Implementing TPP SystmOne Prison HMP Whitemoor

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Implementing TPP SystmOne PrisonHMP Whitemoor
Barbara Ellis Head of Healthcare, HMP
Whitemoor Bill Wilson Project Manager, NHS
Cambridgeshire Alison Brinn Admin Manager, HMP
Whitemoor
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Introducing HMP Whitemoor

• Part of High Security estate (adult sentenced
  males only)
• Operational capacity 458
• Type 3 healthcare (24hr round the clock nursing
  cover, and 9 bed inpatient facility)
• Doctor, registered nurses across 3 disciplines
  (RGNs, RMNs, learning disability), healthcare
  officers and administrative team
• Directly employed by prison, primary care health
  service commissioned by NHS Cambridgeshire
• Onsite DSPDU (Dangerous Severe Personality
  Disorder Unit)
• Pharmacy Services provided by an external
  provider
• 100 paper process prior to implementation of
  SystmOne

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Deployment timeline

• Phase 1 Healthcare Go live March 2008
• Phase 2 Mental Health In-reach Go-Live November
  2008
• Phase 3 DSPDU Go-Live TBC
• Planning started four months prior to Go Live
• Business change pack provided by CSC
• Train the Trainer course arranged by CSC during
  January 2008
• Weekly conference call held with CSC and EofE SHA
  for in-flight prison projects
• CSC Project Manager available throughout the
  project to raise any issues/ risks, provide
  advice or raise areas of concern
• 45 day verification period after go-live. Weekly
  calls with CSC and EofE SHA to ensure identified
  issues were addressed

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How we use the system
An incremental approach

• Now
• All consultations
• All appointments
• READ Coding
• Data entry templates
• Various visiting clinicians
• Audit
• Management information

• Future
• Increase template use
• Care planning
• More frequent audit
• Begin using scanners
• Finalise notes summarising
• Recording of Issued medication

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Whos using the system?

• From Go-Live
• General Practice
• Clinics
• Segregation rounds
• Nursing
• Reception
• Smoking Cessation
• Wellman
• Vaccinations
• Diabetes
• Asthma
• Cardiac
• Flu
• Phlebotomy
• Podiatry
• Dietetics
• Dermatology
• Urology

• From Go-Live (cont.)
• Psychiatry
• Other Visiting Consultants (as required)
• Other Visiting Services (as required)

• More Recent
• Mental Health In-Reach Live November 2008
• Further work required
• DSPDU
• Physiotherapy
• Dentist
• Optician
• GUM
• X-Ray

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Project organisation

• Project governance
• Senior Responsible Owner Assistant Director
  for Out of Hospital Care NHS Cambridgeshire

NHS NPfIT Programme Manager
EofE SHA
Head of Healthcare
NHS Service Improvement Manager (NPfIT)
CSC Project Manager
NHS NPfIT Project Manager
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Project organisation

• Joint project involving HMP Whitemoor, NHS
  Cambridgeshire and Anglia Support Partnership
  (ASP) (shared service provider)
• Project Team meetings held monthly for the
  projects duration (December 2007 to May 2008)
• Head of Healthcare
• Deputy Head of Healthcare
• Healthcare Executive Officer
• Deputy QPC IT/Communications
• IT/Communications Manager
• NHS Service Improvement Manager (NPfIT) (4 days)
• NHS Project Manager (0.6 wte December 2007 May
  2008)
• NHS ICT Project Support Officer (ASP) (10 days)
• 2x NHS IT Technicians (ASP) (10 days per staff
  member)
• 2x NHS Trainers (ASP) (14 days per staff member)
• NHS Service Desk Agent (ASP) (4 days)
• NHS PRIMIS Facilitator (1 day)

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Project initiation and planning

• PID developed
• Involvement with EofE SystmOne Prison Specialist
  Interest Group (SIG) before and during
  implementation built awareness of issues
• Detailed planning was time-consuming but paid
  dividends later
• Consideration of prison environment and needs of
  users led us to take an incremental approach
• Contingency planning was essential
• Secured PCT funding for notes summarising (manual
  migration of basic medical history from paper to
  SystmOne records)

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Supplier relationship

• As the provider of SystmOne, CSC made necessary
  arrangements to support the SystmOne deployment
• Regular contact with CSC was established in
  conjunction with the SHA.
• Specific technical issues could be discussed with
  the System manufacturer (TPP) where warranted.
• Courtesy calls were received from TPP during the
  deployment
• The NHS project manager acted as a conduit
  between the Service and CSC/TPP for the duration
  of the project this structure worked well.
• CSC were accommodating to request for delays due
  to healthcare inspection

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Resource and capacity issues

• Early engagement of Governor and management (e.g.
  re. securing resources for supervision of
  visiting contractors)
• Internal prison IT/ Communications resources were
  planned for, however were still stretched by the
  project requirements
• Healthcare team divided for training purposes and
  backfilled as appropriate to maintain healthcare
  service. Agency staff were used as appropriate.
• Training sessions were provided onsite and
  offsite at PCT locations
• Planned Healthcare activity was reduced during
  first week of implementation.
• Doctors surgeries and visiting services continued
  as normal, however nursing clinics were reduced
  in the first week of go-live.

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Education and training

• Training approach informed by a formal skills
  analysis of all users
• NHS Trainers briefed about site-specific
  processes before training delivered
• Super users selected from different parts of
  healthcare team, ensuring knowledge was spread
  around.
• Individuals trained in their own groups.
  Clinicians, admin staff etc use system
  differently training needs were tailored to them
• Agency nurses, locum GPs, external service
  providers all received appropriate training
• Training scheduled near to go-live and was
  followed by catch all sessions afterwards
• Annual and sick leave factored in
• Tips and reminders made available near to PCs
• All new staff trained and supported

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Business and process change

• Time spent on process mapping was critical and
  invaluable
• Understanding our patient journey meant we
  fully considered how the system could be used to
  support and improve ways of working
• Primary Healthcare moved wholly to TPP SystmOne
  Prison from Day 1 the team quickly got used to
  it
• Reinforced standards around information
  governance
• Ongoing communication at every stage between the
  healthcare team and wider prison to respond to
  any concerns
• Pragmatic and visible project manager contributed
  to our success

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Risks and issues planned for

• Resistance from team
• Regular communications and project updates at
  staff briefings
• Lack of IT literacy
• Pace of training and scope of SystmOne use
  tailored accordingly
• Business Continuity
• Business continuity plans in place should the
  service be unable to access SystmOne
• System Support
• Superusers trained to provide additional support
• Service desk support (ASP) provided via NHS
  Cambridgeshire
• Ongoing access to NHS Trainers (ASP)
• Number of terminals increased to ensure access
  was available
• Note summarising / manual migration
• Complete move to SystmOne wherever possible

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Issues that actually emerged
Nothing major

• Staff acceptance good but allowances had to be
  made for some users
• Reaction of external service providers good but
  resistance in some quarters
• Pathology link
• Users locking themselves out of the system!
• Failed to advise NHS IT of office moves
• In general SystmOne is a good fit for HM Prison
  Service but will need to keep developing and
  address ongoing issues such as LIDS uploads and
  Medicines Management
• Locum and agency staffing issues e.g. training

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Lessons learned

• The time we invested in planning and process
  mapping was well spent
• Project team communication supported common
  understanding
• Training approach was welcomed by all staff
• The incremental approach worked well for us. It
  allowed us to get up-and-running quickly
• The team are getting used to new areas of the
  system at a pace they are comfortable with
• Were right to let varying levels of IT literacy
  and interest among different individuals and
  professional groups influence our training
  approach
• Good project management and business change
  support is crucial
• Understand unique environment of prison
• Ensuring CTC clearance obtained in advance of
  project initiation for any external staff
  (consider mitigation for absences)
• Consideration of non-prison staff entering the
  establishment and orientation to the environment

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Benefits being realised

• Round the clock access to medical records is
  possible for more than one staff member at more
  than one location in the Prison
• Records clear and legible
• Positive contribution to integrated working with
  the Mental Health In-Reach Team
• Transferring records between Prisons is easier
  and will be even better when more prisons are
  using the system
• Ease of audit
• Management information at the touch of a button
• Freeing clinicians of some administrative burdens
  (e.g. producing statistics for Hepatitis B
  clinics)
• Has helped us support other initiatives (Prison
  Health Performance Indicators, Disease Registers)
• Even inexperienced PC users have found the system
  user friendly

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Questions