the requisite infrastructure to support more advanced clinical applications, enterprise MPI, wireless point of care clinical documentation, nurse documentation and use of Web Portal technology by patients and employees and a fully functioning electronic medical record, including enterprise wide scheduling,

Stage 3 Advanced HIS/CIS Hospitals should be laying the groundwork for electronic medical records (EMR’s) by implementing the foundational clinical information systems (CIS), including laboratory information management systems (LIMS), Radiology Information Systems (RIS), Radiology results reporting, picture archiving (PACS), Pharmacy and theatre scheduling management systems, Order Communications for all tests including e prescribing.

Stage 2 Basic PAS In addition to the basic PAS applications there should be more sophisticated administrative capabilities plus the ability to generate discharge summaries and have sophisticated reporting

Stage 1 Basic PAS with Local master patient index (MPI) Core financial and administrative systems are implemented to support patient registration, patient costs, human resources and general finance and other general back office business functions plus reporting

4.2 The Arden Cluster

4.2.1. Integrated Care

The LHC across Coventry & Warwickshire (The Arden Cluster) has a clear focus on

improving outcomes for patients underpinned by a fully joined up and integrated

approach to the provision of care across all health and social care settings.

The new commissioners (CCGs) view information and IT systems as key enablers to

being able to deliver these improved outcomes.

Joined-up and shared information about patients and the care they have received and

are currently receiving across multiple care settings, is increasingly being seen as the

core requirement of information sharing across the Arden Cluster. The question

increasingly being posed is not why organisations should share information rather it is to

justify why they are not sharing information on patients across treating clinicians,

because to not share has to increase not reduce the risk to patient safety.

The Trust is already committed to this integrated and joined up approach to the

provision of patient care. We already receive a copy of pathology results for all GP

registered North Warwickshire patients and this will be extended to Radiology

_______________________________________________________________________________________________


diagnostic reports from June 2013, with the deployment of a new Radiology Information

System (RIS) across the Arden Cluster acute providers. This is a positive step forward

but there is still much more to be done around information sharing if we are to provide

a truly patient centric information environment.

4.2.2 Commissioning Intentions – IM&T

The Commissioners want to see robust and standardised operational and clinical

systems across providers consistent with patient safety requirements. Opportunities to

work collaboratively to enhance digitally enabled healthcare will be encouraged through

collaboration and joined up working with initiatives including:

E-communication between secondary care providers and GPs (note, the Trust

already has over 400 registered community users to our Results Reporting

system and all GPs have the option to receive electronic discharge summaries,

outpatient letters, radiology reports, and pathology results directly into their GP

Practice system).

Telehealth.

Common assessment framework (CAF & eCAT).

Point of care information sharing pilots.

Summary Care Record (SCR) – exploitation of benefits.

Use of extranets to support cross sharing communication and pathways.

Move towards electronic prescription services.

Electronic support for patient pathways including for frail, elderly and

ambulatory patients.

Patient / citizen health portal.

There is also a strong interest in exploring the potential benefits of what an LHC-wide

deployment of LRC could provide.

The QIPP Programme will continue to be used to encourage and incentivise some of

these collaborative schemes (see section 5).

4.3 George Eliot Hospital Business and Clinical Strategy

4.3.1 Lorenzo Regional Care

During 2006/07, the Trust implemented an iSoft IPM Patient Administration System

(PAS) under the NPfIT. This, in conjunction with a number of additional ‘Integrated’

clinical systems, has been the corner stone of a clinical systems road map to move

towards fully integrated electronic patient records (EPR).

To date limited integration has been achieved using the TIE which allows the sharing of

key patient data between both internal and external IT systems.

_______________________________________________________________________________________________


The strategic aspiration is to have a ‘single joined-up’ view of all patient information,

which can then be extended across other care settings across the LHC. However, a

number of our IT systems are either approaching their end of life or requiring significant

additional investment to ensure that they are suitable to support the Trust’s aspirations

for service transformation. These systems include:

EDS - Electronic Discharge System, used for inpatient activities and TTOs.

PCTi EDT Hub - Electronic transmission of documents to GP Practices.

Documentum - EDM system (scanned casenotes).

Review (Indigo 4) - Results Reporting.

Included in this strategy is the consideration of a replacement for IPM PAS, which under

the current NPFIT contract comes to end of life in 2016. The Trust has undertaken a

strategic alignment exercise with CSC, to match the Trust’s strategic IT development

requirements against the functionality and process capabilities offered by the Lorenzo

Regional Care solution. This identified a very close strategic alignment and

demonstrated the potential to provide a wide range of clinical and operational

improvements as well as the enhancement of care to our patients coupled with support

for the emerging commissioning requirements being placed on acute providers.

Within the Strategic IT Development Plan, the Trust identified a number of key

developments that needed to be delivered. These areas include:

Emergency care services covering A&E, Emergency Medical Unit and Surgical

Assessment Unit (emergency care).

Obstetrics and Neonatology Services (Maternity).

Electronic requesting of diagnostic investigations (requests and results).

Comprehensive clinical noting and documentation.

Inpatient and outpatient medicines management – most notably electronic

prescribing (TTP and IPPMA).

The ability to share in a secure and controlled manner clinical and patient data

across the Local Health Community (The Arden Cluster) in line with new

commissioning requirements and national expectations.

LRC is seen as a key opportunity to bring together and deliver a number of threads

within the Trust’s IM&T strategy, whilst also providing a platform to support and enable

clinical service developments and transformation, all will the aim of driving forward

improvements and benefits for patients and the care they receive.

The Trust has received formal confirmation of their acceptance into the LRC Programme

with Phase One scheduled to be delivered by the 17th March 2014 followed by two

more Phases within what is a 3 year Change and Transformation Programme.

_______________________________________________________________________________________________


4.3.2 Securing a Sustainable Future (SSF)

The Trust is seeking to meet the requirements for Foundation Trust (FT) Status and

secure a long term future for Health Services for the people of Nuneaton, Bedworth,

North Warwickshire, Hinckley, Bosworth, North Coventry and the surrounding area.

Based on the stringent requirements for authorisation by Monitor, along with the risks

and challenges that the Trust faces, the Trust Board has concluded that FT status could

only be realistically achieved in association with a strategic partner. A Tripartite

agreement with the SHA and DH is in place to support this approach with the needs of

patients very much at the centre of this.

This IM&T Strategy, particularly the plan for the deployment of LRC, directly supports

the SSF plans. The planned benefits for patients, for clinicians and clinical processes

backed up by robust efficiency improvements all directly feed into a positive and

sustainable future for the organisation.

4.3.3 Trust Business Strategy

The Trust’s vision is underpinned by a set of core values that have been developed by

staff and independently matched with the Board’s values. The core values are:

Effective open communication

Excellence in all that we do

Challenge but support

Expect respect and dignity

Local healthcare that inspires confidence

These core values support five overarching key objectives:

(1) Constantly deliver high quality care in a safe environment.

(2) Enhance patient experience by providing local care.

(3) Develop partnership arrangements to promote and deliver a comprehensive

range of value for many integrated services to protect and improve the health of

the local community.

(4) Improve, develop and support our staff to encourage positive leadership at every

level.

(5) Maintain financial stability, hit all agreed targets and satisfy our regulators.

The table at Appendix B shows how the key IM&T actions and developments support

these objectives.

The diagram in Appendix C shows how the IM&T plans support the Trust’s strategic

objectives.

_______________________________________________________________________________________________


5. Development Road Map

5.1 The IT Development Programme

The Development Programme sets out a short to medium term (12-18months) delivery plan

along with a longer term (2 – 5 year) planning horizon for the strategic development of IM&T

across the organisation.

The Programme is structured into 4 separate but nonetheless related streams:

(1) ICT infrastructure

(2) Clinical information and systems

(3) T (technology) QIPP

(4) Collaboration and sharing

5.2 ICT infrastructure

The core requirements for the organisation are to have IT services that are in effect akin to a

utility based service, available on demand.

The ICT infrastructure needs to be:

Resilient

Reliable

Scalable

Flexible

Responsive to users’ needs

The Trust has continued to invest in this infrastructure including a major resilience and

recovery programme during 2012/13 providing mitigation for any single points of failure

across the server and network estate. This work will continue over the next 12 months,

particularly with the Trust’s internal network.

The Trust deployed a hospital-wide wireless network during 2011/12 and this was built with

a view to providing a highly flexible and mobile working environment. This strategy will start

to further increase utilisation of this capability with, for example, the deployment of wireless

bed side observations (Patientrack), along with wireless devices for clinicians to access high

quality information whilst with the patient.

To support the network and service infrastructure, there will need to be mobile and flexible

access for users to be able to access services and information. To support users the plan is to

ensure that each ward has a standard IT operating environment that will provide IT

equipment to support flexible and efficient working within and between wards.

_______________________________________________________________________________________________


This standard ward IT environment will be:

A minimum of four desk top PC’s.

Two lap tops or computers on wheels.

Three to five Windows 8 touch screen tablet devices with in-built Smart card readers.

Nine to twelve handheld devices (7”) to allow for bed side data capture.

The desk top environment will need to be uploaded to Windows 7 and Office 2010 as

standard and all mobile devices will be centrally managed utilising mobile device

management.

5.3 Development Plan

5.3.1 Plan 12 – 15 months

(1) Replace two core switches to provide enhanced resilience and functionality.

(2) Replacement of key distribution and edge switches to move towards a 100Gbps

network backbone.

(3) Full review of wireless network and deployment of additional access points and

proactive support arrangements to deliver a resilient utility based service.

(4) Roll out a secure guest wireless network capability for patient and visitors to use.

(5) Pilot virtualisation

server virtualisation

desk top virtualisation (VDI)

(6) Deploy mobile device management across the organisation.

(7) Upgrade the Desktop estate to Windows 7 & Office 2010.

(8) Develop/configure the desktop and network estate to support the national

Warranted Environment Specification (WES) required for LRC.

(9) Refresh the server and associated infrastructure to support digitised medical

records.

(10) Complete the deployment of the new TIE and migration of all interfaces onto this

new platform

5.3.2 Plan 2 – 5 years

(1) Complete 100Gbps network backbone.

(2) Develop the business case to support the deployment of unified communications

(UC).

(3) Develop an off-site server room / DR facility.

_______________________________________________________________________________________________


(4) Deploy a virtualised desk top environment to support enhanced flexible and

remote working.

(5) Implement energy saving initiatives to save a minimum of 10% of IT energy

consumption.

(6) Explore the options for more flexible working through secure ‘bring your own

device’ (BYOD).

(7) Review options to extend single sign on into proximity and optical recognition

devices and application access.

5.4 Clinical Information and Systems

The prime requirement is to deliver high quality, joined-up patient information, collected and

accessible for treating clinical staff, at the point of care. This should be irrespective of

location and access device.

LRC will be the main development enabler for the delivery of an electronic patient record

(EPR) but the functionality offered by LRC will be enhanced through the integration of

relevant patient information held on existing clinical systems to deliver a complete and

contextual view of the patients clinical information. Wherever possible the integration of

clinical and patient information will also include information held externally to the Trust to

move towards a complete community based Electronic Health Record (EHR) records.


(1) Deployment of the Patientrack system to record patient observations by nurses

at the bedside along with alerting to clinicians and the electronic completion of

clinical patient assessments including VTE, Sepsis and Tissue Viability. The

electronic recording of the observations will determine early warning scores

(EWS) which will be used to support the patients’ care package with prompt

alerting to clinicians for early intervention.

(2) Deployment of LRC Phase 1 to include:

Care Management (PAS)

Clinical documents

Emergency care

Advanced bed management

(3) Replacement of PACS / RIS (NPFIT provided systems) in collaboration with

University Hospitals Coventry & Warwickshire (UHCW) and South Warwickshire

Foundation Trust (SWFT). This collaboration will also include image sharing across

the Arden Cluster. The systems being implemented are:

Insignia (PACS)

_______________________________________________________________________________________________


Soliton (RIS)

(4) Replacement of the Laboratory Information Management System (LIMS). This

project will be managed by the Coventry & Warwickshire Pathology Service

(CWPS) who provide pathology services across the Arden Cluster.

(5) Extend the electronic transmission of documents through to GP Practices and

the recording of these electronic documents within the Trust’s Results Reporting

System - Review. The Review service will also be enhanced to include:

Explore options for simplifying the clinical user interface.

Identify additional electronic document types to send electronically through

the PCTi Hub, such as for the following specialties:

Oncology

Endoscopy

Ophthalmology


Deployment of Phases 2 & 3 of LRD:

Phase 2

Maternity & Neonatology

Clinical documents and noting

Requests and Results

Inpatient TTO prescriptions

Phase 3

Inpatient Prescribing (IPPMA)

Further deployment of Requests and Results

Extended EPR integration

Extended community integration

5.5 T (Technology) QIPP

Use of effective technology as a key component in supporting the delivery of QIPP:

Quality

Innovation

Performance

Prevention

The organisation has already embraced this pro-active use of technology in delivering a

number of key initiatives including:

An electronic discharge system (EDS)

Electronic transmission of inpatient discharge letters and clinical outpatient

letters to GP’s

_______________________________________________________________________________________________


Development of a range of nursing performance dashboards

A real time bed capacity monitor

New Trust website

One of the key themes moving forward will be to develop initiatives that will improve access

channels for patients, carers and visitors to the hospital. Providing higher quality and safe

care will always be a priority, but this also needs to be supported by a wide consideration

around delivering a valued and positive experience for patients, carers and visitors.


(1) Deployment of a new IP enabled switchboard and contact centre

(2) Deployment of a N3 voice gateway to deliver free “on net” calls across the N3

network

(3) Following the new website a new content focussed intranet will be developed to

enhance and make accessible a valuable knowledge base for all staff.

(4) Pilot deployment of a free to use guest wireless network for patients to use

(5) Procurement and implementation of a new stores management and stock control

system to optimise stock levels whilst ensuring stock availability

(6) As part of the Lorenzo project develop enhanced systems and procedures to

monitor, control, improve and report on data quality

(7) Deliver electronic transmission of A&E cab cards to GP’s


(1) Develop a new data warehouse, linked to Lorenzo, to enhance information and

performance reporting both internally within the Trust and externally to statutory

and commissioning bodies

(2) Expand the range of documents transmitted electronically to external care bodies,

including GP’s, joint care pathway partners and social care bodies

(3) Develop the capability to receive and manage electronic referrals, transfers and

other correspondence relating to patient care.

(4) Rationalise the printer estate across the organisation moving to energy and cost-

efficient multi function devices (MFD’s) for all internal printing

5.6 Collaboration and Sharing

The Local Health Community address Coventry & Warwickshire is known as the Arden

cluster, and there are 3 clinical commissioning groups covering this Local Health Community

(LHC). There is already a high degree of collaboration across this LHC and there is a strong

expectation that this will be further developed, enhanced and extended. The IM&T will be

a key enabler to achieving this across the LHC covering secondary, care,

primary/community care and social care.

_______________________________________________________________________________________________


There is already a high degree of collaboration the LHC with a growing range of joint patient

care pathways. We also have a joint pathology service with the Coventry & Warwickshire

pathology network (CWPS) and this collaboration and sharing will be extended with the

new PACS & RIS systems, which will have at the core the ability to collaborate and share

information across the LHC.

We already provide electronic transmission of documents/information to Community

Services, including GP practices and we have over 400 registered community users of our

reports reporting system. This electronic transmission will be an area that we aim to

develop and grow in conjunction with our partners and stakeholders across the LHC.

The planned development will cover:


(1) Implementation of a Community Of Interest Network (COIN) across the LHC,

initially to support the collaboration and sharing around PACS & RIS, but also

provide the scalability to cover more sharing across more Health Care

Stakeholders.

(2) Enhancements for flexible and mobile working:-

Set up reciprocal wireless network so that staff can use their mobile devices at

multiple sites across the LHC.

(3) Shared Information Initiatives:

Electronic Common Assessment Template (eCAT) pilot.

End of life care.

Summary Care Record.


(1) Develop enhanced collaborative working across multiple care settings utilising the

capabilities of Lorenzo.

(2) Support the development of an Arden cluster information sharing

agreements/protocols.

5.7 Challenges and Risks

There are a number of key challenges and potential risks that this strategy will need to

consider:

(1) Resource Availability

The Trust has continued to invest in IM&T and the external support for the

deployment of Lorenzo will positively support this. Ongoing prioritisation will need

_______________________________________________________________________________________________


to be managed to ensure that resources are aligned to deliver the high priority

deliverables.

(2) Differing Commissioning Intentions

The move to CCGs will bring with it the risk of differing commissioning intentions

across the LHC. Differing system and information requirements may require

separate IM&T solutions to be developed, increasing the challenges for full

interoperability.

(3) Maintaining the focus on patients, clinicians and processes rather than systems.

A strong degree of Clinical/Nursing stakeholder engagement and clinical ownership

will need to be maintained across the IT Development Programme to ensure that

clear patient and clinical outcomes remain the priority.

5.8 Outline Development Plan

The planned phasing of the IM&T Development Plan is detailed in the table at Appendix C.

_______________________________________________________________________________________________


6. Glossary of Terms

A&E Accident and Emergency

ADT Admission Discharge Transfer

AQP Any Qualified Provider

BYOD Bring Your Own Device

CAF Common Assessment Framework

CCG Clinical Commissioning Group

CDS Commissioning Data Set

COIN Community of Interest Network

CSC Computer Sciences Corporation

CWPS Coventry and Warwickshire Pathology Service

DHCP Dynamic Host Configuration Protocol

DNS Domain Name System

DR Disaster Recovery

DTS Data Transfer Service

E CAT Electronic Common Assessment Tool

EDM Electronic Document Management

EDS Electronic Discharge System

EDT Electronic Document Transfer

EHR Electronic Health Record

EPR Electronic Patient Record

EWS Early Warning Score

HL7 Health Level 7

IG Information Governance

IM&T Information Management & Technology

ITK Interoperability Tool Kit

LIMS Laboratory Information Management System

LRC Lorenzo Regional Care

N3 The Secure network used across the NHS

NPfIT National Programme for IT

PACS Picture Archiving and Communication System

PAS Patient Administration System

QIPP Quality, Innovation, Productivity and Prevention initiative

SQL Structured Query Language

SSF Securing a Sustainable Future

SWFT South Warwickshire Foundation NHS Trust

TTO To Take Out

UC Unified Communications

UHCW University Hospitals Coventry and Warwickshire NHS Trust

XML Extensible Mark-up Language

_______________________________________________________________________________________________


7. References

(1) Francis Report: ‘Report of the Mid Staffordshire NHS Foundation Trust Public Enquiry’,

February 2013, The Stationery Office

(2) ‘The Health and Social Care Act 2012’, Department of Health.

(3) ‘Equity and excellence: Liberating the NHS’, Department of Health, July 2010.

(4) ‘Liberating the NHS: An Information Revolution’, Department of Health, October 2010.

(5) ‘Government ICT Strategy’, Cabinet Office, March 2011.

(6) ‘The Power of Information’, Department of Health, May 2012.

(7) ‘The Operating Framework for the NHS in England 2012/13’, Department of Health, Nov

2011.

(8) ‘Healthcare IT Maturity Model: West European Hospital Overview’, IDC, February 2008.

_______________________________________________________________________________________________


8. Appendices

Appendix A: Clinical Systems IT Estate (November 2012)

Clinical Systems IT Estate (Proposed Structure 2015)

Appendix B: IM&T Supporting the Trust Strategic Objectives

Appendix C: Outline Development Plan

____________________________________________________________________________________________________________________________ Ref: GEH 1819 273 IMTStrategy.docx P35/39

APPENDIX A – Clinical Systems IT Estate

____________________________________________________________________________________________________________________________ Ref: GEH 1819 273 IMTStrategy.docx P36/39

__________________________________________________________________________________ Ref: GEH 1819 273 IMTStrategy.docx P37/39

Key Strategic Objectives

IM&T Development Components

(1)

Constantly deliver high quality care in a safe environment

(2) Enhance patient experience by providing local care tailored to the individual needs of the patient

(3) Develop partnership arrangements to promote and deliver a comprehensive range of values for integrated services to protect and improve the health of the local community

(4) Empower, develop and support our staff to encourage positive leadership at entry level

(5) Maintain financial stability, hit all agreed targets and satisfy our regulators

1. Infrastructure Work stream

Trust Interface Engine (TIE) Replacement X

X

SAN Replacement X Indigo 4 Review - Capacity & Configuration X

X

JAC HL7 interface X

Infrastructure Resilience, Failover and documentation X

X

Exchange Server Replacement X

X

COIN

X

X Storage Consolidation and Virtualisation X

X

Windows 7/8 Migration X

X Mobile Device Management implementation

X

X

2. Clinical Systems

Lorenzo Care Management Phase 1 X

X

X

Patientrack - Track & Trigger X

eHandover X

X X X Clinical System integration (Interfaced systems using HL7 message format)

X

X

Dendrite cancer registry database implementation X

EDMS review X

X

E-Docs and EDS accessibility to non Docman practice sites

X

X

APPENDIX B – IM&T Supporting the Trust Strategic

Objectives

__________________________________________________________________________________ Ref: GEH 1819 273 IMTStrategy.docx P38/39

3. T QIPP

Voice over IP (VOIP) X

X

e-stock control system

X

4. Collaboration & Sharing

PACS/RIS Replacement X

X

NN4B Replacement X

X

Intranet (Easysite)

X

Ultra (Pathology) replacement X

E-CAF X

X

End of life Care

X

___________________________________________________________________________________________________________________________ Ref: GEH 1819 273 IMTStrategy.docx P39/39

12 – 18 Months 2 – 5 Years

Resilience - Replacement of 2 Core Switches Resilience – Replacement of Edge Switches – 100gb Network Backbone

Trust Interface Engine – Migration of all Interfaces

Guest Wireless Network Capability

Virtualisation - Pilot Server Virtualisation Desktop Virtualisation Deployment

Mobile Device Management Deployment

Windows 7 & Office 2010 Upgrade

Server Refresh – Digitised Medical Records

WES Deployment - Lorenzo

Resilience - Wireless Network Review & Support

BYOD Options

Energy Savings Deployment

DR Facility

Single Sign On Review BC Unified Comms

Lorenzo Phase I – 1. Care Record2. Clinical Documents 3. Emergency Care 4. Advanced Bed Management

PACS / RIS Replacement

Patient Track & Trigger

LIMS Replacement

eDocs Extention – GP Practices Review User Interface Development

eDocs Migration – 1.Oncology 2. Endoscopy 3. Ophthalmology

Lorenzo Phase II 1. Maternity 2. Clin Docs 3. R&R 4. TTO

Lorenzo Phase III 1. IPOMA 2. EPR Integration 3. Community

Integration

IP Deployment – Switchboard & Contact Centre N3 Voice Gateway Deployment

Intranet Development Trust Wide

Guest Wireless Network Pilot - Patients

Stores Management & Stock Control Deployment

Data Quality Improvements

eCAS Card Deployment

Construct Lorenzo Data Warehouse

eManagement Capability

Printer Rationalisation

eDocs Extention - Partners & Social care Bodies

Community Of Internet Network

Reciprocal Wireless Network - Staff

Electronic Common Assessment Framework Pilot

End of Life

Lorenzo Enhanced Collaborative Working Development

ISA Protocol Development

Summary Care Record

ICT Infrastructure

Clinical Information & Systems

TQIPP

Collaboration & Sharing

APPENDIX C – Outline Development Plan