ehealth UPDATE NHS Highland Board 30 May 2017 Item 4.9 Report by Iain Ross, Head of ehealth on behalf of Deborah Jones, Director of Strategic Commissioning, Planning and Performance The Board is asked to: Note: the work of the ehealth Department and the ehealth Governance Groups. 1 BACKGROUND The terms of reference of the ehealth Delivery Group states that The ehealth Delivery Group will provide a bi-annual update to the NHS Highland Board. The lack of an update has been highlighted in a recent internal audit report and the Audit Committee asked that regular updates are scheduled in the work plan of the Board. 2 GOVERNANCE The revised governance arrangements for the ehealth function have now been in place since January 2016 and have recently been the subject of two internal audits that reviewed both the governance arrangements as well as the adequacy of the ehealth strategic planning and the arrangements in place for its implementation. These audit reports were presented to the Audit Committee in May 2016 and each audit made a number of recommendations which ehealth management have agreed to address during 2017/18. The core governance groups for ehealth are the ehealth Strategy Group and the ehealth Delivery Group. The ehealth Strategy Group meets on an annual basis to review the ehealth strategic vision taking into account the Boards objectives and the National ehealth Strategy (soon to be Digital Health and Care Strategy). The ehealth Delivery Group meets on a quarterly basis and its remit is to translate the ehealth strategic vision into an ehealth delivery plan that will: detail the work that is required over the next three years to support the ehealth strategic aims be in a format that allows easy communication across NHS Highland of the work plan for the ehealth Department be used to construct the Scottish Government Health Department s ehealth Delivery Plan identify the funding (capital and revenue) required to deliver the ehealth strategic aims. The following gives an overview of the governance arrangements of the ehealth function:
3 STRATEGY The ehealth strategic vision remains unchanged for 2017/18 and is as follows: 1 Electronic Patient/Person Record Access to an electronic patient/person record that replaces the existing paper records integrated across NHS Highland (primary, secondary, community and social care) with access available as required regionally and thereafter nationally. 2 Equity of Access to Systems and Services a. Integrate the different environments in use across NHS Highland to ensure that all users have access to similar services and systems. b. To ensure that NHS Highland users have access to modern technology to support care to patients/persons.
4 ehealth DELIVERY PLAN During 2016/17 the ehealth Delivery Group agreed a four year Delivery Plan. This Plan was split into 5 sections which covered 1. Primary Care 2. Secondary Care 3. Community Care 4. Social Care 5. General ehealth For each of these sections a timeline of actions has been created (Appendix 1) with an estimate of the resources required to deliver on each of the actions (Appendix 2). The funding required to support the ehealth Delivery Plan was identified as follows: 2017/2018 8.302m 2018/2019 8.566m 2019/2020 3.707m The actual capital allocation for 2017/18 is 1.279m, however, a bid is being made to the Scottish Government Health Department (SGHD) for capital funding to cover the remaining 5.715m. 5 DRIVERS FOR CHANGE Since the publication of the ehealth Delivery Plan there has been a number of drivers for change that have meant that a revised ehealth Delivery Plan is required. These drivers for change are as follows: 1. The Financial Context: a. Saving target announced of 47m b. A capital allocation of 1.279m 2. The publication of the Quality and Sustainability Plan 3. The publication of the Health and Social Care Delivery Plan 4. The emphasis on partnership working across the region (North of Scotland) At the April ehealth Delivery Group it was agreed that the current ehealth Delivery Plan be refocused and areas of work to be taken forward as a priority are as follows: Delivery of a clinical information sharing solution across primary, secondary, community and social care that will display a patient centric view of clinical information. Delivery of an information sharing solution within the community sector which will reduce the duplication of information being recorded thereby increasing the time available to care for patients. Delivery of a patient status (production board) view of a patient which will allow staff to view the current status of all patients under their care from GP/Community care, into hospital care and back to GP/Community.
Support for the Technology Enabled Care Programme. Delivery of electronic information gathering functionality within the clinical setting to replace the need for paper. Delivery of a solution that will allow primary and secondary care clinicians to have an online clinical dialogue about a patient with a view to reducing outpatient attendances The ehealth Department is currently reviewing the Operational Units/IJB transformational plans with a view to ensuring synergy between these and the ehealth Delivery Plan. The ehealth Department is also working on developing detailed plans to support the above work along with an investment/saving plan. 6 WHAT DOES IT LOOK LIKE Currently core clinical information is held in silos and the ehealth vision is to connect these silos so that staff have access to a holistic view of a patient. The four sectors Primary, Secondary, Community and Social Care are like pieces of a jigsaw that, with ehealth support, can be brought together to create a complete clinical picture of a patient that will benefit both the patient and clinician. Phase 1 A central core of clinical information that is patient centric that is linked to primary, secondary, community & social care so any clinician can see an up to date clinical view of a patient. Options are being considered on how this could link in with a regional portal view. Phase 2 The implementation of the view product set. This will provide patient status information appropriate to the clinical setting.
7 GENERAL ehealth As well as looking forward with the implementation of the ehealth Delivery Plan that supports the ehealth Strategic Vision the ehealth function is required to deliver on its core remit of ensuring that NHS Highlands ehealth systems and services are maintained and developed to an appropriate level. This work covers: Technical and facilitation support for Primary Care Network provisioning Telephony provisioning Desktop support Server support Application support Service Desk provisioning Access Management control Information Governance Business Intelligence provisioning Project Management ehealth Training
A significant amount of ehealth resource (approximately 80%) is committed to the daily/weekly/monthly tasks required to ensure that systems and services are available as close to 100% of the time as possible. The department operates an out of hours on call service that covers the core clinical applications, servers and networks. 8 CURRENT AREAS OF FOCUS The current areas of focus for the ehealth department include the following: Integration work between the Highland Council and NHS Highland Support to the office redesign project Digital GP Rollout of remaining view products o Admission View o Paediatric View o Pharmacy View o Info View o Extension of Ward View to Community Hospitals Upgrade work o Bankstaff o Emergency Department o Occupational Health o Laboratories o Cardio Respiratory ECG Archive o Servers (general) o Intranet o TrakCare PMS o SCI Store o Windows o Office Implementation of Single Sign On WiFi access in all sites (initially for staff only) Primary Care Order Communications As well as the above there are a number of national programmes of work that ehealth are supporting which include: HEPMA (Hospital Electronic Prescribing and Medicine Administration) CHI and Child Health System replacement GP Information Technology re-provisioning Community System procurement Community Virtual Ward specification 9 REGIONAL WORKING The North of Scotland ehealth functions are working together to ensure that ehealth systems can support regional working, in particular, the need to share information across NHS Board boundaries. The vision that is being worked to is that clinicians should be able to access all clinical information regarding a patient from any location in the North of Scotland and staff should be able to access all necessary services from any site in the North of Scotland. To achieve this vision will require considerable technical work within the ehealth function.
For NHS Highland, regional working does not just mean working with colleagues across the North of Scotland as we also need to be aware of the patient flows from the Argyll & Bute Heath and Social Care Partnership into NHS Greater Glasgow & Clyde. Consideration needs to be given on how solutions will be delivered to support these patient flows. 10 CONTRIBUTION TO BOARD OBJECTIVES The ehealth Delivery Plan is consistent with the aims of the Board s Quality and Sustainability Plan. 11 GOVERNANCE IMPLICATIONS 11.1 Staff Governance There are no particular staff governance issues around the ehealth Delivery Plan. Each individual project will have its own staff engagement plan. 11.2 Patient and Public Involvement Each project will have appropriate patient and public engagement. 11.3 Clinical Governance Each project will comply with clinical governance as part of the project delivery. 11.4 Financial Impact The financial impact of the ehealth Delivery Plan is being analysed and where required business cases will be developed and presented to the appropriate governance groups. 12 RISK ASSESSMENT The individual projects will have their own risk assessments and risk governance arrangements. 13 PLANNING FOR FAIRNESS The ehealth Delivery Plan will ensure equity of access to patients by improving the access to clinical information across NHS Highland. 14 ENGAGEMENT AND COMMUNICATIONS Each project will develop its own communications plan which will include communications to staff and patients as required. Iain Ross, Head of ehealth 12 May 2017
ehealth DELIVERY ROADMAP 2016/17 2019/20 Appendix 1
Description of Roadmap Deliverables Vision 360 Vision Anywhere Order Comms and Lab Links Single Sign On Connection to Networks Streaming of data to central data centre for business continuity purposes and to provide environment to support apps deployment App to support mobile vision access Provides ability to request diagnostic tests and receive results back into practice systems Ability to access systems with the one logon Setting up the NHS environment to allow access to systems and services from anywhere Provision of a portal view of patient information Access to Secondary/Social and Community information Audit letters that are still in To run an audit of letters that GP s receive in paper format hardcopy with a view to EDT with a view to turning these into electronic documents GP IT Re-provisioning National procurement for a new GP system framework contract Delivery of Eyecare Connecting Optometrists to allow ereferrals and epayments e-referrals for Dentists Connecting dentists to SCI Gateway Partner in national Working with 5 Consortium Boards on the procurement of a procurement of a community national community system system Development of a business case to support implementation of a national solution Implementation of National solution Implementation of interim sharing solution pending national solution Provide access to systems from Anywhere Electronic Forms Recording of Electronic Obs Record Scanning Order Communications Replacement Labs Access to Primary/Community and Social Care information Access to SAS information HEPMA Upgrade to Trak 2016 To be involved in the development of a business case to support implementation of a national solution To set up a programme of work to support the implementation of an identified national solution To identify an interim solution that will support information sharing and will support the replacement of MIDIS Setting up the NHS environment to allow access to systems and services from anywhere Provision of a solution to support the electronic capture of information within a clinical environment Provision of a solution that links with medical equipment and automatically captures the medical observations and records these in an IT system. The digitisation of the existing paper record System to support electronic requesting and receiving of diagnostic tests Programme to replace the Laboratory system in Northern NHS Highland. Provision of a portal view of patient information Ability to link information captured by the Scottish Ambulance Service to Secondary and Primary Care Hospital Electronic Prescribing and Medicine Reconciliation Upgrade of the TrakCare PMS system to the latest version (2016)
Meds Reconciliation ED/MiU Replacement RIS Replacement Maternity Solution Federated TrakCare Split Highland Council and NHS networks and services. Create links to services so all staff can access as required Investigate options for information sharing (Adults and Children s services) Investigate options for Federated TrakCare Seed CareFirst with CHI number Implement options for data sharing Integration of NHS networks to allow equity of access to systems and services Single Sign On WiFi all buildings WiFi access for patients Phase 3 of TrakCare PMS Data Warehouse Business as Usual Ability to reconcile drugs on admission to discharge Replacement of existing A&E system (EDIS) with a system to support ED and minor injury units National programme to replace the radiology systems Identification of a system to support maternity services across NHS Highland Configuration of TrakCare to support a view of patients across systems e.g. CareFirst and Boards e.g. NHS Grampian Highland Council sponsored project to split the Council and NHS networks to ensure health staff are on a health network using health equipment and vice a versa Process to identify the information that is required to be shared bi-directionally between health and social care with a view to identifying solutions to allow this to happen To look at how Federated TrakCare might support an information sharing environment Investigate options and carry out a CHI seeding exercise to all CHI numbers to be held within the social care systems Implement agreed options to allow bi-directional sharing of information between health and social care To provide solutions where NHS staff can access their required services and information from any NHS connected device To continue adding additional systems onto the single sign on solution To provide WiFi access within all NHS Highland buildings Once WiFi is provided in all buildings to investigate options for patients/visitors to have access To implement the next phase of the PMS Programme The continued development of the data warehouse to support additional systems including Radiology, Datix and SCI Store Ongoing work to ensure the service delivery levels are maintained
Appendix 2 RESOURCE REQUIREMENTS (APPROXIMATE) Roadmap Item 2016/17 2017/18 2018/19 2019/20 PRIMARY CARE Vision 360 85 Vision Anywhere Order Comms & Lablinks 90 180 Infrastructure enabling Single Sign on 30 connection of networks 45 On Lines Services 48 12 Access to Secondary/Social and Community Care Data 40 40 Letters into EDT 50 GP IT Re-Provisioning National Eyecare 34 ereferral Dentists 40 COMMUNITY CARE National Procurement 30 Implementation of National solution 2000 2000 Interim Solution 40 200 200 Access to Systems 50 SECONDARY CARE Electronic Forms 40 80 80 Recording of Obs 600 600 600 Record Scanning 71 100 52 52 Order Communications 60 60 replacement Labs 380 300 Access to Primary/Community/Social Care Info 60 60 Access to SAS info 10 10 HEPMA 1829 700 Upgrade to TrakCare 2016 60 Meds reconcilation 70 ED/MiU replacement 1000 500 RIS Replacement 800 Maternity Solution 400 Federated TrakCare 90 30 30 SOCIAL CARE Split Networks 500 Seed Carefirst with CHI 60 Implement options for data sharing 60 60 GENERAL ehealth Intergration of networks 250 50 WiFi all Buildings 100 100 Phase 3 TrakCare PMS 60 40 Data WareHouse 300 200 200 Business as Usual Capital 1016 2015 1805 2225 Other 71 100 100 100 Estimated Total (ex VAT) * 2775 8302 8566 3707 * Does not include ensuring service delivery