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Information Communication & Technology Strategy
ICT Strategy
ICT Strategy
ICT Strategy
“Towards a Digitally Integrated Healthcare Environment”
April 2016
Health Informatics Directorate
Health Informatics Directorate
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Distribution
Organisation Name Organisation Address
Rotherham Doncaster and South Humber NHS Foundation Trust
Trust Headquarters Woodfield House Tickhill Road Site Weston Road Doncaster DN4 8QN
Channel 3 Consulting Manor House 1 The Crescent Leatherhead Surrey KT22 8DH
Document Control
Approval Sign-off (For formal issue)
Owner Role Signature Date Version
Richard Banks Executive Director Health Informatics
Signature Date Version
Jessica Bradshaw Channel 3 Executive Lead
Review Panel
Name Role
Julie Waters Deputy Director Business Intelligence & Information
Lee Isle
Dave Coney
Change History
Version Status Date Author / Editor Details of Change
0.1 Draft 18/03/16 J Tyacke Initial draft for client review
0.2 Draft 08/04/16 J Tyacke Second draft incorporating comments
1.0 Final 18/04/16 J Tyacke Final version including finance table approved by Jenny Marsh
1.1 Final 28/04/16 J Tyacke Including addendum to section 7.2.1 requested by Finance & Performance Committee
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Table of Contents
1. EXECUTIVE SUMMARY ................................................................................... 4
2. INTRODUCTION ............................................................................................. 7
3. BACKGROUND TO THE TRUST ........................................................................ 8
4. STRATEGIC CONTEXT ..................................................................................... 9
4.1. National Drivers ................................................................................................................. 9 4.1.1. NHS Digital Roadmaps .............................................................................................................9 4.1.2 Digital Maturity Self-Assessment .......................................................................................... 12
4.2. Local Drivers ..................................................................................................................... 13
5. STAKEHOLDER REQUIREMENTS ................................................................... 15
5.1. Patients and the Public .................................................................................................... 15
5.2. Clinicians .......................................................................................................................... 16
5.3. Managers/Decision Makers ............................................................................................. 17
5.4. Administrators ................................................................................................................. 18
6. ICT VISION ................................................................................................... 20
6.1. Improving Patient Experience ......................................................................................... 20
6.2. Supporting Agile Working ................................................................................................ 20
6.3. Enabling Paper-Free Care Delivery .................................................................................. 21
6.4. Reducing Administrative Overheads ............................................................................... 22
7. IT ENVIRONMENT REVIEW ........................................................................... 24
7.1. Scope of the ICT Review .................................................................................................. 24
7.2. Summary of Findings and Recommendations ................................................................. 24 7.2.1. IT Governance, Programme Management & Organisation .................................................. 24 7.2.2. Infrastructure & Service Management ................................................................................. 25
7.3. Impact of the Unity EPR Programme ............................................................................... 27
8. DELIVERING THE ICT STRATEGY ................................................................... 28
8.1. ICT Strategic Work Programme ....................................................................................... 28
8.2. RDaSH ICT Investment Plan ............................................................................................. 28 8.2.1. Additional Sources of Funding .............................................................................................. 28
Figure 1 - RDaSH ICT Work Programme Schedule ........................................................................ 29
Figure 2 - RDaSH ICT Investment Plan .......................................................................................... 31
APPENDIX 1 RISKS ......................................................................................... 33
APPENDIX 2 REFERENCES .............................................................................. 35
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1. Executive Summary
This document presents the future strategic vision for ICT at Rotherham, Doncaster and South
Humber NHS Foundation Trust (RDaSH) over a five year period commencing April 2016. It
should be viewed as a refresh of the previous IT strategy, 2012-2017. It builds upon work
already delivered that has improved infrastructure provision in key service delivery areas. The
reason the strategy is now being refreshed is to ensure that the Trust’s IT infrastructure and
services are ready to support the recently launched Unity EPR Programme which will procure
and implement a single Electronic Patient Record (EPR) across the Trust.
Through information gathered from key stakeholders and reference to a number of NHS and
Trust publications, the high level information needs of clinicians, managers, patients and public
have been identified and an analysis performed to highlight the gaps in current IT provision. The
strategy has been developed to articulate a vision for ICT that will support the Trust’s
development of health services. Section 4 of the document highlights the ways in which this ICT
Strategy will enable the Trust to deliver each of its five strategic goals:
Rotherham, Doncaster and South Humber NHS Foundation Trust – Strategic Goals:
1. To strive for Clinical Excellence
2. To attract, grow and engage our people
3. To deliver excellent services through sound financial management
4. To work flexibly with partners to offer and deliver market-leading services
5. To underpin high quality care with good governance and leadership
The Vision for ICT
The vision statement describes the movement ‘Towards a Digitally Integrated Healthcare
Environment’ that will provide technology to improve patient experience, enable agile working,
eliminate paper, support service transformation, reduce administrative overheads. The following
tables summarises the key components of the vision and how these areas link to the Trusts
strategic objectives:
Key Components of Vision Supports
Objectives
Improving Patient Experience – The Trust will work to expand the channels
of communications in use to include SMS, email and social media. Patients
will be given access to a summary of their own health record, which they will
be able to share with other health professionals involved in their care.
1,2,4,5
Supporting Agile Working – based on a secure and resilient IT infrastructure
service and using modern and relevant IT systems that will support clinicians
and enable them to provide a homogenous service of high quality to patients
regardless of the location in which they are treated. Agile working will be
underpinned by mobile, wireless technology to improve timeliness, patient
safety and efficiency.
1,2,3,4,5
Enabling Paper-Free Care Delivery - The Trust will strive to become a paper 1,2,3,4,5
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free organisation. The patient’s care record will be held electronically and this
will be accessible regardless of the patient’s or the Clinician’s location.
Clinicians will be supported by holistic patient information at the point of
care to enable timely and clinically safe decision-making.
Reducing Administrative Overheads – Both clinical documentation and
management information will be produced as a by-product of clinical and
operational processes.
1,2,4
The Trust is undergoing a transformational change programme, and ICT is an essential enabler to
support extensive integration of clinical and corporate services and the achievement of associated
qualitative and productivity-based performance improvement across the organisation.
Delivering the Strategy
This strategy will be implemented via five strategic workstreams, summarised below. These
strategic themes are consistent with – and indeed are incorporated into the Work Programme
shown in section 8, which sets out the key deployment projects planned for the short and
medium term to deliver the vision, ‘Towards a Digitally Integrated Healthcare Environment’
described above.
1. ICT Governance, Programme Management & Organisation - The profile and structure of
the existing Health Informatics resources is being revised to ensure there is sufficient
quantity and quality of resource available before, during and after the implementation of the
Unity EPR Programme.
2. Infrastructure & Service Management – The Trust will deliver infrastructure
improvements including expansion of wi-fi, end user devices replacement programme, single
sign-on for clinicians to ensure adequacy of support for a more mobile, agile workforce.
3. Unity EPR Programme – This programme will procure, implement and exploit a single
clinical system across all the Trust’s community and mental health services. It will provide
functionality including single sign-on, paperless working and improved integration with
external organisations to provide a better service to clinicians and patients
4. Information Management – The Trust is currently reviewing its options for the future of
the data warehouse (a separate paper will be going to the Board). Based on early successes
with IAPT reporting, the Trust is looking to stabilise, build and enhance current reporting.
Solutions will ensure people will have access to the right information (fit for purpose), at the
right time, in a format that they can readily understand.
5. Corporate Systems – Facilities/features offered by back office systems including office
applications, email and electronic document management solutions 1that will be fully
exploited to maximise their value for money.
1 An electronic document management system (EDMS) is a software system for organizing and storing
different kinds of documents. It is a storage system that helps users to organize and store paper or digital
documents
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The majority of the projects, whilst containing significant ICT elements are fundamentally
transformational in nature. The introduction of technology will involve changes to ways of
working and the delivery of patient care, resulting in more effective, efficient and clinically safe
practice. The Unity EPR Programme will work in tandem with the Trust’s wider Transformation
Programme to enable and support operational changes such as the delivery of an all age service.
Investment Programme
The 5 year investment programme required to deliver the strategy is outlined. This incorporates:
new areas of investment - required to ensure provision of a suitably resilient supporting
technical infrastructure and addresses the need to put in place a rolling replacement
programme for end-user devices, continuing to increase the ratio of mobile workstations
to desktops.
funding already allocated - for the consolidation and re-procurement of the Trust’s
clinical systems.
Full details of the proposed investment programme can be found in section 8.
Where capital funding is required to progress the workstreams, business cases will be developed
to support investment decisions. This will provide the Board with assurance that appropriate
options appraisals have been completed and that the most economically advantageous options
are those taken forward.
Governance Process
The ICT Strategy will be presented to the Health Informatics Sub Committee for comments and
then to the Finance and Performance Committee for approval.
Next Steps
This ICT strategy represents an opportunity for the Trust to deliver ICT systems and services that
will enable service transformation that will keep pace with requirements for increasingly
integrated clinical practice.
The Board is asked to approve this strategy and commence the work programme outlined. The
following actions should be considered as early priorities:
Progress with the Unity EPR Programme to procure and implement a single clinical
system across all of RDaSH’s services;
Develop a business case for the completion of implementation of Wi-Fi across RDaSH’s
estate where clinical and other services will be delivered.
Develop a business case to assess the benefits for Electronic Document Management.
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2. Introduction
This ICT Strategy examines the strategic ambitions of the Trust both as a provider of patient care
and as a business and sets out a vision in which these objectives are supported and enabled
through the innovative use of ICT. Many service improvements and changes that are required
over the coming years will depend on a modern and robust IT infrastructure and good quality
and relevant information provision.
It should be viewed as a refresh of the previous IT strategy, 2012-2017. It builds upon work
already delivered that has improved infrastructure provision in key service delivery areas. The
reason the strategy is now being refreshed is to ensure that the Trust’s IT infrastructure and
services are ready to support the recently launched Unity EPR Programme which will procure
and implement a single Electronic Patient Record (EPR) across the Trust.
The ICT Strategy includes within its scope all aspects of information technology provision for
the Trust including IT management and governance, applications, infrastructure (networks,
servers, storage and end user devices), service management. Information Management is out of
scope for this strategy and will be addressed via a parent document, (Information Management
paper) which is currently in development. The ICT Strategy will enable the Trust to put in place
the IT resources, infrastructure and services to enable delivery of the more detailed vision for
business intelligence laid out in the IM paper.
Through a series of interviews with key stakeholders and reference to a number of reports made
available by the Trust, the high level information needs of clinicians, managers, patients and the
public were identified and an analysis performed to highlight the gaps in current ICT provision.
The strategy articulates a vision for ICT that will support the Trust’s strategic vision for the
transformation of healthcare services.
This document aims to support the Trust’s business strategy and operations by;
• ensuring that information and information technology is used to support Trust staff in giving
patients the highest quality care and experience regardless of their physical location;
• enabling the Trust to support effective management and develop clinical practice that
furthers the Trust’s ambitions for service provision and improvement.
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3. Background to the Trust
RDaSH operates services in over 200 locations across Rotherham, Doncaster, North
Lincolnshire, North-East Lincolnshire and Manchester. The Trust employs over 4,300 staff
equating to 3,700 WTE’s and has more than 200 committed volunteers. Operating expenditure
on health and social care in 2014/15 was £152.37 million and the Trust has achieved its financial
planning targets every year as a Foundation Trust.
The Trust has diversified from mental health and learning disability services to include
community services, such as district nursing and health visiting, and around 115,000 people now
access the Trust’s services each year.
It is important to note that the Trust is committed to working with its health and social care
partners across Doncaster, Rotherham and North Lincolnshire to deliver integrated care
initiatives that will improve the health of local residents. This is evidenced by the ongoing work
to develop Local Digital Roadmaps (LDR) which forms a key part of this ICT strategy as it will
provide the means to deliver integrated health and social care records.
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4. Strategic Context
4.1. National Drivers
The ICT Strategy takes into account a number of national initiatives, expectations and mandates
that have an effect on the ICT agenda:
• NHS Five Year Forward View for Mental Health (2016)
– This recent publication calls for ‘good quality care for all 7 days a week – right
care, right time, right quality’. Focuses on integrating physical and mental health
care, breaking down barriers to accessing healthcare. Recognises the need for
integrated records and heralds a data and transparency revolution
• NHS Five Year Forward View (2014)
– The NHS Five Year Forward View sets out the national direction to upgrade
prevention and public health, give people greater control over their own care and
remove the barriers in the provision of care across providers.
• Personalised Health and Care 2020 – A Framework for Action (National
Information Board November 2014)
– This framework details the progress made by the health and care system in
exploiting technology and sets out a series of proposals to deliver change to
improve health and provide better, sustainable care for all.
• The Power of Information (2012)
– The Power of Information (NHS England) set out a ten year framework for
transforming information for health and care by harnessing the value of
information and new technologies to achieve higher quality care and improve
outcomes for patients and service users.
These publications emphasis similar key themes, including partnership working across NHS
providers, creating new relationships with patients and co-creating new models of care to meet
the challenges of increasing demand within resource constraints.
They seek to establish a more responsive NHS system that allows NHS Commissioners to
commission enhanced service delivery models for their local population. This is to be
underpinned by a significant increase in the use of technology to enable seamless information
flows across the patient journey, helping patients engage with their care plan, and health and
service providers to better manage outcomes.
The national agenda is for integrated working - requiring effective sharing and joint use of
information by those working together in teams that are organised on a scale that can provide
more complex and specialist services than at present.
4.1.1. NHS Digital Roadmaps
The ‘Five Year Forward View’ identified harnessing the information revolution as a key enabler
to securing a sustainable NHS and made a commitment that, by 2020, all electronic health
records would be fully interoperable so that patient records are paperless.
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‘Personalised Health and Care 2020 – A Framework for Action’ established the National
Information Board and laid out its vision to transform the health and care digital landscape. A
key proposal outlined in this document, and later adopted as government policy, was to invite
local areas to produce Local Digital Roadmaps (LDR) detailing the steps they will take, and
when, in their progress towards a fully interoperable way of working. LDR will generate
momentum across local health economies, inform local investment prioritisation and support
local benefit realisation strategies. RDasH is part of three LDR footprint areas:
LDR Footprint
Lead CCG Providers Local Authority
Doncaster NHS
Doncaster Doncaster and Bassetlaw Hospitals NHS
Foundation Trust
FCMS (Not for profit care provider, awarded
Doncaster Urgent Care contract in Dec 2015)
Rotherham Doncaster and South Humber
NHS Foundation Trust
Doncaster
Metropolitan
Borough
Council
North
Lincolnshire
NHS North
Lincolnshire Core Care Lincolnshire
East Midlands Ambulance Service NHS
Trust
GP Federation
Hull and East Yorkshire Hospitals NHS Trust
Lindsey Lodge Hospice
Northern Lincolnshire and Goole NHS
Foundation Trust
Rotherham Doncaster and South Humber
NHS Foundation Trust
Virgin Care
North
Lincolnshire
Council
Rotherham
NHS
Rotherham Rotherham, Doncaster and South Humber
NHS Foundation Trust
Rotherham Hospice
The Rotherham NHS Foundation Trust
35 General Practices
Rotherham
Metropolitan
Borough
Council
By June 2016, every local footprint area will submit their local digital roadmap detailing how
they will achieve the ambition of being paper-free at the point of care by 2020.
The Guidance document for development of LDR was published in April 2016 and has
introduced 10 universal capabilities Every local health and care system will be expected to make
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early progress on these universal capabilities, demonstrating clear momentum between now and
the end of March 2017 and substantive delivery by end-March 2018.
The universal capabilities are:
1. Professionals across care settings can access GP-held information on GP-prescribed
medications, patient allergies and adverse reactions
2. Clinicians in urgent and emergency care settings can access key GP-held information for
those patients previously identified by GPs as most likely to present (in U&EC)
3. Patients can access their GP record
4. GPs can refer electronically to secondary care
5. GPs receive timely electronic discharge summaries from secondary care
6. Social care receives timely electronic Assessment, Discharge and Withdrawal Notices
from acute care
7. Clinicians in unscheduled care settings can access child protection information with
social care professionals notified accordingly
8. Professionals across care settings made aware of end-of-life preference information
9. GPs and community pharmacists can utilise electronic prescriptions
10. Patients can book appointments and order repeat prescriptions from their GP practice.
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4.1.2 Digital Maturity Self-Assessment The Digital Maturity Assessment provides a framework for assessing care and the extent to
which healthcare services in England are supported by the effective use of digital technology. It
has been developed to help identify key strengths and gaps in healthcare providers’ provision of
digital services at the point of care and to develop an initial view of the current baseline position
across the country. In doing so it supports the National Information Board’s commitment to
achieving a fully interoperable health and care system by 2020 that is paper-free at the point of
care.
For 2015/16, the following five objectives were identified for the Digital Maturity Self-
Assessment process:
To identify key strengths and gaps in provider’ ability to operate paper-free at the point of
care;
To support internal planning, prioritisation and investment decisions within providers
towards operating paper-free;
To support planning and prioritization of investment decisions within commissioner led
footprints to move local health and care economies towards operating paper-free;
To provide a means of baselining / benchmarking nationally the current ability of providers
to operate paper-free;
To identify the capacity and capability gaps in local economies to transform services and
operate paper-free.
The first iteration of the digital maturity index was published in March 2016. Moving forwards,
it will become part of the CQC inspection regime and NHS Improvement will play a key role in
supporting providers to make progress.
The Trust completed its inaugural Digital Maturity Self-Assessment return in January 2016. The
table below summarises the areas highlighted the further action and aligns these with the
associated ICT work programme element defined by this strategy:
Area Highlighted for Action Related ICT Strategy Work Programme Elements
Leadership IM&T Governance and Organisation
Records Assessments and Plans Unity EPR Programme
Orders and Results Management Unity EPR Programme
Remote and Assistive Care Unity EPR Programme
Enabling Infrastructure Infrastructure and Service Management
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Area Highlighted for Action Related ICT Strategy Work Programme Elements
Information Governance IM&T Governance and Organisation
Transfers of Care Unity EPR Programme
Medicines Management and Organisation Unity EPR Programme
Standards IM&T Governance and Organisation
Unity EPR Programme
4.2. Local Drivers
The Board of Directors has explored what impact new models of care might have on the
organisation within each of the local health and social care economies that the Trust operates in.
Rotherham and Doncaster CCG’s have requested that RDaSH undertake further work to provide
service models which are all age (initially Adult and Older People’s services but to eventually
include CAMHS).
An all age model is a model which will bring together clinical pathways for patients of any age
into one integrated team which would cover a locally defined area, potentially linked to GP
practices. These would take referrals from hub based single points of access for all mental and
physical health services.
This will require a whole system approach to transformation covering all business divisions, it
requires a review of current service provision identifying where services from a number of
divisions would come together to create all age teams.
Over the past two years the trust has been working with Rotherham and Doncaster Clinical
Commissioning Group’s (CCG) to review our service provision. Both CCG’s commissioned
Attain to undertake a review of mental health services and DCCG undertook a review of its
community provision provided by DCIS.
The outcome of these reviews has resulted in a number of service transformation programmes
being undertaken across the Trust which will support the delivery of future QIPP savings and
meet the challenge of the ‘Five Year Forward View’.
There are a number of key themes identified within RDaSH, and by partner agencies, which act
as drivers for change within the Transformation Programme which focus around service delivery
for the future. These are encompassed in the following:
Provision of co-ordinated integrated care which is patient focused and needs based;
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Improved access to and responsiveness of services particularly out of hours and in times
of crisis – 24/7 access;
All Age services and pathways of care;
Improve patient experience of poor transitions between teams;
Improved multi-disciplinary and multi-agency working, including working with third
sector organisations;
Improved liaison and joint working with primary care, with a preference for locality
based models of care;
Review of specialist services, including inpatient beds;
Silo working of current divisional structure;
Deliver transformation QIPP savings;
CCG and LA requests for more locally managed services;
Parity of esteem.
The overarching intent is to wrap services around the individual patient rather than the patient
around the services and this is central to the Transformation Programme.
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5. Stakeholder Requirements
In this section, the information requirements of each stakeholder group are identified and a brief
analysis of the current situation and opportunities for the future given. This analysis has been
developed based on the following sources of information:
Stakeholder interviews (through Clinical Systems Review and ongoing Unity
engagement work)
Analysis of reports made available by the Trust including recent CQC inspection
feedback and the Digital Maturity Self-Assessment
ICT Review to identify gaps in current provision.
5.1. Patients and the Public
In line with the national and local strategic drivers outlined in the previous section, patients will
be placed at the centre of their care. The expectation is that they will be active participants and in
control of their care.
Patients will need:
To know how to access NHS services, find their way and contact those involved in their
care;
To learn about their condition, treatment and outcomes;
Online access to their health records including: clinical letters; laboratory results;
centrally held patient-identifiable data; community and mental health services
information; personal care plans for people with long terms conditions; and needs
assessments and care plans relating to social care services;
Access to patient information sources including trusted internet sites containing
information on health and lifestyle to help them take care of their own health;
To make informed decisions about their treatment, appointments and admission dates etc;
To have confidence in those caring for them and reassurance that they are fully informed
about their history, condition and treatment to date;
Information about them to be accurate, complete, secure and shared as appropriate;
To know where they are in the healthcare journey and have full knowledge and
transparency about timescales for next steps and to be able to make informed choices
about their care options.
Current Situation:
Information regarding Trust services and signposting to patient information is available
to patients via the Trust web site;
The Trust communicates with patients using a mixture of communication channels
consisting mainly of appointment letters and associated paper based correspondence
although there is some evidence of email and SMS messaging;
There is a need to improve patients awareness of their healthcare journey so that they
understand the care pathway they are following and are empowered to participate in their
own care;
There is no provision for patients to routinely access their own health records.
Opportunities for Enhancement:
The volume of patient letter templates which should be reviewed and standardised to
ensure the quality and consistency of communication messages.
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The quality of information sent out with patient letters should be reviewed and
standardised to ensure that this is of high quality.
Improve communication between patients and their relatives and those caring for them by
providing email addresses and direct telephone numbers for relevant healthcare services
and professionals.
Information systems need to enable communications with patients via the
communications media that they prefer e.g. capturing patient email addresses, enabling
telephone auto-dial facilities, supporting text messaging, use of social media.
Real-time capture of the patient experience during their healthcare journey.
Increase the patient’s level of knowledge of their care pathway, ensure transparency in
their patient journey and enable greater levels of patient participation.
Support for patient access of the own care records.
5.2. Clinicians
Clinicians Want:
To be able to log in quickly with a single sign-on for all clinical systems and similarly, to be
able to leave the PC/laptop quickly to attend to urgent clinical matters whilst maintaining the
security of confidential patient information;
Access to a single, integrated electronic patient centric record giving accurate, complete and
immediately available information on patient history, attendances, clinical correspondence,
investigations and interventions that is available regardless of the patient’s location or the
clinician’s location
Access to real time bed management information so that a bed for a patient requiring
inpatient care can be quickly and easily located;
Access to guidelines and knowledge which will support decision making about patients
treatment and care and to support life-long learning including best-practice, evidence and
access to on-line databases;
To be able to pro-actively identify and treat patients with increasing healthcare needs using
recognised industry standard risk stratification tools;
To be able to communicate rapidly with each other across RDaSH’s various sites and across
organisational boundaries. This includes the ability to securely share patient images, results
or documents with clinical or social care colleagues for advice or an opinion.
Current Situation:
The introduction of mobile working has highlighted connectivity issues and the need for
integrated electronic patient records.
RDaSH operates multiple clinical systems which are not integrated. The two core systems
are:
o TPP SystmOne: supporting Community (Learning Disabilities service also using
community module) and Palliative Care supplied by CSC via the NPfIT. Two
additional modules, EPR Core and Drug Rehab modules have been purchased by the
Trust and not as part of the LSP contract.
o SilverLink: supporting Mental Health services and community inpatient services and
Forensic Services.
Paper assessments still in use across most clinical services, with only some services using
clinical systems to record clinical notes. Paper notes are still in use across most clinical
services, including those where SystmOne is used for clinical noting.
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There is a confusing array of assessments and letters available within the existing clinical
systems.
There are many home grown Excel spreadsheets still in use for recording of patient
information and delivering operational reporting for staff, service managers and in some
cases outside agencies.
Opportunities for Enhancement:
Further investment in mobile working will enable the Trust to develop a more agile
workforce capable of delivering services of a homogeneous quality regardless of the patient’s
location. However there are several enabling factors that will need to be in place to fully
realise the benefits of mobile working. These include:
o Improve provision of Wi-Fi and connectivity solutions to ensure a consistent service
in all RDaSH clinical locations.
o Development of single sign-on for clinical systems that will enable swift log-in and
log-out and enable clinicians to resume a system based activity from the point at
which it was left;
o Provision of end user devices (desktop PCs, laptops, tablets, smartphones) that are
suitable to the user’s role type e.g. office based, fully mobile, partially mobile.
o The Transformation Programme and the Unity EPR Programme will work together to
address:
The deployment of a single EPR across all clinical services (Unity EPR
Programme);
The replacement of existing Excel workarounds;
Develop standards for the use of electronic patient records including
improving the timeliness of data entry and a review of existing clinical
assessments and letters;
o Implement an electronic document management solution for legacy case notes and
other shared clinical and corporate documentation;
Introduce technical solutions to enable clinicians to work seamlessly with staff from external
organisations to deliver care in multi-disciplinary teams.
5.3. Managers/Decision Makers
Managers / Decision Makers Want:
To work with commissioners to develop innovative healthcare services that will improve the
health of the local population;
GPs and other referrers to be able to book direct access services via the national eReferral
Service;
Access to dashboard style information for monitoring and managing performance of the
Trust;
Real-time, high quality data regarding each clinician’s caseload to enhance efficiency,
improve standards of care and assist caseload management;
Support for flexible, agile working, e.g. remote access to clinical systems, word-processing,
email, scheduling applications, document sharing and workflow.
Facilities for the electronic storage of documents to reduce paper and hence the cost of
storage and processing;
Current Situation:
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The Trust is starting to recognise the data capture and recording issues it has within the
service, with its current clinical systems through the recent ‘Task and Finish Groups’ on
IAPT and now CAMHS. More is likely to be identified by the Unity EPR Programme Data
Migration Workstream ‘Data Healthcheck’.
The Trust recognises the need to improve its information management (IM) provision and
work is ongoing to develop an IM plan to facilitate this.
The timeliness and quality of data entry into clinical and corporate systems is variable: in
some cases, data is entered retrospectively; in some cases not at all. Clear definitions of what
constitutes say an “indirect contact” and how to record these on the clinical system are not
uniformly communicated and implemented.
Some performance and operational information is generated directly from clinical source
systems.
The Trust informatics staff have to perform many manual extracts of data to obtain
information required for reporting purposes. This is time consuming and prone to human
error.
Opportunities for Enhancement:
Improving the timeliness and quality of data entry into clinical and corporate systems is
essential to the delivery of improved business intelligence. Having someone who owns data
quality monitoring within the service is key to addressing this;
The Trust needs to invest in its data warehouse. This is an opportunity for the Trust to invest
in a business intelligence solution that is capable of delivering a dashboard style drill-down
reporting system that will highlight issues and alert managers to areas that require attention.
o Invest in the Informatics team appropriately and ensure that the team are
implementing good practice database and report design.
o Integrate new data feeds from various Trust clinical and corporate systems into the
data warehouse to enable delivery of service line reporting (SLR).
o Work with the service to improve standardised definition, appropriate clinical system
configuration and meaningful information insight.
Provision of training and support to improve managers’ understanding of information and to
enable them to use a business intelligence system effectively to fulfil some of their own
reporting needs.
5.4. Administrators
Administrators Want:
Rapid access to accurate and complete patient documentation.
The ability to respond to patient queries in a professional manner.
Access to technology and tools to maximise their time and skills, freeing up time from
routine tasks and to be able to spend more time talking to patients.
Current Situation:
Existing clinical systems are not routinely being updated in real time and therefore do not
always accurately capture the patient journey.
Information is fragmented, causing administrative staff to waste time re-keying manually
recorded information, searching for notes and looking up information in multiple systems.
Patient records are still largely paper based and can be fragmented into service specific
records.
Page 19 of 35
Opportunities for Enhancement:
The administration service should be smooth and almost unseen by the patient as it facilitates
their journey through their healthcare experience.
The Transformation Programme and the Unity EPR Programme will work together to
address standardisation of patient communications and associated patient information sources
will improve the quality of communication.
The Trust should identify opportunities to utilise additional communication channels to
communicate with patients e.g. mobile apps, social networking, email etc.
Use of a document management solution would centralise document storage and enable
online access to a patient’s correspondence history. A project should be initiated to review
options for technology solutions and make a case for investment.
Page 20 of 35
6. ICT Vision
The Trust will develop its ICT service provision ‘Towards a Digitally Integrated Healthcare
Environment’, capable of supporting its staff, patients and partners as it works to deliver high
quality, patient led services across Rotherham, Doncaster and South Humber. Delivery of this
vision for ICT will support staff, patients and partners as the Trust works to deliver new models
of efficient patient-led services.
This Digitally Integrated Healthcare Environment will exploit technology to:
Improve patient experience
Support agile working;
Enable paper-free care delivery;
Reduce administrative overheads;
6.1. Improving Patient Experience
Patients will be given access to a summary of their own health record, which they will be
able to share with other health professionals involved in their care.
Standardised high quality patient communications will be available via a variety of
channels including mobile apps, SMS messaging, email and social networking.
Use of mobile technology including handheld tablets will facilitate discussions with
patients and capture of patient feedback.
High quality, timely information will be provided to support commissioners of Trust
services and enable development of innovative services to meet the needs of the local
population. Links will be developed with local Clinical Commissioning Groups, enabling
secure sharing of information where appropriate to improve access to services, patient
experiences and outcomes.
The Trust will work with partner organisations, particularly GP practices, social care
services and third sector services, to ensure that IT supports seamless care across
organisational boundaries. This will include support for Local Digital Roadmaps (LDRs).
Communication with GPs will be electronic by transmission of information directly into
GP systems where appropriate.
Links to the following Trust strategic goals:
1 To strive for Clinical Excellence
2 To attract, grow and engage our people
4 To work flexibly with partners to offer and deliver market-leading services
5 To underpin high quality care with good governance and leadership
6.2. Supporting Agile Working
A secure and resilient IT infrastructure will be available to all staff. This will incorporate:
o Stable, supported network operating platforms (hardware and software)
o A robust wireless network infrastructure supporting mobile devices
o Access to Trust systems by an agile and mobile workforce that spans all locations
where patient care is delivered.
Page 21 of 35
Modern and relevant IT systems and devices will be provided that support clinicians and
enable them to provide a homogenous service of high quality to patients regardless of the
location in which they are treated.
Clinicians will have access to all clinical systems via a single login. Contextual log-ins
will ensure that clinicians will only need to log in once and thereafter relevant patient
information will be available to them in a clear and logical presentation format.
Devices such as tablets, smart phones and laptops will be deployed where this improves
timeliness of data entry, patient safety and efficiency.
Links to the following Trust strategic goals:
1 To strive for Clinical Excellence
2 To attract, grow and engage our people
3 To deliver excellent services through sound financial management
4 To work flexibly with partners to offer and deliver market-leading services
5 To underpin high quality care with good governance and leadership
6.3. Enabling Paper-Free Care Delivery
The Trust will strive to become a paper free organisation.
The Trust will procure and implement a single integrated electronic patient record system
(EPR).
The patient’s complete care record will be held electronically, with the majority of it
made up from information collected through the clinical process in a single dedicated
clinical system. The electronic patient record will be accessible in all locations where
care is provided.
Real time data entry will streamline patient flow and enable more effective
communication regarding patient care across the organisation.
Appropriate technologies that enable alternate means of communication with patients and
colleagues such as email, SMS messaging and social networking will be used to replace
traditional paper based communication flows.
A document management solution will provide secure access to clinical and corporate
documentation that cannot be maintained within the Trusts strategic systems.
The Trust will work with its local partners to support the development of Local Digital
Roadmaps which will enable development of a single logical view of information about
the patient and associated care activity and pathways, enabling integration across the
wider health and social care community.
Links to the following Trust strategic goals:
1 To strive for Clinical Excellence
2 To attract, grow and engage our people
3 To deliver excellent services through sound financial management
4 To work flexibly with partners to offer and deliver market-leading services
5 To underpin high quality care with good governance and leadership
Page 22 of 35
6.4. Reducing Administrative Overheads
Clinical, operational and administrative processes will be designed and digitised to
enable collection of management information as a by-product of operational activity.
Systems will be integrated to facilitate intra and inter-departmental and organisational
working.
A centralised Business Intelligence solution will be underpinned by a data warehouse, fed
from clinical and corporate systems.
Links to the following Trust strategic goals:
1 To strive for Clinical Excellence
2 To attract, grow and engage our people
4 To work flexibly with partners to offer and deliver market-leading services
Page 23 of 35
Towards a Digitally Integrated Healthcare Environment
Exploiting technology to support care pathway improvements, enable new integrated care models, support agile working, eliminate paper, reduce administrative overheads and improve patient experience and outcomes.
Patients Clinicians Managers Staff CommissionersReview Bodies
Other Stakeholders
Unity EPR Programme
Clinician Single Sign-On
ePrescribing
Video Conferencing Digital Telephony /
VOIP
Robust IT Infrastructure
Business Intelligence Solution
ENABLING TECHNOLOGIESElectronic Document Management
CORPORATESERVICES
CLINICAL RECORDS
PARTNERS & EXTERNAL AGENCIES
EMPLOYEE MANAGEMENT
ESR
Job Planning
Expenses
Attendance Management
FinancialsInventory
Meetings Management
Records
Management
Risk Management
Quality Management
FacilitiesManagement
AssetManagement
Business Intelligence
Communications
Inpatient ServicesLocality Based
All Age Services
Bed Management
Diagnostics
Commissioners
Tertiary Providers
Social Care
Review Bodies
Unified Communications
Virtualised Services
Third Sector Organisations
Pharmacy
Specialist Services
Prison Health Services
Drug & Alcohol Services
CAHMS
Local Digital Roadmaps
NHS e-Referral Service
GPs
Page 24 of 35
7. IT Environment Review
7.1. Scope of the ICT Review
A review of the current IT infrastructure environment at RDaSH has been carried out. The
objective of conducting the review is to inform the strategic objectives for IT over the next five
years, and to determine the level to which the Trust’s current IT environment is able to support
mobile/agile working, and implementation and deployment of an EPR, confirming the level of
readiness or identifying areas where additional investment may be required. The review covers
infrastructure aspects such as physical data centres, server
rooms, networks, servers, storage and the security aspects of
these and also assesses other elements of technology,
applications and processes which relate to the core elements
of the review.
For the purpose of this review the overall IT environment is
broken down into ‘layers’ as depicted in the diagram on the
right. The layers outlined by the dotted lines are the primary
focus for this review (infrastructure), including the associated
process elements. However, the elements within the other
layers will have a bearing upon the infrastructure in terms of
requirements and dependencies as well.
It should be noted that at the time of the review the new EPR
solution is in the process of being procured. The assessment
is based on generic criteria related to procurement and
implementation of an EPR, with a stated preference for an off-premises hosted and managed
solution provided by a third party, working closely with the existing IT teams across all stages of
the lifecycle. The review was conducted through interviews with a set of selected individuals
from across the IT teams, in combination with a review of some documented materials.
Overall, the review found that the Trust has made a good level of investment in the infrastructure
technologies to date, including networks, storage and servers.
7.2. Summary of Findings and Recommendations
The main body of the report highlights a number of aspects within each of the areas (or layers) of
the technology environment. The following is a summary of the ICT Review’s key findings and
recommendations in each of the areas:
7.2.1. IT Governance, Programme Management & Organisation
Programme Management and Governance
The capacity with the IT team itself should be reviewed before, during and after the
implementation phase of the Unity EPR Programme to ensure that they are not only able
to take on and manage new technologies and services, and support larger programmes of
work, but that they continue to be able to cope with the day to day activities of a
demanding healthcare business environment.
The IT team should strengthen its approach to assessment, prioritisation, initiation and
management of technology delivery programmes of work. It is also likely to be necessary
to be stricter on prioritisation of projects, potentially even putting some initiatives on
hold, to ensure EPR implementation is not impacted.
Page 25 of 35
IT Support
The IT department currently provides ICT support to RDaSH, Doncaster CCG, the
associated Doncaster GP practices (52 of them) and four Doncaster prisons (in terms of
supporting the healthcare staff that visit those prisons).
There is a formal service level agreement (SLA) in place with Doncaster CCG and with
Notts Healthcare for staff based at Doncaster prisons, but no such agreement is in place
covering internal RDaSH services. Discussions are ongoing about replicating the
Doncaster CCG SLA for RDaSH services.
Self-service features should be enabled within the TrackIT service management system
for aspects such as password reset, which will reduce the volume of contacts received by
the service desk.
Information Governance and Security
A good level of investment has been put into the technical security measures in place,
and a recent review has recommended that the Trust carry out regular penetration testing,
which is being arranged, together with a broader cyber security review. Cyber Security
and ISO27001 accreditation will be an important differentiator in future SLAs with third
party organisations.
Now that both groups fall under the Health Informatics remit, the IT team should
strengthen the relationship with the IG team. The IG team provide support and guidance
but IT ‘own’ the development and implementation of the IT suite of policies.
Training
Consideration should be given to the likely volume of training that will need to be
delivered when implementing a new EPR solution, including number of staff, training
locations, training systems and data, duration of training courses and delivery methods
(classroom, online, self-service, etc.).
7.2.2. Infrastructure & Service Management
Network and Supporting Services
Work should continue on improvements to the connectivity to remote sites that fall
within the remit of the IT support contracts and which are likely to be used by staff
accessing the primary clinical and business systems of the Trust. This will include mobile
telephony for both voice and data connections.
Improved coverage of the wireless network across the whole site, and in significant
remote working locations, should be a priority. Where possible this should be centrally
funded to ensure full coverage across all areas where records are to be accessed
electronically.
A reduction in use of two SIM cards for staff that have a mobile phone and a SIM-
enabled Trust laptop should be explored, utilising tethering from the mobile phone with
an appropriate data package included in the contract.
A review should be undertaken of the telephony environment and a roadmap developed
to converge voice and data communications, dispensing with the old Siemens telephony
system, which will be unsupported within the period of the five-year IT Strategy. Further
usage of the existing NEC IP telephony solution should be explored in the first instance.
Data Centres
Management processes for the existing data centre environments should be improved, to
avoid using them as additional storage space. The data centre environment should be kept
Page 26 of 35
‘sterile’ in this respect, only containing equipment necessary to run the Trust’s
operations.
Investment in the data centre environments should continue to further improve the
standard of those environments, to bring them up to a more ‘industry standard’
specification.
The relatively close proximity of the two data centres is a concern. Options for a
relocation of one of the data centres should be considered, and this could be tied into a
move out of Chestnut View if this is part of the Estates plans, including consideration of
off-site co-location facilities.
Alternative options for provision of data centre services may also be considered in
addressing the preceding two bullet points.
The disaster recovery (DR) and business continuity plan (BCP) should be reviewed in
light of the recent investment in technologies, the refresh of the IT Strategy, and the
increased reliance on the technology services once a new EPR is implemented and the
Trust becomes increasingly paperless.
Storage
Further work should be carried out on capacity planning, to encompass an improved level
of monitoring and forecasting of storage needs, as well as consideration of an archiving
solution and alternate provision for backups.
The data retention policy for the Trust, and IT’s support for it, should be reviewed,
updated and appropriate technical measures put in place.
Servers
Further work should be carried out on capacity planning, to encompass an improved level
of monitoring and forecasting of server needs.
Work should continue to convert existing physical servers to virtual servers wherever
possible, recognising that some servers will need to remain as physical servers.
Applications (including licensing)
The initiatives underway to upgrade System Centre Configuration Manager (SCCM)
should be completed as a priority.
In the context of the replacement email solution, it is worth reconsidering Office365 as an
option. This would not only provide an email solution, but would also deliver:
o an integrated collaborative working solution;
o information on staff presence - presence is a combination of availability and
willingness to meet, and is a feature that works across many Office 365
applications;
o video conferencing capability via Skype for Business;
o features that support lone worker situations;
o the latest Microsoft Office 2016 suite of tools, enabling the Trust to remove the
current constraint of Office 2010 (an aspect that may also be a constraint of the
new EPR solution).
A broader review of the current licensing agreements and management process should be
undertaken in light of future plans for the Trust, including implications of deployment of
a new EPR solution.
Integration
An appropriate level of skilled technical resource should be established, together with a
technical integration platform, to cope with the integration demands of a new EPR
solution, the information management platform, and other systems that may require it.
Page 27 of 35
Presentation
Revisit the possibility of implementing virtual desktop technology for certain end user
devices and environments, where this would improve accessibility, usability and reduce
maintenance and support costs.
End User Devices
The aging desktop estate is a primary cause for concern, especially in conjunction with
the lack of a central refresh budget. A more centralised and planned approach is likely to
be required as part of the strategic roadmap going forward.
It will be important to define a standard mobile device or set of devices that are fit for
purpose, and that the Trust is able to procure and support in a cost effective manner,
especially as demand increases with a reduction in use of paper and introduction of a new
EPR solution.
The existing security measures for laptop devices are good, and something equivalent or
better should be implemented for other forms of mobile devices used for access to
patients’ clinical, or other sensitive, information.
A roadmap for the desktop operating system should also be determined, including
consideration of Windows 10.
7.3. Impact of the Unity EPR Programme
The expectation is that all clinical services will use the Trust’s new clinical (EPR) system. This
will have implications for Informatics in terms of new groups of staff who will be located in
different (possibly new) buildings, need to be trained, setup as users on the Trust’s systems,
receive Trust equipment (such as laptops and mobile phones), require remote access to those
systems, migration of existing patient data to the Trust’s systems, and so forth.
It will be important to ensure that the Informatics department as a whole is prepared for these
aspects of Trust-level change, alongside the enhancement and transformation work required to
deliver against the refreshed strategic objectives.
Page 28 of 35
8. Delivering the ICT Strategy
The current economic position has impacted negatively on public sector spending and in this
environment the Trust must plan to address inevitable cost reductions. In short, the Trust needs
to eliminate waste, increase efficiency and improve quality. Against this backdrop, and in line
with the QIPP agenda, ICT must now be positioned as a service improvement tool to transform
the organisation, by helping to drive up quality, drive out inefficiency and drive down cost.
8.1. ICT Strategic Work Programme
An indicative high level work programme plan is shown in Figure 1, below. This will be revised
at regular intervals as decisions are made regarding strategic solutions and progress is made
against milestones. Delivery of the ICT work programme will be monitored by the Health
Informatics Sub Committee and the Unity EPR Programme Board which reports to the Board of
Directors.
8.2. RDaSH ICT Investment Plan
To deliver the ICT vision outlined within this strategy, a programme of investment will be
required in addition to the annual ICT budget. This covers the funding required for the
procurement of a new single the Trust-wide clinical system (already approved by the Board of
Directors), plus provision for a suitably resilient supporting technical infrastructure. There is a
need to extend the provision of wireless networking across the Trust estate, to establish a rolling
replacement programme for end-user devices and continue to increase the ratio of mobile
workstations to desktops.
An indicative high level ICT investment plan is shown in Figure 2, below. Where capital funding
is required to progress the work programme, business cases will be developed to support
investment decisions. This will provide the Board with assurance that appropriate options
appraisals have been completed and that the most economically advantageous options are those
taken forward.
8.2.1. Additional Sources of Funding
The Government spending review and autumn statement in November 2015 made available £4.2
billion to deliver the technology revolution promised by the “Five Year Forward View”. While
full details of the funding are yet to be decided by the Department of Health and NHS England, it
is believed that around £1.8 billion has been earmarked for the creation of a paperless healthcare
service, an additional £1 billion to invest in digital security and data consent, and £750 million to
upgrade out-of-hospital care and medicines, and to digitise social and urgent/emergency care
services. A further £400 million will also be invested into improving digital services for
patients- including an updated NHS website and apps- and free Wi-fi across all health service
buildings. The Government is targeting 10% of patients to access GP services online and through
apps by March 2017, and for 25% of patients with chronic conditions such as hypertension,
diabetes and cancer to monitor their symptoms remotely by 2020.
It is unclear how much of this funding will be available to NHS provider organisations or what
mechanism will be used to apportion the central funding between organisations as varying levels
of digital maturity. It is likely that the Lead CCGs for the Local Digital Roadmap footprint
groups will be instrumental in managing and assuring this process. It is important that the Trust
is prepared to submit a credible bid for a share of this additional funding as and when this
becomes available.
Page 29 of 35
Figure 1 - RDaSH ICT Work Programme Schedule
The following high level project sequencing chart depicts the stages in the implementation plan. All the dates shown are subject to further
internal discussion and detailed planning:
Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4
Review priorities, revise project approach
Strengthen IG / IT working relationship
IT Team structure, capacity, capability review & remedy
Review current training provision
Training needs assessment to baseline staff skills
Define & implement strategic training
Network & Telephony
WAN connectivity
Mobile provider review
Enhanced wifi deployment
Telephony options review
Telephony replacement
Data Centres and DR
Improve existing data centre environments
Data centre options review
Data centre solution implementation
DR & BCP review and refresh
Infrastructure (storage & servers)
Physical to virtual (p2v) servers
Capacity planning review and update
Archiving solution
Backup solution revision
Retention policy and implementation
Application, Integration, Licensing
Complete upgrade of SCCM
Review mail options (inc. collaborative working)
Implement email solution
Integration platform options review
Integration platform implementation
Licensing review and tool implementation
Infrastructure & Service
Management
Proposed New Areas of Activity & Investment
IM&T Governance &
Organisation
Training
ICT Work Programme Schedule
Programme Area
Programme Element 2016/17 2017/18 2018/19 2019/20 2020/21
Page 30 of 35
Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4
End User Devices (EUDs)
Review EUD estate; strategic roadmap
Mobile device standardisation
EUD strategic refresh programme
Operational Service Management
TrackIT self service features
Additional ITIL processes
Security
Conduct security review
Revise security processes
IM Solution
IM Solution OBC and Procurement
IM Solution Implementation
IM Solution Enhancement
Electronic Document Management System
OBC / options appraisal
Procurement
Implementation
Existing Clinical Systems Tactical Solution
SystmOne Support Contract 12 months
EPR
EPR System Procurement
EPR Trust Implementation Costs
EPR Supplier Implementation Costs
Contingency
Annual licensing & maintence
Corporate Systems
Programme
Committed Areas of Activity & Investment
Unity EPR Programme
Infrastructure & Service
Management (Cont.)
Proposed New Areas of Activity & Investment
Information
Management Programme
ICT Work Programme Schedule
Programme Area
Programme Element 2016/17 2017/18 2018/19 2019/20 2020/21
Page 31 of 35
Figure 2 - RDaSH ICT Investment Plan
The following investment plan provides a high level view of the expected additional investment required to deliver this ICT Strategy:
Review priorities, revise project approach £0 £0 £0 Interviews, review of current approach, projects, plans, etc.; revised approach
Strengthen IG / IT working relationship £0 £0 £0 Process review and update
IT Team structure, capacity, capability review & remedy £0 £0 £0 £0 All FTE assessment, target operating model definition
Review current training provision £0 £0 £0 Review of existing training environment, systems, processes; revised approach
Training needs assessment to baseline staff skills £0 £0 £0 *Define & implement strategic training £0 £0 £0 £0 * Training needs analysis all IT staff
Network & Telephony
WAN connectivity £650,000 £0 £650,000 * Additional connectivity to sites; capital & revenue
Mobile provider review £0 £0 £0 * Market assessment, tariff options, coverage, innovation, recommendations
Enhanced wifi deployment £180,000 £0 £180,000 * Procure & deploy additional wireless access points
Telephony options review £0 £0 £0 * Including OBC, OBS
Telephony replacement £165,000 £0 £165,000 £995,000 * Procure & deploy new telephony solution (assumed based on existing IP soln)
Data Centres and DR
Improve existing data centre environments £0 £10,000 £10,000 General tidy, review process and procedure, recommendations
Data centre options review £0 £20,000 £20,000 Assess on-premise, co-location, fully hosted options
Data centre solution implementation £200,000 £225,000 £425,000 Includes recurring revenue rental for off site data centre
DR & BCP review and refresh £0 £50,000 £50,000 £505,000 Full review of documentation; interviews across clinical services; update all
Infrastructure (storage & servers)
Physical to virtual (p2v) servers £0 £40,000 £40,000 Continue to port physical servers to virtual servers (assume infrastructure exists)
Capacity planning review and update £0 £35,000 £35,000 Review tools & process; update processes, recommendation for tools
Archiving solution £100,000 £0 £100,000 Review options, procure and implement infrastructure (archive storage) & tool
Backup solution revision £50,000 £0 £50,000 Review options, procure & implement solution (assume no revenue implications)
Retention policy and implementation £90,000 £0 £90,000 £315,000 Review process, solution options, procure and implement; then annual review
Application, Integration, Licensing
Complete upgrade of SCCM £0 £0 £0 Assume already covered within IT budget
Review mail options (inc. collaborative working) £0 £20,000 £20,000 * Complete full assessment of options and costs, including procure & implement
Implement email solution £1,300,000 £0 £1,300,000 * Procure & implement; assume annual revenue cost per user
Integration platform options review £0 £25,000 £25,000 Review requirements; review options; make recommendation
Integration platform implementation £320,000 £0 £320,000 Procure & implement, including initial & ongoing interface development
Licensing review and tool implementation £0 £30,000 £30,000 £1,695,000 Review process; implement in existing Service Management tool
Totals Per GroupingEnables Agile
WorkingNotesCapital Revenue
IM&T Governance &
Organisation
Training
Infrastructure & Service
Management
ICT Investment Plan Ballpark Budget Estimates
Programme Area Programme Element
Proposed New Areas of Activity & Investment
Page 32 of 35
End User Devices (EUDs)
Review EUD estate; strategic roadmap £0 £15,000 £15,000 * Review of exsiting deployment; produce roadmap based on business drivers
Mobile device standardisation£0 £20,000 £20,000 * Define standard; enable management tools, build image(s) / config (not procurement)
EUD strategic refresh programme £1,250,000 £0 £1,250,000 £1,285,000 * Refresh of 4000 devices @ approx £312 each over 5 year period (not all devices)
Operational Service Management
TrackIT self service features £50,000 £0 £50,000 Includes licensing & implementation
Additional ITIL processes £0 £50,000 £50,000 £100,000 Includes definition of process & config within Service Management tool
Security
Conduct security review £0 £35,000 £35,000 Cyber Security Review by external agency
Revise security processes £0 £55,000 £55,000 £90,000 Initial revision & annual review thereafter
IM Solution
IM Solution OBC and Procurement £0 £45,000 £45,000 Develop OBC, run procurement
IM Solution Implementation £600,000 £0 £600,000 Including cost of solution, implementation, data migration & deployment
IM Solution Enhancement £0 £450,000 £450,000 £1,095,000 Ongoing enhancements
Electronic Document Management System
OBC / options appraisal £0 £40,000 £40,000 Develop OBC with options appraisal
Procurement £30,000 £0 £30,000 Run procurement process
Implementation £1,500,000 £0 £1,500,000 £1,570,000 Includes procurement & implementation
TOTAL £6,485,000 £1,165,000 £7,650,000
Existing Clinical Systems Tactical Solution
SystmOne Support Contract 12 months £246,000 £0 £246,000 £246,000 *EPR
EPR System Procurement £500,000 £0 £500,000 * Taken from FIBD 19Nov15 Draft EPR OBC (combining 2015/16 & 2016/17 costs)
EPR Trust Implementation Costs £1,519,000 £0 £1,519,000 * Taken from FIBD 19Nov15 Draft EPR OBC
EPR Supplier Implementation Costs £998,000 £0 £998,000 * Taken from FIBD 19Nov15 Draft EPR OBC
Contingency £251,700 £0 £251,700 * Taken from FIBD 19Nov15 Draft EPR OBC
Annual licensing & maintence £0 £1,625,000 £1,625,000 £4,893,700 * Taken from FIBD 19Nov15 Draft EPR OBC – 5 yrs annual revenue costs @£325k p.a
TOTAL £3,514,700 £1,625,000 £5,139,700
GRAND TOTAL £9,999,700 £2,790,000 £12,789,700
RevenueCapital
Corporate Systems
Programme
Unity Clinical Systems
Programme
Infrastructure & Service
Management (Cont.)
Information
Management Programme
Committed Areas of Activity & Investment
ICT Investment Plan Ballpark Budget Estimates
Programme Area Programme Element
Proposed New Areas of Activity & Investment
Enables Agile
WorkingNotesPer GroupingTotals
Page 33 of 35
Appendix 1 Risks
The following are the key risks identified during development of the ICT Strategy. These should
be captured on a risk register and a mitigation plan put in place:
Ref Description Impact Mitigation
R001 End user device refresh budget constraints
Inconsistent approach to device replacement, meaning older devices are in use for longer and may not be fit fir purpose in an increasingly electronic record world.
Implement a more centrally coordinated and funded approach to device refresh, aligned to broader business objectives and roadmap.
R002 Chestnut View data centre location and potential need to move
Moving the remaining NHS teams from Chestnut View has a major impact on the data centre environment located there, and therefore the systems and services hosted within it.
If a move is required, review options for establishing a new data centre location and required funding; assess against other options such as off-site / remote / cloud-based third party service provision.
R003 The IT team is insufficiently resourced to cope with delivery and ongoing management of the EPR solution.
Implementation of a new EPR solution will require significant input from the IT team, utilising their knowledge and skills of the existing environment, which will impact day-to-day activities and management of issues that arise.
Ensure the IT team members have time available in their normal daily schedules to support the EPR procurement, with adequate forward planning and additional, possibly backfill, resourcing.
R004 Suitability of technical hosting environment provision within the RDaSH data centre environment(s)
If elements of the new EPR solution are to be hosted within the existing RDaSH data centre environment(s) it will be important to ensure that aspects such as cooling and power provision are suitably robust to avoid unnecessary outages impacting EPR availability.
Once the architecture and hosting requirements of the new EPR solution are understood, review the existing environmental provisions required to host any elements that may be required and plan remediation activities that may be necessary.
R005 The lack of a Trust integration platform impacts support for the requirements of a new EPR solution.
Interoperability and integration of the new EPR solution with other Trust systems and services will be critical to ensuring the success of the EPR.
Establish a view of the EPR
integration requirements
and touchpoints as early as
possible in the procurement
process, as well as selecting
a solution that best supports
Page 34 of 35
Ref Description Impact Mitigation
these integration
requirements.
Also worth ensuring that the team responsible for integration are suitably resourced.
R006 Extended mobile / agile working
Increases in new working practices and demand for supporting technology, combined with new EPR system implementation could overload IT’s service provision and ability to cope with demand.
Ensure a clear statement of requirements is available, together with an understanding of what is required and when in a planned / roadmap form, and align IT-related initiatives to meet demand.
Page 35 of 35
Appendix 2 References
Ref Document Title Description
1 RDaSH EPR OBS …. .docx
The Output Based Specification (OBS) for procurement of a new EPR solution
2 RDash EPR OBC …..docx
The Outline Business Case (OBC) for procurement of a new EPR solution
3 Systems Linkage Narrative.xlsx
List of applications, systems and services in use across RDASH (still work in progress)
4 Assessing the Cyber-Risk Self-Assessment
RDaSH baseline self-assessment of security developed using the HM Government Cyber Essentials Scheme
5 Digital Maturity Self-Assessment
RDaSH baseline self-assessment of digital maturity required as part of the Local Digital Roadmap initiative
6 RDaSH CQC Quality Report
CQC quality inspection report published on 19/01/16