Informing Healthcare

An Overview

David Ll. Davies – Programme ManagerDeborah El Sayed – Single Record Project Manager

What is it?• A strategy and an implementation programme

• In summary:

‘…………..It is a significant and strategic approach to investing in information and communications technologies

infrastructure and to modernising service delivery by supporting new ways of working…………………..’

Principles (what’s different?)• Ministerial support• Corporate and All Wales• Comprehensive scope• Long term Investment (£91 m first 3 years)• User led• Incremental implementation• Evidence based development

– F,D,I,E• Concept of ‘dependencies’ & ‘readiness’

Benefit Areas• Single integrated electronic health record for every patient• Service improvement supported by technology• Empowerment of the workforce through information

literacy and tools• Empowerment of patients through shared decision

making• High quality knowledge and information management

Health Services

Informing HealthcareStrategy Implementation Programme Board

Users Executive Resources

Projects

Benefit GroupsChair

& DirectorDesign &

Support Offices

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Programme Organisation

Progress – Setup and Personnel• Year 1 Programme Plan approved by Programme Board

• Support Office Commissioned in Bro Morgannwg Trust (Glanrhyd)• Ian Kelsall appointed as Chair• Bob Grindrod, Interim Director last 12 months• Substantive Director appointment in progress• 2 of 5 Benefit Directors appointed – Drs Rhodri Evans & Adrian

Edwards• Programme Manager, Deputy PM’s and PSO Director in place.• Other key appointments being made

Progress - Activity• Technical Proof of Concept Project completed• Projects moving forward from programme plan in areas of:

– Single record development phase 1– Training and development– Knowledge management– Infrastructure and access devices– Confidentiality and security– Research and development

• Readiness planning progressing in Trusts and LHBS• £18m + invested in 2004/5

Progress – Activity (2)• Engagement of users/stakeholders• Developing relationships with related areas e.g.

– England– Diagnostic Services Review– Social Care– Wanless– Innovations in Care– ESR

• Three year Programme ‘Route Map’ in preparation

So what’s in it for nursing staff?• Recognition – nurses run the show!• Electronic support for day to day work:

– structured ‘intelligent’ records• nursing record and access to all other relevant records

– new electronically supported processes• orders and results• medicines management• referrals, admissions, transfers and discharges• bed management• scheduling• alerts and reminders• pathways/decision support

So what’s in it for nursing staff (2)?

• Training and skills to maximise benefit from electronic systems• Skills as informaticians – evidence based professionals• Benefits:

– actions supported by timely accurate information– automation of routine tasks– reduced possibility of error– reduced wasted effort– improved and safer services for patients– less stressful more rewarding working conditions for staff

Strategy to delivery ( Single Record)

• Structure and objectives of the Single Record Phase 1 Development Project

• How we plan to deliver this

• Progress Made to date

• Next steps

Overview of Work-Streams– Core:

• Functionality • Presentation • Usability • Record structure • Process Redesign

– Dependency

• Network • Patient Identification• Staff Identification • Service Management

Overview of Work-Streams– Dependency Objective

• Network• The ability of the network to

Support the Single Record

– Dependency

• Network • Patient Identification• Staff Identification • Service Management

Overview of Work-Streams– Dependency Objective

• Patient Identification• The ability to uniquely identify

patients in electronic systems

– Dependency

• Network • Patient Identification• Staff Identification • Service Management

Overview of Work-Streams– Dependency Objective

• Staff Identification• The ability to uniquely identify

staff accessing Single Record access

– Dependency

• Network • Patient Identification• Staff Identification • Service Management

Overview of Work-Streams– Dependency Objective

• Service Management• The ability to deliver a co-

ordinated service management function to manage the services to be provided within SR:P1 Dev Project

– Dependency

• Network • Patient Identification• Staff Identification • Service Management

Overview of Work-Streams– Core:

• Functionality • Presentation • Usability • Record structure • Process Redesign

Functionality

What will the system

actually do?

Which clinical

processes

will it support?

Overview of Work-Streams– Core:

• Functionality • Presentation • Usability • Record structure • Process Redesign

Presentation What will the system

look like?

How will it differ to

support the range of

professional groups?

Overview of Work-Streams– Core:

• Functionality • Presentation • Usability • Record structure • Process Redesign

Usability How easy is the system

to use?

How intuitive is it?

How ergonomic is it?

Overview of Work-Streams– Core:

• Functionality • Presentation • Usability • Record structure • Process

Redesign/Change Management

Record structureHow should patient data bestructured within the record?

Overview of work-Streams– Core:

• Functionality • Presentation • Usability • Record structure • Process

Redesign/Change Management

Process Redesign/Change Management

The largest and most complexpart of this project is thechange management aspect.

A good technical systemoverlaid onto an inefficientprocess will not deliverimproved patient care

Development of Outline Business Case

• An Outline Business Case in five case model form is being developed for Single Record

• The Programme is also subject to the Office of Government Commerce (OGC) Gateway process

• Purpose – To provide external/independent assurance – Review at key decision points to ensure that the project is

‘ready’ to progress to the next stage. • Dates for Gateway Reviews to be agreed

Methodology for getting it right• The services and functionality delivered MUST be guided by NHS

stakeholders across NHS Wales

• All Wales stakeholder events• Design Teams established• Reference Groups established • Clinically focused Project Board

• Constant engagement process to maximise numbers of clinicians and NHS staff involved in design, decision making, consultation and validation.

Stakeholder Events and Clinical Representation

• Three stakeholder workshops were held during September and early October for all stakeholders.

• In excess of 200 people attended to provide views on the approach to Single Record across Wales.

• This included clinicians from various disciplines and accounted for 20% of the attendees

• Further development of the options has taken place through a further six OBC options meetings involved over 60 stakeholders.

• Design Team and Reference Group meetings initiated

Stakeholder Prioritisation of Scope for Phase 1

Result of the workshops to date have prioritised the following*1. Access to accurate, consistent corporate patient demographic

information 2. Access to basic clinical information for all Welsh patients 3. Enhanced demographics 4. Requests and results reporting5. Referrals (1°care to 2°care and tertiary referrals)6. Discharge summaries from 2°care (including death notification)

*shown in rank order

Design Team and Reference Group dates for 2004

• Design Team: 23rd November 30th November

7th December 14th December21st December

• Reference Group: 9th December

• 25 people register for Design Team • 54 registered for Reference group

Other issues for consideration • The current requirements of each organisation are likely to be

different – Need a corporate approach to deliver benefits to patients across Wales

• The Requirements of different professional groups will be different need to ensure we have an approach that ensures representation of all of the key professional groups to ensure that we deliver a cohesive service to patients

• The current experience for patients is difference based upon where they live and the approach taken by their local hospital or the pace of development – Need to develop an approach that gives equity of patient experience wherever possible.

Next steps: Scope • Focus for Design Teams and Reference Group

– Outline Business Case ( defines and approves the options and high level scope)

– Develop Clinical (business) Processes for each area of functionality (defines the detailed scope)

– Develop the requirements of systems to support these processes ( refines detailed scope)

– Develop a specification to drive forward procurement activity