September 2004 SOUTHERN INSTITUTE OF HEALTH INFORMATICS 1 NPFIT – The Strategic Health Authority...

September 2004SOUTHERN INSTITUTE OF HEALTH INFORMATICSSOUTHERN INSTITUTE OF HEALTH INFORMATICS

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NPFIT – The Strategic Health

Authority Perspective

Mike SinclairDeputy CIO, NPFIT Programme Manager

Surrey and Sussex SHA


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Agenda

• NPFIT– National– Cluster– Local

• SHA Roles & Responsibilities• How ICT & NPFIT Can Help SHAs• Local and Community Organisation• Recommendations / Actions


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4


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Outline - NPFIT

• National Systems and Services– Spine– E-Booking– PACS– E-Prescribing

• Local Care Record– Service not System (LSP plus)– Community Wide (Deployment Families)– Modular / Bundles– Cluster-wide data centre model– Includes non-NHS (Social Care, Hospices, Prisons etc)


HUNTER

INFORMATIONFARMING INDUSTRIAL

CARECARE

GATHERER

Progress

Time

% ofpeople

Ages of mankind

Meaning context independent

Meaning totally context dependant

Low level of understanding

High levels of understanding

Data

Information

Knowledge

Wisdom Requires brain power

Requires processing power


8

Clusters

• North East - Accenture / iSoft £1099M• London - BT (CCA) / IDX £996M• North West & W Mids - CSC / iSoft £973M• Eastern - Accenture / iSoft £934M• Southern - The Fujitsu Alliance / IDX £896M

NASP Contracts:• Spine (NHS CRS)

- BT £620M• E-Booking

- Schlumberger / Cerner £64.5M

NISP Contract• N3

- BT£530m


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Investment (SMART) Objectives

• Improve Patient Experience• Improve the Quality of Care• Enable Effective Access to Clinical and

Administrative Information• Reduce Fragmentation of Care• Improve Policy Development and Health

Research

Scope and roles

Sample Set of Generic Processes

Range of Care Settings

Flexible Toolkit to Support Range of Data and Viewing Requirements

INT

EG

RA

TE

D C

AR

E R

EC

OR

D S

ER

VIC

E

Master Patient Index (eMPI)

Order Entry

Results Reporting

E-prescribingE-booking

Integrated Care Pathways

Resource scheduling

Screening

Bed Management

Ambulatory Care Management

Mental Health Act Administration

Clinical Decision Support

Confidentiality

Authentication Domiciliary Care Management

Clinical Noting

Clinical Correspondence/Summary

Management InformationGraphical AnalysisImage Management Casenote and Film Tracking

NHS Spine

Personal Demographic Services

E-booking

Electronic Transferof prescriptions

Common Services

Nationally built by NASPsand locally

implemented by LSP'sLocally configured and locally implemented by LSP's

Cardiology Anaesthesiology

Intensive Care

Diabetes Theatres

Radiology

Pathology

MaternityOld Age Psychiatry

Radiotherapy

Child Health Screening

Trauma Rehabilitation

Respite Care

Palliative CareColposcopy

Nephrology

Endoscopy

DTCsACADs

GeneralPractice

AcuteHospital

CommunityNursing

HospitalPsychiatry

Therapies(OT/PT)

CommunityMental Health

DiagnosticDepartments

Home

TertiaryCare

NHSDirect

PrisonSocialCare

HospicesPrivateHealth

AmbulanceWalk-InCentres

National ICRSLocal ICRS

ICRS Overview


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National Care Record Service (NCRS)

• Foundation for entire system• Single point of information• Informs care decisions• Increased safety• Better information for national planning

CommonIntegrated

Health Information‘The Spine’

Internal Health Information

Information

Clinical Events

Patient Care

Example Spine InformationPersonal Details

• Name, address, etcSummary Health Information

• Medication• Allergies and adverse

reactions• Problems• Procedures

Reports of Events• Clinical correspondence• Discharge summaries• Referrals

Current Care Providers

Organisational SystemsGP systems

Hospital systemsNHS Direct

… etc

CommonIntegrated

Health Information‘The Spine’

Internal Health Information

Information

Clinical Events

Patient Care

Example Spine InformationPersonal Details

• Name, address, etcSummary Health Information

• Medication• Allergies and adverse

reactions• Problems• Procedures

Reports of Events• Clinical correspondence• Discharge summaries• Referrals

Current Care Providers

Organisational SystemsGP systems

Hospital systemsNHS Direct

… etc

SpineSpine


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Spine

LSP

Patient info

Broken Leg

Patient visits A&E

Patient info

LSP

Back Pain

Patient visits GP

LSP

Patient info

Chest infection

Patient visits hospital

The Spine – clinical events through time

The information flow is repeated over time


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BundlesCore (Funded) BundlesICRS Portal2 PAS3 Enterprise Architecture 14 Clinicals5 Maternity6 Theatre7 Alternative GP Solution8 Advanced PAS9 Orders11 Advanced Clinicals12 Enterprise Architecture 214 Prescribing15 Ambulance16 Complex Clinicals17 Advanced Scheduling18 Enterprise Architecture 319 Advanced Maternity

Additional (Local Funded) Bundles20 PACS21 Pathology22 Financial Payments23 eHealth24 Document Management25 Dental26 RIS (Radiology)27 Pharmacy Stock Control28 Social Care29 eBooking to Primary Care30 Decision Support Advanced31 Long Term Medical Conditions32 Early delivery PSS (Bundle 52)33 Upgrade of early PSS (Bundle 53)34 Early delivery Prescribing (Bundle 50)35 Upgrade of early Prescribing

(Bundle 51)


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Bundle Diagram Version 0.10: Bundle Release Phasing and Pre-requisites

31/03/09

key

Advanced Clinicals

PrescribingMaternity

Advanced Maternity

ICRS

Clinicals Orders Complex Clinicals

IDX GP

Early Site

PAS

Theatre Management

Ambulance

Advanced PAS Advanced Scheduling

Phase 1 Release 1 Phase 1 Release 2 Phase 2 Release 1 Phase 2 Release 2 Phase 3

Alternative GP 1

Enterprise Architecture 3



Standalone Theatre Mngt

When any Bundle within a release is taken up, the associated foundation (ICRS or EA) with that phased release needs to be installed in the Data Centre.

Core

Additional

Functional Sub-set

Early Release

Standalone

PHASED RELEASE TO BE DETERMINED:

For the Standalones shown here, the requirements are either still to be fully defined with the Authority or there are commercial / contractual discussions underway.. Until this is done these bundles should not be placed in a

phase/release.

Document Management

E-Health(a) & (b)

Financial Payments

Pathology

PACS

Dental

Radiology (incl. RIS)

Pharmacy Stock Control

Social Care

E-Booking to Primary Care

Long Term Conditions

Mental Health

Basic Care Planning

Standalone Doc Mngt

Standalone Pathology


Standalone PACS

Standalone Pharmacy Stock Cntrl

Model Community Complete: 28/09/04 31/03/05 28/09/05 28/09/06

Alternative GP 2

CCA Core Bundle(not FJA)

Standalone RIS

Advanced Decision Support

Standalone Decision Support

Standalone Child Health


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Cluster Roles, Organisation and Issues• FJA / CCA/ IDX - Common Solutions Board• Detail Implementation Plan (DIP) (2006 – 2009)• Cluster and London Collaboration Groups

– Technical Architecture; Information Architecture; Legacy Management; E-Booking; Benefits; ..

– Clinical Advisory Group(s)– Requirements and Design– Integral with London (Common Solutions Board)

• Special Cross-Cluster Initiatives– Interim Solutions for NSFs

• Data Warehouse / Repository– Data Cleansing and Migration


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LSP Deployment Approach – Initial Overview

Nov Dec Jan Feb Mar Apr May Jun Jul/Aug

End User Training

Testing Business Processes

Reporting, IntegrationData Migration and Printers

Training PreparationTraining Materials

Train the Trainer sessions

Test PreparationScript generation

Acceptance Criteria

Local ConfigurationMaster data setup & reports

Data Migration Load and Quality Validation

Open transactions & history

User Registration on NASP

Data Cleansing

End User IT Competency Training and Evaluation

Business Change: Stakeholder Mgmt, Organisation redesign, Business process mapping, communications, benefits realisation

Registration Authority

Set Up User Registration Authentication Prep

Legacy Integration

Project Management

FJA

NHS

Go

Live C

uto

verF

inal Data Load

Security and Controls

45 day live ru

nn

ing

DK

M

Data Extraction (open transactions and history)

ToolkitsAvailable

Phase 1 : Prepare Phase 2 : Roll OutDeploy

Go

Live S

up

po

rt

Card Readers InstallationStageing and Release Management

Technical Design SupportRD

Phase&

PIDSigned

Off

Master Data Capture For Local Configuration

Business Change Implementation and Benefits SupportBusiness Change Strategy and Planning

Alpha software drop

Service Management Preparation and Establishment

First Line Service Desk Establishment

Final PECaM software drop

Warranted Environment upgrade


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Health Service & SHA Pressure& Roles


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Pressures on the NHS

• Political drive to change• Changing demographics• Modernisation of the NHS

– EBM & clinical governance– Impact of information technology– Quality regardless of geography

• Exponential increase in cost• Partnership with patients not Patronage• Putting the “S” in NHS


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Challenges to be TackledChallenges to be Tackled

• Access targets

• Emergency care system

• Mental health

• Integrated working

• Chronic disease management

• Workforce

• Capital stock, estate and capacity

• Social Care market

• IM&T

• Finance


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National Drivers for ChangeNational Drivers for Change

• Patient & public involvement

• Plurality of provision/wider choice

• Integration of health & social care

• National standards

• External regulation & performance management

• Changing workforce

• IM&T investment

• Devolution


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Local Drivers for ChangeLocal Drivers for Change

• Developing a culture of Service Improvement

• Restoring financial health & discipline

• Expanding physical & workforce capacity

• Strengthening the capability of LHSCCs to deliver


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Two Major Areas of ConstraintTwo Major Areas of Constraint

Capacity

• Physical

• Workforce

• IM&T

Culture

• Partnership working

• Person centred care

• Primary care

• Using IM&T

• Modernising the

workforce

• Finance


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The Service Model

Specialist Care

Secondary Care

Primary/Community/Intermediate/Social Care

Prevention/Promotion/Self Care

Patient & Public InvolvementForumsPALS

Scrutiny

Change &

Modernisatio

n

Investment

Capital &

R

evenue

Relation

ship

s &

Partn

ership

sDRIVERS

CONSTRAINTS

Pathways & Networks


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PPIPPI

IM&TIM&T

ClinicalClinical leadershipleadership

Care pathways & clinical networksCare pathways & clinical networks

Local care centresGPs, GDPs

specialist GPs and nursesdiagnostic tests and investigations

joint NHS/Social Services teams eg OTstep up/down (intermediate care) facilities

chronic disease managementconsultant outreach clinics

community MH services

GP practiceslinked to local care centres

Elective treatment centresDTCs concentrating on routine surgery

state of the art day case unitsmaternity services

joint NHS/social services discharge teamsclear clinical networks and links with primary care

close work with nurses and GPs with special interest Consultant outreach to local care centres

MIU, run by specialist nurses

Emergency & complextreatment centres

A&E, MAU, trauma, NICU, PICU, etcemergency surgery & medicine

complex elective surgeryintensive rehabilitation services

GPs on site – perhaps through PMSbase for out of hours and deputising services

Specialist centresclear clinical networks and links to local services

diagnostic/outpatient work done locally where possiblehonorary contracts and clinics/training for local clinicians

outreach to local providersspecialist mental health services

NHS Direct, ambulance &patient contact centre

single call centre and decision process

contact centre for electronic booking

Ack: SR


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SHA (NPFIT) Roles

• Strategy & Planning

• Integration across SHA roles

• Manage LSP Contact

• Manage SHA wide initiatives

• Coordinate London / Southern Connection

• Disseminate and Communicate


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HEALTH INFORMATICS TRANSFORMATIONSHA Inter-working

• Development

• Clinical change

• NSFs

• Policy

• Financial Recovery

• Increasingly delivery of targets


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Mapping the LDP to ICRS - Generic

• Access

• Sharing

• Carers

• Choice

• Capacity

• Prevention

• Pt/Carer Info and Support

• Pt Admin, Index, Spine• Scheduling / Booking• RR and OCs• Integrated internal

Systems• Integrated Community

System• Access to the KB• Decision Support• Health Promotion


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The NHS Plan and LDPs: Plan and Benefits

• LDP Targets

• LCR Functional Requirements

• Investment Objectives

• Service Targets

• SMART Targets

• Benefits Realisation & Management

• Engagement & Change Management


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Local & Community Organisation

• Health Informatics Services

• Organisational Leaders

• Community-Organisational Integration


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The Future Shape of NHS IT - Services

DOHDOHNational IT National IT

Programme) Programme) (RG)(RG)

NSPsNSPsLSPsLSPs

Cluster OfficeCluster Office

Modernisation Modernisation AgencyAgency

SHASHA

Health Informatics Health Informatics Services Services

NHSNHS

National Direction National Services

D.I.P

Cluster wide services: CDR, Helpdesk..etc..

Local Direction & Coordination

Local Links (MS, Choice etc..)

Local Helpdesk(s)IT Services

Delivery

Intelligent Customer

Systems / ICRS

(Spec., Impl.)

Information

&

Intelligence

Local Engagement

IM&T Support Services

(Security, Training, Data Quality, ..etc.

Change Management

IT & Admin /

Clinical Practice

Service liaison,

Strategy Development

Contract Management

, Delivery


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Organisational Structures and Processes

Organisation / Community

• Service Redesign• Change Management• Benefit Realisation• Identification of

needs

Organisational Leads for IT

• Strategy• Benefits• Champion & Lead• Communication• Accountable for

delivery

Transformation & Modernisation

• Engagement• Process Redesign• Communication of needs• Inter/intra organisational

links• Day to day relationships

HIS/SHA/(LSP)

Health Informatics Services

• Plans• Suggests• Implements• Understands

customer needs


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NPFIT Organisation - Working Groups for SAP: London/Southern

BPPDGs Executive

WorkgroupsBPPDGs Executive

Workgroups

Southern Programme

Board

London ICT Program

Common Solution Project

Board

Operations Group

Functional Design Group

Technical Design Group

Information Governance

Group

Solution Test Group

Care Record Development Board*

* Formerly “National Clinical Advisory Board** Southern Cluster Clinical Advisory Group, London CRS Implementation Board, London Cluster Clinical Reference Group

SCCAGLCRSIB& CRG**

CRDB Groups

Joint SAP Best Practice Steering

Group

Common Decisions

BPPDGs Executive Workgroups

Task Groups:eg Information

Management

BPPD Executive Groups

Assurance

Governance

Joint SAP Best Practice Process

Design Group

London SAP Reference Group

Southern Cluster SAP Reference

Group

Southern Cluster Implementation

Executive

National Programme for IT

Southern Cluster SAP Steering

Group

Southern Cluster Technical Design

Group

Southern Cluster Information Governance

Group


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OLIT role

• Strategy & Leadership• Communication & Engagement• Inteface to Service Needs and Requirement• Align and Integrate with Modernisation and Change

Management• Benefits delivery and realisation• External relationship management (SHA, HIS & LSP

etc.)


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Conclusions & Recommendations


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HEALTH INFORMATICS TRANSFORMATION –What does the Patient deserve?

• Change current status:– Discontinuities– Best practice not integrated – Information not available – Patient disempowered

Need to transform care delivery and clinical work underpinned by effective use of technology

Need to function as a single NHS

• Infers strong hands-on role for the SHA


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How Can IT Help ?• Common Infrastructure

– E-mail; NSTS; integrated availability and access to solutions..

• Data and Information Flows– Demographic (Spine)– Core service requirements– Sharing

• Supporting Issues– Confidentiality and Security– Integral with other Health Information– Integral Reporting and Monitoring


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Overall Messages

• Service Improvement• Carer/Education Focus• MDT / Community wide• Patient Based• Pt access to record

• National Programme in fast

• Different approach to management / benefits realisation

True ICRS IM&T core to service IM&T professional needs to

understand the service IM&T now a clinical tool

A new and radical change to the way we use and manage our IM&T systems

A new relationship between SHAs, LHCs and all H&SC organisations


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Issues for Resolution

Terminology Ways of Working Culture and Politics Fit with other service needs and processes Sector targets, performance framework and priorities Governance NPFIT not fully ready and in place for 6,8,10 yrs.. Information Sharing and Ownership Systems Integration Confidentiality


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Approaches• Citizen / Patient first• Centred on service processes not management • Operational Services and IT working together• Listening & Learning• Incremental through joint work and planning• Best Practice work springboard to change• Risks are part of the agenda – honestly expressed• Patience and Persistence Pragmatism - based on patient & citizen need

Ack: Ian S


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Immediate Actions & Recommendations Establish joint processes wherever possible Agree Information Sharing Protocols Establish common data definitions and terminology Explore, use and seize immediate opportunities (e.g.

Interim SAP) Pilot local schemes to test Governance and boundary

issues Connect where possible (NHS net, local networks) Use the NHS number


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• Core SHA NPFIT Roles• Local Alignment with Service Priorities (LDP, Star

Indicators etc) & Modernisation• Organisational Leads (OLITS)• Board Level leadership• HIS / IT organisation • Benefits Management & Realisation

.. all whilst moving to the live use of data and .. all whilst moving to the live use of data and information systems..information systems..

& the 7 practices of effective uses of IT systems& the 7 practices of effective uses of IT systems

Immediate Actions & Recommendations

September 2004 SOUTHERN INSTITUTE OF HEALTH INFORMATICS 1 NPFIT – The Strategic Health Authority...

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