yorkshire ambulance service information communications technology nyhdif presentation 14 th january...

Yorkshire Ambulance Service

Information Communications Technology

NYHDIF Presentation

14th January 2011David JohnsonAssistant Director - ICT

My presentation…• Some Ambulance Facts• Intro to YAS ICT• What we’ve done• Resilience• The Changing World• Things I’d like you to know and support:

• Emergency Care Solution (ECS)• Communication Enabled Business Applications (CEBA)• Clinical Hub

• Capacity Management System (CMS)• Directory of Services (DOS)• SystmOne

Ask Questions as we go along…

My presentation…

• Some Ambulance Facts• Intro to YAS ICT• What we’ve done• Resilience• The Changing World• Things I’d like you to know and support:



A&E Response Standards & Activity

2009-10

• Category A - 8 minute70.84%


• Category B - 19 minute91.1%

• Nationally bottom

April-Nov 2010



• Category B - 19 minute94.6%

• 5th position nationally

2009-10 Activity:• 999 Calls = 711,000

• 999 Incidents Attended = 599,000 (1650 per day)• Transports to Hospital = 485,000

• Not Hospital = 114,000• PTS = 1,200,000 (4,300 per day)

A&E Response Standards

• Winter pressures• Demand increases• System pressures across the health service• Huge improvements in response performance• Delivering our Operational Improvement Plan

Adverse Weather Interesting Facts

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%Impact of Adverse Weather on Performance

Actual Performance

Performance Adjusted for Weather Impact

Biggest impact Wed 1 Dec

1500

1600

1700

1800

1900

2000

2100

2200Impact of Adverse Weather on Demand

Adverse weather Demand

A&E Resources

• New stations - York, Hull East, Hull West, Wetherby, Penistone

• New deployment points• New vehicles - 41 ambulances, 19 RRVs, 19 out-

of-hours doctors’ cars, neonatal vehicle • New equipment • New staff • New ways of working

• Over 750 new staff recruited

• 51 student paramedics graduated with a Foundation Degree in Paramedic Science, and an additional 30 commenced their year one programme

• Nearly 100 technicians were successfully supported to achieve Paramedic qualification

My presentation…




ICT - Some Background Information (1)

1st July 2006:

Merger of-SYASWYMASTENYAS

AD - IM&TDavid Johnson

P.A. -

Julie Gibbon

Purchasing & Admin SupportTracey Wiles

Service Delivery MgrTerry Parker

SupervisorLisa Holling

(Secondment)

Support Analyst X 5James CrabtreeAhmer Hussain

Bill Baggott

Support Technician X 3

Nathan CornerTony Cherry

Shane McConner

Helpdesk / Admin Support

Louise BowlesChris Banks

Danielle McCappin

IT TrainerJo Liles

Infrastructure, Systems & Development MgrOla Zahran

Network and Developer SpecialistAdrian Wallis

Systems & Db SpecialistDave Bird

Systems & Database Admin X 3David Adams

Ian Baynham

Infrastructure & Tech Support X 3

Nick SmithDavid Green

Andrew Kedge

Info Systems DevelopmentRichard Price

Web Developer

Arun Sutharshan

Librarian

Adam Bakal (0.6)(Secondment)

E-Learning System Support(12 month contract)

Brenda Poller

Voice Communications Mgr

SecondmentElliott Thompson

Telecoms Admin Assistant

Emily West

Voice Comms Specialists x 3Shaun MarshallAndy McInnes

Elliott Thompson

Wayne Clowes

Radio Comms SpecialistGraham Elvidge

Project DeliveryDean Fletcher

Project Support Officer

Stephanie Appleyard(maternity) (0.4)

36 WTE

ICT - Some Background Information (2)

Budget 2010-11:

£000’s

Pay 1,232Non-Pay 4,212Total 5,444 (2.9%) Net of £440k CRES saving

Capital 1,500 (11%)

Support Service:

• All 1st and 2nd Line Support• Network, Desktops, Servers, Applications, Telephony & Radio• 24 / 7 / 365 – Service Desk 09:00 to 17:00 Monday to Friday• Project Support and Application Development• Supporting 3rd Parties with e-learning and ECS Reporting• Dell, Cisco, Nortel, Microsoft

ICT - Supporting Patient Services:

• A&E Operations• 999 Communication Centres• Patient Transport Services• GP Out Of Hours

• Supporting Support Services

My presentation…




What Have We Completed?• From 3 to 2

• Communication Centres VIRTUALISATION• From 3 to 1

• PTS System• Resource Management• Fleet Management• Finance System• HR / Payroll ESR• Domain / Email / Intranet / Internet• Management Information

• New Telephony and Call Centre Management Tools• Emergency Call Management and Call Connect Support• Desktop and Network Infrastructure Standardisation• WAN Upgrades and Encryption• Estates Reconfigurations• GP OOH software upgrade and hardware refresh

Continued…• Mobile Data System• Radio System• Controlled Drugs and Access Control• PTS Mobile Data• PTS Communication Centre Re-design• Telephony Management – GUI and IVR• Enterprise Backup / Virtualisation / Email

Archiving• Sharepoint Enterprise• Expanded Citrix Farm• Lone Worker Protection

My presentation…




Pstn. / BTOS

Vodafone APN

Airwave DigitalRadio Infrastructure

“Envoy” Enterprise **CEBA Hosting (under

development)

VPNVPN

WakefieldS-Hill 1

WakefieldS-Hill 2

YorkFairfields

York DRFairfields

GPOOH & Remote SitesRemote Sites

iSDN Services(2 x Independent Suppliers)

YAS WAN

Fibre Fibre

100MB

30MB

Telephony

Digital Radio

Telephony

Digital Radio

Telephony

Digital Radio

SAN ‘Mirrored’Application

InfrastructureCADClericDNSNASFleet

SAN ‘Mirrored’Application

InfrastructureCADClericDNSNASFleet

YASLAN

YASLAN

YAS PTSControl Room

YAS A&EControl Room

YAS A&EControl Room

YAS DRControl Room

Centricity

PDA & MDT & ‘Lone Worker’ Support

Common YAS DesktopsCommon Telephony & Contacts Database

Common Digital Radio Interface

Common YAS DesktopsCommon Telephony & Contacts Database

Common Digital Radio Interface

Multiple Channels

Of iSDN Delivery

Multiple Channels

Of iSDN Delive

ry

Multiple Channels

Of iSDN Delivery

Exte

rnal

Ser

vice

Del

iver

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al S

iteYA

S IC

T In

fras

truc

ture

Cont

rol R

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Ope

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ns

Technical & Operational Interoperability BCP & DR

999 & Non-999 Telephone Traffic

**CEBA is a multi-channel automatedMulti-media contact management platform

Yorkshire Ambulance Service – NHS TrustService Delivery & Interoperability Architecture

Virtualised CAD System Infrastructure

Wakefield

SAN-CX300

WAN

C3 CAD

York DR

C3 interface

Reporting server

IRIS PCs

Centricity

SMG

Terrafix MDT

BT EISEC

PSIAM

100 MB

C3 CAD R900

Reporting server

PSIAM

BT EISEC

CS1K

CC6

Centricity

Pilot

999 & non-999 for Central-North-South

SAN-CX320

C3 Web Server

IRIS PCs

30 MB CAD traffic only

Terrafix MDT

Vodafone

York C3

AQUA

AQUA

999 & non-999 for Central-North-South

My presentation…




The Changing World:• Doing more with less (ICT as enabler)

• Green IT

• KPIs CPIs Clinical Outcomes• Clock Start• Cat B• The complete patient experience

• PbR• Calls• Hear & Treat• See & Treat• See & Convey

• Clinical Hub – Pathways (CMS-DOS) - 111

My presentation…




Clearly this is not good…

• For the Ambulance Service, Or• The Receiving Hospital.

• We know the problems/limitations of paper!!!

• However, there is a tradition for the Ambulance PRF…

Where are we heading?

What, Why and When:

The Emergency Care Solution (ECS) from CSC• An Electronic Patient Report Form for Pre-Hospital Care• Panasonic Toughbook• 3G/GPRS Bearer• Access to Protocols, Drug lists, links to Medical

Equipment, etc

To Improve data capture, transfer and ultimately patient care.

Over the next 2-3 years• Over 600 vehicles• Over 2000 staff

ECS?

• This is not a stand alone product

• Integration to wider NPfIT solutions is key

• Our primary interface is with our patient receiving locations (RLs)

Engagement…

Completed Roll-out: Current Stations:

Wakefield

South Kirby

Castleford

Sherburn

Over 30 vehicles

24/7

Over 120,000 e-PRFs

Current Hospitals with RLs:

Pontefract General Hospital

Pinderfields General Hospital

Dewsbury District Hospital

Leeds Teaching Hospitals

Barnsley & District General Hospital

Doncaster Royal Infirmary

Montagu Hospital

Bassetlaw Hospital

Fieldhead Hospital

Bradford Royal Infirmary

Thanks to: SHA Support and Staff at Hospital Receiving Locations

Completed 2010-11:

Hull Royal InfirmaryLink to ED Ambulance pre-Arrival informationElectronic Capture of Patient Handover Information to Support ED Escalation process

Extend usage to RRV Vehicles in the Wakefield Area

Training Department (mainstreaming…)

HART Vehicles

Officers

Continuing the project:

Engage with other Hospitals to provide RLs

Roll out to other Ambulance AreasComplete Hull and East Riding

Improve access to Clinical Audit Information

Provide Paramedic access to their individual reports

Upgrade to Release 5 (Sept 2011)

Further integration – Pathways / CMS, SystmOne…

Summary:

• The ECS is a key part of the Modernisation of the NHS

• It is designed to be a solution integrated with the wider NHS

• Now it is about making it happen across Yorkshire to improve patient care…

My presentation…


• Emergency Care Solution (ECS)• Communication Enabled Business Applications

(CEBA)• Clinical Hub


CEBA – Modernising PTS

Automated Journey Confirmation

Automated On-Day Journey Status

CEBA – Message Cascade & Major Incidents

Automated Incident Management

Automated Incident Management

My presentation…




Clinical Hub…Changing the Response…

• Capacity Management System (CMS)

• Directory of Services (DOS)

= PATHWAYS = Reduced ED Admissions

= most appropriate patient care

= supporting the informed patient.

• SystmOne…

SystmOne Implementation Project

• Access to full patient data on SystmOne will only be made by Clinical Hub staff who are clinically qualified.

• The information on SystmOne will be used by Clinical Hub staff to support better patient care.

• It will support decision making on the best course of action such as an alternative care pathway or other care advice.

Patient Data Access

Patient Consent and Governance

• Patients, with conditions appropriate for telephone advice, will be asked for their consent to view the data by the emergency call receiver.

• This consent will be entered onto the control logs and be passed on to the Clinical Hub advisors.

• The patient data will not be retrieved in the case of an explicit refusal.

• If no explicit consent/refusal can be obtained, the box ‘Consent not asked’ would be checked and only if the presenting condition warranted would access to data be undertaken, any access would be supported - stating the reason why the data was retrieved and this recorded in the call logs.

• Where the patient cannot be found or where there are multiple patients matched and the correct one cannot be identified on SystmOne with complete certainty, no patient information will be retrieved. Current YAS processes will be used.

Patient Consent and Governance

Patient Record Update and Communications• The Clinical Hub advisors will update the patient

record with a brief statement of the action taken. This text will be selected from a list of options which is to be agreed.

• An automatic task will be sent to the SystmOne GP/User informing them of the access of the patient record by the YAS 999 Communication Centre.

• All patients not found on SystmOne will be handled within current processes.

How will YAS use SystmOne?

? Category A or B

Category C non life threatening

YAS will ask if the caller wishes to speak to a clinical advisor? If No then YAS will refer back to a If Yes then we will gain all personal information and request authorisation to access their GP medical records

Clinical Response

Transfer call to Clinical Advisor

999 Call YAS Comms Triage

Clinical Advisor

•

• The clinical advisor will confirm all patient details and that there is consent to access the patient’s GP record.

• The advisor will only read review the records for pre-existing conditions and present pharmacology before calling the patient back.

• Following the outcome of the call the advisor will make an entry into the journal to inform the Primary Care SystmOne user of the YAS Clinical Hub record access and patient care advice.

• Any follow on actions will be a decision for the Primary Care SystmOne user.

Clinical Health desk

Clinician on scene requests referral to alternative care pathway e.g. falls, diabetic after gaining the patient’s permission to authorise - informing their GP by accessing their medical record.

The health desk will complete the referral documentation and forward it to the required team.

The health desk will access SystmOne and leave a message for information only to the Primary Care user of YAS actions/referral to an alternative response.

Benefits of using SystmOne

• Better and more informed patient care.

• Increased caller satisfaction by improving the quality of information and pro-active support.

• Reducing unnecessary emergency ambulance responses and transports to ED.

My presentation…




Thank you for your time.

…the end…

yorkshire ambulance service information communications technology nyhdif presentation 14 th january...

Documents

support services slide

yas ict

day slide

wte slide

microsoft slide

telephony radio

paramedic qualification

patient services