enclosure k 2012-03-15 imt trust board header gw of report information management &technology...
TRANSCRIPT
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Date of Trust Board
28 March 2012
Title of Report Information Management &Technology (IM&T) Strategy Purpose of Report
Sets out the IM&T strategy for the next 5 years
Abstract
Vision statement
The vision of Norfolk Community Health and Care NHS Trust (NCH&C) is: looking after you locally. IM&T must support and transform the organisation to achieve this – creating a connected community. A connected community is a place where patients, carers and staff are included in decision making; where information is given and shared in real time with the people who need it. Creating a connected community
Looking after you locally means delivering care in and near patients’ homes which is customised for them. Appropriate use of technology can remove barriers to access and can support patient and staff inclusion in new communities. Creating a connected community means enabling patients, carers, general practitioners and staff to use information to make informed decisions together. Supporting and transforming
IM&T must support and enable transformation to create our connected community. There are three steps to doing this: infrastructure, information and innovation. As a leader of connected health and care, NCH&C can become an agile organisation with a culture of innovation enabled by transformation. Figure 1 – Three IM&T steps supporting and transforming
Step 1 –
Infrastructure
Step 2 -
Information
Step 3 –
Innovation
Infrastructure – Fundamental building blocks of health and care, IT services,
physical assets
Information – IT services working together to
deliver real time connected information
Innovation -
Transformation, enabled
by technology
IM&T must support
and transform the
organisation
NCH&C leads in
creating a connected
community of
health and care
ENCLOSURE: K
2
What are the priorities?
There are several priority work streams and these span all three steps of infrastructure, information and innovation. This is because we need to get the fundamentals right while joining up information to deliver innovation in health and care which can transform patients’ lives. There are six priority work streams which are:
• Mobile working
• Assistive technology
• Telehealth
• SystmOne optimisation
• Accurate real time data, captured once
• Information sharing with health and social care partners
Risks and benefits of proposed action
There are risks associated with not having a robust IM&T strategy as IT support and development projects would not be aligned to the business and clinical needs of the trust.
Recommendation
It is recommended that the board approves the IM&T strategy
Presented by
Roy Clarke, Director of Finance
Previous consideration by Board Committee or EDT
Approved by IM&T Programme Board on 15th March 2012 and Approved by EDT on 20th March 2012
Appendices
N/A
In completing this report, I confirm the following matters have been considered:
a) Implications for the NHS Constitution b) Implications for CQC registration c) Equalities Impact d) Environmental impact
Any material considerations arising from the above are reported below.
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Information Management
and Technology (IM&T)
Strategy 2012 – 2017
March 2012
Looking after you locally
2
Document control
DOCUMENT NAME: IM&T Strategy 2012 – 2017 v0.5
ABSTRACT:
DOCUMENT ID:
Distribution list
COPY NO. ISSUED TO
0.2 Key stakeholders
0.3 IM&T programme board
0.4 Executive directors team
0.5 Trust board
Version history
VERSION DATE AUTHOR Comments / Reasons for change
Draft 0.1 29/02/12 Geraldine
Wingfield-Hill
First draft
Draft 0.2 02/03/12 Geraldine
Wingfield-Hill
Review by key stakeholders
Draft 0.3 13/03/12 Geraldine
Wingfield-Hill
Review by IM&T PB
Draft 0.4 15/03/12 Geraldine
Wingfield-Hill
Review by EDT
Draft 0.5 21/03/12 Geraldine
Wingfield-Hill
Review by trust board
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1 Contents
Document control.................................................................................................... 2
Version history ........................................................................................................ 2
1 Contents ............................................................................................................ 3
2 Executive summary ........................................................................................... 5
2.1 Vision statement ........................................................................................ 5
3 Creating a connected community ...................................................................... 7
4 Where are we now? ........................................................................................... 9
5 Where do we want to be? ................................................................................ 12
5.1 Trust objectives ........................................................................................ 12
5.2 IM&T objectives ....................................................................................... 12
5.3 Step 1 - Infrastructure .............................................................................. 12
5.4 Step 2 – Information................................................................................. 13
5.5 Step 3 – Innovation .................................................................................. 13
6 IM&T priority work streams .............................................................................. 13
6.1 IM&T objectives and priorities .................................................................. 13
6.2 Mobile and agile working ......................................................................... 14
6.3 Assistive technology ................................................................................ 14
6.4 Telehealth ................................................................................................ 14
6.5 SystmOne optimisation ............................................................................ 15
6.6 Accurate real time data ............................................................................ 15
6.7 Information sharing with health and social care partners .......................... 15
6.8 IM&T steps over five years ....................................................................... 15
6.9 Working to manage a flexible estate ........................................................ 16
7 Governance for the IM&T strategy ................................................................... 17
7.1 IM&T strategy development ..................................................................... 17
7.2 IM&T service management ...................................................................... 17
7.3 IM&T programme board ........................................................................... 17
7.4 IM&T standards ....................................................................................... 18
8 Financing the IM&T strategy ............................................................................ 18
8.1 NHS funding constraints .......................................................................... 18
8.2 NCH&C cost improvements ..................................................................... 18
8.3 IM&T budget ............................................................................................ 18
8.4 Three year capital plan ............................................................................ 18
8.5 IM&T Service Income ............................................................................... 19
8.6 IM&T Funding Innovation ......................................................................... 19
9 External drivers ............................................................................................... 19
9.1 International, national and local drivers .................................................... 19
9.2 National drivers ........................................................................................ 19
9.3 International and technology drivers ........................................................ 20
9.4 Local drivers ............................................................................................ 20
10 Summary ......................................................................................................... 20
11 References ...................................................................................................... 21
The table below lists the documents which have been referenced in this IM&T
strategy. .................................................................................................................. 21
12 Appendix A: Linking up local data services ..................................................... 22
12.1 NCH&C data services .............................................................................. 22
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12.2 GP data services in Norfolk ...................................................................... 23
13 Appendix B: Technology architecture .............................................................. 24
13.1 Wide area network plan ........................................................................... 24
13.2 Virtual server plan .................................................................................... 25
13.3 Storage area network plan ....................................................................... 25
13.4 Citrix plan ................................................................................................. 26
13.5 Desktop and devices plan ........................................................................ 26
14 Appendix C: Information standards ................................................................. 27
15 Appendix D: IM&T programme board terms of reference ................................ 28
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2 Executive summary
2.1 Vision statement
The vision of Norfolk Community Health and Care NHS Trust (NCH&C) is: looking
after you locally. IM&T must support and transform the organisation to achieve this –
creating a connected community. A connected community is a place where patients,
carers and staff are included in decision making; where information is given and
shared in real time with the people who need it.
2.2 Creating a connected community
Looking after you locally means delivering care in and near patients’ homes which is
customised for them. Appropriate use of technology can remove barriers to access
and can support patient and staff inclusion in new communities. Creating a
connected community means enabling patients, carers, general practitioners and
staff to use information to make informed decisions together.
2.3 Supporting and transforming
IM&T must support and enable transformation to create our connected community.
There are three steps to doing this: infrastructure, information and innovation. As a
leader of connected health and care, NCH&C can become an agile organisation with
a culture of innovation enabled by transformation.
Figure 1 – Three IM&T steps supporting and transforming
2.4 What are the priorities?
There are several priority work streams and these span all three steps of
infrastructure, information and innovation. This is because we need to get the
fundamentals right while joining up information to deliver innovation in health and
care which can transform patients’ lives.
Step 1 –
Infrastructure
Step 2 -
Information
Step 3 –
Innovation
Infrastructure – Fundamental building blocks of health and care, IT services,
physical assets
Information – IT services working together to
deliver real time connected information
Innovation -
Transformation, enabled
by technology
IM&T must support
and transform the
organisation
NCH&C leads in
creating a connected
community of
health and care
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There are six priority work streams which are:
• Mobile working
• Assistive technology
• Telehealth
• SystmOne optimisation
• Accurate real time data, captured once
• Information sharing with health and social care partners
These work streams are fully described in Section 6 with timelines over the next five
years.
2.5 Drivers for change
Investment in medical devices that directly support patient care must be made –
sometimes at the expense of investment in IT. However clinical operations are now
increasingly reliant on IT to support effective and efficient clinical care. This has
leads to a situation where the lack of IT facilities is a risk to not achieving the vision of
looking after you locally.
At the moment during peak times there are insufficient PCs for the number of staff
wanting to access IT services. There is a lack of resilience in the IT infrastructure
which is a risk to the availability of services. There are also some commercial
challenges which are creating drivers for change.
2.6 Achieving the vision
These challenges are not unique to NCH&C; they are shared by other healthcare
providers and public sector organisations. Adoption of this IM&T strategy will enable
us to intelligently invest, to support and transform the organisation. New
procurement frameworks are available from April 2012 that will support
implementation of this strategy, coupled with a change in approach so that we
procure IM&T services jointly with local community partners.
The vision will be achieved by working together with GP groups and other health
providers, local authorities, patient and carer groups, community sector groups,
strategic technology suppliers and the wider community. Success will look like
clinical leaders working together supported and facilitated by IM&T within the
connected community.
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3 Creating a connected community
3.1 What do we mean by community?
In this IM&T strategy, “community” includes:
• Communities of place – People in a defined area like a town, a
neighbourhood or locality.
• Communities of interest or belonging – People who share a particular
experience, interest or characteristic, such as carers, service users, young
people and older people.
People often belong to more than one community, and communities are nearly
always diverse. The internet, smart phones, social media, email and mobile phones
have enabled new ways for people to connect and interact – creating new
communities which are accessed via technology. We need to follow this lead and
use the same methods.
For some, including older people or hard to reach groups, there are barriers to
accessing these communities. This can lead to health inequality or isolation and the
trend is increasing, therefore our strategy needs to consider these groups as well.
This strategy aims to deliver appropriate technology both for staff and patients. This
means delivering care in and near patients’ homes which is customised to them. We
aim to use technology to remove access barriers and support patients and staff
inclusion in new communities.
3.2 What do we mean by connected?
As a community services trust, NCH&C operates within and contains many different
communities. NCH&C aims to provide services that are both near and in patient’s
homes, with input from service users and carers, which are designed to promote
positive health and wellbeing.
Being connected means staff having access to the tools which can help them both
now and in the future.
• IM&T must develop a service portfolio of appropriate connection tools to link
in to communities such as social networking, NHS 111 non-emergency line,
SystmOne and the internet.
• IM&T must help staff within appropriate information governance guidelines to
connect to vital data.
• By empowering staff to be connected to the right information for effective
decision making, staff can help patients and carers to connect. Joint
decisions can be made together about patient care when information is given
and shared in real time with the people who need it.
Connected and enabled IM&T means people and patients having access to essential
information everywhere – in the wards, in patient’s home, in transit. Information
should always be captured at the point nearest to the source and be shared
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appropriately. The right information is therefore captured once, removing the
possibility for discrepancies and improving efficiency.
3.3 Collaboration with patient groups
NCH&C clinical leads liaise with patient experience groups and some examples of
strong patient community groups include:
• Pricilla Bacon Lodge, palliative care patient group
• Neurology network
• Coleman Road, cardiac and pulmonary rehabilitation group
We propose to implement this strategy in consultation with community patient
groups.
3.4 Collaboration with local community partners
NCH&C is part of a local health economy community which includes GPs, patients,
suppliers, schools, health and social services and other NHS trusts. Building
stronger partnerships with groups is a key part of a connected community. There are
opportunities for efficiency savings on shared procurements.
For example there is a new network called public services network (PSN) that will in
the future provide a secure way to share information with partners. It could
potentially transform multi agency working between health and social care, and with
the local authority, by joining them up using the same IT and telephony network.
Figure 2 – Norfolk County Council
Being able to create and access up to date information anywhere and anytime is
fundamental to efficient and safe care delivery. Appropriate use of IM&T is critical to
achievement of this goal. The aim of IM&T is using information technology to
support, enable and transform delivery of clinical care.
Figure 3 – Norfolk County Council
“We have 150,000 staff and children within schools in Norfolk now using
(web based cloud) applications.” Head of ICT, Norfolk County Council
“With PSN we should no longer have the situation where a Heath computer
is next to a Norfolk County Council computer in the same office because of
security issues.” Head of ICT, Norfolk County Council
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4 Where are we now?
4.1 Current situation for IM&T
Right now there are still some fundamental gaps in the IM&T services in the
organisation. Table 1 describes the IM&T situation and what this means for our
community partners, including GPs and patients and our staff.
Table 1 – The current IT challenges
What is a challenge for our IT now? What does it mean for me?
There are not enough PCs for everyone
at peak times
Staff have to wait to use a PC and data
quality suffers
40% of desktop computers are over five
years old and are obsolete
Up to 166 hours could be lost per day
because of 20 minute login times
Staff have better computers at home
with more up to date software
Telephony has just moved into IM&T Modern unified communications running
telephones over the network are not
options for us – we currently wire
buildings with copper cables
There are no videoconferencing facilities Trust wide communication is limited to
email newsletters
Our datacentre facility and infrastructure
is not resilient
A single event such as a datacentre
power failure could mean losing 90% of
IM&T services for a day
There is a current and real NHS wide
funding challenge
Replacing essential IT equipment
competes for funding with replacing
medical devices for patients – both are
needed
NCH&C also has some significant advantages which are described below in Table 2.
Table 2 – The current IT advantages
What is good about our IT now? What does it mean for me?
SystmOne has been deployed widely
across Norfolk and East of England
There is one platform to communicate
with GPs with but some areas are older
and need to be refreshed
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What is good about our IT now? What does it mean for me?
We have a mobile working pilot which is
the first in East of England
Options are being explored to take the
electronic patient record into the patient
home
Norfolk County Council is rolling out
Broadband for Norfolk to connect homes
Staff and patients’ homes will have faster
connections to the internet community
Good collaboration with other NHS
community trusts and health providers
Stronger partnerships preparing for
information sharing
We have a number of main information
services but these are not connected
These add significant local value and
joined up better offer us more potential in
the longer term
We have an IT team who understand
clinical priority as well as technical
services
The service desk will prioritise a call if
clinical services are affected by the fault
We have a training team recognised for
delivering quality IT Training
Microsoft office skills training centre of
excellence 2010/11, regional centre of
the year 2010/11
IM&T projects are prioritised according
to clinical benefits
Business solutions team manage a
prioritised programme of IM&T projects
delivering measurable benefits to the
organisation
4.2 Stakeholders’ views
As an IT services department the views of our stakeholders are key. The value of
services we deliver needs to be measured against how those services are perceived.
Asking for stakeholder views is part of taking a baseline to measure value and
continually improve. Below are some of our stakeholders’ views.
Figure 4 – Staff case studies of where we are now
“We have always found the service very helpful, informative and always try
to do their best. The issues we have are delays to problems. In this day
and age we are now so heavily reliant on IT. When IT goes down the
structure starts to crumble, affecting everything from patient care indirectly,
staff management and day to day tasks. Even issues that may seem to be
trivial on paper on the ground can be very negative and time consuming,
especially when our team is so remote from any other base. Whilst in this
time of austerity we have to all come in on budget any delay in IT services
has a negative impact on that budget. Having the front line services in IT
able to react with swiftness means the staff delivering a service are more
efficient and therefore saves the money.”
Community Nursing & Therapy Team Leader, NCH&C
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General practitioners are key stakeholders in our local health economy and they hold
the patients records. It is vital we communicate with our GP community – but this is
not always happening in the right way.
Figure 4 – GP case studies of where we are now
4.3 Continual service improvement
As an IM&T department which needs to support, as well as transform NCH&C, the
function needs to be developed as an organisational capability and a strategic asset.
Here are the immediate service improvement plans for 2012/13.
Figure 5 – Year one (2012/13) service improvement plans
Step 1 - Infrastructure
• Align IM&T services around the locality structure
• Introduce an on-call service to support the 24 x 7 x 365 clinical operations
Step 2 - Information
• Develop IM&T service portfolio which is transparent on what IM&T deliver
• Develop IM&T programme board into forum for joint clinical and service prioritisation
• Form an NHS community trust SystmOne user group
Step 3 - Innovation
• Work with community partner GPs and patient groups to develop the right IM&T service portfolio
• Collaborate with Norfolk County Council, NHS Norfolk & Waveney, Mental Health, NHS Ambulance Trust, local Acute Hospitals shareing resources and procurements
By end of Q2 By end of Q3 By end of Q4
“I’m a GP practice manager and I get very frustrated when I receive an
email from NCH&C. All of the emails are encrypted even the unimportant
ones and this causes my Outlook to crash. If my staff see an email from
NCH&C they sometimes just delete it or don’t open it because then we
can’t use email. I fully understand the reasons for using email encryption
but this has taken it too far and we really need a better way of working
together.”
GP Practice Manager at North Elmham Surgery
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4.4 Benchmarking with other community NHS
It is proposed during year one of this IM&T strategy, to undertake a benchmarking
exercise against other NHS community trusts. A forum for collaboration has been
created which includes the following:
• Bridgewater Community Healthcare NHS Trust
• Birmingham Community Healthcare NHS Trust
• Cambridgeshire Community Services NHS Trust
• Central London Community Healthcare NHS Trust
• Hertfordshire Community NHS Trust
• Kent Community Health NHS Trust
• Liverpool Community Health NHS Trust
These links will be developed to include other NHS community trusts and to
benchmark against them by the end of Q4 2012/13. We will develop benchmarking
on the basis of service portfolios, cost and provision of NHS community IM&T.
5 Where do we want to be?
5.1 Trust objectives
This section outlines the trust objectives and IM&T objectives. These inform the
priority IM&T work streams.
The trust objectives are:
• Our primary goal is to keep people well at home and therefore out of acute
hospital wherever possible
• Patients need to be treated at the lowest level of intervention close to or in
their own homes
• To achieve this we will work closely with our partners – the GP and Clinical
Commissioning – to build up our services first and foremost around the
patient
• As a key partner in the community we will support and sometimes lead
community initiatives that create social value
5.2 IM&T objectives
IM&T must support and enable transformation to create a connected community. To
do this there are three steps: infrastructure, information and innovation. As a leader
of connected health and care, NCH&C can become an agile organisation with a
culture of transformation enabled by innovation.
5.3 Step 1 - Infrastructure
Step one is delivery of core infrastructure services which connect staff and patients.
The strategic priority is to get people connected and some fundamental building
blocks are needed to make this happen. Much of the cost and effort is here as right
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now we do not have everything we need (for example electronic rosters for nursing
and an in-patients administration service.) These are in the five year roadmap and
for more detail on infrastructure see Appendix B.
5.4 Step 2 – Information
Step two is delivery of joined up information. Information exists but it is not joined up
in real time and in needs to work better together. Delivering this means defining a
data architecture for interoperable core information systems in year one. This will be
based on the core clinical service, SystmOne. Successful implementation means
adherence to standards in every IT data solution from year one onwards. For more
detail on this see Appendix C.
Some core IT services (for example email) need to be redesigned or replaced to
work better with GPs and others. Right now email is addressed as this is causing us
communication issues with community partners. For more detail on this including
linking up with GPs see Appendix A.
Data service standards are defined in the NHS interoperability toolkit which follows
the strategy “connect all” rather than “replace all” endorsed in ‘Equity and excellence:
Liberating the NHS’. Information sharing will be done within appropriate NHS
information governance frameworks.
Making data transparent drives up data quality, and the trusts’ data quality strategy is
a key part of getting this right. If staff and patients collecting and giving data can see
the output and understand what the data is used for this will improve data quality
which will enable NCH&C to make informed decisions about better patient outcomes.
5.5 Step 3 – Innovation
Step three is delivery of innovation and this can be through adoption or spreading of
innovation from the NHS and other sectors. When the information platform is open
and any IT device can access data and services at any location – innovation is
enabled.
Innovations can enable real time data reporting by patients and appropriate use of
technology within or near patients’ homes. Patients will be appropriately connected
as members of a health enabled technology community. The trust will become agile
and easily able to adapt to change.
6 IM&T priority work streams
6.1 IM&T objectives and priorities
The priority work streams each contain all three steps of infrastructure, information
and innovation.
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Figure 6 - IM&T priorities for supporting and transforming NCH&C
These six priority work streams are described in the sections below.
6.2 Mobile and agile working
Working from an organisational-wide agreed strategic goal for mobile working, we will
explore all available mobile working technologies to identify appropriate solutions to
enable the workforce to be as agile as possible.
6.3 Assistive technology
Currently NCH&C patients are treated using assistive technology, small pieces of
equipment which people can use at home to take regular readings of aspects of their
condition, such as blood oxygen levels. This is used in management of COPD, or
Chronic Obstructive Pulmonary Disease.
Following the successful deployment of assistive technology health pods, this work
stream is further exploring and investing in technology which has a clear low
investment to high gain benefit to patient care such as bed sensors, remote controls
and speech synthesisers.
6.4 Telehealth
Telehealth in this strategy means a clinician at one location (for example in an acute
hospital) with a patient and nurse at another site (for example a community hospital).
This work stream means exploring, evaluating and investing in higher investment
technology which can deliver dramatic improvements in patient care. This would
mean video-conferencing that could enable real-time consultation of a community
patient in a remote acute hospital. This would save valuable time leading to the
patient being treated faster without physical transport.
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6.5 SystmOne optimisation
Building on the basic functionality in use at present by ensuring best practice tools
are being utilised as well as providing access to enhanced functionality that matches
business needs which in turn leads to efficiency improvements.
6.6 Accurate real time data
Adhering to common information standards which can connect corporate systems
together will provide improved capability for information accessibility from data
sources in a more timely fashion.
6.7 Information sharing with health and social care partners
As health and social care organisations continue to work more closely together
around patients, the need to share information and improve accessibility
increases. This will drive the need for collaboration and shared information systems.
Successful delivery of these priority work streams relies on cross trust working and
strong operational leadership. Partnerships have been formed with technology
suppliers, patients and their representatives, and others in the local health economy.
These will be strengthened as IM&T work with clinical teams during 2012/13 year
one of the strategy.
6.8 IM&T steps over five years
This section describes how the three steps relate to key decisions, projects and
works streams in the next five years. The table below includes proposals from the
agreed three year capital plan.
Table 3 – IM&T steps over five years
IM&T step Year one
2012/13
Year two
2013/14
Year three
2014/15
Year four - five
2015/16 -
2016/17
Step 3 -
Innovation
Mobile working
and agile
working (1)
Mobile working
trial of new tablet
devices (2)
Home working
and mobile
working (3)
Technology used
by and with
patients enabling
improved health
outcomes
Assistive
technology
refresh
Patients treated
using telehealth
Mobile
applications and
low cost assistive
technology
Email with GPs
(1)
NCH&C email
upgrade or
replacement (2)
Interoperability
with GP
services
NCH&C fully
connected with
GP partners
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IM&T step Year one
2012/13
Year two
2013/14
Year three
2014/15
Year four - five
2015/16 -
2016/17
Step 2 -
Information
Options for
accurate real
time data (1)
Implement
information
sharing (2)
Review
ICARUS
information
service
The right
information is
delivered to
patients and staff
and partners to
enable agile
decision making
SystmOne
optimisation (1)
SystmOne
optimisation (2)
– inpatients and
scanner
Norfolk &
Norwich joint
PAS
replacement
Step 1 -
Infrastructure
Secure remote
access for all
staff
Second or
resilient
datacentre (1)
Second or
resilient
datacentre (2)
SaaS and IaaS
can replace in-
house assets
(see Section 7)
IM&T services
can be hosted
remotely with a
small in-house
infrastructure
base
Network
modifications
and
infrastructure
optimisation (1)
Contract renewal
COIN refresh for
network (2)
Video -
conferencing
Unified
communications
(3)
Data backups
(1)
Data and server
(2)
NCH&C
document
management
Telephony
modifications
Wireless
community
hospital (1)
Wireless
community
hospital (2)
Self-check-in
arrival kiosks
for patients
Virtual ward and
E-prescribing (3)
PC and laptop
programme (1)
PC and laptop
programme (2)
PC and laptop
programme (3)
PC and laptop
programme (4)
and (5)
6.9 Working to manage a flexible estate
Within the NCH&C estate, IM&T is key to realising new ways of working which
enable rationalisation of the estate releasing financial efficiencies. Mobile and home
working, flexible shifts and service delivery outside of the office hours working from
home, are all ways in which we can better use our fixed estates asset and reduce
costs associated with them. As part of the estate strategy the estates and facilities
department will work closely with IM&T, corporate and operational departments to
17
realise new thinking and realise these new opportunities. The inclusive and
partnering approach to estate management will continue and be critical to the
success of the trusts vision.
7 Governance for the IM&T strategy
7.1 IM&T strategy development
This strategy sets out a vision for IM&T services over the next five years. The
strategy was developed in interviews with senior members of staff of the organisation
and other key organisations in the local health economy.
The document has been refined through comments from those participants and
operational leadership. It is proposed to consult with patient groups and start NHS
community SystmOne user groups as well as a regional Norfolk group shared
between health and local authority.
7.2 IM&T service management
A number of service management initiatives have been described in Section 4.3 and
these are essential enabling steps to delivering the IM&T Strategy. The IM&T
services are run according to IT Service Management principles (IT Infrastructure
Library) and the IM&T Programme Board is run according to MSP and PRINCE2
project management methodology. Both of these are recognised best practice from
the UK Cabinet Office with wide adoption in the NHS and the wider public sector.
Figure 7 – Continual service improvement
7.3 IM&T programme board
The IM&T programme board has been established to steer both the IM&T capital
programme and IM&T service developments. The group has strong operational
leadership who represent clinical views.
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This board reports to the investment group and executive directors’ team. For terms
of reference please see Appendix D.
7.4 IM&T standards
The NHS must comply with the information governance standards set out in the
information governance toolkit. For more information see Appendix C.
8 Financing the IM&T strategy
8.1 NHS funding constraints
The NHS must save £20 billion by 2014/15 under targets set by the Department of
Health. Community NHS must develop new models of care delivery and these will
be enabled by appropriate technology.
8.2 NCH&C cost improvements
NCH&C has a target to save £8.9 million in 2012/13 and £7.3 million in 2013/14 -
which is years one and two of this IM&T strategy respectively. The finance
directorate which includes IM&T have identified plans to reduce costs by 20% over
two years.
The role of IM&T in enabling cost improvements in other areas is recognised.
Clinical staff (such as the Community Nursing and Therapies team lead quoted in this
strategy), recognise the key role of IM&T to automate and support frontline services
when they are making cost improvements. Options for different ways of funding
services which are more agile will be implemented. This will happen through using IT
service management to further understand and optimise the unit cost of IM&T service
delivery.
8.3 IM&T budget
The roll out of information technology services for community based staff is key to the
success of the organisation. This is integral to the ability to record accurate activity
to enable appropriate management decisions to be made and ultimately cost and
price the services accurately. It also releases clinical time helping to deliver cost
improvement plans via the roll out of mobile working and is an integral part of service
innovation such as telehealth and single points of access. Investment in IM&T will
increase significantly from 2011/12 to 2012/13 onwards.
The details of the capital investment are in the three year plans. They are also
detailed in the integrated business plan V7 and summarised in the next section.
8.4 Three year capital plan
There is significant planned capital IM&T investment in 2012/13 and this reflects the
need to invest in core infrastructure services. There are seven priority areas detailed
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below. These are priorities which connect remote sites and enable a more
productive, mobile operational workforce.
8.5 IM&T Service Income
The IM&T department is an external service provider delivering services to four
external clients as well as internally to NCH&C. The external services generate
income for NCH&C and deliver economies of scale for the IM&T department.
Getting the fundamentals right for IM&T means good quality IM&T services and the
right investment model. Good quality IM&T services are fully part of NCH&C
supporting the organisation.
8.6 IM&T Funding Innovation
IM&T must support and enable the transformation of clinical operations. This
includes supporting trust wide cost improvement plans and finding innovative ways of
working.
As the technology market develops for the NHS into Infrastructure as a Service
(IaaS) and Software as a Service (SaaS) new funding models within NCH&C need to
develop. To take advantage of the new innovations in the market, the trust will need
options to purchase services under financial lease, alongside the current purchase of
physical assets on site.
Under the Quality, Innovation, Productivity and Prevention challenge there are
innovation opportunities for early adoption or diffusion of external innovations and
these must be exploited. To innovate, IM&T will need to invest back into projects.
The ambition is for all IT projects to have a pay-back time within 24 months and to
fund innovation by withholding 20% of savings from all projects.
9 External drivers
9.1 International, national and local drivers
There are international, national and local factors informing NHS challenges and
opportunities over the next five years. Emerging trends are likely to accelerate and
alter aspects of the IM&T roadmap. There is a large volume of existing research
which supports and informs the IM&T work streams and this is also outlined here.
9.2 National drivers
National changes are leading to options for use of telehealth and an opening up of
the NHS IM&T market place for suppliers. Some national services such as NHSmail
and SystmOne remain however there is more choice on the market for almost every
other service.
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9.3 International and technology drivers
Different technologies are appropriate for different age groups. A service portfolio will
be developed of appropriate ways to reach out to Norfolk patients of different
demographics – mobile applications for hard to reach, email and web portals for ages
50-65, telephone support for age 75+. This will be developed in collaboration with
patient groups.
Technologies such as the Cloudstore (Department of Health Application store) the
development of Infrastructure as a service (IaaS), Software as a service (SaaS) and
the evolving mobile device market including smartphones have already changed the
home consumer market and the next five years will see much more of this in health.
9.4 Local drivers
There are a variety of local drivers and these are:
• NCH&C integrated business plan V7
• Development of the commissioning landscape in the East of England
• East of England innovation hub
• Health & wellbeing boards working across health and social care
• Move to integrated team working within community NHS
There needs to be a strengthened focus on innovation and it is recommended
partnerships are developed with GPs, suppliers, others in the local health economy
and the East of England innovation hub. Through QIPP more focus will be able to
develop on potential funding for innovative investment proposals.
10 Summary
Looking after you locally means delivering care in and near patients’ homes which is
customised to them. Creating a connected community means enabling patients,
carers, GPs and staff to use information to make informed decisions together.
IM&T must support and transform the services in NCH&C using the three steps of
infrastructure, information and innovation. Through strong operational leadership
and priority works streams needs to be delivered.
• Mobile working
• Assistive technology
• Telemhealth
• SystmOne optimisation
• Accurate real time data captured once
• Information sharing with health and social care partners
The vision for IM&T is a connected and enabled workforce using the tools they need
to deliver patient care effectively in the community. The vision is patients using
technology to give real time feedback and patients being supported in self-
management of their conditions as members of a technology enabled community.
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11 References
The table below lists the documents which have been referenced in this IM&T
strategy.
Table 4 – Reference documents
DOCUMENT
Department of Health, ‘Transforming Community Services’,
http://www.dh.gov.uk/en/Healthcare/TCS/index.htm
Department of Health, 12 July 2010, ‘Equity and excellence: Liberating the NHS’,
http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAnd
Guidance/DH_117353
Department of Health, 24 November 2011, ‘The Operating Framework for the NHS in
England 2012/13’,
http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAnd
Guidance/DH_131360
Department of Health, 4 August 2011, ‘National Innovation Procurement Plan’,
http://www.dh.gov.uk/en/Managingyourorganisation/NHSprocurement/DH_121248
Department of Health, 5 December 2011, ‘Whole system demonstrator programme:
Headline findings’, http://www.dh.gov.uk/health/2011/12/wsd-headline-findings
Kent and Medway NHS and Social Care Partnership Trust, 26 January 2012,
‘Community Engagement Strategy 2011–2016’, http://www.kmpt.nhs.uk/community-
engagement-strategy.htm
Linkage, November 2011, ‘Technology Survey Age 65 to 100’,
http://www.linkageconnect.com/index.cfm?fuseaction=home.download&folder_file_id=
EE568D08-C3A3-F56D-B59035067EB981CA
Norfolk Community Health and Care NHS Trust, March 2012, ‘Integrated Business
Plan’ (draft version 7)
Norfolk County Council, March 2012, ‘Norfolk ICT Strategy’ (draft)
Journal of Assistive Technologies, Volume 1 Issue 2, December 2007, ‘Telecare,
telehealth and assistive technologies – do we know what we’re talking about?’,
http://www.telecareaware.com/index.php/telecare-talking-about.html
UK Parliament, ‘Health and Social Care Bill 2010–12’,
http://services.parliament.uk/bills/2010-12/healthandsocialcare.html
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12 Appendix A: Linking up local data services
12.1 NCH&C data services
NCH&C community trust has already acquired a portfolio of information services.
These provide local or administrative value to individual services or functions
however they have not been designed into the trust as a whole. This means while
the information infrastructure is present, the systems are not inter-operable or
connected – and may not support strategic transformation. There are some
information silos and the main one is SystmOne which increasingly needs to be
addressed by data services architecture. The following are the main clinical
information services in use:
Table 5 – NCH&C data services
Data service Purpose Service users
SystmOne Community clinical record Community Clinical Staff
Choose and Book Direct hospital booking from GP
surgeries via SystmOne
Some SystmOne clinical
units
Datix Incident logging and
management
All NCH&C staff
SOEL Health Dental clinic appointments and
patient records
Siskin and Kings Lynn
Dental Access Centres
Broadcare Long Term Care administration
and reporting
Long Term Care Team
LS400
Electronic Staff Record
(ESR)
Staff and payroll records
administration
HR, Finance
E-Rostering Electronic rostering nursing
(pending)
HR
Patient Administration
System (PAS)
Patient administration system Clinical units and
information services
ICARUS Activity reporting service Information services
RSL Steeper and
MeaSules
Patient administration system Prosthetics service
Meridian Incident and risk management
service
Quality and risk
Pukka J Patient records and images Diagnostic imaging
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12.2 GP data services in Norfolk
In terms of GP services there are four main patient record services and these are
shown in the table below. EMIS and InPS are already open and inter-operable. ISoft
is not although it is an NHS wide product and as such covered by the NHS
Interoperability Toolkit. TPP SystmOne is the main service where information sharing
with other services remains a challenge.
Table 6 – GP data services by June 2012
GP data service Number of GP practices using % GP practices using
TPP SystmOne 46 51%
EMIS (LV, PCS, Web) 25 28%
InPS (Vision, VES) 15 16%
iSoft Synergy 5 5%
Total in Norfolk 91
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13 Appendix B: Technology architecture
13.1 Wide area network plan
Current position
At present, the wide area network (WAN) infrastructure is overly complex with a
mixture of circuit types. The national network for the NHS is called N3 and this has
several services running (N3 community of interest network or “COIN” circuits, N3
catalogue circuits and private leased circuits) delivering connectivity across the trust
estate. The use of NHS catalogue and private circuits has increased since the COIN
contract was signed because of its inflexibility. New sites cost more than their N3 or
private counterparts because they take longer to commission and have a
management service overhead. Furthermore, the COIN firewall is a managed
service which results in revenue expenditure whenever a change is required and a
significant lead time to provide connectivity.
The current WAN has no general resilience and the COIN no resilience for ethernet
circuits at major sites since the circuits terminate at a single point. In addition, the
original COIN contract proposal assumed that this topology would lead to a shared
hub for local health economy partners however, this was not realised as most
organisations have evolved their own WAN topology.
The COIN contract expires in 2013 and this provides an ideal opportunity to design a
new WAN infrastructure which will deliver a fit for purpose, resilient and agile
infrastructure that will provide the foundations for improved connectivity for both a
static and mobile workforce.
Figure 8 – Current WAN topology
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Strategic direction
A new WAN design will be formulated and a specification produced to enable
suppliers to offer a modern and cost-effective solution. This will examine options
such as public services network (PSN). The objective will be to implement a new
WAN topology which provides improved connectivity for all static and mobile users to
improve clinical systems access and performance by delivering enhanced
connectivity and bandwidth availability. Moreover, this will reduce complexity, be
more efficient to manage and will provide business agility not previously possible.
This in turn will enable additional capabilities such as data replication to improve our
business continuity capability.
This new WAN topology will be of greatest benefit in the delivery of key business
services such as voice over IP, video conferencing, modernising the desktop
experience and providing a springboard to unified communications.
There exists an opportunity to realise the original vision of the strategic WAN and
through collaboration with partners in the local health economy to share
procurements. This could potentially deliver a shared “platform for Norfolk” with
health and local authority working together.
13.2 Virtual server plan
Current position
By the end of 2012/13, 60% of the underlying hardware server estate will be end of
life and the virtual platform in need of upgrade.
Strategic direction
Replacement servers will be deployed as part of a capital investment server
optimisation programme. New hardware will enable an upgrade to the virtual server
software platform which will enable performance improvements and increased
robustness of the virtual environment.
New procurement frameworks such as infrastructure as a service (IaaS) and
software as a aervice (SaaS) from April 2012 will bring options for hosting data
offsite. NCH&C no longer needs consider “building” infrastructure but acting as an
informed consumer to “buy” infrastructure services which are resilient and secure.
This approach will allow NCH&C to take advantage of cloud services as these
mature and become suitable for the NHS.
13.3 Storage area network plan
Current position
By Q1 of 2013/14, the existing storage area network (SAN) will be end of life and
need replacing. Furthermore, the current SAN storage is expensive and not cost
effective for all purposes. For example, business intelligence servers need the
fastest storage performance with resilience whereas archive data is better suited to
lower end inexpensive storage.
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Strategic direction
We will take this opportunity to formulate an intelligent storage strategy which will use
capital investment to introduce new tier 1&2 storage platforms so that appropriate
cost-effective storage technology is deployed to areas where they are best suited.
This will be aligned with the WAN and virtual server strategies to deliver step-change
improvements to our disaster recovery/business continuity capabilities.
13.4 Citrix plan
Current position
By end 2012 the current Citrix platform will be end of life and further upgrades will
require a server operating system and active directory upgrade from 2003 to
2008/10. The current Citrix platform is not able to deliver SystmOne which results in
a confusing end user desktop experience with users having to toggle between a fat
and thin environment. Furthermore, inherent issues with printing and profile
management can be better managed with alternative desktop technologies.
Strategic direction
We will maximise any improvement opportunities to the current platform whilst
developing a desktop strategy for 2013 and beyond. This will involve moving a small
number of corporate sites to fat-client where infrastructure permits and identifying
alternative desktop technology options such as virtual desktop infrastructure (VDI)
which will deliver a PC-like experience to those sites where fat-client is not
appropriate. This will provide a consistent and more resilient desktop user
experience where clinical applications are accessed within the same environment as
the corporate applications/documents. Printing will be more robust and profiles will
be easier to manage. Users will be able to operate from within a single consistent
environment therefore reducing complexity and allowing for increased
productivity/efficiency.
13.5 Desktop and devices plan
Current position
NCH&C have 2750 PC and laptop assets. Of these 40% are at or near five years old
which is obsolete in technology terms. Some sites with an older PC take 20 minutes
to log on. 500 staff (half the amount of old PCs) losing 20 minutes per day equates
to 166 hours lost per day due to older IT equipment.
Strategic direction
A rolling replacement budget for PC and laptop equipment has been developed.
Technologies such as virtual desktop infrastructure (VDI) can sometimes extend the
usable life of the PC estate.
Mobile working will be key to this and a variety of laptop devices are appropriate for
different scenarios. Through the mobile working work stream, and innovation pilots a
variety of devices will be trialled. This will inform the desktop and devices roadmap
which will appraise options such as migration to open source platforms to eliminate
licence costs. New options for data on handheld devices, including blackberries and
smart phones, are opened up by the launch of the government application store in
April 2012.
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14 Appendix C: Information standards
Information architecture and interoperability are key considerations. All data services
solutions must meet IM&T architectural guidelines and these need to be developed
from existing guidance. The guidelines must comply with:
• Confidentiality NHS Code of Practice (2003) – External website here
• Common law duty of confidence – External website here
• The Caldicott Guardian Manual, DH (2010) – External website here
• Access to Health Records Act 1990 – External website here
• NHS Care Record Guarantee – External website here
• Records Management NHS Code of Practice (2006) and Records
Management Roadmap – External website here
• NHS IG Toolkit (Version 9) – External website here
• Data Protection Act 1998 External website here
• (Search here for registration number Z2396668 for NCH&C’s registration)
• Freedom of Information Act 2000 - External website here
• Computer Misuse Act 1990 - External website here
• Human Rights Act 1998 – External website here
• NHS Operating Framework for England 2010/11 – External website here
• Information Security NHS Code of Practice (2007) – External website here
• ISO 27001/2 Standards (BS7799) - External website here
• ISO 20000 Standards - External website here
• NHS Interoperability Toolkit – External website here
• Integrated Governance Handbook (2006) – External website here
• Care Quality Commission Regulations – External website here
• HL7 Standards for Information Solutions
• CCOW compliance for messaging and Information Architecture
This is not an exhaustive list.
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15 Appendix D: IM&T programme board terms of reference
14.1 Document control
Release: V1.1
Release Date: 07 November 2011
Review Date: Annual
Author: Geraldine Wingfield-Hill, Assistant Director of IM&T
Owner: Roy Clarke Director of Finance
Document Name: IMT PB Terms of Reference (V1.1)
14.2 Scope
The Information Management Programme Board (IMT PB) implements the IM&T
strategy for the trust and makes recommendations as to the development of the
strategy to the trust board. For capital investment purposes IMT PB has delegated
authority to determine the annual IM&T investment plan within the limit approved
annually by the board, and approve and monitor investments within IM&T.
The IMTPB is chaired by the Director of Finance who is a member of the trust Board.
The group reports to Executive Directors Team (EDT).
14.3 IM&T strategy
Identify and promote a comprehensive strategy to deliver information technologies
and service developments to the trust which enable and underpin the trust’s strategy.
14.4 IM&T investment
Exercise appropriate financial controls by:
• Ensuring all projects considered and approved by the Board are within the
investment plan, properly budgeted and provide value for money
• Monitoring IT capital investment against the annual plan within agreed
contingency
• Clarify funding and obtain approval for revenue expenditure commitments
arising from a capital investment or major service development
• Ensure the trust’s procurement procedures are adhered to for any IM&T
projects
14.5 Programme management
Ensure benefits are realised by use of appropriate programme management
governance including:
• Checking articulation and ownership of benefits for each project
• Ensuring stakeholder ownership of IM&T systems and for projects that
include an IM&T element
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• Monitoring the IT capital investment against the annual plan to ensure
appropriate resources have been allocated to enable IM&T projects to be
delivered effectively within risk tolerance
• Ensuring each project has clear deliverables able to be measured with critical
success factors
14.6 Authority and responsibility
The IMTPB is responsible for:
• Authorising project initiation and key decisions within the project lifecycle
• Providing final approval of project deliverables and handover to service
support
• Approving requests for capital allocation under the IM&T programme of work
• Approving service developments under the IM&T programme of work
The IMTPB has authority to represent all directorates and business units within the
trust in making recommendations EDT relating to the above purpose
14.7 Membership
Core membership of the IMT PB is expected to be:
• Director of Finance (Chair)
• Deputy Director of Service Pathways
• Assistant Director of IM&T
• Associate Director of Information
• Assistant Director of Information Governance
Additional members of the IMTPB are expected to be:
• Assistant Director of Estates
• Head of IT Operations
• Head of IT Projects
• Assistant Director of Business Development
Additional staff representing key stakeholders may be invited to attend the as
appropriate.
14.8 Meetings
Meetings will be held on a monthly basis unless otherwise determined by the
members.
Meeting papers and secretariat will be handled by the IM&T program office. Papers
will be sent out at least three working days before the meeting.
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14.9 Quorum
If any member of the IMT PB is unable to attend the meeting, they should nominate a
representative to attend in their place or nominate one of the other members to
represent their interests.
Members will be expected to attend a minimum of eight meetings out of twelve
meetings per year. The chair of the group will discuss any failure to meet this
standard.
For a quorum, there must be a minimum of four members present, including at least
three of the core members. Only one nominated deputy standing in for a member
will be allowed to meet the requirements of a quorum.