WHICTS County ICT Programme Board

1
Worcestershire Health ICT Services County ICT
Programme Board Presentation (21st Oct
08) John Thornbury Director, Worcestershire
Health ICT Services John.thornbury_at_nhs.net 078
667 213 71 (wictp_n_081021_00_presentation.ppt)
2
Ag. 2 Demo (W031 e-consent) (POSTPONED)

• Extra Detail in Attachment 1.
• Aims of project
• Implement DoH model consent policy.
• Ensure compliance with NHSLA risk management
  standards (Level 3), which have replaced previous
  CNST standards.
• Ensure compliance with Standards for Better
  Health (C13b C16)
• Make the consent process more user friendly,
  benefiting patients, healthcare professionals and
  the organisation.
• Drivers included
• 51 of medical notes lack documented evidence
  that the benefits and risks of a procedure have
  been discussed with the patient.
• 31 of consent forms lacked date that the consent
  obtained recorded.
• 37 lacked patients NHS number recorded.
• 26 of consent forms were not signed by a health
  care professional.
• 5 lacked name of procedure to be performed
  recorded.
• lt 5 of patients received relevant information
  leaflet.
• Objectives Approach
• Identify procedures performed within Trust
  requiring written consent.
• Establish procedure requiring written consent
  within the Trust.
• Produce Trust wide gold standard, clinically
  approved patient info.
• Distribute information provide appropriate
  training.

3
Ag. 2 Demonstration (W031 e-consent) (contd.)

• The System
• Via Web front end, designed built in-house.
• Integrated to user account system (Active
  Directory) to provide authorised consent list.
• Links the relevant documentation together to
  provide a consistent view and process. Pulls
  together the associated patient information for a
  consent form which could detail one of more
  procedures and provides this as one pdf document
  which is printed at time of consultation.
• User Base
• Currently has a user base of 70 clinicians.
• 610 distinct patient consent forms with
  associated patient information.
• Planned to extend the user base to approx 370
  clinicians.
• HSJ Award
• Application submitted in Jun 08.
• Notified Aug 08 of short listing.
• Mr Lake and Emma Duggan presented to the judges
  on 29th Sep.
• Understand approx 80 applicants in our category
  short listed to 5.
• Award ceremony on 1st Dec - winner announced on
  the night.

4
Ag. 3 - Actions List (PCT)
5
Ag. 3 (contd.) Actions List (Acute)
6
Ag. 3 (contd.) Actions List (MHP)
7
Ag. 3 (contd.) Actions List (ICT)
8
Ag. 3 (contd.) Actions List (SHA)
9
Ag. 4 ICT Services Strategy (2009-10)

• Aim is to move ahead of (expected?) SHA guidance
  on strategy format so that we can provide further
  supporting information to FT work.
• Trust service plans would be welcomed asap the
  Acute Local Plan has already been received.
• Attaining FT status necessitates delivering
  services within a new operating regime. The
  Trust will require a robust and sustainable ICT
  framework to support this. The strategy will
  reflect this.
• The new perception of ICT as a key enabler to
  achieving business change and improvement rather
  than an end in itself will allow a closer
  relationship between service developments and
  supporting ICT to be discussed.
• The past two years focus has been on
  consolidating the infrastructure and systems to
  support each Trust but maximize, where possible,
  the benefits gained from countywide developments.
  The emerging strategy will build on these whilst
  recognizing that each trust may have specific
  service developments it wishes to explore.
• It is anticipated that countywide working will
  also fortify the relationship between the Trust
  as well as deliver economies of scale for common
  services, for example data and voice networking.
• Greater attention to delivering against SLAs will
  be discussed so as to make these more meaningful
  to both commissioner and supplier, setting out
  the responsibilities of each party.

10
Ag. 5 - ICT Services Report (Operational)

• Full report available in Attachment 2.
• Service Availability
• Networks Server consistently excellent.

11
Ag. 5 - ICT Services Report (Operational Contd.)

• Applications
• NCRS reliability has improved but outages still
  occurring.
• Bluespier downtime (64 hrs) was scheduled.
• Service / Helpdesk Calls
• Application Call
• Calls closed continue to match calls opened.
• Calls opened closed in same month consistently
  gt 90
• Call makeup (Sep 08)
• 43 Account set up
• 31 NCRS
• 21 Oasis
• Service Desk
• Sep 08 calls closed (3439) close to calls opened
  (3542) (97)
• Averaging gt70 calls logged online.
• New service changes include
• Now open 8-6.
• Automated call reference e-mail.
• e-mail notification on call resolution.
• Link to satisfaction survey incorporated in call
  resolution.

12
Ag. 5 - ICT Services Report (Operational Contd.)

• Provision of Equipment (Quarterly)

13
Ag. 5 - ICT Services Report (Operational Contd.)

• Provision of Equipment (Last 3 Months)

14
Ag. 5 - ICT Services Report (Projects Contd.)

• (W040) GPSoC (PRIORITY 1).
• An amalgamation of other projects (EPS, GP2GP,
  CaB).
• Current supplier compliance (detail in Attachment
  3)
• Level 1 CaB functionality
• Yes EMIS LV, EMIS PCS, InPS Vision3, iSoft
  Premiere, iSoft Synergy
• No Ascribe Exeter
• Level 2 EPS functionality
• Yes EMIS LV, EMIS PCS, InPS Vision3, iSoft
  Premiere, iSoft Synergy
• No Ascribe Exeter
• Level 3 GP2GP functionality
• Yes EMIS LV, InPS Vision3
• No EMIS PCS, Ascribe Exeter, iSoft Premiere,
  iSoft Synergy
• Level 4 hosted solution
• Yes InPS Vision3
• No EMIS PCS, Ascribe Exeter, iSoft Premiere,
  iSoft Synergy, EMIS LV
• Current local take-up / enabled
• Level 1 63/67 (94)
• Level 2 49/67 (73)
• Level 3 24/67 (36)

15
Ag. 5 - ICT Services Report (Projects)

• (W02b) Choose Book (PRIORITY 1)
• System continues to function well.
• Appointment of Director of Delivery (Simon
  Hairsnape) duties include revitalising CB
  Programme in County.
• Stats
• Utilised for 37 Sep 08 (29 in May 08). Target
  was 50 by Sep 08.
• Referrals
• 2006/7 (11390)
• 2007/8 (26709) Q1(6346), Q2(6477), Q3(7057),
  Q4(6829).
• Q1(Apr08Jun08) 6017 (216118581998)
• Q2(Jul08-Sep08) 6445 (187518832687)
• (W02c) Electronic Prescription Service (R1
  Technical) (PRIORITY 1).
• GP Pharmaceutical suppliers slow to get systems
  accredited
• 65/67 (97) of General Practices are capable of
  being made operational.
• 2 remaining practices are non accredited Exeter.
  (PCS migration planned)
• 49/65 (75) are operational.
• 77/89 (87) of pharmacy systems are approved.
• 72/77 (94) of pharmacies live being encouraged
  to more.
• PCT prescriptions transmitted rate is 4th highest
  in SHA. (10K per month)

16
Ag. 5 - ICT Services Report (Projects Contd.)

• (W029) GP2GP (PRIORITY 1)
• Good progress
• 20/21 of initial InPS EMIS practices are live
  (1 withdrawn).
• Further 4/5 practices (InPS) also enabled.
• Remaining deployments on hold as iSoft not
  expected to become accredited until 2009.
• (W022) NSTS Closure (PRIORITY 1)
• Phase 1 now complete.
• Phases 2 (Secondary Uses Services Reports) 3
  (Batch Trace Replacement) work updates awaited
  from National Team.
• Acute RA Management (sponsorship - not smartcard
  issuing) has not functioned well during period of
  project a continuing issue that needs to be
  addressed.
• Guidance received concerning back office
  functions for the issuing of new NHS numbers
  being discussed through (W045) NHAIS project.

17
Ag. 5 - ICT Services Report (Projects Contd.)

• (W045) NHAIS (Exeter) to National Patient
  Demographics Service (PDS) Migration Stage 3
  (PRIORITY 1)
• A technical project to remove the use of
  temporary and old-format patient identifier
  numbers, and then ensure that FHS staff involved
  in patient registration are connected to the PDS
• Stage 1 complete (reduce old format / temporary
  NHS numbers).
• Stage 2 complete (eliminate old format /
  temporary NHS numbers).
• Stage 3 (direct updating of PDS) awaiting
  national products.
• (W049) Palliative Care (PRIORITY 1)
• Covers WRH, Alex Hsp, Evesham Hsp, POWCH 3
  hospices.
• Awaiting notification of contract reset sign off
  from SHA. However
• Project Brief completed (Attachment 4) and sent
  to PCT ICT Steering Group for formal sign off.
• IT infrastructure stakeholder list generation
  underway.
• Go live PID sign off 8 weeks.
• Expected go live 9th Feb 09.
• Followed by Deployment Verification Period (45
  days)

18
Ag. 5 - ICT Services Report (Projects Contd.)

• (W056) Equitable Access to Primary Care Medical
  Services
• ICT providing project assurance resource to PCT
  project.
• 9 Pre Qualification Questionnaire (PQQ)
  evaluated.
• Invitation to Tender (ITT) short listing 17th
  Nov 08.
• Final interviews scheduled 24th Nov 08.
• (W055) Map of Medicine Pilot (PRIORITY 1)
• Involves generating a framework to support other
  care pathway deployments interested in using MoM
  steps to deploy.
• MoM supporting County Diabetes Care Pathway
  Group.
• Various training (reviewer, editing etc.)
  completed.
• Localisation of national diabetes care pathway
  nearing completion.
• Discussions on rollout framework for other
  pathways commenced.
• (W027) Acute Medical Records (PRIORITY 2)
• Preferred supplier identified (Iron Mountain).
• Contract development and processing commenced
  financial detail.
• TUPE discussions continuing with Gov Actuaries
  Dept (GAD).

19
Ag. 5 - ICT Services Report (Projects Contd.)

• (W059) Prison Systems (PRIORITY 1)
• Covers new configuration of HMP Hewell
  (previously Hewell Grange, Blakenhurst
  Brockhill) HMP Long Lartin
• Awaiting notification of contract reset sign off
  from SHA. However
• Project Brief completed (Attachment 5) and sent
  to PCT ICT Steering Group for formal sign off.
• IT infrastructure stakeholder list generation
  underway.
• Go live PID sign off 8 weeks.
• Expected go live 27th Jan 09 (Hewell) 10th
  Feb 09 (Long Lartin).
• Followed by Deployment Verification Period (45
  days).
• (W03d) Maternity (PRIORITY 2)
• System reviewed 31st Mar 08 considered not fit
  for purpose.
• Agreement to prioritise on generation of
  maternity management reports (for end Dec 08) and
  then clinical functionality.
• Datasets being directed by Project Executive
  (Elaine Newell) and assisted by clinical
  informatics.
• Interfacing expected end Oct delivery remains a
  risk.
• Training planned but resourcing remains a risk.

20
Ag. 5 - ICT Services Report (Projects Contd.)

• (W037) GP OOH Tender (PRIORITY 2)
• ICT Services both service and ICT project
  management components.
• (W036) tender project completed Total Care
  Network (TCN) preferred supplier.
• TCN took over full responsibility for service on
  1st Oct 08.
• 1st performance stats expected at end Oct 08.
• (W028) Infection Control Management System
  (PRIORITY 2)
• Go live completed.
• Full handover will complete close Jul 08.
• Lessons Learnt Report (Attachment 6) report
  highlights
• Benefit of robust and clear service leadership.
• Need for clear scope and defined sign off
  criteria.
• Services need to prepare themselves for a
  significant amount of extra effort during the
  project period including duplication of effort
  and need to cover for leave of staff involved in
  the project.
• Appreciation of difficulty in releasing staff for
  training and local system configuration which
  requires a more realistic and pragmatic set of
  time scales to projects (based on ability rather
  than arbitrary completion dates).

21
Ag. 5 - ICT Services Report (Projects Contd.)

• (W048) Order Results Pilot (PRIORITY 3)
• Pilot to test Anglia system for ordering of
  results. c.6-9 months.
• 3 General Practices 5 Acute wards.
• Pathology Radiology basic test base.
• User lists and configuration commenced.
• Interfaces being developed.
• Rollout to pilot sites expected late Nov 08
  followed by assessment.
• (W024) GP Data Capture incl. Diabetic registers)
  (PRIORITY 4)
• Mechanism for capturing structured information
  from GP registers.
• Interfaced with diabetic management system.
• Can be extended to other structured GP data.
• 14/67 (24) sites installed of which..
• 6/14 (43) sites live.
• Significant technical issues have arisen review
  planned late Oct 08.
• (W031) E-consent (PRIORITY 4)
• BT E-Health Insider Awards winner tba 1st Dec
  award ceremony.
• Closure processes commenced.

22
Ag. 5 - ICT Services Report (Projects Contd.)

• (W058) GP Notes Scanning (PCTi Docman) (PRIORITY
  4).
• Method of supporting general practices to move
  paper documentation into clinical system.
• 41 (13 of 34) available sites have Docman
  (basic) now installed.
• 36 (15 of 42) also have Intellisense installed.
  This is designed to automatically recognise a
  document and the patient it belongs to based on
  its content.
• 0 of electronic Data Transfer (EDT)
  installations completed. This enables practices
  to receive documents sent electronically from
  participating Acute Trusts directly into Docman.
• (W033) Acute Incident Reporting (PRIORITY 4)
• Initiative to increase capture of incidents
  reported and enhance subsequent management
  processes incl. uptake of recommendations.
• Upgrade to existing system (Datix) but involves
  significant remapping of processes service /
  ICT training.
• Desktop equip for pilot (Maternity Radiology)
  sites confirmed.
• Training plan being developed (potentially
  combined with Oasis training)
• Intranet Pages (Interfaces) design commenced.
• Datix Web form is configured and a link is now
  available.

23
Ag. 5 - ICT Services Report (Projects Contd.)

• (W058) Theatres (Alex. Hsp.) (W051) WRH
  (PRIORITY 4)
• Go live (Alex.) 1st Apr 08 - Reporting tests now
  critical for sign off.
• Kidd. Hsp. WRH await Alex interfacing (Oct
  08). Without this, double entry required.
  Generation of user lists and equipment audits
  commenced. Change management have commenced.
• (W025) Web Publishing (PRIORITY 5)
• Technical refinements continuing. Increasing
  frustration for all at lack of ability of
  supplier to complete work agreed / provide time
  scales for delivery / communicate on progress.
• Internets
• Acute live but not FS
• MHP live
• PCT not live (exp Oct08) (outstanding tech
  issues - no date issued)
• ICT not live (outstanding technical issues - no
  date issued)
• Intranets
• Acute - not live (exp late Sep08) (outstanding
  tech issues-no date issued)
• MHP not live (exp early Sep08) (outstanding
  tech issues-no date issued)
• PCT not live (exp Oct08) (outstanding technical
  issues - no date issued)
• ICT not live (outstanding technical issues - no
  date provided).

24
Ag. 5 - ICT Services Report (Projects Contd.)

• (W026) Programme Project Reporting (PRIORITY 5)
• Awaiting review of proposal by Microsoft for best
  technical approach.
• (W061) MHP / PCT Phone Replacement (PRIORITY 5)
• Project Brief signed off.
• Technical surveys stakeholder list creation
  commenced. PCT / MHP placing pressure on
  locations to complete initial surveys.
• Telephone directories current directories are
  not being updated by departments. A new
  technical solution will only marginally improve
  this situation Trusts should ensure they are
  using the existing systems appropriately.
• Longer term intention is to interface with
  Electronic Staff Record (ESR) during the next
  deployment phase (Self Service). This still
  requires service to update details.
• (W050) Digital Dictation Framework (PRIORITY 5)
• Head Neck / Ophthalmology Rheumatology to
  take system and to be used to test framework for
  future and ongoing deployments.
• End user training commenced.
• Longer term deployment framework being developed.

25
Ag. 5 - ICT Services Report (Vacancies)

• Total of 9 Vacancies Open in Directorate
• 1 post awaiting consideration
• CIF007 (Senior Application Support Administrator)
• 2 being advertised
• 1LS019 (IT Desktop Technician)
• CIF008 (Clinical Administrator Assistant)
• 0 interviews scheduled
• 2 Appointments made (positions serving notice)
• KMT006 (Library Informatics Assistant,
  Worc/Evesham)
• TRA006 (IT Training Officer)
• 4 posts on hold
• 1LS003 (IT Junior Desktop Technician),
• 1LS005 (IT Junior Desktop Technician),
• TRA003 (E Learning Facilitator),
• TRA004 (I T Training Officer)

26
Ag. 6 Information Governance

• Laptop Encryption
• Safeboot McAfee encryption software installed
  on laptops throughout the county. If not loaded
  and access to the network is attempted Safeboot
  will automatically download when a laptop next
  connects to WHICTS domain.
• If a member of staff has not registered their
  laptop or themselves and they log onto the
  network they will be locked out and unable to use
  their laptop.
• In the interim, all owners of laptops and other
  mobile devices are being asked to ensure that any
  sensitive or person identifiable data is stored
  on network drives and not transported until the
  encryption is complete.
• IG Toolkits - The PCT is providing further IG
  support and advice to GPs to assist them to
  complete their IG Toolkits and Statements of
  Compliance.
• Worcestershire Information Sharing Protocol - is
  to be developed between Worcestershire County
  Council and the Worcestershire Local Health
  Community. The current Protocol expired in 2003.
• Countywide Safe Haven Policy - is to be
  developed. This will take into account the
  PCT/MHP Telephone Replacement Project. (W061).

27
Ag. 6 Information Governance (Contd.)

• Significant IG Related Risks / Issues
• IG01 - Out of Hours RA Support required for
  staff who access to CfH compliant applications.
  This is exacerbated in the Acute Trust were
  issues over RA management arrangements remain.
• IG02 - WHICTS IG Related Policies - Many of the
  WHICTS IG related policies are out of date and
  need renewing. Ruth King has begun to update the
  policies, priority being given to Email and
  Internet/Intranet Policy.
• IG07 IT Hardware Asset Register This is
  lacking (particularly around mobile devices such
  as laptops and tablets) and is considered a risk.
  Each Trust has added this to its risk register.

28
Ag. 7 - Monthly Budget Report

• To Be Tabled.

29
Ag. 8 - Any Other Business

• NCRS Instance Consolidation
• Paper (Attachment 7) explains new thoughts on the
  deployment of NCRS.
• The strategic direction of travel is to move all
  Trusts across the North, Midlands and Eastern
  (NME) cluster onto a single shared instance -
  coming into effect with the deployment of Lorenzo
  Regional Care Release 2.
• CSCA would like to reduce the number of instances
  they currently have as a medium term strategy.
• We would share a patient master index with
  Herefordshire but would retain our own facility
  IDs.
• Ahead of migration we would need to work on our
  and those shared duplicates with Herefordshire.
  CSCA have agreed that resources would be made
  available.
• The recommendation is that both the PCT MHP
  Trust support this and commence planning towards
  a shared instance with Herefordshire.

30
Ag. 8 - Any Other Business (Contd.)

• Anticipated Benefits of Proposal
• Early infrastructure refresh - includes a move to
  a new data centre. Outages experienced in Jun
  Jul 08 were hardware related - application server
  blade issues. CSCA indicate that of the 25
  Trusts already live in the new data centre, none
  have experienced any issues related to
  application / blade servers.
• CSCA report improved performance, reliability and
  stability for the 25 Trusts already on this
  infrastructure.
• Once migrated, reporting will be processed on a
  mirrored database thus removing conflict /
  performance implications in production
  environments.
• Improved monitoring and alerting capability
  through use of HP Openview in the new data centre
  will help CSCA proactively monitor the hardware.
• When planning upgrades/patches, Worcestershire
  could share testing scripts with Herefordshire.
• Where issues are found, greater leverage to
  resolving issues will exist.

31
Ag. 8 - Any Other Business (Contd.)

• Potential Dis-benefits of Proposal
• When taking new releases or patches
  Worcestershire would need to plan releases dates
  and scheduled outages with Herefordshire.
• Herefordshire use additional functionality that
  Worcestershire dont use e.g. CaB, AE and
  interface messaging. If bugs/regression issues
  are found during testing by them in relation to
  this functionality, that doesnt affect
  Worcestershire it would delay the upgrade to the
  new release until both parties have approved the
  upgrade.
• Worcestershire would be encouraged to move to the
  shared instance first, which would incur a
  downtime of 10 hours. When Hereford moves onto
  the shared instance after us, we would also
  experience a period of downtime but have been
  reassured that it would be about 6 hours.
• Worcestershire would need to agree the process
  for merging common duplicates with Herefordshire
  ahead of Hereford migrating to the shared
  instance.

32
Ag. 8 - Any Other Business (Contd.)

• Adoption of NHS Number
• Safer Practice Notice (Sep 08) (Attachment 8)
  updates letter (May 08) (Attachment 9) from NHS
  Medical Director (Sir Bruce Keogh).
• By 18 Sep 09, all NHS organisations should
• Use the NHS Number as the national patient
  identifier OR the NHS Number as the national
  patient identifier in conjunction with a local
  hospital numbering system (NB where local
  hospital numbers are used they must be used
  alongside , not instead of the NHS Number).
• Use the NHS Number (and its bar coded equivalent)
  in/on all correspondence, notes, patient
  wristbands and patient care systems to support
  accuracy in identifying patients and linking
  records.
• Put processes in place to ensure that patients
  can know their own NHS Number and are encouraged
  to make a note of it (for example through patient
  literature that explains the NHS Number, its uses
  and advantages, and how patients can use it to
  increase safety).
• Primary care organisations that have stopped
  issuing medical record cards should reinstate
  this practice and use it as a means of informing
  patients about their NHS Number and encouraging
  them to use it where appropriate.

33
Ag. 9 Date Time Next Meeting
Schedule
PLUS NEW DATES