Description
Information management (IM) is the collection and management of information from one or more sources and the distribution of that information to one or more audiences. This sometimes involves those who have a stake in, or a right to that information.
Making Life Better Together Information Management & Technology Strategy 2011 – 2016
Principle Author: David Green, Director of IM&T
Version History Version Summary of Changes 0.1 First draft 0.2 Second draft, following first review 0.3 Inclusion of new national MH Strategy, and comments from IM&T Strategy 0.31 Final QA
Date Jan 11 04 Feb 11 18 Mar 11 08 Apr 11
South West London & St George?s Mental Health NHS Trust
Information Management & Technology Strategy: 2011 - 2016 ___________________________________________________________________
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Contents 1. Executive Summary Context 2. 3. 4. 5. 6. 7. 8. 9. 10. Background Trust Vision and Values Development of the Trust?s IM&T Strategy Strategic Context Local Environment Internal Environment Current Provision Changes in the Last Eight years Perception of Stakeholders The Case for Change 11. 12. 13. Benchmarking Areas for Development SWOT Analysis Priority Service Changes 14. 15. 16. 17. 18. Areas for Disinvestment Areas for Investment Trust-wide Plan Resourcing the Strategy Review of IM&T Strategy Links With Other Strategies 19. 20. 21. 22. Relationship with Workforce Strategy Relationship with Estates Strategy Relationship with Clinical service Strategy Relationship with Communications Strategy 58 58 59 60 40 41 42 56 57 32 35 39 7 7 8 9 23 24 25 27 30 5
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Appendices A. B. C. D. IM&T Strategy Implementation Plan Knowledge Management Capability Self Assessment RiO Development: Version 6, Releases 1 and 2 Glossary 61 65 67 68
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1.
Executive Summary
1.1 Building upon the success of the previous IM&T Strategies (2002-2006 and 2006-2010) and this strategy sets out the vision, goals and actions for IM&T to enable the Trust to achieve its business objectives and to meet the requirements of NHS national policy. 1.2 The Trust?s IM&T Strategy has been developed to meet the Trust?s strategic objectives: lmprove the quality of services we deliver, underpinned by the recovery approach Develop and deliver a modern model of service provision within appropriate built environments. Support existing services to thrive and become more competitive and to develop and deliver new services, relationships and business opportunities. Develop the capacity and capability of our workforce to deliver our vision and strategic objectives, while operating efficiently and effectively. Grow and develop mental health knowledge and practice and its application for current and future generations. 1.3 In summary the key areas for investment are: Electronic Care Records (RiO) – Electronic care record with clinical tools providing more effective communication, decision support and better planning of care that enables improvements in patient experience and clinical outcomes. Clinical functionality such as electronic prescribing, pathology/radiology results ordering and reporting. The replacement of RiO as the clinical system during the strategic period. Knowledge Management – Knowledge management aims to ensure knowledge is effectively created and shared around the organisation and used to best effect so that there is an environment where mistakes are not repeated, good practices are not ignored, and people do not feel disconnected or undervalued. Effective Use of Information – The effective use of information and analytical techniques in decision-making at all levels in the organisation enables optimum performance and effective services. Give service users access to information so they can make informed choices about services and treatments. Technology for More Effective Working – Mobile technology to support a mobile workforce. Telecare, self-monitoring, self-assessment, communication and information applications for innovative care packages.
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Information Management & Technology Strategy: 2011 - 2016 ___________________________________________________________________ Streamlined business / clinical processes to enable more effective and efficient working using applications e.g. eLearning, collaborative software and unified communications. The integration of systems for more effective working within the Trust and with partner organisations. IT Infrastructure – A robust IT infrastructure, that is resilient, secure, highly available with optimal capacity. An accredited IM&T service that is responsive, efficient and meets the business objectives of the Trust. 1.5 The IM&T Strategy will enable improvements in clinical excellence, clinical outcomes, patient experience and productivity. The achievement of these benefits will mean a greater reliance on the IM&T service and require Strong leadership in clinical services Changes to working practices Benefits realisation managed in clinical services Greater IT literacy and a significant amount of training
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Information Management & Technology Strategy: 2011 - 2016 ___________________________________________________________________ 2. Background
This document provides an IM&T (Information Management & Technology, also referred to as ICT (Information Communications and Technology)) strategy to enable the Trust to meet its business objectives, and to deliver the requirements of the NHS national policy. This strategy builds upon the success of the Trust?s IM&T Strateg ies and programmes 2002 – 2010.
2.1 Trust Profile 2.1.1 South West London & St George?s Mental Health Trust provides secondary mental health services across five London boroughs – Kingston, Merton, Richmond, Sutton and Wandsworth – together with specialist services where the Trust is a regional or national centre. The Trust is a Teaching Trust, and is working towards Foundation Trust status. 2.1.2 The Trust?s clinical services are managed in a sector structure, headed by a Service Director: Kingston & Richmond; Sutton & Merton; Wandsworth; Specialist services. Services are provided from over 50 sites.
3.
Vision and Values for Trust Services
Vision 3.1 A future in which people with mental health problems have the same opportunity as other citizens to participate in and contribute to our communities. Values 3.2 The most important people in our services are those who use them and their relatives, friends and carers. The most important resources that we have are the staff that provide their care and support. 3.3 In all our actions we will recognise and value the diversity that exists in our services and our local community and strive to ensure equality of access, experience and outcome irrespective of race or ethnicity, disability, age, gender, sexuality or religious belief, or place of residence. 3.4 We will treat everyone with dignity and respect, involve them in decisions that affect them and provide them with whatever information they feel will help them. 3.5 In all that we do we strive for excellence, equity and the efficient use of resources.
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Information Management & Technology Strategy: 2011 - 2016 ___________________________________________________________________ Our Purpose 3.6 The Trust recognises that everyone with mental health problems faces the challenge of retaining or recovering a life that is as meaningful, satisfying and valued as possible. 3.7 The purpose of the Trust is to help people with mental health problems to do the things they want to do, live the lives they want to live and access those opportunities that all citizens should take for granted. 3.8 To achieve this purpose we will work in partnership with those who use our services, their relatives, carers and friends, and other stakeholders to: ? Foster hope in those whom we serve and do our best to ensure that everyone?s experience of using our services is a positive one. ? Provide effective treatment and help people to take back control over their problems and their lives and the help they receive. ? Improve people?s life chances by promoting their health, safety a nd wellbeing and assisting them to access the opportunities that they value: homes, jobs, friends, relationships, education, social pursuits, leisure activities and spiritual possibilities. ? Undertake teaching and research, to enable us to continue to do this work for those who will use our services in the future. ? Cultivate a workforce that is committed to pursuing our vision and purpose and ensure they have the support and development opportunities they need to do so. 4. Development of the Trust’s IM&T Strategy 4.1 The Trust?s IM&T Strategy has been developed to meet the Trust?s strategic objectives: lmprove the quality of services we deliver, underpinned by the recovery approach Develop and deliver a modern model of service provision within appropriate built environments. Support existing services to thrive and become more competitive and to develop and deliver new services, relationships and business opportunities. Develop the capacity and capability of our workforce to deliver our vision and strategic objectives, while operating efficiently and effectively. Grow and develop mental health knowledge and practice and its application for current and future generations. 4.2 Key investment areas were identified from an analysis of the Trust?s business objectives. For each key investment area priorities emerged which informed the development of the high level plan (see Appendix A).
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Information Management & Technology Strategy: 2011 - 2016 ___________________________________________________________________ 4.3 The following table summarises how each key investment area enables the Trust to deliver its Objectives:
IT Infrastructure Effective Use of Information Electronic Care Records Technology for More Effective Working Knowledge Management
Trust Objective
1. Quality of services 2. Modern service provision 3. New and thriving services 4. Developing the workforce 5. Developing mental health knowledge and practice
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5.
Strategic Context
National Strategic Context 5.1 Equity and Excellence: Liberating the NHS (July 2010)
5.1.1 The Collation Government ?s White Paper Equity and Excellence: Liberating the NHS upholds the values and principles of the NHS and sets out a new vision for the NHS. The vision put patients at the heart of the NHS, through an information revolution and greater choice and control: Shared decision-making will become the norm: no decision about me without me. Patients will have access to the information they want, to make choices about their care. They will have increased control over their own care records. Patients will have choice of any provider, choice of consultant-led team, choice of GP practice and choice of treatment. The Government will enable patients to rate hospitals and clinical departments according to the quality of care they receive, and hospitals are to be open about mistakes and always tell patients if something has gone wrong. The system will focus on personalised care that reflects individuals? health and care needs, supports carers and encourages strong joint arrangements and local partnerships.
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Information Management & Technology Strategy: 2011 - 2016 ___________________________________________________________________ Local authorities to champion patient and public views, and at national level, through a new consumer champion, HealthWatch England, located in the Care Quality Commission. Everyone, whatever their need or background, benefits from these arrangements. 5.1.2 The White Paper puts great emphasis on improving healthcare outcomes. The NHS must be focused on outcomes and the quality standards that deliver them. The Government?s objectives are to reduce mortality and morbidity, increase safety, and improve patient experience and outcomes for all. The NHS will be held to account against clinically credible and evidence-based outcome measures, not process targets. 5.1.3 A culture of open information, active responsibility and challenge will ensure that patient safety is put above all else. Quality standards, developed by NICE, will inform the commissioning of all NHS care and payment systems. Inspection will be against essential quality standards. 5.1.4 Money will follow the patient through transparent, comprehensive and stable payment systems across the NHS to promote high quality care, drive efficiency, and support patient choice. Providers will be paid according to their performance. Payment should reflect outcomes, not just activity, and provide an incentive for better quality. 5.1.5 The Government will devolve power and responsibility for commissioning services to the healthcare professionals closest to patients: GPs and their practice teams working in consortia. An independent and accountable NHS Commissioning Board will be established to lead on the achievement of health outcomes, allocate and account for NHS resources, lead on quality improvement and promoting patient involvement and choice. 5.1.6 The NHS will need to achieve unprecedented efficiency gains, with savings reinvested in front-line services, to meet the current financial challenge and the future costs of demographic and technological change. The NHS will release up to £20 billion of efficiency savings by 2014, which will be reinvested to support improvements in quality and outcomes. The Government will reduce NHS management costs by more than 45% over the next four years, freeing up further resources for front-line care.
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5.2
Health & Social Care Bill 2011
5.2.1 The Health and Social Care Bill was introduced into Parliament on 19 January 2011. The Bill is part of the Government?s vision to modernise the NHS. The Bill takes forward the areas of Equity and Excellence: Liberating the NHS (July 2010) and the subsequent Government response Liberating the NHS: legislative framework and next steps (December 2010), which require primary legislation. It also includes provision to strengthen public health services and reform the Department?s arm?s length bodies.
5.3
Quality Innovation, Performance & Prevention (QIPP)
5.3.1 The Government has reaffirmed the need to place quality of care at the heart of the NHS, whilst identifying the need to save on costs and achieve value for money. The Quality, Innovation, Productivity and Prevention (QIPP) programme is all about ensuring that each pound spent is used to bring maximum benefit and quality of care to patients. The NHS needs to achieve up to £20 billion of efficiency savings by 2015 through a focus on quality, innovation, productivity and prevention. Every saving made will be reinvested in patient care by supporting frontline staff, funding innovative treatments and giving patients more choice. 5.3.2 Recommendations in the QIPP report on “ Back office efficiency and management optimisation” include: Organisations should regularly benchmark themselves. All organisations should develop an appropriately structured QIPP programme to deliver benefits ensuring that identified savings are realised. Organisations are encouraged to publish key performance indicators on the performance and efficiency of their back office functions. 5.3.3 The Report stresses that enhanced automation offers provider organisations a cost-effective approach to integrating processes, technology and staff on a standard platform. It minimises paper transactions, facilitates the flow of information and improves data collection, thus increasing efficiencies and eliminating errors. 5.3.4 There are a number of benefits that can be realised through greater use of technology. These include: Improvements in the quality of service experienced by clients; Reduced headcount, with consequent savings freed to support frontline services; A more consistent and uniform approach to business processes through automation of standard process flows; and Rapid turnaround of transactions requiring approval and / or exception handling (workflow).
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5.3.5 Organisations making progress towards automation may also realise unexpected benefits. These benefits arise through enhanced organisational responsiveness and adaptiveness and support more innovation. These benefits are not a direct consequence of automation but secondary effects that flow from enabling the organisation to respond in different ways. 5.3.6 The QIPP Report cites use of the following systems as examples of technology investments to reduce back office overheads. eRostering systems as crucial in meeting the challenge of controlling workforce costs and, particularly, temporary staffing costs. Digital imaging includes scanning and OCR (optical character recognition). This facilitates document movement around an organisation and also in and out of organisations. It also enables electronic storage of documents and supports access to information. The benefits of this are considerable as the traditional model of storage, retrieval and use of hard copy documentation is costly and also carries a risk of misplacing or losing documents. Document scanning and electronic document management systems offer simplification and standardisation of each step of the process. The process offers users quick retrieval of information and enables the organisation to remove administrative staff responsible for delivering and keeping track of where hard-copy data is stored and where it physically is at any given time and who should be able to access it. Efficiency is increased since all areas of electronic document management require a lot less time than any traditional hard-copy document management system would. E-invoicing is typically defined as the electronic delivery of an invoice and other information from an organisation. A proper e-invoice scheme can provide benefits through elimination of printing a paper invoice and putting it in the envelope, the mailing costs of the paper invoice, the opening the invoice letter and archiving the paper invoice; and manual input of the invoice data to the payables / accounting system at the payer. It provides a basis for the reengineering of accounts payable departments with significant savings for organisations. E-HR is „the application of conventional, web and voice technologies to improve HR administration, transactions and process performance?. It involves using technology to provide HR services, such as recording and monitoring systems, automating aspects of recruitment and disseminating information such as HR policies on the intranet. In addition, there may be greater scope to enhance skills through the use of e-learning methods. Sickness absence can be managed more effectively by using e-HR technologies such as electronic monitoring. E-HR can be used to accurately monitor and promote action to support equality and diversity in the workforce. Workflow is a process tool which delivers the right work to the right people at the right time and, in doing so, optimises the processing time within an operation. Workflow solutions manage, distribute and monitor work as it
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Information Management & Technology Strategy: 2011 - 2016 ___________________________________________________________________ progresses through pre-defined business processes and therefore assist with the efficient running of an organisation?s operations. Workflow enables a range of benefits including process visibility – which is essential for tracking progress and improvement. The benefit of workflow technology is that it streamlines and simplifies clinical and business processes, connecting providers directly to the information they need – where, when, and how they need it. By managing care transitions and information gaps between diverse systems, departments and facilities, workflow technology can deliver crucial patient information with speed, efficiency and logic. It bridges the gap between the business and the clinicians.
5.4
National Mental Health Policy
5.4.1 No Health Without Mental Health No health without mental health the cross-Government mental health outcomes strategy for people of all ages was issued in 2011. The Strategy aims at achieving parity of esteem between physical and mental health, and stresses the interconnections between mental health, housing, employment, and the criminal justice system. The strategy has six objectives: (i) More people will have good mental health More people of all ages and backgrounds will have better wellbeing and good mental health. Fewer people will develop mental health problems – by starting well, developing well, working well, living well and ageing well. (ii) More people with mental health problems will recover More people who develop mental health problems will have a good quality of life – greater ability to manage their own lives, stronger social relationships, a greater sense of purpose, the skills they need for living and working, improved chances in education, better employment rates and a suitable and stable place to live. (iii) More people with mental health problems will have good physical health Fewer people with mental health problems will die prematurely, and more people with physical ill health will have better mental health. (iv) More people will have a positive experience of care and support Care and support, wherever it takes place, should offer access to timely, evidence-based interventions and approaches that give people the greatest choice and control over their own lives, in the least restrictive environment, and should ensure that people?s human rights are protected. (v) Fewer people will suffer avoidable harm People receiving care and support should have confidence that the services they use are of the highest quality and at least as safe as any other public service. (vi) Fewer people will experience stigma and discrimination
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Information Management & Technology Strategy: 2011 - 2016 ___________________________________________________________________ Public understanding of mental health will improve and, as a result, negative attitudes and behaviours to people with mental health problems will decrease. The Strategy recognises that information technology and telecommunications have the potential to offer new ways of working with people at risk of, or suffering from, mental health problems. While younger people are often the first to embrace new technologies, such approaches are likely to be equally applicable to adults of any age. Technology can be used to share information about health online, put people in touch with others in similar positions, offer services such as computerised cognitive behavioural therapy and keep people in touch with healthcare professionals – for example, texting reminders of appointments. The use of technology can support innovation, increase choice and make services more accessible – for example, for deaf people – while being more cost effective. Technology can also offer a less stigmatising way of accessing support. Improved use of information technology can promote better and more systematic collection, analysis and use of information across all protected characteristic groups so as to improve delivery and measure outcomes. 5.4.2 Dementia Strategy The aim of the Dementia Strategy is to ensure that significant improvements are made to dementia services across three key areas: improved awareness, earlier diagnosis and intervention, and a higher quality of care. The Strategy identifies 17 key objectives which, when implemented, largely at a local level, should result in significant improvements in the quality of services provided to people with dementia and should promote a greater understanding of the causes and consequences of dementia. 5.4.3 Making Recovery a Reality At its heart “Recovery” is a set of values about a person?s right to build a meaningful life for themselves, with or without the continuing presence of mental health symptoms. Recovery is based on ideas of self-determination and self-management. It emphasises the importance of „hope? in sustaining motivation and supporting expectations of an individually fulfilled life. 5.4.4 Improving Access to Psychological Therapies (IAPT) The IAPT programme aims to provide better access to a choice of evidence-based psychological therapies for people suffering from depression and anxiety disorders. IAPT is concerned with raising standards of recognition and treatment for the many people who suffer from depression and anxiety disorders. The programme is at the heart of the Governm ent?s drive to give greater access to, and choice of, talking therapies to those who would benefit from them. 5.4.5 Improving Access to Child & Adolescent Mental Health Services
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Information Management & Technology Strategy: 2011 - 2016 ___________________________________________________________________ Children and young people in need of more specialised help from child and adolescent mental health services (CAMHS) should have clearly signposted routes to specialist help and timely access to this, with help available during any wait. 5.4.6 Improving Health Supporting Justice Adults and young people who are socially excluded, have a high proportion of health inequalities and are in contact with the criminal justice system are more likely to experience mental health problems or learning disabilities, or to have difficulties with drugs and alcohol. The overarching aim at each stage of the offender journey is to develop the mechanisms that enable the provision of effective mental health care in the most appropriate environment, whether in the criminal justice system or in health settings. The aim is to remove the obstacles to effective cross-agency working and create a far more coherent and integrated system – one which is based on shared responsibility and ownership by those working in it, irrespective of which agency or sector employs them. There is a need to improve the identification of people with a learning disability at every point in the criminal justice system, and at as early a stage as possible, so that appropriate diversion and sentencing options can be applied. The aim is to improve the overall well-being of offenders with learning disabilities in the criminal justice system by aiding early identification, by providing accessible materials, and by assisting front-line professionals to develop skills and a knowledge base to help them manage offenders with learning disabilities more effectively.
5.5 Wanless Report A key conclusion of the Wanless Report, published in January 2002 was “ Without a major advance in the effective use of ICT the health service will find it increasingly difficult to deliver the efficient, high quality service which the public demand. This is a major priority which will have a crucial impact on the health service over future years”. Although the Wanless Report is a decade old this conclusion remains relevant and has informed subsequent national IM&T strategy.
5.6 Information Revolution The Information Revolution is the new national IM&T strategy for the NHS, published in 2011. 5.6.1 Vision The vision of the Information Revolution is that people have the information they need to stay healthy, to take decisions about and exercise more control of their care, and to make the right choices for themselves and their families. This includes an accurate record of their care, available to them electronically. Health and adult social care information will be liberated “from a closed, bureaucratic system” in order to serve patients and the public, and to help drive better care, improving outcomes, innovation and the better use of resources.
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Information Management & Technology Strategy: 2011 - 2016 ___________________________________________________________________ It signals a move from information belonging to the system, to information enabling patients and service users to be in clear control of their care; and for patients and service users merely receiving care, to patients and service users being active participants in their care. Information would be based on the patient or service user consultation and on good clinical and professional practice rather than based on administrative and technical needs. Significantly, in relation to digital technologies there will be a move away from an approach where every organisation is expected to use the same system, to one where systems are connected and joined up. 5.6.2 The Strategy Patient / Service User Control of Records There is evidence to show that giving people greater access to and control over their health records improves relationships with clinicians and provides more involvement; patients are enabled to correct errors and omissions, and increases people?s ability to manage their own health care and their confidence to do so. Patient and service user control of their record does not mean they will be able to remove the original record from the care provider, or alter or delete what a clinician or care professional has entered into their record unless it is incorrect. Comprehensive, professionally-assured record keeping standards will be needed to ensure consistency. The Royal Colleges are working to introduce comprehensive standards for record keeping, principles for shared records and guidance on good practice in giving people access to their own records. All care records will be required to adhere to nationally agreed standards, including use of the NHS Number as the means of identification. Electronic records must meet appropriate standards of safety, security, reliability and resilience. Some key elements for early standardisation of recording would be: • physiological observations; • pathology and diagnostic imaging results; • procedures, including surgery; • medication; • scheduling / disposition (is the patient admitted, discharged, awaiting a clinic appointment, if so, with whom); and • „diagnoses?, such as discharge diagnoses (secondary care) current problems (primary care). For professionals and teams to offer high quality, safe, individualised care, they need access to a single source of information about patients and service users. It should include the decisions made, actions taken, and outcomes achieved. It should be accessible whatever the care setting. Information should be entered at the point of care by patients, service users, clinicians and care professionals.
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Information Management & Technology Strategy: 2011 - 2016 ___________________________________________________________________ Prevention and Self Care There will an increased emphasis on providing information for better prevention, self-care and healthier lives. Information for improved outcomes The Information Revolution introduces a new focus on outcomes. This will include Quality Accounts - an annual report to the public from providers of NHS healthcare about the quality and outcomes of their services. There will be a review of central data collections to ensure that data that is collected meets the requirements of the Information Revolution and time and effort is not taken up with collecting data for outdated purposes. Patient and service user generated information will contribute to the information available on outcomes. This will include information c ollected from staff and patients or service users through surveys, real-time feedback, ratings of services, and Patient Reported Outcome Measures (PROMs). Good commissioning involves using the resources available to secure the highest quality services and best possible care outcomes for a local population. Effective benchmarking against comparable areas will be supported by The NHS Atlas of Variation, to be published shortly. Information for professionals For professionals and teams to offer high quality, safe, individualised care, they need access to a single source of information about patients and service users. Clinicians and care professionals need to be able to access the best evidence (including international evidence) of outcomes, interventions and risks. Clinical audit will be used to compare the effectiveness of different clinical approaches and in identifying areas for quality improvement participation in clinical audit is seen as the “professional norm”. Research is vital in providing the new knowledge needed to improve health and care outcomes and reduce inequalities. Informatics workforce capacity and capability Information management and IT capability will be essential to delivering the Information Revolution. Strong leadership is needed from CEOs and Boards, clinical leaders and leaders of the information and IT professions. A culture within each organisation needs to be created where information is seen as the lifeblood. Information for Accountability The Revolution provides an emphasis on the provision of information to support autonomy, accountability and democratic legitimacy and using information to drive efficiency.
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Information Management & Technology Strategy: 2011 - 2016 ___________________________________________________________________ 5.7 National Programme for IT (NPfIT) The Information Revolution has initiated a move away from an approach where every organisation is expected to use the same system, to one where systems are connected and joined up. Whilst the NPfIT was the implementation approach for previous NHS IM&T strategies some elements will remain to ensure systems are connected and joined up. Systems implemented under the banner of the NHS Care Record Service (CRS) will remain in place until replaced by successor systems. The components of the National Programme for IT delivering connectivity and interoperability are: N3 (National Network for the NHS) NHS Spine Choose & Book Electronic Transfer of Prescriptions (ETP) National applications such as, PACS (Picture Archive and Communication Systems) – digital x-rays Interoperability Toolkit 5.7.1 N3 N3 is the national network for the NHS. N3 has been updated to include QoS (Quality of Service). This enables the prioritisation of different types of traffic on the N3 network, in accordance with business priorities. For example, access to national applications could be given a higher priority than e-mail. Future developments include the routing of voice traffic (telephone calls) and enabling home and remote working via N3.
5.7.2 NHS Spine The main components of the NHS Spine may be summarised as follows: ? PDS (Personal Demographics Service): A national directory of citizens containing basic personal details such as NHS Number, name, address, and date of birth ? SDS (Spine Directory Service): National directories containing details of NHS organisations and basic details of NHS staff such as name, job title, job role, organisation, e-mail address. ? PSIS (Personal Spine Information Service) also known as the Summary Record: Provides an up-to-date summary of information and key events in a patient?s life and care – drug allergies, operations, conditions, medical history – as well as details of contacts with care providers. 5.7.3 Choose & Book Choose & Book is a national application combining electronic booking and a choice of place, date and time for first outpatient appointments. Patients are able to choose their initial hospital appointment, and book it on the spot in the surgery or later on the phone or via the internet at a time that is more convenient to them.
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Information Management & Technology Strategy: 2011 - 2016 ___________________________________________________________________ The development path for Choose & Book to accommodate the requirements of mental health services remains unclear. The implementation of Choose & Book in mental health services is dependent upon clear guidance from the Department of Health, which as yet, is not available. 5.7.4 Electronic Transmission of Prescriptions (ETP) Programme The ETP programme will create and implement the Electronic Prescription Service and then integrate it with the NHS Care Record Service. The Electronic Prescription Service will allow prescriptions (including those for repeat dispensing) generated by GPs and other prescribers to be transferred electronically between prescribers, dispensers and the reimbursement agency (Prescription Pricing Authority). Implementation of ETP into secondary health services is some years away. 5.8 A Vision for Adult Social Care “A Vision for Adult Social Care: Capable Communities and Active Citizens” (2010) sets out the Government?s plans to reforming the s ystem of social care in England. Its aim is to provide much more control to individuals and their carers. The vision centres on prevention; plurality and partnerships; providing protection; productivity and people, and in particular: break down barriers between health and social care funding to incentivise preventative action; extend the greater rollout of personal budgets to give people and their carers more control and purchasing power; and use direct payments to carers and better community-based provision to improve access to respite care. “Transparency in outcomes: a framework for adult social care”, like the “Information Revolution”, places a greater emphasis on measuring outcomes. The main proposals are summarised below. Evidence Base The role of the National Institute for Health and Clinical Excellence (NICE) will be expanded, subject to legislation, to include adult social care from 2012/13. NICE will work through the social care sector to bring together the evidence on best practice and publish Quality Standards from 2012/13. Local government and the social care sector will have a new role in building the evidence base – working jointly to identify areas for Quality Standards. Demonstrate Progress A single Quality and Outcomes Data Set will be introduced to bring together all routine social care data requirements with the aim to reduce the overall reporting burdens placed on councils. There will be no national performance management, no targets nor league tables, and the current annual assessment of councils as commissioners of adult social care will be replaced with a more proportionate, sector-led approach. The Care Quality Commission will continue to inspect services where concerns have been raised. As with health reporting, there will be a
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Information Management & Technology Strategy: 2011 - 2016 ___________________________________________________________________ fundamental review of all data requirements. It is proposed to publish a set of outcome measures, with the benchmarking of results. Support Transparency All agreed social care data and outcome-focused measures will be published in a consistent format and on an annual basis, through a single information portal. Councils will publish a local account on their priorities for quality and outcomes in social care, as a key tool for transparent reporting to their local population. This local role for accounting will replace the Care Quality Commission?s annual assessment of Councils as commissioners (including the former requirement for a Self-Assessment) from 2011/12. Reward & Incentivise The new „excellence? rat ing for social care providers, currently in development, will act as an accredited marker of best practice and high quality and an incentive for providers, as well as an important tool for supporting choice. Secure the Foundations The role of the Care Quality Commission (CQC) will be strengthened and refocused as an effective quality inspectorate. A key challenge for mental health services is the avoidance of duplicate data capture whilst contributing to both electronic records in health and social care and the integration or virtual integration of systems.
Local Strategic Context 5.9 Making Life Better Together Making Life Better Together is the Trust?s strategy for the future of mental health services. The main drivers for the strategic change are: • Tackling health inequalities • Strengthening relationships with communities • Supporting the management of long term conditions • Learning from the other health sectors • Personalisation – healthcare tailored to an individual?s requirements and wishes • Poly-systems: providing mental health care as part of integrated service model The Trust?s utmost priority is to serve its local population through managed care pathways, in conjunction with other providers: statutory and voluntary. The proposed model of care will ensure that everyone will be assessed quickly by an experienced psychiatrist and offered advice, treatment, information and education. This will be underpinned by shared decision making with service users. By the end of the strategic period, the people of South West London will have mental health services that will:
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Information Management & Technology Strategy: 2011 - 2016 ___________________________________________________________________ • Provide Early Expert Assessment ? Supported by senior clinicians from allied professions ? Restoring the quality standards for community practice set in 1990s. Includes telephone consultation GP to consultant, with direct communication between GP and consultant psychiatrist ? Aims to reach common agreement on treatment plan between primary care and secondary care and patient ? Early Expert Assessment service will constitute the „point of entry? to the secondary care services ? Managerially integrated with community teams Provide NICE compliant interventions in clinic settings (ref: QIPP) Safeguard vulnerable people from harm and encourage managed risk-taking and harm minimisation Provide a personalised approach with shared decision making. Service users will benefit from well-defined responses to their individual care needs (ref: QIPP) and have choices with reference to purchasing services from their personal budget Embed the recovery approach in all that we do, enabling our service users to regain their lives.
• • •
•
5.9.1 Provide Community Services • The Trust?s Recovery College is at the centre of the Trust?s intention to help people (and their families) understand and manage their conditions and support people to gain more control over their lives • The Trust will work closely with primary care to ensure that individuals are assessed and treated as early as possible, as evidence suggests that outcomes are improved • The Trust will offer evidence based treatment packages in community clinic settings to enable us to treat high numbers of patients rapidly and return them to primary care, for example: • Neuro-developmental clinics • Dementia • Side effect monitoring • Prescribing • Physical health checks • Family work • The Trust aims to support navigation of the whole mental health system (e.g. through Personal Budgets) to ensure that patients and their families/carers can access all relevant health and social care services, including children?s services. This supports choice and personalised care. • Ongoing support will be offered in the recovery / support teams, with professional input from psychiatrists and nurses, clinical interventions, often in clinic settings as well as courses at the Recovery College. Day to day support will be offered by Trust trained peer support workers
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Information Management & Technology Strategy: 2011 - 2016 ___________________________________________________________________ 5.9.2 Provide Intensive Support • Crisis and home treatment teams • Provide Liaison psychiatry in acute hospitals • Provide the following Trust Inpatient services on a Trust –wide basis rather than borough: ? Acute ? Rehab ? PICU ? Step down ? P.D. Services ? A.L.D. Services ? CAMHS ? Older People ? Specialist Services
5.10 Foundation Trust status The attainment of foundation trust status requires trusts to take a business-type approach that focuses on corporate and financial risk management and value for money. The organisation also has a more integrated approach to its strategic planning. As a consequence having the right information about services provided is crucial. Detailed information is required to target cost savings, to negotiate contracts and match cost to income flows as far as is possible. Trust boards need to take a strategic view, planning and designing services required over future years.
5.11 New Commissioning Arrangements Relationships with GP practices will be increasingly important as the new commissioning arrangements are brought into place following the enactment of the Health and Social Care Bill 2011. Trusts need to have the knowledge at practice level about which services are needed. As the health service moves away from being provider driven, mental health trust boards need to assess the competition for providing services, particularly specialised services, and identify potential new entrants to the market.
5.12 Patient choice In future, patients will increasingly be able to make choices about their care, such as assessment and treatment options, as well as providers. Mental health trusts need to be flexible and adaptive in their provision of services to ensure that they reflect patient demand and patients have a positive experience. Trusts also need to ensure that patients and carers receive accurate and appropriate information, so that they can make informed choices about these services.
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Information Management & Technology Strategy: 2011 - 2016 ___________________________________________________________________ 8 5.13 Mental Health Act The 2007 Mental Health Act amended the 1983 Mental Health Act and the 2005 Mental Capacity Act. The main changes included the introduction of supervised treatment in the community and broadening the range of professionals who have roles in the Mental Health Act, as well as the need to make assessments of a person?s mental capacity.
5.14 Operating challenges There are a number of challenges faced by mental health trusts. These include: ? the increasing emphasis on treatment in community settings; ? potential changes in the funding and commissioning of mental health services through Payment by Results and Practice Based Commissioning ? meeting the mental health needs of particular groups, such as those involved with the criminal justice system (including the prison and youth offender institution population), people with learning disabilities and older people, children and young people; ? partnership working with other agencies, such as primary care, adults? and children?s services, the criminal justice system, housing and education and the voluntary sector; ? working with GPs to reduce inappropriate referrals to specialist mental health services; ? providing high quality services to ensure that they reflect patient demand as patient choice develops, whilst ensuring equality in services, particularly for people from black and minority ethnic groups; ? the change in definition and caseload of dual diagnosis. Particular challenges include collaboration between community drug and alcohol teams and mental health teams, liaison with housing departments and training for staff in treating substance misuse and dual diagnosis; ? promoting and enabling social inclusion and challenging the stigmatisation and discrimination through employment projects and engaging community participation; and ? the introduction of service-line reporting as part of the financial management regime. Mental health trusts require information to assess and monitor progress in meeting these challenges.
6.
Local Environment
6.1 In London, electronic care record systems (formerly known as the Care Records Service) are provided by BT through a contract with the Department of Health. RiO is the electronic care record system provided for mental health
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Information Management & Technology Strategy: 2011 - 2016 ___________________________________________________________________ services. The London Programme for IT (LPfIT) manages the contract on behalf of the Department and supports the development and operation of RiO. 6.2 A governance structure is in place to support RiO and London-wide developments. For mental health services, the Mental Health Programme Board oversees all developments. It is chaired by Judy Wilson, Chief Executive of SW London & St George?s Mental Health Trust. The Trust has two representatives on the London RiO User Group. The Trust?s Director of IM&T chairs the Directors of ICT (Mental Health) Forum which provides IM&T professional advice to the London Programme on IM&T issues affecting mental health services. 6.3 Locally, a 5 Borough (local authority) – Trust ICT Forum meets on a regular basis, in particular to work on issues affecting integrated health and social care services, but also to act as a forum for sharing good practice and experience. The Forum also assists in maintaining good working relationships between the IM&T departments of the six organisations. 6.4 Directors of IM&T from the London Mental Health Trusts meet periodically to discuss and work on issues of mutual interest. A forum of the London Directors of IM&T for all NHS organisations meets quarterly.
7.
Internal Environment
7.1 IM&T in the Trust is managed within a single department (with the exception of Information Governance which is managed by the Governance Directorate). The IM&T Strategy Group is responsible for setting strategic direction, overseeing the implementation of the strategy and acts as the Programme Board for the IM&T Programme. New capacity, capability and other benefits are delivered through a set of projects, all managed within the IM&T Programme. 7.2 PRINCE2 project management methodology is used to manage all IM&T projects. The IM&T Programme is managed using the MSP (Managing Successful Programmes) methodology. 7.3 Clinical and business engagement in the IM&T agenda is achieved through: Senior clinicians and senior management on the IM&T Strategy Group The Operational Management Group (chaired by the Chief Operating Officer) acts as the Management Board for the Trust?s IT Service Level Agreement. Senior clinicians and mangers on IM&T project boards Clinicians and clinical managers in IM&T project teams Clinical Leads working in the IM&T Department Presentations to manager and clinician forums IM&T briefing presentation on the Trust induction programme
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8.
Current Provision
8.1 Current Systems The Trust?s current main business and clinical systems are summarised in the table below.
System RiO Function Electronic care record Notes National Programme Care Record Service solution for mental health services in London. Locally hosted
IAPTus
Electronic Staff Record eFinancials Data Warehouse / “The Pulse” JAC IAT; Care First; Framework-I; PARIS; Framework
Electronic care record for the psychological therapies in primary care service National application for human resources and payroll General Ledger, Accounting system Data warehousing and executive information system Pharmacy stock control Social care referrals, social care purchasing, care planning for the London Boroughs of Kingston, Merton, Richmond, Sutton and Wandsworth. Corporate Reporting tool
National NHS system.
Data sets in the Data Warehouse include clinical, finance and workforce Local authority social care systems used by integrated Mental Health Teams.
Performance Accelerator Roster Pro At Learning
Electronic Rostering system . Learning management system to record training information
8.2 IM&T Staffing The IM&T department is based at Springfield University Hospital. The Director of IM&T reports to the Director of Finance. 8.2.1 IT The IT function is managed by the IT Systems Manager providing networking, telephony, application support, technical support, hardware maintenance, helpdesk support, and IT security services to all the Trust sites. The IT staffing levels benchmark well, that is, they are relatively low for the number of users supported.
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8.2.2 IM&T Training IM&T training is provided for basic IT skills, RiO, Word (basic and intermediate), Excel (basic and intermediate), Internet and web browsing, e-mail, the data warehouse, and to support other system upgrades. The IM&T training resource is augmented with contractors at the time of increased demand for training, for example, for new system implementations and upgrades. 8.2.3 Information Management Information Management function provides / supports information analytical tools and a business intelligence and data analysis service. It also provides a clinical coding function, data quality back office and undertakes the development and implementation of information management policy. 8.2.4 Library services Library services are managed by neighbouring trusts. St Georges Medical School library services at St George?s Hospital are available to SW London & St George?s staff. There are also staffed library facilities at Springfield Hospital (3 days per week), and Sutton Hospital (2 days per week). There is also a small library in the Shaftesbury Clinic (Springfield Hospital site). Librarian support is available via email, when libraries are not staffed. 8.2.5 Staffing Levels The staffing levels in IM&T are summarised in the following table. Staffing levels were increased to provide additional support for RiO during and post implementation. Permanent posts are supplemented by contractors and fixed term appointments to provide project resource. Cost improvement savings in the next few years will require the IM&T staffing levels to fall substantially. The tension between the need for cost savings and the need to invest in technology, the demands for higher availability and capacity management of systems (as downtime will not be tolerable) is going to be a challenge. IM&T Establishment.
2007/08 IM&T Function
IT Service Desk IT Systems Admin IT Technical Support IT Network Admin Telecoms & Cabling IT Service Manager Information Analysis Coding & Data Quality IM&T Training Project Management Change Management Clinical Leads
Estab Posts (wte) Temp. Posts (wte)
2008/09
Estab Posts (wte) Temp. Posts (wte)
2009/10
Estab Posts (wte) Temp. Posts (wte)
2010/11
Estab Posts (wte) Temp. Posts (wte)
2011/12
Estab Posts (wte) Temp. Posts (wte)
4.00 5.00 11.00 2.00 6.00 1.00 5.00 4.30 4.00 1.60
1.00 1.00 1.00 2.00 5.00 8.00 5.00 1.00 2.70
6.00 4.00 10.00 4.00 6.00 1.00 5.00 4.30 4.00 1.60 0.90
1.00
1.00 5.00 1.00
7.00 4.00 10.00 4.00 6.00 1.00 5.00 3.25 5.00 1.60
1.00 1.00
3.00 1.00 0.90
6.00 4.00 9.50 4.00 5.50 1.00 5.00 3.25 5.00 4.60 1.00 0.90
1.00
6.00 4.00 7.50 4.00 3.50 1.00 5.00 3.00 4.00 4.60 1.00 0.90
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2007/08 IM&T Function
Information Governance Director of IM&T PA to Dir. of IM&T Librarian TOTALS
Estab Posts (wte) Temp. Posts (wte)
2008/09
Estab Posts (wte) Temp. Posts (wte)
2009/10
Estab Posts (wte) Temp. Posts (wte)
2010/11
Estab Posts (wte) Temp. Posts (wte)
2011/12
Estab Posts (wte) Temp. Posts (wte)
1.00 1.00 1.00 1.00 47.90
26.70
1.00 1.00 1.00 1.00 50.80
8.00
2.00 1.00 0.80 1.00 51.65
6.90
2.00 1.00 0.80 1.00 54.55
1.00
2.00 1.00 0.80 1.00 49.30
9.
Changes in the Last Eight Years
9.1 The Trust?s previous IM&T Strateg ies each set out a series of strategic goals. During that period the national strategic context changed substantially, for example the IMHER (Integrated Mental Health Electronic Record) became the Care Record Service (CRS) and the timescales shifted. However, the Trust was able to achieve most of what the Strategy set out to deliver. 9.2 The main achievements of the period 2002 - 2010 are summarised in the table below.
Key Action Implement eCPA (electronic Care Programme Approach). Implement IMHER (Integrated Mental Health Electronic Record) – later updated to CRS (the Care Record Service), i.e. electronic care records for all service users. Improve NHS Number coverage Implement single Patient Master Index Progress Made eCPA system developed and implemented in 2003. Electronic care record system (RiO) implemented in 2006/07. IAPTus went live in 2009/10 for primary care psychological therapies. Coverage of NHS Numbers for current and recent patients increased to 97%. Achieved for all services with the exception of CAMHS. In 2002 Kingston and Richmond services were still using Kingston Hospital PAS and Kingston PCT?s TCS community system. In 2003 all services were using CMIS, with the exception of CAMHS which used MAISY. Electronic care record system (RiO) implemented in 2006/07 enable a single Patient Master Index. RiO v5 implemented in 2010 provide a link to the NHS Spine directories enabling demographic data to be kept up-to-date. New web site went live in 2005. Review took place in 2005. All IT equipment has been tagged. A new asset register has been created. New processes and procedures implemented in 2010. The IM&T Service Desk system is now used to manage assets. Data Accreditation as a national initiative
Develop the Trust web site. Review patient leaflets. Update IT hardware and software inventories.
Gain Data Accreditation for the quality of
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Key Action data processes. Progress Made was replaced by the Information Governance Toolkit. The Trust achieved 97% compliance by March 2007, and has since maintained an acceptable level of compliance. Policies and procedures developed to BS7799 standard. ITIL version 2 (the IT service standard) implemented in 2006 and 2007. Policy defined and approved in 2005/06. Achieved in 2002, and sustained. Achieved in 2003, and sustained. Achieved in 2003. N3 (National NHS Network) replaced Trust WAN links in 2005. New Service Desk system implemented. Staffing Levels increased from 1.0 w.t.e. (in 2002) to 4.0 w.t.e. (2006), 6.0 w.t.e. (2010). IM&T Service Desk processes redefined using ITIL (IT Infrastructure Library). IM&T Service Desk awarded national accreditation annually since 2007. Review undertaken. Implementation of VoIP (Voice over Internet Protocol), which is now available on most sites. Electronic Staff Record (ESR) went live in May 2007. Active Directory implemented in 2003/04. Interface to ESR installed to provide automatic update of staff starters and leavers (2009). ESR data quality to be addressed. Implemented according to national timetable. Local PIs developed and reported against. Performance analysis available via The Pulse and updated daily (since 2006). Some dashboards in place; development programme in place. Information Sharing Agreements now in place. Staffing levels increased in 2006, and sustained. Data Warehouse procured in 2006. Performance analysis available via The Pulse and updated daily (since 2006). The system has 200+ registered users. Some
Implement the information security standard BS7799.
Devise records management policy Complete “Clinician Connect” – ensuring that all clinicians have access to a computer. Complete “NHS Connect” – ensuring that all staff have access to a computer. IT & networking rationalisation – ensuring all Trust sites are connected to the Trust?s WAN (Wide Area Network). Review IT Helpdesk support
Review of infrastructure including telecoms Implement National HR/Payroll system Review provision of internal staff directory
Implement the Mental Health Minimum Data Set Devise local Performance Indicators
Develop information sharing with partner organisations Increase analytical capacity Develop the reporting and information analysis service to managers, clinicians and researchers.
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Key Action Progress Made dashboards in place; development programme in place. The level of IT literacy has increased. All clinical staff now use electronic records. However, this needs to increase further to in order to realise the full benefits of electronic working. Comprehensive training programmes for clinical systems and non-clinical systems in place. High levels achieved: 97% of clinical staff trained before RiO v5 went live (2010). All staff now have objectives and personal development plans. All mobile staff (800+ clinicians working in the community) now have mobile access to electronic care records, e-mail etc via a laptop with a mobile connection. A modern industry standard data storage solution is in place with a disaster recovery centre. Virtualisation to follow. The core data network was upgraded to distributed network (2008). Compression software has been deployed to increase capacity and performance of the data network. QoS (Quality of Service) is being introduced to prioritise network traffic. Wireless networks (WiFi) have been installed on some sites. PCs for patient use have been made available on many inpatient wards. Text messaging has been piloted and now being rolled out. IT industry specification adopted. New data centres to industry best-practice standards (including Disaster Recovery site). IM&T Dept used to be based in two different locations on the Springfield Hospital site. Now co-located this had enabled improved communications and the streamlining of processes. The range of data sets in the Trust?s data warehouse have been extended to include population data, finance data and workforce data. The Trust has invested in GIS (Geographical Information System) software to enable geographical analysis of data to be presented as maps. The ordering of goods and services is now an electronic process via an eProcurement
Improve basic IT skills
Training for clinical systems
Develop IM&T staff Support a mobile workforce
Upgrade data storage
Modern optimised Network
Computing for patients
Modern data centres
Co-locate IM&T staff
Extend range of information analysis
Automate business processes
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Key Action Progress Made system, saving time and money. An eRostering system went live in 2009 enabling the better scheduling of nursing shifts on the ward replacing a paper process. A business case for collaborative software has been approved. Interim arrangements have been put in place to enable clinicians to access pathology reports on-line. A programme to scan old paper medical records and create an electronic archive is underway. All records at Tolworth Hospital were scanned in 2009.
Results reporting
EDM
This strategy builds upon the achievements of previous IM&T Strategy and enables the Trust to move forward.
10.
Perception of Stakeholders
10.1 Service Users Service users requested access to computing and patient surveys highlighted the need to provide meaningful activities during inpatient stays. To this end computers for service users were rolled out across the Trust following a feasibility study that was completed in 2006. . Access to the internet and computing helps service users with rehabilitation and employment prospects. Text messaging and video conferencing have been introduced to provide different means of communication. During the next strategic period the Trust plans to invest in technologies and applications to further service user and carer engagement and support self care and recovery. 10.2 Trust Staff Clinicians and admin staff in clinical services now use RiO as the main (electronic) clinical record. The move to an electronic clinical record has involved a considerable change in working practices. The implementation of RiO has been supported by a programme of change management. However, it is a continual process to ensure that RiO fits well with new and emerging models of care. Some clinical processes may need to further adapt further to take full advantage of electronic functionality. Later versions of RiO will address some of these issues and in the meantime workarounds are being used. Since RiO was implemented, at times the level of system availability and the performance of the RiO system fell well below that needed for a clinical record system. This poor performance adversely affected staff confidence in the system. The Trust has been working with the London Programme for IT and BT to improve system availability and performance, and will continue to do so.
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10.3 Commissioners The PCTs as commissioners of mental health services are provided with information of activity and quality indicators. The implementation of RiO and the Data Warehouse has enabled the Trust to expand the range of information available. With the forthcoming developments in commissioning – the introduction of Payment by Results and new commissioning currencies; the establishment of GP commissioning consortia – the Trust is well placed to meet these challenging demands in terms of rich data sources and its data warehouse. However, there will be a need to develop analysis, reporting and data presentation to meet these demands. It may be necessary to increase the data analytical capacity, at least for a short period.
10.4 Local Authorities RiO as a health and social care record supports integrated Community Mental Health Teams. The Trust is currently working with local partner boroughs to reduce duplicate data capture by using the RAP reporting extract. Further developments on data capture, information systems and technology will support true integrated working between health and social services. Local organisations are committed to the same vision and are working together to meet the challenge. 10.5 Other providers The development of electronic care records in London will enable the integration of care information and access across care settings and the development of messaging to support processes such as referral and discharge. Electronic messaging such as pathology and radiology requests and reports which are embedded into RiO will be implemented during the strategic period. The Trust will work with the local Acute Trusts to take advantage of these and other developments. 10.6 London Programme for IT / Connecting for Health The Trust has been committed to the National Programme for IT and the London Programme, as demonstrated by being the first Mental Health Trust to implement RiO in London. In seeing the opportunities that the Programmes bring, the Trust has participated in its development; Trust clinicians have contributed to the development workshops for RiO. The Trust has volunteered to assist in national developments such as the Common User Interface and the IT Infrastructure Maturity Model. 10.7 The Trust plans to join other mental health trusts to form a consortium to procure a replacement system for RiO. 10.8 The Trust was a runner-up in the Health Informatics Accolades Scheme in 2007 for its implementation of RiO.
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Information Management & Technology Strategy: 2011 - 2016 ___________________________________________________________________ 10.9 The Trust?s IM&T Service Desk has been accredited to national standards by NHS Connecting for Health – the first mental trust nationally and the second trust in London to be accredited. The accreditation has been awarded for three consecutive years.
The Case for Change 11. Benchmarking
11.1 Health Informatics Service Benchmarking Club (HIBC) The Trust is a member of the national HIBC. The Club run a service benchmarking, the 2010 results for the Trust are shown below. Twenty health informatics services took part in the benchmarking
Trust Score 100% 100% 97% 96% 95% 92% 88% 87% 87% 86% 84% 83% 83% 75% 72% 67% 66% 64% 63% 63% 56% N/A N/A Range of Scores 63% - 100% 32% - 100% 50% - 100% 50% - 100% 57% -100% 68% - 100% 74% - 100% 23% - 100% 29% - 100% 71% 95% 65% - 100% 33% - 91% 66% - 100% 60% - 95% 52% - 96% 60% - 87% 33% - 100% 37% - 100% 33% - 100% 43%- 100% 40% - 76% 44% - 100% 65% -100%
Workforce Development User Support Service Desk Information Analysis Services Information Services Governance Robust Business Processes Advisory Services Development & Improvement Planning IM&T Training Project Management Efficient Use of Resources Network Management Telecoms IT Security Policy Development Planning Advice Programme Management Support Specialist Info & Knowledge Management IT System Operations, Service Support & Delivery Customer Focus & Engagement Long Term Resource Framework Benefits Realisation & Change Management Effective Leadership Application Design & Development Information Governance
11.2
IM&T Spend
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Information Management & Technology Strategy: 2011 - 2016 ___________________________________________________________________ NHS Connecting for Health collects information from each Trust on annual investment (spend) on IM&T. In 2005/06 the actual spend placed the Trust 29th out of 48 Mental Health Trusts in England in terms of percentage of turnover spent on IM&T (1.48% in a range of 0.57% - 4.14%). The average for the NHS in London (all provider types) is 2.2%. It has been difficult to obtain data on subsequent returns to make a more recent comparison. 11.3 Data Quality All Mental Health Trusts are required to collect a nationally agreed data set for all episodes of mental health care – the Mental Health Minimum Data Set (MHMDS). These data sets are submitted to the Department of Health (a national reporting requirement), from which a set of data quality benchmarks are produced.
% Valid % Valid Position * th 98.03% All “Core” Data Items 84.16921% 16 th 99.87% Commissioner Code 99.50581% 60 th 99.37% NHS Number 98.16926% 36 th 97.51% Registered GP Practice 94.35615% 77 th 99.99% Gender 99.97754% 48 rd 94% Marital Status 67.54647% 53 th 99.79% Birth Date 99.77537% 54 th n/a Ethnic Category 86.61201% 18 th 99% Postcode 99.32611% 48 n/a CPA Level 78.53734% 13th 97.26% Occupation (CPA Care Co-ordinator) 83.19200% 10th 51.63% HoNOS (Most Recent) 0% 40th = 55.31% Settled Accommodation Indicator n/a n/a 51.73% Employment Status n/a n/a * 85 Trusts submitted MH Minimum Data Sets (data volumes vary considerably). n/a = not available. Data Item 2008 2010 Position 3rd 26th n/a st 61 th 47 19th 50th n/a 59th n/a 4th 3rd 4th 4th
A validity level of 95% for any one data item can be considered to be good and 98% very good. The Trust has generally good data recording levels on the “core” data items of the MHMDS but has to address the quality of data recording in particular in respect of diagnosis and clinical outcome. 11.4 Knowledge Management – Self Assessment A self-assessment of Knowledge Management (KM) capability was undertaken by the IM&T Strategy Group to inform the development of this strategy using the KM assessment tool developed by Knowledgeable Ltd. See Appendix B for more details.
Dimension KM Strategy Leadership Behaviours Current Level Level 1 Level 2 Two Highest Priority Targets Level 5
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Networking Learning Before During & After Capturing Knowledge Level 3 Level 2 Level 2
Level 4
11.5 Information Governance Toolkit In the NHS an Information Governance Toolkit (IGT) has been developed. The IGT also provides a measure of an NHS organisation?s compliance to information governance standards. The IGT is updated annually, and is currently divided into six initiatives: Information Governance Management; Confidentiality & Data Protection Assurance; Clinical Information Assurance; Secondary Use Assurance; Corporate Information Assurance; and Information Security Assurance. The Trust?s compliance to the requirements of the Information Governance Toolkit is as follows:
Version 4 Mar 2007 91% 96% 66% 92% 84% 86% 88% % Compliance Version 5 Version 6 Mar 2008 Mar 2009 90% 85% 96% 86% 66% 66% 92% 77% 85% 80% 86% 86% 88% 81% Version 7 Mar 2010 87% 86% 75% 86% 80% 87% 84%
Initiative Clinical Information Assurance Confidentiality & Data Protection Assurance Corporate Information Assurance Information Governance Management Information Security Assurance Secondary Use Assurance Overall Score
In 2007 South West London and St George?s Mental Health Trust achieved the highest IGT score in London for Mental Health Trusts, the second highest IGT score in England for Mental Health Trusts and the third highest overall IGT score in England. In 2009, additional requirements and changes in Information Governance Managers with the post being vacant for sometime led to the IGT score being reduced.
11.6 NHS IT Infrastructure Maturity Model (NIMM) NHS Connecting for Health (CfH) has developed an IT Infrastructure Maturity Model for Trusts to self-assess the level of maturity of their IT services. The Model has five levels of maturity: Level 1: Basic Level 2: Controlled Level 3: Standardised Level 4: Optimised
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An assessment has been undertaken and appears in the table below. Infrastructure Technology Average Highest Lowest Patterns & Practices End User Devices Common Applications & Services Operating Systems Infrastructure Hardware Platforms Network Devices & Services IT Security & Information Governance 3.9 3.3 3.2 3.0 4.1 4.2 3.6 4.1 3.5 5.0 4.4 5.0 4.7 4.6 3.5 3.1 1.6 1.4 3.0 3.6 1.6
3.6 5.0 1.4
Infrastructure Management
Infrastructure Governance Business Alignment Procurement People & Skills Financial Management PSPG Average Highest 3.7 3.6 3.2 4.3 3.5 3.1 4.0 4.1 3.3 4.4 4.4 3.5 Lowest 3.3 3.0 3.1 4.2 3.0 2.5
3.5 4.4 2.5
12. Areas for Development A set of vision statements were developed with reference to the Trust?s strateg ic objectives and corporate priorities to describe the future Trust enabled by technology where information and knowledge are use to best effect. These vision statements enabled the identification of five key investment areas and the high level implementation plan. The following table shows how the vision statements relate to each Trust objective.
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Trust Strategic Objective Developing the Workforce Developing Knowledge & Practice Quality of Services Modern Service Provision
Vision Statement
A framework where tools are in place that enables learning before, during and after Accessibility to systems is via a single portal and there is a common user interface in the NHS, that is, systems have the same look and feel wherever they exist and are accessed in the NHS. Business and clinical processes are automated and/or supported by technology to improve efficiency and effectiveness to enable the patient experience, clinical outcomes, cost effectiveness to be of the highest possible standard. This could include mobile devices, teleworking and wireless communications. Business processes (for example procurement, recruitment) are automated and use information to enable efficiency and effectiveness. Clinical information is held in a single electronic record, collected in real time and fully supports the patient’s journey. Patient information is shared on a need-to-know basis. Communities of practice / interest networks act as guardians of the knowledge. There are clearly defined roles and responsibilities in respect of acquiring and sharing knowledge. Communities of practice / interest networks have a clear purpose, some have clear deliverables; others develop capability in the organisation, and meet at least annually. Comprehensive risk management is in place. Confidential person-identifiable information is shared only on a need-to-know basis and with informed consent. Contingency arrangements are in place and regularly tested to mitigate against any disaster or critical incident such as loss of power or loss of service. Data is kept securely, where its integrity is protected. Data protection and confidentiality is enabled and supported by suitably skilled IM&T professionals. Appropriate levels of investment are made in both technology and people. There is planned growth in capacity and developments are project managed within a development programme.
?
New & Thriving Services
? ? ?
? ? ? ? ? ? ? ? ? ? ? ?
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Trust Strategic Objective Developing the Workforce Developing Knowledge & Practice Quality of Services Modern Service Provision
Vision Statement
Data, information and knowledge are regarded as vital assets to the Trust. Data, information and knowledge assets are kept up-todate, comply with all relevant standards and legislation. Disparate data and systems are brought together where possible to support an information and knowledge based environment. Information analytical processes are automated. Information and knowledge are used to best effect to make informed decisions. Where possible, data for research is a bi-product of everyday data collection. Information is used at every level to monitor performance – patient care level, operational level and strategic level. These business requirements are readily understood within the organisation and the workforce is equipped with the tools and the know how to monitor performance and continuous development and improvement. Information and knowledge shared across organisational boundaries is an enabler to partnership working. Information technology enables “intelligent buildings” where clinical and working environments are controlled and protected to best effect with technology. Systems are integrated where possible taking advantage of a common infrastructure. Information technology is used to best effect in the organisation, where IT is seen as an investment rather than an overhead. Investment ensures future-proofing, taking advantage of new developments and evolving technology where it is proven, reducing costs where possible. There is a culture where it is possible to pilot, experiment and it is allowable to make mistakes in order to test new technologies and their use. The future organisation will rely on technology. Knowledge is easy to get to, easy to retrieve and relevant knowledge is pushed to you. Knowledge is constantly refreshed and distilled. Medical technology is integrated with information technology where appropriate to allow medical data to be entered into the electronic care record. Patients have access to their own records, and to relevant understandable information and knowledge sources (clinical & service) avoiding information overload. Profiling and end-user recognition uses a secure solution (e.g. biometrics) and enables single log-on access to all systems appropriate to job role.
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Information Management & Technology Strategy: 2011 - 2016 ___________________________________________________________________
Trust Strategic Objective Developing the Workforce Developing Knowledge & Practice Quality of Services Modern Service Provision
Vision Statement
Prompts for learning built into business processes, and people routinely find out who knows what they want to know and can talk with them. A common language, templates and guidelines lead to effective knowledge sharing. Remote and mobile working and new ways of working are enabled by technology (for example virtual offices, “hot desking”). The Trust’s mobile workforce is better supported by technology. Senior management in the Trust recognise the link between knowledge and performance. The culture of the Trust enables the right attitudes to exist to share and use others’ know-how, a behaviour that is reinforced by leaders within the trust who act as role models. Standardisation of technology is used to enable the optimum interoperability of systems whilst meeting personspecific requirements (e.g. meeting the needs of disability). Systems are reliable and secure. Technology is used to support new ways of working and innovative service delivery models. This could include: telemedicine, telepsychiatry, remote support to patients, self monitoring, monitoring of medication compliance, the electronic tagging of patients and/or equipment, messaging and reminder systems, e-learning. The analysis of data is not restricted to patient-based data. Data from different sources are brought together where relevant to support information analysis. Data sources might include those related to patient care, financial, workforce, estates and facilities, general population and morbidity. The availability of data, information and knowledge assets is ensured to the highest achievable level with the best possible security, protection and disaster recovery in place. The information and knowledge based environment is enabled and supported by suitably skilled IM&T professionals. The technology-enabled Trust is supported by suitably skilled IM&T professionals. Appropriate levels of investment are made in both technology and people. There is planned growth in capacity and developments are project managed within a development programme. The Trust takes advantage of new and emerging technologies and security models to best protect data and confidentiality, for example, encryption and network security. The Trust will work to NHS national standards and industry best practice in respect of information governance.
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Information Management & Technology Strategy: 2011 - 2016 ___________________________________________________________________
Trust Strategic Objective Developing the Workforce Developing Knowledge & Practice Quality of Services Modern Service Provision
Vision Statement
The Trust’s workforce is fully aware of its information governance responsibilities and acts in accordance to all Trust policies and procedures. The Trust’s Workforce Strategy is supported by developments in information technology. The workforce of the Trust is enabled to use and take advantage of technology to the best effect. Person specifications and job descriptions are up-to-date to reflect the need for staff to be computer literate. There are clearly identified Intellectual assets and a Knowledge Management (KM) strategy is embedded in the Trust’s business strategy. There is clinical involvement in all information, knowledge, and technological developments affecting clinical. There is role-based access in place to sensitive or confidential data/information. The NHS Spine and local workforce policies and procedures ensure the control of this access. Those in receipt of information and data have confidence in its quality and relevance. Processes, procedures and systems are in place to ensure data is fit-for-purpose. Trust staff are sufficiently skilled to use and interpret information and knowledge sources.
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13. SWOT Analysis A SWOT (Strengths, Weakness, Opportunities and Threats) analysis of information management and IT in the Trust was undertaken to inform the development of this strategy.
Strengths
? ? ? ? ? ? ? ? Good technical environment Sound project management Robust and resilient IT infrastructure Skilled and motivated IM&T staff Clear vision Very experienced in implementation of new systems and medium - large projects. Flexible approach Robust approach to information governance
Weaknesses
? ? ? ? ? ? ? ? Vision not widely owned Communications are weak across the Trust (difficult to get key messages to all staff) Duplicate data collection for social care Clinical coding Knowledge Management Use of information in decision making could be stronger Many sites to support Dependence upon the IT departments of
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? ? ? ? ? ? ? ? Most staff have been trained to use computers Accredited IM&T service desk IT internal process to ITIL standard IM&T governance Exec director ownership Mobile workforce supported by mobile technology Hand-over of project deliverables into operational environment Internal IM&T Service Level Agreement other organisation where sites are shared or not owned by the Trust Benefit realisation could be stronger Inflexibility of business critical systems Support provided for electronic care system by third party suppliers could be more robust Engagement with the business could be stronger Promoting application of IM&T services Locating mobile staff and mobile technology High power consumption technologies
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Opportunities
? ? ? ? ? ? ? ? ? ? ? ? New technology New and improved ways of working by using new technologies Wireless networking The Trust?s Data Warehouse system offers an opportunity to exploit information resources RiO development in London Knowledge Management tools and techniques Build upon infrastructure Link IM&T training with main stream training Closer integration with social care Internal IM&T skills Local changes within the NHS Green IT
Threats
? ? ? ? ? ? ? ? ? ? ? ? Too many IM&T projects at any one time High expectation Recruitment and retention Loss of tacit knowledge, reliant on experts Outsourcing of IT service leading to loss of control and loss of knowledge Off-shoring of support for national applications Externally hosted systems = loss of control and possible misfit with Trust goals and priorities. Lack of funding (Trust) Lack of funding in partner organisations which the Trust depend upon Local changes within the NHS Reduction in funding undermines IM&T service provision Loss of national enterprise agreements for software licences
Priority Service Changes 14. Areas for Disinvestment
14.1 The move to electronic clinical records signals a move from the reliance of the paper medical record. During the strategic period there will be the scanning of the medical records archive, a substantial reduction in paper records and a consequent reduction in staffing.
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Information Management & Technology Strategy: 2011 - 2016 ___________________________________________________________________ 14.2 The Trust has many paper-driven processes: clinical and business. these processes are computerised administrative overheads are reduced. As
15.
Areas for Investment
In summary the key areas for investment are: Electronic Care Records (RiO) – Electronic care record with clinical tools providing more effective communication, decision support and better planning of care that enables improvements in patient experience and clinical outcomes. Clinical functionality such as electronic prescribing, pathology/radiology results ordering and reporting. The replacement of RiO as the clinical system during the strategic period. Knowledge Management – Knowledge management aims to ensure knowledge is effectively created and shared around the organisation and used to best effect so that there is an environment where mistakes are not repeated, good practices are not ignored, and people do not feel disconnected or undervalued. Effective Use of Information – The effective use of information and analytical techniques in decision-making at all levels in the organisation enables optimum performance and effective services. Give service users access to information so they can make informed choices about services and treatments. Technology for More Effective Working – Mobile technology to support a mobile workforce. Telecare, self-monitoring, self-assessment, communication and information applications for innovative care packages. Streamlined business / clinical processes to enable more effective and efficient working using applications e.g. eLearning, collaborative software and unified communications. The integration of systems for more effective working within the Trust and with partner organisations. IT Infrastructure – A robust IT infrastructure, that is resilient, secure, highly available with optimal capacity. An accredited IM&T service that is responsive, efficient and meets the business objectives of the Trust. Section 16 describes these priorities in more detail and Appendix A details the actions to implement this Strategy.
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16. 16.1
Trust-wide Plan Implementing the IM&T Strategy
16.1.1 An IM&T Development Programme is in place to deliver IM&T developments. The Programme will be revised to include the tasks and projects required to deliver this strategy and the benefits realisation. Since the IM&T Strategy is a supporting strategy in the Trust, as is the IM&T Development Programme, the realisation of benefits will also occur at a higher level where Trust programmes come together. For example, the development of an innovative new clinical service to improve patient experience and clinical outcomes could require the outputs of clinical development projects, estates projects, workforce projects and IM&T projects. 16.1.2 The IM&T Development Programme is managed using the Managing Successful Programmes (MSP) methodology and projects are managed using the PRINCE2 (Projects IN Controlled Environments) project management methodology. Owned by the Office of Government Commerce, these methodologies are standard practice across all government departments and widely used in the commercial sector. 16.1.3 The Trust?s IM&T Strategy Group is the custodian of this strategy and acts as the IM&T Development Programme Board. It oversees the review and implementation of this Strategy. The IM&T Strategy Group is chaired by the Chief Executive. The Head of IM&T will act as Programme Manager. 16.1.4 The IM&T Strategy Group is specifically responsible for approving project mandates, approving business cases (within delegated limits), resourcing the IM&T Development Programme and the realisation of benefits. The membership of the IM&T Strategy Group is as follows: Chair / Senior Responsible Owner Chief Executive Senior Business Director of Finance & Information Senior Business Chief Operating Officer Senior Business Director of Service Development & Performance Senior Business Director of Human Resources Senior User Medical Director Senior User Director of Nursing & Governance Senior User Assistant Director, Facilities & Patient Experience Senior User Director of Social Work Senior User Director of Estates Senior User Head of Commissioning and Contracting Senior Supplier Director of IM&T 16.1.5 The IM&T Strategy Group will meet at least ten times annually.
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16.1.6 Implementation of this strategy will be with reference to national standards (existing, and emerging), national policy and guidance (existing and emerging), and national targets. 16.1.7 The IM&T Strategy Group members are responsible for ensuring the alignment of the IM&T Strategy implementation with other strategies in the Trust. 16.1.8 The Director of IM&T will meet at least quarterly with the programme managers of the other strategies to review interfaces and to ensure that implementation activities are complementary. 16.1.9 An implementation plan showing timescales appears in Appendix A. The following sections summarise the components of the IM&T Strategy.
16.2
Electronic Care Records
16.2.1 RiO is the Care Record Service solution for London for mental health services. RiO (version 4) was implemented across the Trust on a borough-byborough basis in 2006 and 2007. The Trust updated to RiO v5 in 2010. It is now possible to connect to the NHS Spine via RiO, in particular the PDS (Personal Demographic Service), enabling improvements in data quality. 16.2.2 The main components of the NHS Spine may be summarised as follows: ? PDS (Personal Demographics Service): A national directory of citizens containing basic personal details such as NHS Number, name, address, and date of birth. ? SDS (Spine Directory Service): National directories containing details of NHS organisations and basic details of NHS staff such as name, job title, job role, organisation, e-mail address. ? PSIS (Personal Spine Information Service) also known as the Summary Record: Provides an up-to-date summary of information and key events in a patient?s life and care – drug allergies, operations, conditions, medical history – as well as details of contacts with care providers. In RiO Version 5 it is possible to query and update personal information. This will help ensure that all NHS organisations involved in a patient?s care have up -to-date address and GP registration details, for example. 16.2.3 RiO has a development path with additional functionality being provided in two further major releases: Release 1 in 2011; and Release 2 in 2013, as well as maintenance release and configuration upgrades, bring new or updated functionality. Details of each release is summarised in Appendix D.
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Information Management & Technology Strategy: 2011 - 2016 ___________________________________________________________________ 16.2.4 The pathology and radiology needs of the Trust are provided by local acute Trusts. Strategically, an interface between RiO and pathology / radiology systems will enable the electronic communication of results into RiO, enabling better communication and improvements to patient care. The receipt of results into RiO will be available in RiO Release 1. The facility to order tests from RiO will be available from RiO Release 2. 16.2.5 RiO Version 5 will provide electronic prescribing (e-prescribing) functionality in outpatient settings, that is, instead of writing prescriptions prescribers will select the medication, dosage etc on RiO and a prescription will be printed. A separate prescribing record will then be held on the system (currently part of clinical noting). In RiO version 6 (release 1) e-prescribing will be provided for inpatient services including a drug administration record. The implementation of e-prescribing will involve substantial change to clinical processes and will need to be carefully managed. There will be e-prescribing pilots in London and early adopters in the Trust before a full rollout. 16.2.6 The contract for RiO is due to expire in 2015. The Trust?s intention is to work with other Mental Health Trusts in a consortium type approach to procure a replacement system. Options for shared management of a replacement system would also be explored. 16.2.7 Integration with Social Care RiO will be developed to include some integration functionality (Release 2). Integration with social care is a particular requirement for mental health services. RiO is currently able to produce a social care data set (for RAP reporting) which can help to reduce the duplication of data capture that has been in place for many years. The Trust is working with local authority colleagues to maximise the benefit of this functionality. The Trust will explore with partner organisations the integration or interoperability of health and social care systems as opportunities present and the business case made. 16.2.8 Medical Records RiO has enabled the Trust to introduce paper-light working. RiO is the clinical record but needs some further development before it can completely replace all paper forms. A limited secondary paper medical record will used until such time that it can be completely replaced. Where possible paper forms are being scanned and attached to the electronic record in RiO. Record keeping policies are managed by the Health and Care Records Group, chaired by the Medical Director. The Trust is in the process of scanning it paper medical records currently held in libraries. By 2012 the Trust plans to only have an electronic / microfilmed archive, instead of a paper one.
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16.3
Knowledge Management
16.3.1 Knowledge Management (KM) has been variously defined. One definition is: “knowing what you know, knowing what you don't know, learning what you need to know and sharing it”. The National Library for Health expresses this succinctly as: “Knowledge Management is based on the idea that an organisation's most valuable resource is the knowledge of its people. Therefore the extent to which an organisation performs well will depend, among other things, on how effectively its people can create new knowledge, share knowledge around the organisation and use that knowledge to best effect.” 16.3.2 Knowledge Management is a hybrid discipline, neither art nor science; functionally it can straddle the fields of learning and organisational development, human resources and IT. KM is far more than just know-how. 16.3.3 A self-assessment of Knowledge Management capability was undertaken by the IM&T Strategy Group. See section 11.3 and Appendix B. 16.3.4 A new KM strategic approach will be developed for the Trust. In particular this strategy will address the following: ? The identification of clinical champions and role models to promote Knowledge Management; ? The promotion of a culture of sharing and using know-how within the Trust; ? Implementing tools to support communities of practice and inter-professional networks; ? The identification of information and knowledge sources, and the technology needed to enable access to them; ? How to ensure that a suitable level of expertise exists to access these knowledge sources; ? Develop electronic document software to improve access to the Trust?s knowledge sources ? Develop a learning framework, with clear links to knowledge and information sources is to be defined and implemented; ? Develop eLearning applications; ? Exploit KM tools and techniques. 16.3.5 Implementing KM initiatives in the Trust has many potential benefits: Supporting a learning organisation Supports education, research and development Supports training and development The improved sharing of knowledge and lessons learned could lead to improved patient care, patient safety and patient satisfaction Identifying new opportunities for research and innovation Increased learning opportunities, through networking with other NHS organisations and colleagues
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Information Management & Technology Strategy: 2011 - 2016 ___________________________________________________________________ Support Communities of Practice – improved communication and collaboration to support best practice and innovation More informed decision making by learning from others, with a reduction in repeating of mistakes and “reinventing wheels”. Information and knowledge can be used together to best effect to ensure that informed decisions are made. 16.3.6 Document Management The Trust has identified a need to improve the management of its corporate records. The management of electronic documents can be problematic: documents are saved in multiple locations with little or no version control often in personal folders; corporate e- mail is often “locked” away in personal e-mail accounts. The Trust will invest in software, processes and procedures to better manage its corporate knowledge base. 16.3.7 Intranet A well- managed intranet is an organisation?s key communication tool and portal into knowledge sources. The options for replacing and / or improving the current intranet will be investigated in order to improve knowledge sharing, access to knowledge, internal communications, collaborative working and supporting networks and communities of interest.
16.4
Effective Use of Information
16.4.1 In the last few years the Trust has increased its analytical capacity, implemented a new data warehouse, improved data quality and increased its use in information and statistical analysis to support decision making at all levels in the organisation. 16.4.2 Sets of key performance indicators have been in use for some time. These have been shaped by national targets, local and national priorities and have driven reporting and information development. The Intelligent Mental Health Board, published in March 2007, is a guide for Trust Boards in using information and intelligence to increase their effectiveness. This guidance has been used to review information reporting in the Trust. The Trust has recently produced a Performance Management Strategy. Information reporting and statistical analysis will continue to develop over the course of this strategy taking into account the needs of new developments such as Foundation Trust status. 16.4.3 The Trust has invested in and implemented a new data warehouse. The system has a dynamic reporting tool which enables managers and clinicians to have easy access to summary reports. Information is reported in “cubes” which enable the user to “drill down” to lower levels of detail or to change the dimensions of the report. The “cubes” are refreshed on a daily basis, providing up -to-date reporting.
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Information Management & Technology Strategy: 2011 - 2016 ___________________________________________________________________ 16.4.4 The data warehouse currently holds data and provides reports from a number of Trust systems relating to patient based clinical information (RiO), workforce including staff training and appraisal, incidents, complaints, maintenance and IM&T service desk. The data warehouse has a multidimensional reporting tool “the Pulse” as well as well as a range of „click of a button? patient level reports for clinicians who inform them at patient level about their clinical caseloads and any data quality issues. The data warehouse also produces automated emails to clinicians to support them in their work. Examples of emails include those relating to seven day follow-up and CPA reviews that are overdue. Data recording screens have also been developed to allow clinicians to easily capture information that cannot easily be recorded on RiO. Examples include information relating to smoking cessation and Home Treatment Team gate-keeping.
16.4.5 The Trust has been using the Pulse since 2007 and it allows for the dissemination of a broad range of data taken from a number of sources. The Pulse is an excellent tool for the gathering of information by staff who are regular users and where extracting this information is a current essential element of their job. The system is not used by the vast majority of staff who require a desk top icon that when clicked tells them what they need to know. The Trust?s vision is to supplement the Pulse with sets of dashboards using technologies such as MS Performance Point to display different information in a single screen from varying data sources. Such reporting tools will better support service line reporting and Payment by Results, and bring a single focus to the Trust on what is important at a point in time to deliver common aims. The Pulse will continue to be used by those staff who require a more in depth analysis and greater detail. 16.4.6 The better use of information generally leads to improved data quality. However, this needs to be supplemented by data quality initiatives targeting priority areas. For example, a recent initiative has been the increase of NHS Number coverage (see NHS Number section) and an improvement of the quality of patient demographic data. Data quality initiatives are more successful if they relate to clinical policies or procedures such as those developed by the Trust RiO Expert User Group – a group of clinicians that advise on the correct use of the RiO system. 16.4.7 The Trust in recent years has adopted statistical process control techniques to monitor performance. As routine information reporting becomes more automated the Information Management Department will further develop the use of statistical techniques. 16.4.8 The Trust has invested in a Geographical Information System (GIS) to enhance spatial and geographical analysis of data particularly to support commissioning, epidemiology, research, service provision, marketing, and ensuring equality.
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Information Management & Technology Strategy: 2011 - 2016 ___________________________________________________________________ 16.4.9 The Trust will develop “dashboards” to meet the needs of its clinicians and managers, using data from the Trust data warehouse and software and present the results in an easy-to-use format. There will need to a training / awareness programme to support the use of dashboards to ensure that staff can use the analysis and understand the data. 16.4.10 Business analytics is a term used to describe the use of statistical analytical predictive models to answer “what if?” questions, and is particularly helpful in planning and remodelling services. The Trust has made some use of business analytics but will further develop this during the strategic period developing in-house capability. 16.4.11 NHS Number The NHS Number is the national strategic solution for a patient identifier in electronic records. The current level of NHS Number recording is over 96% on all the Trust?s patient records. The high coverage has been achieved through data quality improvement projects. A local “back office” supported by processes and procedures are in place to maintain these levels. 16.4.12 Information for the Public, Service Users and Carers Information for service users and carers has often been poor in the past. For service users and their carers coming to terms with and dealing with mental health problems the provision of quality information can help ease the process and positively contribute to the care outcome. Information for service users and their carers can be broken down into four main categories: Information about the provision and availability of NHS and social care services Information about the provision and availability of other public services (e.g. state benefits, housing, education) Information about voluntary services and self-help groups and how to access them Information about specific conditions and treatments The Trust has a public-facing website, which will be continually reviewed and developed in order to ensure its design, content and functionality meet the needs of its diverse audiences. BSL video clips, social media bookmarking and user feedback tools will be added to the site to encourage user engagement and increase the site's accessibility. 16.4.13 Classifications & the Language of Health National standards, classifications and coding structures enable a common understanding of conditions and treatments. In turn this will facilitate: A common “language of health”, and thereby effective communication between care professionals The accurate sharing of service user information to facilitate better care and health outcomes
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Information Management & Technology Strategy: 2011 - 2016 ___________________________________________________________________ Better support for clinical governance Better informed research to be undertaken More informed planning and management of services and resources. 16.4.14 ICD10 (International Classification of Diseases, version 10) ICD10 serves mental health a lot better than previous versions. As well as the primary diagnosis (main reason for admission) secondary, or co-morbidities are also recorded. Co-morbidities may relate to physical health conditions as well as associated mental health conditions. This is particularly useful in the analyses of patient episodes of older people, who tend to have multiple health needs. The recording of diagnoses and the classification of that diagnoses has been poor in some areas. The Trust has initiated work to improve the recording and accuracy of diagnoses and coding using ICD10. New clinical coding policies and procedures will be enacted in the first year of the strategy. 16.4.15 OPCS4 OPCS4 is the codification of operative procedures undertaken as part of an inpatient or outpatient episode. It is recorded retrospectively. For mental health services there is a limited application, confined mainly to ECT (Electro Convulsive Therapy) and minor physical health procedures. It is mandatory for the Trust to collect this information. The Trust will monitor completeness and accuracy of the coding as part of data quality work. 16.4.16 Snomed Clinical Terms Snomed Clinical Terms (Snomed CT) is a thesaurus or standardisation of clinical terms. Clinical terms include presenting symptoms, prognosis, treatments, and interventions. It is a marriage of the Read codes (versions 2 & 3) once used in general practice in the UK and the US Snomed used by pathologists. It has been jointly developed in the US by the College of American Pathologists (CAP) and in the UK by NHS Connecting for Health and has been adopted by other countries. It now has an International Editorial Board that resides in Denmark and the Chair of the Board is Dr Martin Severs from the UK, who also Heads the NHS Information Standards Board. Snomed CT will be introduced in RiO from Rel 1 (see section 16.2). Strategically Snomed CT is important to the Trust but a full scale implementation will require a significant amount of training and, therefore investment. The Trust will introduce Snomed CT where the benefits are strong. 16.4.17 HoNOS (Health of the Nation Outcome Scale) HoNOS is a method of recording dependency for mental health service users. It is a mandatory data item in the Mental Health Minimum Data Set (MHMDS). As well as being a useful measure of severity it is now a key data item in determining care clusters in Payment by Results and commissioning currencies (the method by which provider organisations will be paid for providing care). It can also be used to inform clinical practice, a measure of a service user?s progress, and an indication of relative workloads amongst Community Mental Health Teams, for example. In 2007, the Trust initiated a rollout programme to implement HoNOS (and its specialty-specific
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Information Management & Technology Strategy: 2011 - 2016 ___________________________________________________________________ variants). HoNOS data will enable the Trust to further develop its information reporting.
16.5
Technology for More Effective Working
16.5.1 Improving access to clinical information (particularly RiO) for communitybased staff has been achieved by providing mobile technology and wireless working. During the strategic period, developments in technology to support mobile working will be exploited where the investment will lead to more effective and / or efficient working. 16.5.2 Telemedicine and Telecare Information technology offers potential opportunities for telemedicine and telecare; that is, using technology for monitoring, in lieu of care professional interventions or to assist with interventions. Opportunities for service users include self-care, selfmonitoring, communication systems leading to more innovative care packages and supporting recovery. Telemedicine and telecare may take different forms and possible applications in mental health Virtual consultations by the use of video conferencing Self diagnosis and treatment advice for minor conditions Self-monitoring by service users Communication contact with service users Forwarding of video clips (of service users) for second opinion Computer-based support packages Training packages Remote monitoring of service users. 16.5.3 RFID (Radio Frequency Identification) is an emerging technology which enables the tracking of objects or people. There are many potential applications in mental health services to increase security, efficiency or clinical safety. The Trust will assess the potential for such technologies and make investments where the business case is made. 16.5.4 The Trust will explore the opportunities to use information technology in providing new models of care, taking into consideration the need to safeguard confidentiality and maintain choice. 16.5.5 Unified Communications Unified communications (UC) is the integration of real-time communication services such as instant messaging (chat), presence information, IP telephony, video conferencing, call control and speech control with non real-time communication services such as unified messaging (integrated voicemail, e-mail, SMS and fax). UC is not a single product, but a set of products that provides a consistent unified user interface and user experience across multiple devices and media types.
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Information Management & Technology Strategy: 2011 - 2016 ___________________________________________________________________ UC also refers to a trend to offer business process integration, i.e. to simplify and integrate all forms of communications in view to optimise business processes and reduce the response time, manage flows and eliminate device and media dependencies. Typically benefits of UC fall into the broad categories: Improve support for mobile workers Bring telephony to the PC Bring computer applications to the telephone Establish Unified Messaging Enterprise Instant Messaging Integration Web conferencing Unified Conferencing Video The Trust will develop its strategy is respect of voice communications and data networks and produce a Voice & Data Network Strategy that details the strategic approach to developing the data network, telecommunications and unified communications. 16.5.6 Workflow Management There are many opportunities to streamline business and clinical processes to enable more effective and efficient working using applications such as eLearning, collaborative software and unified communications. The Trust will exploit these opportunities prioritising those areas which yield the greatest benefit. 16.5.7 Integration During the strategic period the Trust will explore the opportunities f or the integration of systems within the Trust and also with partner organisations – primary care, social care, acute secondary care and other mental health providers.
16.6
IT Infrastructure
16.6.1 The Trust has N3 connections to most of its sites, and has taken advantage of QoS (Quality of Service) – the prioritisation of network traffic, in accordance with business priorities. As a principle, the Trust will take advantage of N3 developments as they become available or when there are sound business reasons for doing so. 16.6.2 The Trust?s data network has evolved over the years into a distributed core data network. The Trust?s services and estate are increasingly using and reliant upon a sound IT infrastructure. In recent years there has been some investment in wireless networks (WiFi) notably on the Tolworth Hospital and Springfield Hospital sites. Strategically the Trust will continue to invest in wireless networks and increase the resilience and optimise the performance of its whole infrastructure.
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Information Management & Technology Strategy: 2011 - 2016 ___________________________________________________________________ 16.6.3 In accordance with the Trust?s estate strategy, buildings will become intelligent, using information technology to control and manage environments, security and optimisation of use. The IT infrastructure of the Trust will need to develop in line with the Estates Strategy. 16.6.4 The cost of information technology is more than the hardware and licence costs. Whilst power consumption of devices has generally decreased and software to shutdown idle desktop computers has been deployed there are opportunities to reduce this further. The Trust will follow a “Green IT” policy in terms of power consumption, consumables, virtualisation, utilisation, recycling, and disposal of assets. Virtualisation (see below) and printing rationalisation projects will be early deliverables. 16.6.5 As polyclinics and poly systems come on stream the Trust will work with partner organisations to ensure that the benefits of shared infrastructure are maximised, whilst ensuring the security and confidentiality requirements are met. As services become more integrated or cross organisational boundaries systems the infrastructure will need to flex to meet these requirements. 16.6.6 The Trust has a VoIP (Voice over Internet Protocol) solution in place across many of its sites. VoIP is a technology that routes voice traffic (telephone calls) over the data network, thereby saving the cost of calls between sites. The Trust will take advantage of developments in this technology where is makes financial sense. Possible examples are using N3 to route voice traffic to other NHS organisations, and technologies that integrate VoIP with mobile telephony. 16.6.7 The Trust is part of National N3 VC directory. This enables the Trust to communicate with other NHS Organisations and partners remotely. Adding a virtual geographical layer will bring visibility to non-focused items and services, with the financial benefits of reduction in travelling costs, and better use of staff time. 16.6.8 The optimisation of technical performance is a key strategic aim to ensure that the maximum value can be obtained from the Trust?s IT resource. The IT industry continues to develop technology to address optimisation. As a principle the Trust will seek to optimise performance subject to the availability of resources. 16.6.9 One example of optimisation is the virtualisation of servers. Virtualisation is the creation of several servers on one physical server hardware platform. Instead of purchasing one server for one application that only utilises 10% of a server potentially three applications could be run on three virtual instances on one physical server platform. Benefits include: reduced cost of new servers for new applications; reduced power consumption; reduced physical space; better server utilisation; increased ease of system recovery. Another example of achieving optimisation is the acceleration of WAN links using intelligent protocols, which has given 60% more capacity. Benefits included fast connectivity to business applications (e.g. RIO, Email and File shares) from smaller sites, and a reduced revenue cost.
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16.6.10 A modern IT infrastructure with the use of mobile technology (see section 16.5 above) provides an opportunity to redefine the working environment creating an “office of the future” and to support home working. Together with paper-light working, the accommodation requirements are reduced as are the overheads of owning/renting and maintaining the Trust?s estate. 16.6.11 IT Service Support The Trust IT Department provides IT and Telecoms first-line maintenance support for all IT services. Some second and third line support is provided for locally hosted systems and local data storage. The IT Department has introduced a new IT Service Desk support system in recent years and has implemented new processes and procedures in line with the ITIL (IT Infrastructure Library) IT industry service management standard. The first phase of implementation was in the areas of: Incident management Problem Management Change Management Service Desk Service Management (part) Release Management (part) The other modules of ITIL have now been implemented. It is now policy that all IT staff will be trained in ITIL to the “Green Badge” level (within three months of joining the Department), with at least one senior member of staff trained to the “Red Badge” level. The Trust IM&T Service Desk has received national accreditation from NHS Connecting for Health and has maintained the accreditation for 3 consecutive years. ITIL is a component of ISO9000 (the international service standard). During the lifetime of this strategy the IT Department will work towards gaining accreditation, including ISO9000. The IT Service Desk operates 08:00 – 18:00 Monday to Friday (except bank holidays). Outside of these hours there is an IT Manager-on-call to handle emergencies or urgent situations. The IT Service desk at present handles up to 3,200 calls per month. During the strategic period as systems develop and reliance on IT support grows these arrangements will be reviewed and enhanced according to business need and affordability.
16.7
Business Applications
16.7.1 Electronic Staff Record
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Information Management & Technology Strategy: 2011 - 2016 ___________________________________________________________________ The Trust has implemented the (national) Electronic Staff Record system (ESR). ESR is used for payroll, to support recruitment and other Human Resources processes, and to provide workforce information and training records. The Trust will develop its use of the ESR system and implement other features such as establishment control, interfaces to other applications and “self -service” (direct use of ESR by managers and staff). The “self -service” function will need to be piloted and processes developed before a full implementation can proceed. 16.7.2 Learning Management System The Trust has invested in a system to manage training courses and mandatory training – both general and IM&T training. The system integrates with the Electronic Staff Record and provides on-line booking of courses. There is further work need to realise all the benefits of this investment and this will be undertaken in the first year of the strategy. 16.7.3 Financial systems The Trust has used its current general ledger / accounting system (eFinancials) for some time. During the life of this strategy the Trust will test the market and replace or renegotiate the existing contract. Developments in financial management such as service line reporting and payment by results may require new systems. The systems currently used for asset tracking and reference costs need to be reviewed and possibly replaced. 16.7.4 Electronic Rostering Roster Pro – a system for rostering nursing shifts – has been implemented. Interfaces will be established to ESR (primarily for payroll) and the Data Warehouse (for reporting). Further work on benefit realisation is taking place. The intention is to extend the use of the system to all staff for scheduling absences.
16.8 Training & Development The realisation of the benefits from the investment in information management and technology often requires changes in working practices and cultural change. The modernisation of the NHS will see the move to a knowledge and information culture. These initiatives will be supported by appropriate training. Much IM&T training is delivered in classroom style training sessions. As the level of IT literacy increases the trust will adopt alternative or complementary training methods, for example, e-learning and self-learning packages, thus offering a much more blended approach. The following IM&T training is provided: Basic IT literacy and use of standard applications : Levels of IT literacy have increased in the Trust in the last few years. Training in basic IT skills and MS Office
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Information Management & Technology Strategy: 2011 - 2016 ___________________________________________________________________ applications (such as Word and Excel) will be provided to complement the NHS Essential IT Skills (EITS) programme. Use of clinical and other critical systems : RiO is the clinical record in the Trust. As it is an electronic record training in RiO is mandatory and has to be completed (and the course passed) before access is given to the system. RiO training is in accordance with job role. Training is also provided for IAPTus – the system used by psychological therapy in primary care services. Recently an e-procurement system has been implemented and access to the Summary Care Record rolled out. Training was provided for these implementations and will be provided on an on-going basis for new members of staff. Training is mandatory for all Trust critical systems. Using Information to Manage: In order to improve the use of information to manage performance in the Trust training will be developed for managers and clinicians in the use of data and analytical techniques. Training is also provided in the use of the Pulse EIS tool. Training in data capture to support initiatives such as Payment by Results will be undertaken to improve the quality of data capture in data items such as HoNOS. Knowledge Management: The better application of knowledge in decision-making processes (clinical and non-clinical) is expected to deliver better health outcomes for the Trust?s clients and carers . The Trust will develop training in the use of knowledge and KM techniques. IM&T Staff Development: The demands placed upon IM&T staff are ever changing – technology changes at a rapid pace and as the general Trust workforce becomes more IT literate IM&T staff will require more specialist skills in order to provide the right level of support. The recruitment and retention of such staff will largely depend upon a suitable professional development programme to be in place. The Trust will ensure that each member of the IM&T staff has an active personal development plan and participates in continuous professional development.
16.9
Information Governance
Information is a vital asset to an organisation, for example in the provision of care and the efficient management of services and resources. Information governance is the proper management of that information in terms of protecting it, holding it securely, complying with the law, ensuring confidentiality (for personal data), ensuring availability to those who need it and when they need it, and for personal data collected with the informed consent of the individual.
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Information Management & Technology Strategy: 2011 - 2016 ___________________________________________________________________ In the Trust information governance is seen as an essential component of providing quality services – quality healthcare. There are a number of initiatives and legislation that are relevant to Information Governance. These include: The Data Protection Act BS7799 (ISO17799) (the information security standard). Data Accreditation Caldicott (the standard for handling patient-based information) Data quality monitoring Controls Assurance The Freedom of Information Act Human Rights Act NHSIA Security Policy NHS Statement of Compliance 16.9.1 Information Governance Group The Information Governance Group is responsible for information governance in the Trust, supported by working subgroups: Health Care Records IT Security, and Information Management, with annual work plans. The Medical Director is the Caldicott Guardian and the Director of Finance is the Senior Information Responsible Owner (SIRO). The Information Governance Manager is responsible for the development, implementation and monitoring of information governance policies and procedures. In particular this strategy will address the following: Ensure regular audits are undertaken, feedback is provided and outcomes are reviewed Apply information sharing agreements, building upon the Agreements that are in place Continue to monitor and respond to risks. Keep policies for critical systems under review and ensure integration with Trust-wide contingency plans Ensure take of information governance training Ensure that data quality is sufficient for purpose Implement pseudonymisation.
17.
Resourcing the Strategy
17.1 Investment in IM&T does create some cash-releasing benefits, but often the benefits are in terms of improvements to the quality services. The appropriate level of investment in IM&T will enable the Trust objectives to meet its objectives.
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Information Management & Technology Strategy: 2011 - 2016 ___________________________________________________________________ 17.2 On average NHS organisations spend 2.2% of their total turnover on IM&T. Other service industries, such as retail and the financial sector spend approximately 5% of turnover. The Wanless Report (2002) recommended that the NHS needed to spend 4% of turnover in order to achieve efficient and effective working. 17.3 The actual / budgeted spend on IM&T as at January 2011 is shown in the table below.
Total Trust Income Total IM&T Spend % Turnover 2003/04 £142M £2,117k 1.49% 2008/09 £176M £2,876k 1.63% 2004/05 £155M £2,481k 1.60% 2009/10 £180.2M £3,282k 1.82% 2005/06 £153M £2,688k 1.76% 2010/11 £175.1M £2,970k 1.70% 2006/07 £161M £3,870k 2.40% 2011/12 £188.5M £2,751k 1.45% 2007/08 £176M £3,181k 1.81%
Total Trust Income Total IM&T Spend % Turnover Notes:
Actual spend to 2009/10; budgeted/projected spend for years 2010/11 and 2011/12. The IM&T spend in years 2006/07 and 2007/08 includes costs associated with the implementation of RiO.
17.4 As with many other NHS organisations, the Trust uses national systems – RiO, the Electronic Staff Record for example – and the support costs are not met from Trust budgets. With the shift from national systems to local systems the Trust will need to plan to take on these support costs. 17.5 The implementation of RiO was estimated to cost £2.4m, spread over three financial years. The project has been funded by strategic capital, with the £152k full year revenue costs being met by the Trust. 17.6 The implementation of this strategy may require additional IM&T staff from time-to-time in order to deliver on projects, or to provide on-going support. 17.7 Business cases will be developed for IM&T investments which will detail any revenue consequences. Where possible the increase in operational IM&T costs will be funded by savings enabled by the investment. 17.8 The availability of funds will largely determine whether this Strategy can be delivered.
18.
Review of Strategy
The Strategy will be formally reviewed annually by the IM&T Strategy Group. Following the review the IM&T Programme (the programme that implements this Strategy) will be revised accordingly. It is expected that this strategy will require rewriting in approximately 4 years time.
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Links with Other Strategies 19. Relationship with Workforce Strategy
19.1 The successful implementation of technology often involves changes in working practices with possible job redesign. The workforce will need to adapt to exploit the benefits that new technology brings. 19.2 The implementation of the IM&T Strategy involves a substantial programme of training. The need to increase the level of IT literacy is a strategic priority for both strategies. Other training priorities are in knowledge management, the use of information, the use of the Trust intranet, and the awareness and application of information governance. The Trust will invest in eLearning applications and move away from classroom training in order to provide training in a more cost effective way. 19.3 There are opportunities to improve the management of staff information: many directories of staff are held independently for many purposes. Moving to a primary source of workforce information which populates secondary staff directories will increase data quality and improve the efficiency of business processes. 19.4 The Trust needs to exploit the Electronic Staff Record to its full potential to support business processes. 19.5 There are opportunities to improve the availability of summary workforce data to support effective decision making. By bringing together workforce data with other data sets it will be possible to undertake more detailed analysis and for the Trust to understand better its productivity. 19.6 The development of a Knowledge Management culture in the Trust supports the concept of a learning organisation, invests in our workforce and will minimise the risk of an environment where mistakes are repeated, good practices are ignored, and people feel disconnected and undervalued.
20.
Relationship with Estates Strategy
20.1 The Trust has a substantial programme to rationalise and develop its estate into modern care facilities. Information Technology supports modern buildings in enabling improved environmental control, improved security and increased energy efficiency. 20.2 The redevelopment of the Trust?s estate will involve the relocation and the renewal of the IT infrastructure.
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20.3 The design of new buildings needs to take account of IT not only in terms of providing space for computers, networks and server rooms, but also in terms of new working practices that have come about because of computerisation. 20.4 Investment in the IT infrastructure and mobile technology will contribute to modern working environments enabling a more effective use of the Trust?s estate. This approach is complementary to the Estate Strategy which calls for a reduction in the proportion of overall Trust expenditure that is spent on estate facilities. 20.5 The implementation of both strategies will be aligned to ensure the maximisation of benefits to the organisation.
21.
Relationship with Clinical Services Strategy
21.1 The introduction and development of electronic care records and clinical tools (the Care Record Service – RiO) enables the development of clinical services but also implies changes in working practice. 21.2 The benefits of RiO include improvements to patient experience, clinical safety and quality of care. 21.3 The introduction of mobile technology will support an increasingly mobile clinical workforce, enabling more efficient services and productivity gains. 21.4 Improvements in the availability and range of information to support decision making achieved by exploiting the Data Warehouse and “Pulse” will enable the performance of clinical services to be better monitored and managed. 21.5 Similarly, a wide range of clinical data and information will be available in electronic format to better support clinical governance and research. 21.6 An improvement to knowledge management in the Trust will greatly benefit clinical services enabling the sharing of best practice, shared learning, decision support and the putting of results of research into practice. 21.7 Strong leadership in clinical services is needed to support the implementation of the IM&T Strategy, particularly in respect of changing working practices and benefits realisation. 21.8 A greater level of IT literacy amongst clinical staff and support staff will be required to deliver this strategy. Whilst IT literacy has improved greatly over the last 5 years there is still a requirement for a large amount of training.
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Information Management & Technology Strategy: 2011 - 2016 ___________________________________________________________________ 22. Relationship with Communications Strategy
22.1 The implementation of the IM&T strategy needs to be underpinned by good communications in the Trust. 22.2 The development of Knowledge Management will require the development of the Trust?s web site and intranet, and in particular the development of tools to aid communication, for example, for virtual groups. 22.3 The development of the Data Warehouse, data sets, and information analysis will provide more information to support communications about the Trust, and the mar keting of the Trust?s services. 22.4 The Trust will publish more information about its services, outcomes and performance to inform service users, carers and the public to enable more choice and accountability.
Appendices A. B. C. D. IM&T Strategy Implementation Plan Knowledge Management Capability Self Assessment Development Path for RiO Glossary
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Information Management & Technology Strategy: 2011 - 2016 ___________________________________________________________________ Appendix A: IM&T Strategy High Level Implementation Plan
2011/12 2012/13 2013/14 2014/15 2015/16
Electronic Care Records Explore integration of medical devices RiO Release 1 (core) ePrescribing (RiO) RiO Results Reporting RiO Release 1 (other non-mandatory functionality) RiO Release 2 (core) RiO Release 2 Results Ordering RiO Release 2 (other non-mandatory functionality) NHS Spine: Summary Care Records RiO Replacement Integration with Social Care and other partners Knowledge Management Electronic Document Management Collaboration tools – knowledge sharing Replacement Intranet Collaboration tools – document flows Develop other supporting tools & techniques Explore and implement decision support systems Promote the cultural change Train staff in use of knowledge / KM techniques Support communities of interest Effective Use of Information Develop geographical analysis (GIS) Develop use of business analytics Develop clinical and performance dashboards Develop analysis to support Payment by Results Develop analysis for Service Line Reporting Reporting for new commissioning arrangements Support clinical research and development Information for service users and carers Information for the public Data Quality: NHS Numbers - maintain coverage Review and improve data collection for RiO Improve Clinical Coding Technology for More Effective Woking Collaboration tools: streamline processes Telecare / telemedicine, initiatives Client self assessment / monitoring apps Client communication apps. eLearning RFID applications
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2011/12 2012/13 2013/14 2014/15 2015/16
Unified Communications Fax e -mail integration (FAX server) Video Conferencing Building Management System CCTV over IT network Integration of systems IT Infrastructure Upgrade of server rooms to industry standard Implement test domain Implement fail-over servers for critical systems Virtualisation (server optimisation) Virtualisation (server hardware optimisation) Server application software refresh Virtualisation (desktop optimisation) Rationalise printing and reprographics Replace Windows XP with Windows 7 Replace Server Operating Systems Refresh PCs / mobile devices / laptops / printers Address Network Single Points of Failure WiFi Quality of Service (network traffic) Complete VoIP / IP Telephony PBX / Voicemail upgrades Single Number Tel Refresh Network equipment Refresh Telephony equipment Support building programme (refurb./ new) IT Service and Support: ITIL v3 -review Review service scope, coverage, hours of operation, SLAs IM&T Service accreditation Achieve ISO9000 standard Review Service Desk system; possibly replace Business Systems Review & procure new finance system Upgrade MS Office Implement AT-L Learning Management System Develop the use of Electronic Staff Record Information Governance Secure Outbound e-mail Single-sign-on Review and improve IT security Review Information Sharing agreements Review / develop policies and procedures
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2011/12 2012/13 2013/14 2014/15 2015/16
Monitor and manage risk Undertake audits and reviews Training, Awareness & Communication Support eLearning ePrescribing implementation training RiO Release 1 training (core and non-core) RiO Release 2 training (core and non-core) Knowledge Management tools - awareness Training Core systems (on-going) AT-L Learning Management System Information skills for managers, clinicians Mandatory training for Information Governance IM&T specialist skill training Establish clinical champions Establish a Clinical Reference Group Develop a communication plan Raise awareness of IM&T - benefits, IG Supportive change management programme Communications to support the Strategy
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SW London & St George?s Mental Health NHS Trust Information Management & Technology Strategy: 2010 - 2015 ________________________________________________________________________________________________________ Appendix B. Knowledge Management Capability Self Assessment The IM&T Strategy Group assessed the current level for each of the five KM practices (marked with an “X”). It then selected target scores for the first 12 months of the IM&T Strategy for the two most important practices (marked with an “O”).
Learning before, during and after
? ? ? Prompts for learning built into business processes. People routinely find out who knows and talk with them. Common language, templates and guidelines lead to effective sharing. Learning before, during and after is what we do things around here. “Customers” and partners participate in review sessions.
KM Strategy
Leadership Behaviours
? Leaders recognise the link between KM and performance. The right attitudes exist to share and use others? know-how. Leaders reinforce the right behaviour and act as role models. KM is everyone?s responsibility; a few jobs are dedicated to managing knowledge. “Knowledge sharing is power”. Leaders set expectations by “asking the right questions”. And rewarding the right behaviours. ? ?
Networking
Clearly defined roles and responsibilities. Networks and Communities have a clear purpose, some have clear deliverables, others develop capability in the organisation. Networks meet annually.
Capturing knowledge
? Knowledge is easy to get to, easy to retrieve. Relevant knowledge is pushed to you. It is constantly refreshed and distilled. Networks act as guardians of the knowledge.
?
? ?
Clearly identified intellectual assets. KM Strategy is embedded in the business strategy. Framework and tools enable learning before, during after.
Level 5
? ?
? ?
? ? ? ?
? ? Discussions ongoing about organisation?s intellectual assets. A\KM strategy exists but is not linked to business results. A clear framework and set of tools learning is widely communicated and understood.
? ?
? ?
Networks are organised around business needs. Networks have a clear governance document. Supportive technology is in place and is well used.
? ?
? ? ?
Just-in-time knowledge is current and easily accessible. One individual distils and refreshes it, though many contribute. That individual acts as the owner.
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KM Strategy
? There is no framework or articulated strategy. Some job descriptions include knowledge capture, sharing and distillation. People are using a number of tools to help with learning and sharing.
Leadership Behaviours
? ? ? KM is viewed as the responsibility of a specialist team. Some leaders talk the talk but don?t always walk the walk! Some managers give people the time to share and learn, but there is little visible support from the top. ?
Networking
People are networking to get results. Networks and communities are created. People can choose to participate.
Learning before, during and after
? People can easily find out what the company knows. Examples of sharing and using are recognised. Peers are helping peers across organisational boundaries. People learn before doing and programme review sessions. They capture what they learn for others to access. In practice few do access it. People are conscious of the need to learn from what they do but rarely get the time. Sharing is for the benefit of the team.
Capturing knowledge
? Networks take responsibility for their knowledge; collect their subject?s knowledge in one place in a common format. Searching before doing is encouraged. Little or no distillation. Teams capture lessons learned after a project. Teams look for knowledge before starting a project. Access to lots of knowledge, though not summarised. Some individuals take the time to capture their lessons in any number of cupboards and databases. They are rarely refreshed, few contribute, even fewer search.
Level 3
? ?
?
? ? ? ? ? ?
?
? ? Ad hoc networking to help individuals who know each other. ? ?
Level 2
? ?
Most people say sharing knowhow is important to the organisation?s success. People are using some tools to help with learning and sharing. A few people express that know-how is important to the organisation. Isolated people with a passion for KM begin to talk and share how difficult it is. ?
?
?
? ?
KM viewed as a management fad. Leaders are sceptical as to the benefits. Leaders think networking leads to a lack of accountability. “Knowledge is power”.
? ? Knowledge hoarders seem to get rewarded. ?
Level 1
?
© Copyright Knowledgeable Ltd 2006.
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South West London & St George?s Mental Health NHS Trust Information Management & Technology Strategy: 2010 – 2015 __________________________________________________________________ Appendix D: Glossary
Below, is a summary of terms and abbreviations used in or associated within this document.
BS7799
British Standard for information security also adopted as an International Standard ISO17799. Caldicott Named after the author of a report on patient information flows, generally applied to actions on implementing the report?s recommendations. CAMHS Child & Adolescent Mental Health Services Cedar Software Supplier of eFinancials - Finance system Choose & Book A national computer system which is used to book new appointments in hospital outpatients clinics and other secondary healthcare services. The system also provides choice of date, location, consultant and hospital etc. CMIS See InteHEALTH® CPA Care Programme Approach, a systematic approach to assessing, planning for, and reviewing care requirements for mental health service users CRS / NHS CRS Care record Service - electronic clinical records, or electronic health and social care record Data Warehouse A computer system that is capable of handling large and complex data sets and has the ability to join different data sets together. It is used to support analysis of data and/or the transmission of data between different data sources. eCPA An electronic system recording and supporting CPA eGIF Electronic Government Interoperability Framework – a set of technical standards for data, communication, applications and security. eSMTP Extended Simple Mail Transfer Protocol. A technical standard for sending and receiving data. ESR Electronic Staff Record. A national computer system for maintaining employment records and payroll for NHS staff. ETP Electronic Transfer of Prescriptions. A system for electronically transferring prescriptions from the prescriber to the dispenser. Initially the system will be used by General Practitioners (GPs) and high street pharmacies. In years to come prescribers in secondary health care services (hospitals etc) will also use the system. Excel Brand name of Microsoft?s s preadsheet package. Health Informatics A term used to describe IT, information management, telecommunications, knowledge management, library services that support health services.
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South West London & St George?s Mental Health NHS Trust Information Management & Technology Strategy: 2010 – 2015 __________________________________________________________________ HoNOS Health of the Nation Outcome Scale –a method of recording dependency for mental health service users (patients). There are variations for specialist mental health services, for example, HoNOS-CA for child and adolescent mental health services. Human Resources (workforce) International Classification of Diseases, version 10. An international classification system using a set of codes to record cause of death and illnesses/conditions. The codes enable the analysis of mortality and morbidity at locally, nationally and globally. Information Communications & Technology. A term used to describe IT and telecommunication services. Similarly to “IM&T” but a narrow definition. Information Management & Technology – a term incorporating IT services, information management, IT training, telecommunications and related services. Informatics professional (see above). A term used to describe IT, information management, telecommunications, knowledge management, library services. The management of data and information in respect of ensuring its safekeeping and ensuring confidentiality of personal information. The Trust?s legacy patient administration and data collection system for inpatient, outpatient and community based services (adult). Also known as CMIS. Pharmacy stock management system See Knowledge Management A term encompassing the concepts of sharing knowledge, accessing knowledge, learning, sharing learning, decision support and networking. Local Area Network. A self contained data network local to a site (i.e. that does not use any public infrastructure). Legacy system for CAMHS in the Trust. Mental Health Mental Health Minimum Data Set. A nationally defined data set for recording information about mental health care episodes. The NHS national network for electronic communication. Generally all NHS sites have a connection that enables access to national computer systems, sending and receiving e-mail and access to the internet. Public advice line on conditions, treatment and NHS services. Unique identifier for all citizens for NHS use only. Overseas visitors have pseudo NHS Numbers.
HR ICD10
ICT
IM&T
Informatician Informatics
Information Governance InteHEALTH®
JAC KM Knowledge Management LAN MAISY MH MHMDS
N3
NHS Direct NHS Number
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South West London & St George?s Mental Health NHS Trust Information Management & Technology Strategy: 2010 – 2015 __________________________________________________________________ NHS Spine A national computer system that has three components (PDS, SDS and PSIS) provides directories of citizens, NHS staff, NHS organisations and a summary health record. The NHS Pine is the system that allows the Care Record Systems to link up nationally. See also PDS, SDS and PSIS. The main gateway or portal on the internet to information on the NHS and its services. The web address is www.nhs.uk. National Service Framework. Service standard for NHS services. National Strategic Tracing Service, for tracing NHS Numbers for patients / service users. (See NHS Number). Codification system for clinical procedures, version 4. Codes for operations and other clinical procedures to enable analysis of data. Patient Advice & Liaison Service – a service to assist patients and service users in their use and access to services Primary Care Trust. Personal Demographic Service. A component of the NHS Spine, a national directory of citizens containing basic details such as name, address, NHS Number, date of birth, and GP registration. See also NHS Spine. A legacy computer system used to manage the Mental Health Act requirements in the Trust. Personal Spine Information Service. Also known as the Summary Record or Summary Healthcare Record. A component of the NHS Spine, an up-to-date summary of information and key events in a patient?s life, e.g. allergies, operations, conditions. See also NHS Spine. The name of a management reporting tool that enable the analysis of data and information reports for management and research purposes. The Pulse uses the product HyperCube® supplied by the Sollis Partnership. The Trust?s intranet that provides access to local Trust information, for example news, directories and policies. Radio Frequency IDentification. An emerging technology that enables the tracking of objects or people via a wireless network. The brand name of an electronic care record computer system. In London RiO is the Care Record Service (CRS) system for mental health and community health services. See also CRS. Spine Directory Service. A component of the NHS Spine, a set of national directories of GPs, NHS organisations and NHS staff. See also NHS Spine. Service Level Agreement. A formal agreement between two or more parties which sets out agreed levels of providing a
nhs.uk NSF NSTS OPCS4
PALS PCT PDS
Protocol PSIS
Pulse
Quick RFID
RiO
SDS
SLA
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South West London & St George?s Mental Health NHS Trust Information Management & Technology Strategy: 2010 – 2015 __________________________________________________________________ particular service and how the arrangement is to be managed. A unique plastic card with a magnetic strip that can be used to access computer systems and which contains personal information. Similar to a credit card, an example is the Oyster card used on London Transport. Simple Mail Transfer Protocol A thesaurus of conditions, symptoms, treatments and drugs. It is supported by an invisible coding structure (in the background computer code) that enables that the transfer of clinical information from one computer system to another. A method of providing care interventions (advice, monitoring etc) remotely by using telecommunications and information technology. A method of providing medical interventions (advice, diagnosis etc) remotely by using telecommunications and information technology. Voice over Internet Protocol. A technical standard that enables voice (telephone calls) to be transmitted over data networks – LANs and WANs. (See LAN and WAN). Wide Area Network. A self contained data network local to an organisation that comprises of LANs joined by dedicated connections across the public infrastructure. See also LAN. Brand name of Microsoft?s word processing package. Extensible Mark-up Language – a technical standard used to mark-up text or pieces of information for exchange and/or analysis.
Smartcard
SMPT Snomed CT
Telecare
Telemedicine
VoIP
WAN
Word XML
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Information management (IM) is the collection and management of information from one or more sources and the distribution of that information to one or more audiences. This sometimes involves those who have a stake in, or a right to that information.
Making Life Better Together Information Management & Technology Strategy 2011 – 2016
Principle Author: David Green, Director of IM&T
Version History Version Summary of Changes 0.1 First draft 0.2 Second draft, following first review 0.3 Inclusion of new national MH Strategy, and comments from IM&T Strategy 0.31 Final QA
Date Jan 11 04 Feb 11 18 Mar 11 08 Apr 11
South West London & St George?s Mental Health NHS Trust
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Information Management & Technology Strategy: 2011 - 2016 ___________________________________________________________________
Contents 1. Executive Summary Context 2. 3. 4. 5. 6. 7. 8. 9. 10. Background Trust Vision and Values Development of the Trust?s IM&T Strategy Strategic Context Local Environment Internal Environment Current Provision Changes in the Last Eight years Perception of Stakeholders The Case for Change 11. 12. 13. Benchmarking Areas for Development SWOT Analysis Priority Service Changes 14. 15. 16. 17. 18. Areas for Disinvestment Areas for Investment Trust-wide Plan Resourcing the Strategy Review of IM&T Strategy Links With Other Strategies 19. 20. 21. 22. Relationship with Workforce Strategy Relationship with Estates Strategy Relationship with Clinical service Strategy Relationship with Communications Strategy 58 58 59 60 40 41 42 56 57 32 35 39 7 7 8 9 23 24 25 27 30 5
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Appendices A. B. C. D. IM&T Strategy Implementation Plan Knowledge Management Capability Self Assessment RiO Development: Version 6, Releases 1 and 2 Glossary 61 65 67 68
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1.
Executive Summary
1.1 Building upon the success of the previous IM&T Strategies (2002-2006 and 2006-2010) and this strategy sets out the vision, goals and actions for IM&T to enable the Trust to achieve its business objectives and to meet the requirements of NHS national policy. 1.2 The Trust?s IM&T Strategy has been developed to meet the Trust?s strategic objectives: lmprove the quality of services we deliver, underpinned by the recovery approach Develop and deliver a modern model of service provision within appropriate built environments. Support existing services to thrive and become more competitive and to develop and deliver new services, relationships and business opportunities. Develop the capacity and capability of our workforce to deliver our vision and strategic objectives, while operating efficiently and effectively. Grow and develop mental health knowledge and practice and its application for current and future generations. 1.3 In summary the key areas for investment are: Electronic Care Records (RiO) – Electronic care record with clinical tools providing more effective communication, decision support and better planning of care that enables improvements in patient experience and clinical outcomes. Clinical functionality such as electronic prescribing, pathology/radiology results ordering and reporting. The replacement of RiO as the clinical system during the strategic period. Knowledge Management – Knowledge management aims to ensure knowledge is effectively created and shared around the organisation and used to best effect so that there is an environment where mistakes are not repeated, good practices are not ignored, and people do not feel disconnected or undervalued. Effective Use of Information – The effective use of information and analytical techniques in decision-making at all levels in the organisation enables optimum performance and effective services. Give service users access to information so they can make informed choices about services and treatments. Technology for More Effective Working – Mobile technology to support a mobile workforce. Telecare, self-monitoring, self-assessment, communication and information applications for innovative care packages.
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Information Management & Technology Strategy: 2011 - 2016 ___________________________________________________________________ Streamlined business / clinical processes to enable more effective and efficient working using applications e.g. eLearning, collaborative software and unified communications. The integration of systems for more effective working within the Trust and with partner organisations. IT Infrastructure – A robust IT infrastructure, that is resilient, secure, highly available with optimal capacity. An accredited IM&T service that is responsive, efficient and meets the business objectives of the Trust. 1.5 The IM&T Strategy will enable improvements in clinical excellence, clinical outcomes, patient experience and productivity. The achievement of these benefits will mean a greater reliance on the IM&T service and require Strong leadership in clinical services Changes to working practices Benefits realisation managed in clinical services Greater IT literacy and a significant amount of training
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Information Management & Technology Strategy: 2011 - 2016 ___________________________________________________________________ 2. Background
This document provides an IM&T (Information Management & Technology, also referred to as ICT (Information Communications and Technology)) strategy to enable the Trust to meet its business objectives, and to deliver the requirements of the NHS national policy. This strategy builds upon the success of the Trust?s IM&T Strateg ies and programmes 2002 – 2010.
2.1 Trust Profile 2.1.1 South West London & St George?s Mental Health Trust provides secondary mental health services across five London boroughs – Kingston, Merton, Richmond, Sutton and Wandsworth – together with specialist services where the Trust is a regional or national centre. The Trust is a Teaching Trust, and is working towards Foundation Trust status. 2.1.2 The Trust?s clinical services are managed in a sector structure, headed by a Service Director: Kingston & Richmond; Sutton & Merton; Wandsworth; Specialist services. Services are provided from over 50 sites.
3.
Vision and Values for Trust Services
Vision 3.1 A future in which people with mental health problems have the same opportunity as other citizens to participate in and contribute to our communities. Values 3.2 The most important people in our services are those who use them and their relatives, friends and carers. The most important resources that we have are the staff that provide their care and support. 3.3 In all our actions we will recognise and value the diversity that exists in our services and our local community and strive to ensure equality of access, experience and outcome irrespective of race or ethnicity, disability, age, gender, sexuality or religious belief, or place of residence. 3.4 We will treat everyone with dignity and respect, involve them in decisions that affect them and provide them with whatever information they feel will help them. 3.5 In all that we do we strive for excellence, equity and the efficient use of resources.
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Information Management & Technology Strategy: 2011 - 2016 ___________________________________________________________________ Our Purpose 3.6 The Trust recognises that everyone with mental health problems faces the challenge of retaining or recovering a life that is as meaningful, satisfying and valued as possible. 3.7 The purpose of the Trust is to help people with mental health problems to do the things they want to do, live the lives they want to live and access those opportunities that all citizens should take for granted. 3.8 To achieve this purpose we will work in partnership with those who use our services, their relatives, carers and friends, and other stakeholders to: ? Foster hope in those whom we serve and do our best to ensure that everyone?s experience of using our services is a positive one. ? Provide effective treatment and help people to take back control over their problems and their lives and the help they receive. ? Improve people?s life chances by promoting their health, safety a nd wellbeing and assisting them to access the opportunities that they value: homes, jobs, friends, relationships, education, social pursuits, leisure activities and spiritual possibilities. ? Undertake teaching and research, to enable us to continue to do this work for those who will use our services in the future. ? Cultivate a workforce that is committed to pursuing our vision and purpose and ensure they have the support and development opportunities they need to do so. 4. Development of the Trust’s IM&T Strategy 4.1 The Trust?s IM&T Strategy has been developed to meet the Trust?s strategic objectives: lmprove the quality of services we deliver, underpinned by the recovery approach Develop and deliver a modern model of service provision within appropriate built environments. Support existing services to thrive and become more competitive and to develop and deliver new services, relationships and business opportunities. Develop the capacity and capability of our workforce to deliver our vision and strategic objectives, while operating efficiently and effectively. Grow and develop mental health knowledge and practice and its application for current and future generations. 4.2 Key investment areas were identified from an analysis of the Trust?s business objectives. For each key investment area priorities emerged which informed the development of the high level plan (see Appendix A).
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Information Management & Technology Strategy: 2011 - 2016 ___________________________________________________________________ 4.3 The following table summarises how each key investment area enables the Trust to deliver its Objectives:
IT Infrastructure Effective Use of Information Electronic Care Records Technology for More Effective Working Knowledge Management
Trust Objective
1. Quality of services 2. Modern service provision 3. New and thriving services 4. Developing the workforce 5. Developing mental health knowledge and practice
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5.
Strategic Context
National Strategic Context 5.1 Equity and Excellence: Liberating the NHS (July 2010)
5.1.1 The Collation Government ?s White Paper Equity and Excellence: Liberating the NHS upholds the values and principles of the NHS and sets out a new vision for the NHS. The vision put patients at the heart of the NHS, through an information revolution and greater choice and control: Shared decision-making will become the norm: no decision about me without me. Patients will have access to the information they want, to make choices about their care. They will have increased control over their own care records. Patients will have choice of any provider, choice of consultant-led team, choice of GP practice and choice of treatment. The Government will enable patients to rate hospitals and clinical departments according to the quality of care they receive, and hospitals are to be open about mistakes and always tell patients if something has gone wrong. The system will focus on personalised care that reflects individuals? health and care needs, supports carers and encourages strong joint arrangements and local partnerships.
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Information Management & Technology Strategy: 2011 - 2016 ___________________________________________________________________ Local authorities to champion patient and public views, and at national level, through a new consumer champion, HealthWatch England, located in the Care Quality Commission. Everyone, whatever their need or background, benefits from these arrangements. 5.1.2 The White Paper puts great emphasis on improving healthcare outcomes. The NHS must be focused on outcomes and the quality standards that deliver them. The Government?s objectives are to reduce mortality and morbidity, increase safety, and improve patient experience and outcomes for all. The NHS will be held to account against clinically credible and evidence-based outcome measures, not process targets. 5.1.3 A culture of open information, active responsibility and challenge will ensure that patient safety is put above all else. Quality standards, developed by NICE, will inform the commissioning of all NHS care and payment systems. Inspection will be against essential quality standards. 5.1.4 Money will follow the patient through transparent, comprehensive and stable payment systems across the NHS to promote high quality care, drive efficiency, and support patient choice. Providers will be paid according to their performance. Payment should reflect outcomes, not just activity, and provide an incentive for better quality. 5.1.5 The Government will devolve power and responsibility for commissioning services to the healthcare professionals closest to patients: GPs and their practice teams working in consortia. An independent and accountable NHS Commissioning Board will be established to lead on the achievement of health outcomes, allocate and account for NHS resources, lead on quality improvement and promoting patient involvement and choice. 5.1.6 The NHS will need to achieve unprecedented efficiency gains, with savings reinvested in front-line services, to meet the current financial challenge and the future costs of demographic and technological change. The NHS will release up to £20 billion of efficiency savings by 2014, which will be reinvested to support improvements in quality and outcomes. The Government will reduce NHS management costs by more than 45% over the next four years, freeing up further resources for front-line care.
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5.2
Health & Social Care Bill 2011
5.2.1 The Health and Social Care Bill was introduced into Parliament on 19 January 2011. The Bill is part of the Government?s vision to modernise the NHS. The Bill takes forward the areas of Equity and Excellence: Liberating the NHS (July 2010) and the subsequent Government response Liberating the NHS: legislative framework and next steps (December 2010), which require primary legislation. It also includes provision to strengthen public health services and reform the Department?s arm?s length bodies.
5.3
Quality Innovation, Performance & Prevention (QIPP)
5.3.1 The Government has reaffirmed the need to place quality of care at the heart of the NHS, whilst identifying the need to save on costs and achieve value for money. The Quality, Innovation, Productivity and Prevention (QIPP) programme is all about ensuring that each pound spent is used to bring maximum benefit and quality of care to patients. The NHS needs to achieve up to £20 billion of efficiency savings by 2015 through a focus on quality, innovation, productivity and prevention. Every saving made will be reinvested in patient care by supporting frontline staff, funding innovative treatments and giving patients more choice. 5.3.2 Recommendations in the QIPP report on “ Back office efficiency and management optimisation” include: Organisations should regularly benchmark themselves. All organisations should develop an appropriately structured QIPP programme to deliver benefits ensuring that identified savings are realised. Organisations are encouraged to publish key performance indicators on the performance and efficiency of their back office functions. 5.3.3 The Report stresses that enhanced automation offers provider organisations a cost-effective approach to integrating processes, technology and staff on a standard platform. It minimises paper transactions, facilitates the flow of information and improves data collection, thus increasing efficiencies and eliminating errors. 5.3.4 There are a number of benefits that can be realised through greater use of technology. These include: Improvements in the quality of service experienced by clients; Reduced headcount, with consequent savings freed to support frontline services; A more consistent and uniform approach to business processes through automation of standard process flows; and Rapid turnaround of transactions requiring approval and / or exception handling (workflow).
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5.3.5 Organisations making progress towards automation may also realise unexpected benefits. These benefits arise through enhanced organisational responsiveness and adaptiveness and support more innovation. These benefits are not a direct consequence of automation but secondary effects that flow from enabling the organisation to respond in different ways. 5.3.6 The QIPP Report cites use of the following systems as examples of technology investments to reduce back office overheads. eRostering systems as crucial in meeting the challenge of controlling workforce costs and, particularly, temporary staffing costs. Digital imaging includes scanning and OCR (optical character recognition). This facilitates document movement around an organisation and also in and out of organisations. It also enables electronic storage of documents and supports access to information. The benefits of this are considerable as the traditional model of storage, retrieval and use of hard copy documentation is costly and also carries a risk of misplacing or losing documents. Document scanning and electronic document management systems offer simplification and standardisation of each step of the process. The process offers users quick retrieval of information and enables the organisation to remove administrative staff responsible for delivering and keeping track of where hard-copy data is stored and where it physically is at any given time and who should be able to access it. Efficiency is increased since all areas of electronic document management require a lot less time than any traditional hard-copy document management system would. E-invoicing is typically defined as the electronic delivery of an invoice and other information from an organisation. A proper e-invoice scheme can provide benefits through elimination of printing a paper invoice and putting it in the envelope, the mailing costs of the paper invoice, the opening the invoice letter and archiving the paper invoice; and manual input of the invoice data to the payables / accounting system at the payer. It provides a basis for the reengineering of accounts payable departments with significant savings for organisations. E-HR is „the application of conventional, web and voice technologies to improve HR administration, transactions and process performance?. It involves using technology to provide HR services, such as recording and monitoring systems, automating aspects of recruitment and disseminating information such as HR policies on the intranet. In addition, there may be greater scope to enhance skills through the use of e-learning methods. Sickness absence can be managed more effectively by using e-HR technologies such as electronic monitoring. E-HR can be used to accurately monitor and promote action to support equality and diversity in the workforce. Workflow is a process tool which delivers the right work to the right people at the right time and, in doing so, optimises the processing time within an operation. Workflow solutions manage, distribute and monitor work as it
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Information Management & Technology Strategy: 2011 - 2016 ___________________________________________________________________ progresses through pre-defined business processes and therefore assist with the efficient running of an organisation?s operations. Workflow enables a range of benefits including process visibility – which is essential for tracking progress and improvement. The benefit of workflow technology is that it streamlines and simplifies clinical and business processes, connecting providers directly to the information they need – where, when, and how they need it. By managing care transitions and information gaps between diverse systems, departments and facilities, workflow technology can deliver crucial patient information with speed, efficiency and logic. It bridges the gap between the business and the clinicians.
5.4
National Mental Health Policy
5.4.1 No Health Without Mental Health No health without mental health the cross-Government mental health outcomes strategy for people of all ages was issued in 2011. The Strategy aims at achieving parity of esteem between physical and mental health, and stresses the interconnections between mental health, housing, employment, and the criminal justice system. The strategy has six objectives: (i) More people will have good mental health More people of all ages and backgrounds will have better wellbeing and good mental health. Fewer people will develop mental health problems – by starting well, developing well, working well, living well and ageing well. (ii) More people with mental health problems will recover More people who develop mental health problems will have a good quality of life – greater ability to manage their own lives, stronger social relationships, a greater sense of purpose, the skills they need for living and working, improved chances in education, better employment rates and a suitable and stable place to live. (iii) More people with mental health problems will have good physical health Fewer people with mental health problems will die prematurely, and more people with physical ill health will have better mental health. (iv) More people will have a positive experience of care and support Care and support, wherever it takes place, should offer access to timely, evidence-based interventions and approaches that give people the greatest choice and control over their own lives, in the least restrictive environment, and should ensure that people?s human rights are protected. (v) Fewer people will suffer avoidable harm People receiving care and support should have confidence that the services they use are of the highest quality and at least as safe as any other public service. (vi) Fewer people will experience stigma and discrimination
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Information Management & Technology Strategy: 2011 - 2016 ___________________________________________________________________ Public understanding of mental health will improve and, as a result, negative attitudes and behaviours to people with mental health problems will decrease. The Strategy recognises that information technology and telecommunications have the potential to offer new ways of working with people at risk of, or suffering from, mental health problems. While younger people are often the first to embrace new technologies, such approaches are likely to be equally applicable to adults of any age. Technology can be used to share information about health online, put people in touch with others in similar positions, offer services such as computerised cognitive behavioural therapy and keep people in touch with healthcare professionals – for example, texting reminders of appointments. The use of technology can support innovation, increase choice and make services more accessible – for example, for deaf people – while being more cost effective. Technology can also offer a less stigmatising way of accessing support. Improved use of information technology can promote better and more systematic collection, analysis and use of information across all protected characteristic groups so as to improve delivery and measure outcomes. 5.4.2 Dementia Strategy The aim of the Dementia Strategy is to ensure that significant improvements are made to dementia services across three key areas: improved awareness, earlier diagnosis and intervention, and a higher quality of care. The Strategy identifies 17 key objectives which, when implemented, largely at a local level, should result in significant improvements in the quality of services provided to people with dementia and should promote a greater understanding of the causes and consequences of dementia. 5.4.3 Making Recovery a Reality At its heart “Recovery” is a set of values about a person?s right to build a meaningful life for themselves, with or without the continuing presence of mental health symptoms. Recovery is based on ideas of self-determination and self-management. It emphasises the importance of „hope? in sustaining motivation and supporting expectations of an individually fulfilled life. 5.4.4 Improving Access to Psychological Therapies (IAPT) The IAPT programme aims to provide better access to a choice of evidence-based psychological therapies for people suffering from depression and anxiety disorders. IAPT is concerned with raising standards of recognition and treatment for the many people who suffer from depression and anxiety disorders. The programme is at the heart of the Governm ent?s drive to give greater access to, and choice of, talking therapies to those who would benefit from them. 5.4.5 Improving Access to Child & Adolescent Mental Health Services
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Information Management & Technology Strategy: 2011 - 2016 ___________________________________________________________________ Children and young people in need of more specialised help from child and adolescent mental health services (CAMHS) should have clearly signposted routes to specialist help and timely access to this, with help available during any wait. 5.4.6 Improving Health Supporting Justice Adults and young people who are socially excluded, have a high proportion of health inequalities and are in contact with the criminal justice system are more likely to experience mental health problems or learning disabilities, or to have difficulties with drugs and alcohol. The overarching aim at each stage of the offender journey is to develop the mechanisms that enable the provision of effective mental health care in the most appropriate environment, whether in the criminal justice system or in health settings. The aim is to remove the obstacles to effective cross-agency working and create a far more coherent and integrated system – one which is based on shared responsibility and ownership by those working in it, irrespective of which agency or sector employs them. There is a need to improve the identification of people with a learning disability at every point in the criminal justice system, and at as early a stage as possible, so that appropriate diversion and sentencing options can be applied. The aim is to improve the overall well-being of offenders with learning disabilities in the criminal justice system by aiding early identification, by providing accessible materials, and by assisting front-line professionals to develop skills and a knowledge base to help them manage offenders with learning disabilities more effectively.
5.5 Wanless Report A key conclusion of the Wanless Report, published in January 2002 was “ Without a major advance in the effective use of ICT the health service will find it increasingly difficult to deliver the efficient, high quality service which the public demand. This is a major priority which will have a crucial impact on the health service over future years”. Although the Wanless Report is a decade old this conclusion remains relevant and has informed subsequent national IM&T strategy.
5.6 Information Revolution The Information Revolution is the new national IM&T strategy for the NHS, published in 2011. 5.6.1 Vision The vision of the Information Revolution is that people have the information they need to stay healthy, to take decisions about and exercise more control of their care, and to make the right choices for themselves and their families. This includes an accurate record of their care, available to them electronically. Health and adult social care information will be liberated “from a closed, bureaucratic system” in order to serve patients and the public, and to help drive better care, improving outcomes, innovation and the better use of resources.
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Information Management & Technology Strategy: 2011 - 2016 ___________________________________________________________________ It signals a move from information belonging to the system, to information enabling patients and service users to be in clear control of their care; and for patients and service users merely receiving care, to patients and service users being active participants in their care. Information would be based on the patient or service user consultation and on good clinical and professional practice rather than based on administrative and technical needs. Significantly, in relation to digital technologies there will be a move away from an approach where every organisation is expected to use the same system, to one where systems are connected and joined up. 5.6.2 The Strategy Patient / Service User Control of Records There is evidence to show that giving people greater access to and control over their health records improves relationships with clinicians and provides more involvement; patients are enabled to correct errors and omissions, and increases people?s ability to manage their own health care and their confidence to do so. Patient and service user control of their record does not mean they will be able to remove the original record from the care provider, or alter or delete what a clinician or care professional has entered into their record unless it is incorrect. Comprehensive, professionally-assured record keeping standards will be needed to ensure consistency. The Royal Colleges are working to introduce comprehensive standards for record keeping, principles for shared records and guidance on good practice in giving people access to their own records. All care records will be required to adhere to nationally agreed standards, including use of the NHS Number as the means of identification. Electronic records must meet appropriate standards of safety, security, reliability and resilience. Some key elements for early standardisation of recording would be: • physiological observations; • pathology and diagnostic imaging results; • procedures, including surgery; • medication; • scheduling / disposition (is the patient admitted, discharged, awaiting a clinic appointment, if so, with whom); and • „diagnoses?, such as discharge diagnoses (secondary care) current problems (primary care). For professionals and teams to offer high quality, safe, individualised care, they need access to a single source of information about patients and service users. It should include the decisions made, actions taken, and outcomes achieved. It should be accessible whatever the care setting. Information should be entered at the point of care by patients, service users, clinicians and care professionals.
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Information Management & Technology Strategy: 2011 - 2016 ___________________________________________________________________ Prevention and Self Care There will an increased emphasis on providing information for better prevention, self-care and healthier lives. Information for improved outcomes The Information Revolution introduces a new focus on outcomes. This will include Quality Accounts - an annual report to the public from providers of NHS healthcare about the quality and outcomes of their services. There will be a review of central data collections to ensure that data that is collected meets the requirements of the Information Revolution and time and effort is not taken up with collecting data for outdated purposes. Patient and service user generated information will contribute to the information available on outcomes. This will include information c ollected from staff and patients or service users through surveys, real-time feedback, ratings of services, and Patient Reported Outcome Measures (PROMs). Good commissioning involves using the resources available to secure the highest quality services and best possible care outcomes for a local population. Effective benchmarking against comparable areas will be supported by The NHS Atlas of Variation, to be published shortly. Information for professionals For professionals and teams to offer high quality, safe, individualised care, they need access to a single source of information about patients and service users. Clinicians and care professionals need to be able to access the best evidence (including international evidence) of outcomes, interventions and risks. Clinical audit will be used to compare the effectiveness of different clinical approaches and in identifying areas for quality improvement participation in clinical audit is seen as the “professional norm”. Research is vital in providing the new knowledge needed to improve health and care outcomes and reduce inequalities. Informatics workforce capacity and capability Information management and IT capability will be essential to delivering the Information Revolution. Strong leadership is needed from CEOs and Boards, clinical leaders and leaders of the information and IT professions. A culture within each organisation needs to be created where information is seen as the lifeblood. Information for Accountability The Revolution provides an emphasis on the provision of information to support autonomy, accountability and democratic legitimacy and using information to drive efficiency.
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Information Management & Technology Strategy: 2011 - 2016 ___________________________________________________________________ 5.7 National Programme for IT (NPfIT) The Information Revolution has initiated a move away from an approach where every organisation is expected to use the same system, to one where systems are connected and joined up. Whilst the NPfIT was the implementation approach for previous NHS IM&T strategies some elements will remain to ensure systems are connected and joined up. Systems implemented under the banner of the NHS Care Record Service (CRS) will remain in place until replaced by successor systems. The components of the National Programme for IT delivering connectivity and interoperability are: N3 (National Network for the NHS) NHS Spine Choose & Book Electronic Transfer of Prescriptions (ETP) National applications such as, PACS (Picture Archive and Communication Systems) – digital x-rays Interoperability Toolkit 5.7.1 N3 N3 is the national network for the NHS. N3 has been updated to include QoS (Quality of Service). This enables the prioritisation of different types of traffic on the N3 network, in accordance with business priorities. For example, access to national applications could be given a higher priority than e-mail. Future developments include the routing of voice traffic (telephone calls) and enabling home and remote working via N3.
5.7.2 NHS Spine The main components of the NHS Spine may be summarised as follows: ? PDS (Personal Demographics Service): A national directory of citizens containing basic personal details such as NHS Number, name, address, and date of birth ? SDS (Spine Directory Service): National directories containing details of NHS organisations and basic details of NHS staff such as name, job title, job role, organisation, e-mail address. ? PSIS (Personal Spine Information Service) also known as the Summary Record: Provides an up-to-date summary of information and key events in a patient?s life and care – drug allergies, operations, conditions, medical history – as well as details of contacts with care providers. 5.7.3 Choose & Book Choose & Book is a national application combining electronic booking and a choice of place, date and time for first outpatient appointments. Patients are able to choose their initial hospital appointment, and book it on the spot in the surgery or later on the phone or via the internet at a time that is more convenient to them.
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Information Management & Technology Strategy: 2011 - 2016 ___________________________________________________________________ The development path for Choose & Book to accommodate the requirements of mental health services remains unclear. The implementation of Choose & Book in mental health services is dependent upon clear guidance from the Department of Health, which as yet, is not available. 5.7.4 Electronic Transmission of Prescriptions (ETP) Programme The ETP programme will create and implement the Electronic Prescription Service and then integrate it with the NHS Care Record Service. The Electronic Prescription Service will allow prescriptions (including those for repeat dispensing) generated by GPs and other prescribers to be transferred electronically between prescribers, dispensers and the reimbursement agency (Prescription Pricing Authority). Implementation of ETP into secondary health services is some years away. 5.8 A Vision for Adult Social Care “A Vision for Adult Social Care: Capable Communities and Active Citizens” (2010) sets out the Government?s plans to reforming the s ystem of social care in England. Its aim is to provide much more control to individuals and their carers. The vision centres on prevention; plurality and partnerships; providing protection; productivity and people, and in particular: break down barriers between health and social care funding to incentivise preventative action; extend the greater rollout of personal budgets to give people and their carers more control and purchasing power; and use direct payments to carers and better community-based provision to improve access to respite care. “Transparency in outcomes: a framework for adult social care”, like the “Information Revolution”, places a greater emphasis on measuring outcomes. The main proposals are summarised below. Evidence Base The role of the National Institute for Health and Clinical Excellence (NICE) will be expanded, subject to legislation, to include adult social care from 2012/13. NICE will work through the social care sector to bring together the evidence on best practice and publish Quality Standards from 2012/13. Local government and the social care sector will have a new role in building the evidence base – working jointly to identify areas for Quality Standards. Demonstrate Progress A single Quality and Outcomes Data Set will be introduced to bring together all routine social care data requirements with the aim to reduce the overall reporting burdens placed on councils. There will be no national performance management, no targets nor league tables, and the current annual assessment of councils as commissioners of adult social care will be replaced with a more proportionate, sector-led approach. The Care Quality Commission will continue to inspect services where concerns have been raised. As with health reporting, there will be a
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Information Management & Technology Strategy: 2011 - 2016 ___________________________________________________________________ fundamental review of all data requirements. It is proposed to publish a set of outcome measures, with the benchmarking of results. Support Transparency All agreed social care data and outcome-focused measures will be published in a consistent format and on an annual basis, through a single information portal. Councils will publish a local account on their priorities for quality and outcomes in social care, as a key tool for transparent reporting to their local population. This local role for accounting will replace the Care Quality Commission?s annual assessment of Councils as commissioners (including the former requirement for a Self-Assessment) from 2011/12. Reward & Incentivise The new „excellence? rat ing for social care providers, currently in development, will act as an accredited marker of best practice and high quality and an incentive for providers, as well as an important tool for supporting choice. Secure the Foundations The role of the Care Quality Commission (CQC) will be strengthened and refocused as an effective quality inspectorate. A key challenge for mental health services is the avoidance of duplicate data capture whilst contributing to both electronic records in health and social care and the integration or virtual integration of systems.
Local Strategic Context 5.9 Making Life Better Together Making Life Better Together is the Trust?s strategy for the future of mental health services. The main drivers for the strategic change are: • Tackling health inequalities • Strengthening relationships with communities • Supporting the management of long term conditions • Learning from the other health sectors • Personalisation – healthcare tailored to an individual?s requirements and wishes • Poly-systems: providing mental health care as part of integrated service model The Trust?s utmost priority is to serve its local population through managed care pathways, in conjunction with other providers: statutory and voluntary. The proposed model of care will ensure that everyone will be assessed quickly by an experienced psychiatrist and offered advice, treatment, information and education. This will be underpinned by shared decision making with service users. By the end of the strategic period, the people of South West London will have mental health services that will:
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Information Management & Technology Strategy: 2011 - 2016 ___________________________________________________________________ • Provide Early Expert Assessment ? Supported by senior clinicians from allied professions ? Restoring the quality standards for community practice set in 1990s. Includes telephone consultation GP to consultant, with direct communication between GP and consultant psychiatrist ? Aims to reach common agreement on treatment plan between primary care and secondary care and patient ? Early Expert Assessment service will constitute the „point of entry? to the secondary care services ? Managerially integrated with community teams Provide NICE compliant interventions in clinic settings (ref: QIPP) Safeguard vulnerable people from harm and encourage managed risk-taking and harm minimisation Provide a personalised approach with shared decision making. Service users will benefit from well-defined responses to their individual care needs (ref: QIPP) and have choices with reference to purchasing services from their personal budget Embed the recovery approach in all that we do, enabling our service users to regain their lives.
• • •
•
5.9.1 Provide Community Services • The Trust?s Recovery College is at the centre of the Trust?s intention to help people (and their families) understand and manage their conditions and support people to gain more control over their lives • The Trust will work closely with primary care to ensure that individuals are assessed and treated as early as possible, as evidence suggests that outcomes are improved • The Trust will offer evidence based treatment packages in community clinic settings to enable us to treat high numbers of patients rapidly and return them to primary care, for example: • Neuro-developmental clinics • Dementia • Side effect monitoring • Prescribing • Physical health checks • Family work • The Trust aims to support navigation of the whole mental health system (e.g. through Personal Budgets) to ensure that patients and their families/carers can access all relevant health and social care services, including children?s services. This supports choice and personalised care. • Ongoing support will be offered in the recovery / support teams, with professional input from psychiatrists and nurses, clinical interventions, often in clinic settings as well as courses at the Recovery College. Day to day support will be offered by Trust trained peer support workers
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Information Management & Technology Strategy: 2011 - 2016 ___________________________________________________________________ 5.9.2 Provide Intensive Support • Crisis and home treatment teams • Provide Liaison psychiatry in acute hospitals • Provide the following Trust Inpatient services on a Trust –wide basis rather than borough: ? Acute ? Rehab ? PICU ? Step down ? P.D. Services ? A.L.D. Services ? CAMHS ? Older People ? Specialist Services
5.10 Foundation Trust status The attainment of foundation trust status requires trusts to take a business-type approach that focuses on corporate and financial risk management and value for money. The organisation also has a more integrated approach to its strategic planning. As a consequence having the right information about services provided is crucial. Detailed information is required to target cost savings, to negotiate contracts and match cost to income flows as far as is possible. Trust boards need to take a strategic view, planning and designing services required over future years.
5.11 New Commissioning Arrangements Relationships with GP practices will be increasingly important as the new commissioning arrangements are brought into place following the enactment of the Health and Social Care Bill 2011. Trusts need to have the knowledge at practice level about which services are needed. As the health service moves away from being provider driven, mental health trust boards need to assess the competition for providing services, particularly specialised services, and identify potential new entrants to the market.
5.12 Patient choice In future, patients will increasingly be able to make choices about their care, such as assessment and treatment options, as well as providers. Mental health trusts need to be flexible and adaptive in their provision of services to ensure that they reflect patient demand and patients have a positive experience. Trusts also need to ensure that patients and carers receive accurate and appropriate information, so that they can make informed choices about these services.
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Information Management & Technology Strategy: 2011 - 2016 ___________________________________________________________________ 8 5.13 Mental Health Act The 2007 Mental Health Act amended the 1983 Mental Health Act and the 2005 Mental Capacity Act. The main changes included the introduction of supervised treatment in the community and broadening the range of professionals who have roles in the Mental Health Act, as well as the need to make assessments of a person?s mental capacity.
5.14 Operating challenges There are a number of challenges faced by mental health trusts. These include: ? the increasing emphasis on treatment in community settings; ? potential changes in the funding and commissioning of mental health services through Payment by Results and Practice Based Commissioning ? meeting the mental health needs of particular groups, such as those involved with the criminal justice system (including the prison and youth offender institution population), people with learning disabilities and older people, children and young people; ? partnership working with other agencies, such as primary care, adults? and children?s services, the criminal justice system, housing and education and the voluntary sector; ? working with GPs to reduce inappropriate referrals to specialist mental health services; ? providing high quality services to ensure that they reflect patient demand as patient choice develops, whilst ensuring equality in services, particularly for people from black and minority ethnic groups; ? the change in definition and caseload of dual diagnosis. Particular challenges include collaboration between community drug and alcohol teams and mental health teams, liaison with housing departments and training for staff in treating substance misuse and dual diagnosis; ? promoting and enabling social inclusion and challenging the stigmatisation and discrimination through employment projects and engaging community participation; and ? the introduction of service-line reporting as part of the financial management regime. Mental health trusts require information to assess and monitor progress in meeting these challenges.
6.
Local Environment
6.1 In London, electronic care record systems (formerly known as the Care Records Service) are provided by BT through a contract with the Department of Health. RiO is the electronic care record system provided for mental health
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Information Management & Technology Strategy: 2011 - 2016 ___________________________________________________________________ services. The London Programme for IT (LPfIT) manages the contract on behalf of the Department and supports the development and operation of RiO. 6.2 A governance structure is in place to support RiO and London-wide developments. For mental health services, the Mental Health Programme Board oversees all developments. It is chaired by Judy Wilson, Chief Executive of SW London & St George?s Mental Health Trust. The Trust has two representatives on the London RiO User Group. The Trust?s Director of IM&T chairs the Directors of ICT (Mental Health) Forum which provides IM&T professional advice to the London Programme on IM&T issues affecting mental health services. 6.3 Locally, a 5 Borough (local authority) – Trust ICT Forum meets on a regular basis, in particular to work on issues affecting integrated health and social care services, but also to act as a forum for sharing good practice and experience. The Forum also assists in maintaining good working relationships between the IM&T departments of the six organisations. 6.4 Directors of IM&T from the London Mental Health Trusts meet periodically to discuss and work on issues of mutual interest. A forum of the London Directors of IM&T for all NHS organisations meets quarterly.
7.
Internal Environment
7.1 IM&T in the Trust is managed within a single department (with the exception of Information Governance which is managed by the Governance Directorate). The IM&T Strategy Group is responsible for setting strategic direction, overseeing the implementation of the strategy and acts as the Programme Board for the IM&T Programme. New capacity, capability and other benefits are delivered through a set of projects, all managed within the IM&T Programme. 7.2 PRINCE2 project management methodology is used to manage all IM&T projects. The IM&T Programme is managed using the MSP (Managing Successful Programmes) methodology. 7.3 Clinical and business engagement in the IM&T agenda is achieved through: Senior clinicians and senior management on the IM&T Strategy Group The Operational Management Group (chaired by the Chief Operating Officer) acts as the Management Board for the Trust?s IT Service Level Agreement. Senior clinicians and mangers on IM&T project boards Clinicians and clinical managers in IM&T project teams Clinical Leads working in the IM&T Department Presentations to manager and clinician forums IM&T briefing presentation on the Trust induction programme
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8.
Current Provision
8.1 Current Systems The Trust?s current main business and clinical systems are summarised in the table below.
System RiO Function Electronic care record Notes National Programme Care Record Service solution for mental health services in London. Locally hosted
IAPTus
Electronic Staff Record eFinancials Data Warehouse / “The Pulse” JAC IAT; Care First; Framework-I; PARIS; Framework
Electronic care record for the psychological therapies in primary care service National application for human resources and payroll General Ledger, Accounting system Data warehousing and executive information system Pharmacy stock control Social care referrals, social care purchasing, care planning for the London Boroughs of Kingston, Merton, Richmond, Sutton and Wandsworth. Corporate Reporting tool
National NHS system.
Data sets in the Data Warehouse include clinical, finance and workforce Local authority social care systems used by integrated Mental Health Teams.
Performance Accelerator Roster Pro At Learning
Electronic Rostering system . Learning management system to record training information
8.2 IM&T Staffing The IM&T department is based at Springfield University Hospital. The Director of IM&T reports to the Director of Finance. 8.2.1 IT The IT function is managed by the IT Systems Manager providing networking, telephony, application support, technical support, hardware maintenance, helpdesk support, and IT security services to all the Trust sites. The IT staffing levels benchmark well, that is, they are relatively low for the number of users supported.
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8.2.2 IM&T Training IM&T training is provided for basic IT skills, RiO, Word (basic and intermediate), Excel (basic and intermediate), Internet and web browsing, e-mail, the data warehouse, and to support other system upgrades. The IM&T training resource is augmented with contractors at the time of increased demand for training, for example, for new system implementations and upgrades. 8.2.3 Information Management Information Management function provides / supports information analytical tools and a business intelligence and data analysis service. It also provides a clinical coding function, data quality back office and undertakes the development and implementation of information management policy. 8.2.4 Library services Library services are managed by neighbouring trusts. St Georges Medical School library services at St George?s Hospital are available to SW London & St George?s staff. There are also staffed library facilities at Springfield Hospital (3 days per week), and Sutton Hospital (2 days per week). There is also a small library in the Shaftesbury Clinic (Springfield Hospital site). Librarian support is available via email, when libraries are not staffed. 8.2.5 Staffing Levels The staffing levels in IM&T are summarised in the following table. Staffing levels were increased to provide additional support for RiO during and post implementation. Permanent posts are supplemented by contractors and fixed term appointments to provide project resource. Cost improvement savings in the next few years will require the IM&T staffing levels to fall substantially. The tension between the need for cost savings and the need to invest in technology, the demands for higher availability and capacity management of systems (as downtime will not be tolerable) is going to be a challenge. IM&T Establishment.
2007/08 IM&T Function
IT Service Desk IT Systems Admin IT Technical Support IT Network Admin Telecoms & Cabling IT Service Manager Information Analysis Coding & Data Quality IM&T Training Project Management Change Management Clinical Leads
Estab Posts (wte) Temp. Posts (wte)
2008/09
Estab Posts (wte) Temp. Posts (wte)
2009/10
Estab Posts (wte) Temp. Posts (wte)
2010/11
Estab Posts (wte) Temp. Posts (wte)
2011/12
Estab Posts (wte) Temp. Posts (wte)
4.00 5.00 11.00 2.00 6.00 1.00 5.00 4.30 4.00 1.60
1.00 1.00 1.00 2.00 5.00 8.00 5.00 1.00 2.70
6.00 4.00 10.00 4.00 6.00 1.00 5.00 4.30 4.00 1.60 0.90
1.00
1.00 5.00 1.00
7.00 4.00 10.00 4.00 6.00 1.00 5.00 3.25 5.00 1.60
1.00 1.00
3.00 1.00 0.90
6.00 4.00 9.50 4.00 5.50 1.00 5.00 3.25 5.00 4.60 1.00 0.90
1.00
6.00 4.00 7.50 4.00 3.50 1.00 5.00 3.00 4.00 4.60 1.00 0.90
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2007/08 IM&T Function
Information Governance Director of IM&T PA to Dir. of IM&T Librarian TOTALS
Estab Posts (wte) Temp. Posts (wte)
2008/09
Estab Posts (wte) Temp. Posts (wte)
2009/10
Estab Posts (wte) Temp. Posts (wte)
2010/11
Estab Posts (wte) Temp. Posts (wte)
2011/12
Estab Posts (wte) Temp. Posts (wte)
1.00 1.00 1.00 1.00 47.90
26.70
1.00 1.00 1.00 1.00 50.80
8.00
2.00 1.00 0.80 1.00 51.65
6.90
2.00 1.00 0.80 1.00 54.55
1.00
2.00 1.00 0.80 1.00 49.30
9.
Changes in the Last Eight Years
9.1 The Trust?s previous IM&T Strateg ies each set out a series of strategic goals. During that period the national strategic context changed substantially, for example the IMHER (Integrated Mental Health Electronic Record) became the Care Record Service (CRS) and the timescales shifted. However, the Trust was able to achieve most of what the Strategy set out to deliver. 9.2 The main achievements of the period 2002 - 2010 are summarised in the table below.
Key Action Implement eCPA (electronic Care Programme Approach). Implement IMHER (Integrated Mental Health Electronic Record) – later updated to CRS (the Care Record Service), i.e. electronic care records for all service users. Improve NHS Number coverage Implement single Patient Master Index Progress Made eCPA system developed and implemented in 2003. Electronic care record system (RiO) implemented in 2006/07. IAPTus went live in 2009/10 for primary care psychological therapies. Coverage of NHS Numbers for current and recent patients increased to 97%. Achieved for all services with the exception of CAMHS. In 2002 Kingston and Richmond services were still using Kingston Hospital PAS and Kingston PCT?s TCS community system. In 2003 all services were using CMIS, with the exception of CAMHS which used MAISY. Electronic care record system (RiO) implemented in 2006/07 enable a single Patient Master Index. RiO v5 implemented in 2010 provide a link to the NHS Spine directories enabling demographic data to be kept up-to-date. New web site went live in 2005. Review took place in 2005. All IT equipment has been tagged. A new asset register has been created. New processes and procedures implemented in 2010. The IM&T Service Desk system is now used to manage assets. Data Accreditation as a national initiative
Develop the Trust web site. Review patient leaflets. Update IT hardware and software inventories.
Gain Data Accreditation for the quality of
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Key Action data processes. Progress Made was replaced by the Information Governance Toolkit. The Trust achieved 97% compliance by March 2007, and has since maintained an acceptable level of compliance. Policies and procedures developed to BS7799 standard. ITIL version 2 (the IT service standard) implemented in 2006 and 2007. Policy defined and approved in 2005/06. Achieved in 2002, and sustained. Achieved in 2003, and sustained. Achieved in 2003. N3 (National NHS Network) replaced Trust WAN links in 2005. New Service Desk system implemented. Staffing Levels increased from 1.0 w.t.e. (in 2002) to 4.0 w.t.e. (2006), 6.0 w.t.e. (2010). IM&T Service Desk processes redefined using ITIL (IT Infrastructure Library). IM&T Service Desk awarded national accreditation annually since 2007. Review undertaken. Implementation of VoIP (Voice over Internet Protocol), which is now available on most sites. Electronic Staff Record (ESR) went live in May 2007. Active Directory implemented in 2003/04. Interface to ESR installed to provide automatic update of staff starters and leavers (2009). ESR data quality to be addressed. Implemented according to national timetable. Local PIs developed and reported against. Performance analysis available via The Pulse and updated daily (since 2006). Some dashboards in place; development programme in place. Information Sharing Agreements now in place. Staffing levels increased in 2006, and sustained. Data Warehouse procured in 2006. Performance analysis available via The Pulse and updated daily (since 2006). The system has 200+ registered users. Some
Implement the information security standard BS7799.
Devise records management policy Complete “Clinician Connect” – ensuring that all clinicians have access to a computer. Complete “NHS Connect” – ensuring that all staff have access to a computer. IT & networking rationalisation – ensuring all Trust sites are connected to the Trust?s WAN (Wide Area Network). Review IT Helpdesk support
Review of infrastructure including telecoms Implement National HR/Payroll system Review provision of internal staff directory
Implement the Mental Health Minimum Data Set Devise local Performance Indicators
Develop information sharing with partner organisations Increase analytical capacity Develop the reporting and information analysis service to managers, clinicians and researchers.
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Key Action Progress Made dashboards in place; development programme in place. The level of IT literacy has increased. All clinical staff now use electronic records. However, this needs to increase further to in order to realise the full benefits of electronic working. Comprehensive training programmes for clinical systems and non-clinical systems in place. High levels achieved: 97% of clinical staff trained before RiO v5 went live (2010). All staff now have objectives and personal development plans. All mobile staff (800+ clinicians working in the community) now have mobile access to electronic care records, e-mail etc via a laptop with a mobile connection. A modern industry standard data storage solution is in place with a disaster recovery centre. Virtualisation to follow. The core data network was upgraded to distributed network (2008). Compression software has been deployed to increase capacity and performance of the data network. QoS (Quality of Service) is being introduced to prioritise network traffic. Wireless networks (WiFi) have been installed on some sites. PCs for patient use have been made available on many inpatient wards. Text messaging has been piloted and now being rolled out. IT industry specification adopted. New data centres to industry best-practice standards (including Disaster Recovery site). IM&T Dept used to be based in two different locations on the Springfield Hospital site. Now co-located this had enabled improved communications and the streamlining of processes. The range of data sets in the Trust?s data warehouse have been extended to include population data, finance data and workforce data. The Trust has invested in GIS (Geographical Information System) software to enable geographical analysis of data to be presented as maps. The ordering of goods and services is now an electronic process via an eProcurement
Improve basic IT skills
Training for clinical systems
Develop IM&T staff Support a mobile workforce
Upgrade data storage
Modern optimised Network
Computing for patients
Modern data centres
Co-locate IM&T staff
Extend range of information analysis
Automate business processes
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Key Action Progress Made system, saving time and money. An eRostering system went live in 2009 enabling the better scheduling of nursing shifts on the ward replacing a paper process. A business case for collaborative software has been approved. Interim arrangements have been put in place to enable clinicians to access pathology reports on-line. A programme to scan old paper medical records and create an electronic archive is underway. All records at Tolworth Hospital were scanned in 2009.
Results reporting
EDM
This strategy builds upon the achievements of previous IM&T Strategy and enables the Trust to move forward.
10.
Perception of Stakeholders
10.1 Service Users Service users requested access to computing and patient surveys highlighted the need to provide meaningful activities during inpatient stays. To this end computers for service users were rolled out across the Trust following a feasibility study that was completed in 2006. . Access to the internet and computing helps service users with rehabilitation and employment prospects. Text messaging and video conferencing have been introduced to provide different means of communication. During the next strategic period the Trust plans to invest in technologies and applications to further service user and carer engagement and support self care and recovery. 10.2 Trust Staff Clinicians and admin staff in clinical services now use RiO as the main (electronic) clinical record. The move to an electronic clinical record has involved a considerable change in working practices. The implementation of RiO has been supported by a programme of change management. However, it is a continual process to ensure that RiO fits well with new and emerging models of care. Some clinical processes may need to further adapt further to take full advantage of electronic functionality. Later versions of RiO will address some of these issues and in the meantime workarounds are being used. Since RiO was implemented, at times the level of system availability and the performance of the RiO system fell well below that needed for a clinical record system. This poor performance adversely affected staff confidence in the system. The Trust has been working with the London Programme for IT and BT to improve system availability and performance, and will continue to do so.
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10.3 Commissioners The PCTs as commissioners of mental health services are provided with information of activity and quality indicators. The implementation of RiO and the Data Warehouse has enabled the Trust to expand the range of information available. With the forthcoming developments in commissioning – the introduction of Payment by Results and new commissioning currencies; the establishment of GP commissioning consortia – the Trust is well placed to meet these challenging demands in terms of rich data sources and its data warehouse. However, there will be a need to develop analysis, reporting and data presentation to meet these demands. It may be necessary to increase the data analytical capacity, at least for a short period.
10.4 Local Authorities RiO as a health and social care record supports integrated Community Mental Health Teams. The Trust is currently working with local partner boroughs to reduce duplicate data capture by using the RAP reporting extract. Further developments on data capture, information systems and technology will support true integrated working between health and social services. Local organisations are committed to the same vision and are working together to meet the challenge. 10.5 Other providers The development of electronic care records in London will enable the integration of care information and access across care settings and the development of messaging to support processes such as referral and discharge. Electronic messaging such as pathology and radiology requests and reports which are embedded into RiO will be implemented during the strategic period. The Trust will work with the local Acute Trusts to take advantage of these and other developments. 10.6 London Programme for IT / Connecting for Health The Trust has been committed to the National Programme for IT and the London Programme, as demonstrated by being the first Mental Health Trust to implement RiO in London. In seeing the opportunities that the Programmes bring, the Trust has participated in its development; Trust clinicians have contributed to the development workshops for RiO. The Trust has volunteered to assist in national developments such as the Common User Interface and the IT Infrastructure Maturity Model. 10.7 The Trust plans to join other mental health trusts to form a consortium to procure a replacement system for RiO. 10.8 The Trust was a runner-up in the Health Informatics Accolades Scheme in 2007 for its implementation of RiO.
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Information Management & Technology Strategy: 2011 - 2016 ___________________________________________________________________ 10.9 The Trust?s IM&T Service Desk has been accredited to national standards by NHS Connecting for Health – the first mental trust nationally and the second trust in London to be accredited. The accreditation has been awarded for three consecutive years.
The Case for Change 11. Benchmarking
11.1 Health Informatics Service Benchmarking Club (HIBC) The Trust is a member of the national HIBC. The Club run a service benchmarking, the 2010 results for the Trust are shown below. Twenty health informatics services took part in the benchmarking
Trust Score 100% 100% 97% 96% 95% 92% 88% 87% 87% 86% 84% 83% 83% 75% 72% 67% 66% 64% 63% 63% 56% N/A N/A Range of Scores 63% - 100% 32% - 100% 50% - 100% 50% - 100% 57% -100% 68% - 100% 74% - 100% 23% - 100% 29% - 100% 71% 95% 65% - 100% 33% - 91% 66% - 100% 60% - 95% 52% - 96% 60% - 87% 33% - 100% 37% - 100% 33% - 100% 43%- 100% 40% - 76% 44% - 100% 65% -100%
Workforce Development User Support Service Desk Information Analysis Services Information Services Governance Robust Business Processes Advisory Services Development & Improvement Planning IM&T Training Project Management Efficient Use of Resources Network Management Telecoms IT Security Policy Development Planning Advice Programme Management Support Specialist Info & Knowledge Management IT System Operations, Service Support & Delivery Customer Focus & Engagement Long Term Resource Framework Benefits Realisation & Change Management Effective Leadership Application Design & Development Information Governance
11.2
IM&T Spend
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Information Management & Technology Strategy: 2011 - 2016 ___________________________________________________________________ NHS Connecting for Health collects information from each Trust on annual investment (spend) on IM&T. In 2005/06 the actual spend placed the Trust 29th out of 48 Mental Health Trusts in England in terms of percentage of turnover spent on IM&T (1.48% in a range of 0.57% - 4.14%). The average for the NHS in London (all provider types) is 2.2%. It has been difficult to obtain data on subsequent returns to make a more recent comparison. 11.3 Data Quality All Mental Health Trusts are required to collect a nationally agreed data set for all episodes of mental health care – the Mental Health Minimum Data Set (MHMDS). These data sets are submitted to the Department of Health (a national reporting requirement), from which a set of data quality benchmarks are produced.
% Valid % Valid Position * th 98.03% All “Core” Data Items 84.16921% 16 th 99.87% Commissioner Code 99.50581% 60 th 99.37% NHS Number 98.16926% 36 th 97.51% Registered GP Practice 94.35615% 77 th 99.99% Gender 99.97754% 48 rd 94% Marital Status 67.54647% 53 th 99.79% Birth Date 99.77537% 54 th n/a Ethnic Category 86.61201% 18 th 99% Postcode 99.32611% 48 n/a CPA Level 78.53734% 13th 97.26% Occupation (CPA Care Co-ordinator) 83.19200% 10th 51.63% HoNOS (Most Recent) 0% 40th = 55.31% Settled Accommodation Indicator n/a n/a 51.73% Employment Status n/a n/a * 85 Trusts submitted MH Minimum Data Sets (data volumes vary considerably). n/a = not available. Data Item 2008 2010 Position 3rd 26th n/a st 61 th 47 19th 50th n/a 59th n/a 4th 3rd 4th 4th
A validity level of 95% for any one data item can be considered to be good and 98% very good. The Trust has generally good data recording levels on the “core” data items of the MHMDS but has to address the quality of data recording in particular in respect of diagnosis and clinical outcome. 11.4 Knowledge Management – Self Assessment A self-assessment of Knowledge Management (KM) capability was undertaken by the IM&T Strategy Group to inform the development of this strategy using the KM assessment tool developed by Knowledgeable Ltd. See Appendix B for more details.
Dimension KM Strategy Leadership Behaviours Current Level Level 1 Level 2 Two Highest Priority Targets Level 5
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Networking Learning Before During & After Capturing Knowledge Level 3 Level 2 Level 2
Level 4
11.5 Information Governance Toolkit In the NHS an Information Governance Toolkit (IGT) has been developed. The IGT also provides a measure of an NHS organisation?s compliance to information governance standards. The IGT is updated annually, and is currently divided into six initiatives: Information Governance Management; Confidentiality & Data Protection Assurance; Clinical Information Assurance; Secondary Use Assurance; Corporate Information Assurance; and Information Security Assurance. The Trust?s compliance to the requirements of the Information Governance Toolkit is as follows:
Version 4 Mar 2007 91% 96% 66% 92% 84% 86% 88% % Compliance Version 5 Version 6 Mar 2008 Mar 2009 90% 85% 96% 86% 66% 66% 92% 77% 85% 80% 86% 86% 88% 81% Version 7 Mar 2010 87% 86% 75% 86% 80% 87% 84%
Initiative Clinical Information Assurance Confidentiality & Data Protection Assurance Corporate Information Assurance Information Governance Management Information Security Assurance Secondary Use Assurance Overall Score
In 2007 South West London and St George?s Mental Health Trust achieved the highest IGT score in London for Mental Health Trusts, the second highest IGT score in England for Mental Health Trusts and the third highest overall IGT score in England. In 2009, additional requirements and changes in Information Governance Managers with the post being vacant for sometime led to the IGT score being reduced.
11.6 NHS IT Infrastructure Maturity Model (NIMM) NHS Connecting for Health (CfH) has developed an IT Infrastructure Maturity Model for Trusts to self-assess the level of maturity of their IT services. The Model has five levels of maturity: Level 1: Basic Level 2: Controlled Level 3: Standardised Level 4: Optimised
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An assessment has been undertaken and appears in the table below. Infrastructure Technology Average Highest Lowest Patterns & Practices End User Devices Common Applications & Services Operating Systems Infrastructure Hardware Platforms Network Devices & Services IT Security & Information Governance 3.9 3.3 3.2 3.0 4.1 4.2 3.6 4.1 3.5 5.0 4.4 5.0 4.7 4.6 3.5 3.1 1.6 1.4 3.0 3.6 1.6
3.6 5.0 1.4
Infrastructure Management
Infrastructure Governance Business Alignment Procurement People & Skills Financial Management PSPG Average Highest 3.7 3.6 3.2 4.3 3.5 3.1 4.0 4.1 3.3 4.4 4.4 3.5 Lowest 3.3 3.0 3.1 4.2 3.0 2.5
3.5 4.4 2.5
12. Areas for Development A set of vision statements were developed with reference to the Trust?s strateg ic objectives and corporate priorities to describe the future Trust enabled by technology where information and knowledge are use to best effect. These vision statements enabled the identification of five key investment areas and the high level implementation plan. The following table shows how the vision statements relate to each Trust objective.
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Trust Strategic Objective Developing the Workforce Developing Knowledge & Practice Quality of Services Modern Service Provision
Vision Statement
A framework where tools are in place that enables learning before, during and after Accessibility to systems is via a single portal and there is a common user interface in the NHS, that is, systems have the same look and feel wherever they exist and are accessed in the NHS. Business and clinical processes are automated and/or supported by technology to improve efficiency and effectiveness to enable the patient experience, clinical outcomes, cost effectiveness to be of the highest possible standard. This could include mobile devices, teleworking and wireless communications. Business processes (for example procurement, recruitment) are automated and use information to enable efficiency and effectiveness. Clinical information is held in a single electronic record, collected in real time and fully supports the patient’s journey. Patient information is shared on a need-to-know basis. Communities of practice / interest networks act as guardians of the knowledge. There are clearly defined roles and responsibilities in respect of acquiring and sharing knowledge. Communities of practice / interest networks have a clear purpose, some have clear deliverables; others develop capability in the organisation, and meet at least annually. Comprehensive risk management is in place. Confidential person-identifiable information is shared only on a need-to-know basis and with informed consent. Contingency arrangements are in place and regularly tested to mitigate against any disaster or critical incident such as loss of power or loss of service. Data is kept securely, where its integrity is protected. Data protection and confidentiality is enabled and supported by suitably skilled IM&T professionals. Appropriate levels of investment are made in both technology and people. There is planned growth in capacity and developments are project managed within a development programme.
?
New & Thriving Services
? ? ?
? ? ? ? ? ? ? ? ? ? ? ?
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Trust Strategic Objective Developing the Workforce Developing Knowledge & Practice Quality of Services Modern Service Provision
Vision Statement
Data, information and knowledge are regarded as vital assets to the Trust. Data, information and knowledge assets are kept up-todate, comply with all relevant standards and legislation. Disparate data and systems are brought together where possible to support an information and knowledge based environment. Information analytical processes are automated. Information and knowledge are used to best effect to make informed decisions. Where possible, data for research is a bi-product of everyday data collection. Information is used at every level to monitor performance – patient care level, operational level and strategic level. These business requirements are readily understood within the organisation and the workforce is equipped with the tools and the know how to monitor performance and continuous development and improvement. Information and knowledge shared across organisational boundaries is an enabler to partnership working. Information technology enables “intelligent buildings” where clinical and working environments are controlled and protected to best effect with technology. Systems are integrated where possible taking advantage of a common infrastructure. Information technology is used to best effect in the organisation, where IT is seen as an investment rather than an overhead. Investment ensures future-proofing, taking advantage of new developments and evolving technology where it is proven, reducing costs where possible. There is a culture where it is possible to pilot, experiment and it is allowable to make mistakes in order to test new technologies and their use. The future organisation will rely on technology. Knowledge is easy to get to, easy to retrieve and relevant knowledge is pushed to you. Knowledge is constantly refreshed and distilled. Medical technology is integrated with information technology where appropriate to allow medical data to be entered into the electronic care record. Patients have access to their own records, and to relevant understandable information and knowledge sources (clinical & service) avoiding information overload. Profiling and end-user recognition uses a secure solution (e.g. biometrics) and enables single log-on access to all systems appropriate to job role.
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Information Management & Technology Strategy: 2011 - 2016 ___________________________________________________________________
Trust Strategic Objective Developing the Workforce Developing Knowledge & Practice Quality of Services Modern Service Provision
Vision Statement
Prompts for learning built into business processes, and people routinely find out who knows what they want to know and can talk with them. A common language, templates and guidelines lead to effective knowledge sharing. Remote and mobile working and new ways of working are enabled by technology (for example virtual offices, “hot desking”). The Trust’s mobile workforce is better supported by technology. Senior management in the Trust recognise the link between knowledge and performance. The culture of the Trust enables the right attitudes to exist to share and use others’ know-how, a behaviour that is reinforced by leaders within the trust who act as role models. Standardisation of technology is used to enable the optimum interoperability of systems whilst meeting personspecific requirements (e.g. meeting the needs of disability). Systems are reliable and secure. Technology is used to support new ways of working and innovative service delivery models. This could include: telemedicine, telepsychiatry, remote support to patients, self monitoring, monitoring of medication compliance, the electronic tagging of patients and/or equipment, messaging and reminder systems, e-learning. The analysis of data is not restricted to patient-based data. Data from different sources are brought together where relevant to support information analysis. Data sources might include those related to patient care, financial, workforce, estates and facilities, general population and morbidity. The availability of data, information and knowledge assets is ensured to the highest achievable level with the best possible security, protection and disaster recovery in place. The information and knowledge based environment is enabled and supported by suitably skilled IM&T professionals. The technology-enabled Trust is supported by suitably skilled IM&T professionals. Appropriate levels of investment are made in both technology and people. There is planned growth in capacity and developments are project managed within a development programme. The Trust takes advantage of new and emerging technologies and security models to best protect data and confidentiality, for example, encryption and network security. The Trust will work to NHS national standards and industry best practice in respect of information governance.
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Information Management & Technology Strategy: 2011 - 2016 ___________________________________________________________________
Trust Strategic Objective Developing the Workforce Developing Knowledge & Practice Quality of Services Modern Service Provision
Vision Statement
The Trust’s workforce is fully aware of its information governance responsibilities and acts in accordance to all Trust policies and procedures. The Trust’s Workforce Strategy is supported by developments in information technology. The workforce of the Trust is enabled to use and take advantage of technology to the best effect. Person specifications and job descriptions are up-to-date to reflect the need for staff to be computer literate. There are clearly identified Intellectual assets and a Knowledge Management (KM) strategy is embedded in the Trust’s business strategy. There is clinical involvement in all information, knowledge, and technological developments affecting clinical. There is role-based access in place to sensitive or confidential data/information. The NHS Spine and local workforce policies and procedures ensure the control of this access. Those in receipt of information and data have confidence in its quality and relevance. Processes, procedures and systems are in place to ensure data is fit-for-purpose. Trust staff are sufficiently skilled to use and interpret information and knowledge sources.
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13. SWOT Analysis A SWOT (Strengths, Weakness, Opportunities and Threats) analysis of information management and IT in the Trust was undertaken to inform the development of this strategy.
Strengths
? ? ? ? ? ? ? ? Good technical environment Sound project management Robust and resilient IT infrastructure Skilled and motivated IM&T staff Clear vision Very experienced in implementation of new systems and medium - large projects. Flexible approach Robust approach to information governance
Weaknesses
? ? ? ? ? ? ? ? Vision not widely owned Communications are weak across the Trust (difficult to get key messages to all staff) Duplicate data collection for social care Clinical coding Knowledge Management Use of information in decision making could be stronger Many sites to support Dependence upon the IT departments of
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? ? ? ? ? ? ? ? Most staff have been trained to use computers Accredited IM&T service desk IT internal process to ITIL standard IM&T governance Exec director ownership Mobile workforce supported by mobile technology Hand-over of project deliverables into operational environment Internal IM&T Service Level Agreement other organisation where sites are shared or not owned by the Trust Benefit realisation could be stronger Inflexibility of business critical systems Support provided for electronic care system by third party suppliers could be more robust Engagement with the business could be stronger Promoting application of IM&T services Locating mobile staff and mobile technology High power consumption technologies
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Opportunities
? ? ? ? ? ? ? ? ? ? ? ? New technology New and improved ways of working by using new technologies Wireless networking The Trust?s Data Warehouse system offers an opportunity to exploit information resources RiO development in London Knowledge Management tools and techniques Build upon infrastructure Link IM&T training with main stream training Closer integration with social care Internal IM&T skills Local changes within the NHS Green IT
Threats
? ? ? ? ? ? ? ? ? ? ? ? Too many IM&T projects at any one time High expectation Recruitment and retention Loss of tacit knowledge, reliant on experts Outsourcing of IT service leading to loss of control and loss of knowledge Off-shoring of support for national applications Externally hosted systems = loss of control and possible misfit with Trust goals and priorities. Lack of funding (Trust) Lack of funding in partner organisations which the Trust depend upon Local changes within the NHS Reduction in funding undermines IM&T service provision Loss of national enterprise agreements for software licences
Priority Service Changes 14. Areas for Disinvestment
14.1 The move to electronic clinical records signals a move from the reliance of the paper medical record. During the strategic period there will be the scanning of the medical records archive, a substantial reduction in paper records and a consequent reduction in staffing.
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Information Management & Technology Strategy: 2011 - 2016 ___________________________________________________________________ 14.2 The Trust has many paper-driven processes: clinical and business. these processes are computerised administrative overheads are reduced. As
15.
Areas for Investment
In summary the key areas for investment are: Electronic Care Records (RiO) – Electronic care record with clinical tools providing more effective communication, decision support and better planning of care that enables improvements in patient experience and clinical outcomes. Clinical functionality such as electronic prescribing, pathology/radiology results ordering and reporting. The replacement of RiO as the clinical system during the strategic period. Knowledge Management – Knowledge management aims to ensure knowledge is effectively created and shared around the organisation and used to best effect so that there is an environment where mistakes are not repeated, good practices are not ignored, and people do not feel disconnected or undervalued. Effective Use of Information – The effective use of information and analytical techniques in decision-making at all levels in the organisation enables optimum performance and effective services. Give service users access to information so they can make informed choices about services and treatments. Technology for More Effective Working – Mobile technology to support a mobile workforce. Telecare, self-monitoring, self-assessment, communication and information applications for innovative care packages. Streamlined business / clinical processes to enable more effective and efficient working using applications e.g. eLearning, collaborative software and unified communications. The integration of systems for more effective working within the Trust and with partner organisations. IT Infrastructure – A robust IT infrastructure, that is resilient, secure, highly available with optimal capacity. An accredited IM&T service that is responsive, efficient and meets the business objectives of the Trust. Section 16 describes these priorities in more detail and Appendix A details the actions to implement this Strategy.
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16. 16.1
Trust-wide Plan Implementing the IM&T Strategy
16.1.1 An IM&T Development Programme is in place to deliver IM&T developments. The Programme will be revised to include the tasks and projects required to deliver this strategy and the benefits realisation. Since the IM&T Strategy is a supporting strategy in the Trust, as is the IM&T Development Programme, the realisation of benefits will also occur at a higher level where Trust programmes come together. For example, the development of an innovative new clinical service to improve patient experience and clinical outcomes could require the outputs of clinical development projects, estates projects, workforce projects and IM&T projects. 16.1.2 The IM&T Development Programme is managed using the Managing Successful Programmes (MSP) methodology and projects are managed using the PRINCE2 (Projects IN Controlled Environments) project management methodology. Owned by the Office of Government Commerce, these methodologies are standard practice across all government departments and widely used in the commercial sector. 16.1.3 The Trust?s IM&T Strategy Group is the custodian of this strategy and acts as the IM&T Development Programme Board. It oversees the review and implementation of this Strategy. The IM&T Strategy Group is chaired by the Chief Executive. The Head of IM&T will act as Programme Manager. 16.1.4 The IM&T Strategy Group is specifically responsible for approving project mandates, approving business cases (within delegated limits), resourcing the IM&T Development Programme and the realisation of benefits. The membership of the IM&T Strategy Group is as follows: Chair / Senior Responsible Owner Chief Executive Senior Business Director of Finance & Information Senior Business Chief Operating Officer Senior Business Director of Service Development & Performance Senior Business Director of Human Resources Senior User Medical Director Senior User Director of Nursing & Governance Senior User Assistant Director, Facilities & Patient Experience Senior User Director of Social Work Senior User Director of Estates Senior User Head of Commissioning and Contracting Senior Supplier Director of IM&T 16.1.5 The IM&T Strategy Group will meet at least ten times annually.
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16.1.6 Implementation of this strategy will be with reference to national standards (existing, and emerging), national policy and guidance (existing and emerging), and national targets. 16.1.7 The IM&T Strategy Group members are responsible for ensuring the alignment of the IM&T Strategy implementation with other strategies in the Trust. 16.1.8 The Director of IM&T will meet at least quarterly with the programme managers of the other strategies to review interfaces and to ensure that implementation activities are complementary. 16.1.9 An implementation plan showing timescales appears in Appendix A. The following sections summarise the components of the IM&T Strategy.
16.2
Electronic Care Records
16.2.1 RiO is the Care Record Service solution for London for mental health services. RiO (version 4) was implemented across the Trust on a borough-byborough basis in 2006 and 2007. The Trust updated to RiO v5 in 2010. It is now possible to connect to the NHS Spine via RiO, in particular the PDS (Personal Demographic Service), enabling improvements in data quality. 16.2.2 The main components of the NHS Spine may be summarised as follows: ? PDS (Personal Demographics Service): A national directory of citizens containing basic personal details such as NHS Number, name, address, and date of birth. ? SDS (Spine Directory Service): National directories containing details of NHS organisations and basic details of NHS staff such as name, job title, job role, organisation, e-mail address. ? PSIS (Personal Spine Information Service) also known as the Summary Record: Provides an up-to-date summary of information and key events in a patient?s life and care – drug allergies, operations, conditions, medical history – as well as details of contacts with care providers. In RiO Version 5 it is possible to query and update personal information. This will help ensure that all NHS organisations involved in a patient?s care have up -to-date address and GP registration details, for example. 16.2.3 RiO has a development path with additional functionality being provided in two further major releases: Release 1 in 2011; and Release 2 in 2013, as well as maintenance release and configuration upgrades, bring new or updated functionality. Details of each release is summarised in Appendix D.
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Information Management & Technology Strategy: 2011 - 2016 ___________________________________________________________________ 16.2.4 The pathology and radiology needs of the Trust are provided by local acute Trusts. Strategically, an interface between RiO and pathology / radiology systems will enable the electronic communication of results into RiO, enabling better communication and improvements to patient care. The receipt of results into RiO will be available in RiO Release 1. The facility to order tests from RiO will be available from RiO Release 2. 16.2.5 RiO Version 5 will provide electronic prescribing (e-prescribing) functionality in outpatient settings, that is, instead of writing prescriptions prescribers will select the medication, dosage etc on RiO and a prescription will be printed. A separate prescribing record will then be held on the system (currently part of clinical noting). In RiO version 6 (release 1) e-prescribing will be provided for inpatient services including a drug administration record. The implementation of e-prescribing will involve substantial change to clinical processes and will need to be carefully managed. There will be e-prescribing pilots in London and early adopters in the Trust before a full rollout. 16.2.6 The contract for RiO is due to expire in 2015. The Trust?s intention is to work with other Mental Health Trusts in a consortium type approach to procure a replacement system. Options for shared management of a replacement system would also be explored. 16.2.7 Integration with Social Care RiO will be developed to include some integration functionality (Release 2). Integration with social care is a particular requirement for mental health services. RiO is currently able to produce a social care data set (for RAP reporting) which can help to reduce the duplication of data capture that has been in place for many years. The Trust is working with local authority colleagues to maximise the benefit of this functionality. The Trust will explore with partner organisations the integration or interoperability of health and social care systems as opportunities present and the business case made. 16.2.8 Medical Records RiO has enabled the Trust to introduce paper-light working. RiO is the clinical record but needs some further development before it can completely replace all paper forms. A limited secondary paper medical record will used until such time that it can be completely replaced. Where possible paper forms are being scanned and attached to the electronic record in RiO. Record keeping policies are managed by the Health and Care Records Group, chaired by the Medical Director. The Trust is in the process of scanning it paper medical records currently held in libraries. By 2012 the Trust plans to only have an electronic / microfilmed archive, instead of a paper one.
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16.3
Knowledge Management
16.3.1 Knowledge Management (KM) has been variously defined. One definition is: “knowing what you know, knowing what you don't know, learning what you need to know and sharing it”. The National Library for Health expresses this succinctly as: “Knowledge Management is based on the idea that an organisation's most valuable resource is the knowledge of its people. Therefore the extent to which an organisation performs well will depend, among other things, on how effectively its people can create new knowledge, share knowledge around the organisation and use that knowledge to best effect.” 16.3.2 Knowledge Management is a hybrid discipline, neither art nor science; functionally it can straddle the fields of learning and organisational development, human resources and IT. KM is far more than just know-how. 16.3.3 A self-assessment of Knowledge Management capability was undertaken by the IM&T Strategy Group. See section 11.3 and Appendix B. 16.3.4 A new KM strategic approach will be developed for the Trust. In particular this strategy will address the following: ? The identification of clinical champions and role models to promote Knowledge Management; ? The promotion of a culture of sharing and using know-how within the Trust; ? Implementing tools to support communities of practice and inter-professional networks; ? The identification of information and knowledge sources, and the technology needed to enable access to them; ? How to ensure that a suitable level of expertise exists to access these knowledge sources; ? Develop electronic document software to improve access to the Trust?s knowledge sources ? Develop a learning framework, with clear links to knowledge and information sources is to be defined and implemented; ? Develop eLearning applications; ? Exploit KM tools and techniques. 16.3.5 Implementing KM initiatives in the Trust has many potential benefits: Supporting a learning organisation Supports education, research and development Supports training and development The improved sharing of knowledge and lessons learned could lead to improved patient care, patient safety and patient satisfaction Identifying new opportunities for research and innovation Increased learning opportunities, through networking with other NHS organisations and colleagues
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Information Management & Technology Strategy: 2011 - 2016 ___________________________________________________________________ Support Communities of Practice – improved communication and collaboration to support best practice and innovation More informed decision making by learning from others, with a reduction in repeating of mistakes and “reinventing wheels”. Information and knowledge can be used together to best effect to ensure that informed decisions are made. 16.3.6 Document Management The Trust has identified a need to improve the management of its corporate records. The management of electronic documents can be problematic: documents are saved in multiple locations with little or no version control often in personal folders; corporate e- mail is often “locked” away in personal e-mail accounts. The Trust will invest in software, processes and procedures to better manage its corporate knowledge base. 16.3.7 Intranet A well- managed intranet is an organisation?s key communication tool and portal into knowledge sources. The options for replacing and / or improving the current intranet will be investigated in order to improve knowledge sharing, access to knowledge, internal communications, collaborative working and supporting networks and communities of interest.
16.4
Effective Use of Information
16.4.1 In the last few years the Trust has increased its analytical capacity, implemented a new data warehouse, improved data quality and increased its use in information and statistical analysis to support decision making at all levels in the organisation. 16.4.2 Sets of key performance indicators have been in use for some time. These have been shaped by national targets, local and national priorities and have driven reporting and information development. The Intelligent Mental Health Board, published in March 2007, is a guide for Trust Boards in using information and intelligence to increase their effectiveness. This guidance has been used to review information reporting in the Trust. The Trust has recently produced a Performance Management Strategy. Information reporting and statistical analysis will continue to develop over the course of this strategy taking into account the needs of new developments such as Foundation Trust status. 16.4.3 The Trust has invested in and implemented a new data warehouse. The system has a dynamic reporting tool which enables managers and clinicians to have easy access to summary reports. Information is reported in “cubes” which enable the user to “drill down” to lower levels of detail or to change the dimensions of the report. The “cubes” are refreshed on a daily basis, providing up -to-date reporting.
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Information Management & Technology Strategy: 2011 - 2016 ___________________________________________________________________ 16.4.4 The data warehouse currently holds data and provides reports from a number of Trust systems relating to patient based clinical information (RiO), workforce including staff training and appraisal, incidents, complaints, maintenance and IM&T service desk. The data warehouse has a multidimensional reporting tool “the Pulse” as well as well as a range of „click of a button? patient level reports for clinicians who inform them at patient level about their clinical caseloads and any data quality issues. The data warehouse also produces automated emails to clinicians to support them in their work. Examples of emails include those relating to seven day follow-up and CPA reviews that are overdue. Data recording screens have also been developed to allow clinicians to easily capture information that cannot easily be recorded on RiO. Examples include information relating to smoking cessation and Home Treatment Team gate-keeping.
16.4.5 The Trust has been using the Pulse since 2007 and it allows for the dissemination of a broad range of data taken from a number of sources. The Pulse is an excellent tool for the gathering of information by staff who are regular users and where extracting this information is a current essential element of their job. The system is not used by the vast majority of staff who require a desk top icon that when clicked tells them what they need to know. The Trust?s vision is to supplement the Pulse with sets of dashboards using technologies such as MS Performance Point to display different information in a single screen from varying data sources. Such reporting tools will better support service line reporting and Payment by Results, and bring a single focus to the Trust on what is important at a point in time to deliver common aims. The Pulse will continue to be used by those staff who require a more in depth analysis and greater detail. 16.4.6 The better use of information generally leads to improved data quality. However, this needs to be supplemented by data quality initiatives targeting priority areas. For example, a recent initiative has been the increase of NHS Number coverage (see NHS Number section) and an improvement of the quality of patient demographic data. Data quality initiatives are more successful if they relate to clinical policies or procedures such as those developed by the Trust RiO Expert User Group – a group of clinicians that advise on the correct use of the RiO system. 16.4.7 The Trust in recent years has adopted statistical process control techniques to monitor performance. As routine information reporting becomes more automated the Information Management Department will further develop the use of statistical techniques. 16.4.8 The Trust has invested in a Geographical Information System (GIS) to enhance spatial and geographical analysis of data particularly to support commissioning, epidemiology, research, service provision, marketing, and ensuring equality.
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Information Management & Technology Strategy: 2011 - 2016 ___________________________________________________________________ 16.4.9 The Trust will develop “dashboards” to meet the needs of its clinicians and managers, using data from the Trust data warehouse and software and present the results in an easy-to-use format. There will need to a training / awareness programme to support the use of dashboards to ensure that staff can use the analysis and understand the data. 16.4.10 Business analytics is a term used to describe the use of statistical analytical predictive models to answer “what if?” questions, and is particularly helpful in planning and remodelling services. The Trust has made some use of business analytics but will further develop this during the strategic period developing in-house capability. 16.4.11 NHS Number The NHS Number is the national strategic solution for a patient identifier in electronic records. The current level of NHS Number recording is over 96% on all the Trust?s patient records. The high coverage has been achieved through data quality improvement projects. A local “back office” supported by processes and procedures are in place to maintain these levels. 16.4.12 Information for the Public, Service Users and Carers Information for service users and carers has often been poor in the past. For service users and their carers coming to terms with and dealing with mental health problems the provision of quality information can help ease the process and positively contribute to the care outcome. Information for service users and their carers can be broken down into four main categories: Information about the provision and availability of NHS and social care services Information about the provision and availability of other public services (e.g. state benefits, housing, education) Information about voluntary services and self-help groups and how to access them Information about specific conditions and treatments The Trust has a public-facing website, which will be continually reviewed and developed in order to ensure its design, content and functionality meet the needs of its diverse audiences. BSL video clips, social media bookmarking and user feedback tools will be added to the site to encourage user engagement and increase the site's accessibility. 16.4.13 Classifications & the Language of Health National standards, classifications and coding structures enable a common understanding of conditions and treatments. In turn this will facilitate: A common “language of health”, and thereby effective communication between care professionals The accurate sharing of service user information to facilitate better care and health outcomes
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Information Management & Technology Strategy: 2011 - 2016 ___________________________________________________________________ Better support for clinical governance Better informed research to be undertaken More informed planning and management of services and resources. 16.4.14 ICD10 (International Classification of Diseases, version 10) ICD10 serves mental health a lot better than previous versions. As well as the primary diagnosis (main reason for admission) secondary, or co-morbidities are also recorded. Co-morbidities may relate to physical health conditions as well as associated mental health conditions. This is particularly useful in the analyses of patient episodes of older people, who tend to have multiple health needs. The recording of diagnoses and the classification of that diagnoses has been poor in some areas. The Trust has initiated work to improve the recording and accuracy of diagnoses and coding using ICD10. New clinical coding policies and procedures will be enacted in the first year of the strategy. 16.4.15 OPCS4 OPCS4 is the codification of operative procedures undertaken as part of an inpatient or outpatient episode. It is recorded retrospectively. For mental health services there is a limited application, confined mainly to ECT (Electro Convulsive Therapy) and minor physical health procedures. It is mandatory for the Trust to collect this information. The Trust will monitor completeness and accuracy of the coding as part of data quality work. 16.4.16 Snomed Clinical Terms Snomed Clinical Terms (Snomed CT) is a thesaurus or standardisation of clinical terms. Clinical terms include presenting symptoms, prognosis, treatments, and interventions. It is a marriage of the Read codes (versions 2 & 3) once used in general practice in the UK and the US Snomed used by pathologists. It has been jointly developed in the US by the College of American Pathologists (CAP) and in the UK by NHS Connecting for Health and has been adopted by other countries. It now has an International Editorial Board that resides in Denmark and the Chair of the Board is Dr Martin Severs from the UK, who also Heads the NHS Information Standards Board. Snomed CT will be introduced in RiO from Rel 1 (see section 16.2). Strategically Snomed CT is important to the Trust but a full scale implementation will require a significant amount of training and, therefore investment. The Trust will introduce Snomed CT where the benefits are strong. 16.4.17 HoNOS (Health of the Nation Outcome Scale) HoNOS is a method of recording dependency for mental health service users. It is a mandatory data item in the Mental Health Minimum Data Set (MHMDS). As well as being a useful measure of severity it is now a key data item in determining care clusters in Payment by Results and commissioning currencies (the method by which provider organisations will be paid for providing care). It can also be used to inform clinical practice, a measure of a service user?s progress, and an indication of relative workloads amongst Community Mental Health Teams, for example. In 2007, the Trust initiated a rollout programme to implement HoNOS (and its specialty-specific
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Information Management & Technology Strategy: 2011 - 2016 ___________________________________________________________________ variants). HoNOS data will enable the Trust to further develop its information reporting.
16.5
Technology for More Effective Working
16.5.1 Improving access to clinical information (particularly RiO) for communitybased staff has been achieved by providing mobile technology and wireless working. During the strategic period, developments in technology to support mobile working will be exploited where the investment will lead to more effective and / or efficient working. 16.5.2 Telemedicine and Telecare Information technology offers potential opportunities for telemedicine and telecare; that is, using technology for monitoring, in lieu of care professional interventions or to assist with interventions. Opportunities for service users include self-care, selfmonitoring, communication systems leading to more innovative care packages and supporting recovery. Telemedicine and telecare may take different forms and possible applications in mental health Virtual consultations by the use of video conferencing Self diagnosis and treatment advice for minor conditions Self-monitoring by service users Communication contact with service users Forwarding of video clips (of service users) for second opinion Computer-based support packages Training packages Remote monitoring of service users. 16.5.3 RFID (Radio Frequency Identification) is an emerging technology which enables the tracking of objects or people. There are many potential applications in mental health services to increase security, efficiency or clinical safety. The Trust will assess the potential for such technologies and make investments where the business case is made. 16.5.4 The Trust will explore the opportunities to use information technology in providing new models of care, taking into consideration the need to safeguard confidentiality and maintain choice. 16.5.5 Unified Communications Unified communications (UC) is the integration of real-time communication services such as instant messaging (chat), presence information, IP telephony, video conferencing, call control and speech control with non real-time communication services such as unified messaging (integrated voicemail, e-mail, SMS and fax). UC is not a single product, but a set of products that provides a consistent unified user interface and user experience across multiple devices and media types.
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Information Management & Technology Strategy: 2011 - 2016 ___________________________________________________________________ UC also refers to a trend to offer business process integration, i.e. to simplify and integrate all forms of communications in view to optimise business processes and reduce the response time, manage flows and eliminate device and media dependencies. Typically benefits of UC fall into the broad categories: Improve support for mobile workers Bring telephony to the PC Bring computer applications to the telephone Establish Unified Messaging Enterprise Instant Messaging Integration Web conferencing Unified Conferencing Video The Trust will develop its strategy is respect of voice communications and data networks and produce a Voice & Data Network Strategy that details the strategic approach to developing the data network, telecommunications and unified communications. 16.5.6 Workflow Management There are many opportunities to streamline business and clinical processes to enable more effective and efficient working using applications such as eLearning, collaborative software and unified communications. The Trust will exploit these opportunities prioritising those areas which yield the greatest benefit. 16.5.7 Integration During the strategic period the Trust will explore the opportunities f or the integration of systems within the Trust and also with partner organisations – primary care, social care, acute secondary care and other mental health providers.
16.6
IT Infrastructure
16.6.1 The Trust has N3 connections to most of its sites, and has taken advantage of QoS (Quality of Service) – the prioritisation of network traffic, in accordance with business priorities. As a principle, the Trust will take advantage of N3 developments as they become available or when there are sound business reasons for doing so. 16.6.2 The Trust?s data network has evolved over the years into a distributed core data network. The Trust?s services and estate are increasingly using and reliant upon a sound IT infrastructure. In recent years there has been some investment in wireless networks (WiFi) notably on the Tolworth Hospital and Springfield Hospital sites. Strategically the Trust will continue to invest in wireless networks and increase the resilience and optimise the performance of its whole infrastructure.
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Information Management & Technology Strategy: 2011 - 2016 ___________________________________________________________________ 16.6.3 In accordance with the Trust?s estate strategy, buildings will become intelligent, using information technology to control and manage environments, security and optimisation of use. The IT infrastructure of the Trust will need to develop in line with the Estates Strategy. 16.6.4 The cost of information technology is more than the hardware and licence costs. Whilst power consumption of devices has generally decreased and software to shutdown idle desktop computers has been deployed there are opportunities to reduce this further. The Trust will follow a “Green IT” policy in terms of power consumption, consumables, virtualisation, utilisation, recycling, and disposal of assets. Virtualisation (see below) and printing rationalisation projects will be early deliverables. 16.6.5 As polyclinics and poly systems come on stream the Trust will work with partner organisations to ensure that the benefits of shared infrastructure are maximised, whilst ensuring the security and confidentiality requirements are met. As services become more integrated or cross organisational boundaries systems the infrastructure will need to flex to meet these requirements. 16.6.6 The Trust has a VoIP (Voice over Internet Protocol) solution in place across many of its sites. VoIP is a technology that routes voice traffic (telephone calls) over the data network, thereby saving the cost of calls between sites. The Trust will take advantage of developments in this technology where is makes financial sense. Possible examples are using N3 to route voice traffic to other NHS organisations, and technologies that integrate VoIP with mobile telephony. 16.6.7 The Trust is part of National N3 VC directory. This enables the Trust to communicate with other NHS Organisations and partners remotely. Adding a virtual geographical layer will bring visibility to non-focused items and services, with the financial benefits of reduction in travelling costs, and better use of staff time. 16.6.8 The optimisation of technical performance is a key strategic aim to ensure that the maximum value can be obtained from the Trust?s IT resource. The IT industry continues to develop technology to address optimisation. As a principle the Trust will seek to optimise performance subject to the availability of resources. 16.6.9 One example of optimisation is the virtualisation of servers. Virtualisation is the creation of several servers on one physical server hardware platform. Instead of purchasing one server for one application that only utilises 10% of a server potentially three applications could be run on three virtual instances on one physical server platform. Benefits include: reduced cost of new servers for new applications; reduced power consumption; reduced physical space; better server utilisation; increased ease of system recovery. Another example of achieving optimisation is the acceleration of WAN links using intelligent protocols, which has given 60% more capacity. Benefits included fast connectivity to business applications (e.g. RIO, Email and File shares) from smaller sites, and a reduced revenue cost.
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16.6.10 A modern IT infrastructure with the use of mobile technology (see section 16.5 above) provides an opportunity to redefine the working environment creating an “office of the future” and to support home working. Together with paper-light working, the accommodation requirements are reduced as are the overheads of owning/renting and maintaining the Trust?s estate. 16.6.11 IT Service Support The Trust IT Department provides IT and Telecoms first-line maintenance support for all IT services. Some second and third line support is provided for locally hosted systems and local data storage. The IT Department has introduced a new IT Service Desk support system in recent years and has implemented new processes and procedures in line with the ITIL (IT Infrastructure Library) IT industry service management standard. The first phase of implementation was in the areas of: Incident management Problem Management Change Management Service Desk Service Management (part) Release Management (part) The other modules of ITIL have now been implemented. It is now policy that all IT staff will be trained in ITIL to the “Green Badge” level (within three months of joining the Department), with at least one senior member of staff trained to the “Red Badge” level. The Trust IM&T Service Desk has received national accreditation from NHS Connecting for Health and has maintained the accreditation for 3 consecutive years. ITIL is a component of ISO9000 (the international service standard). During the lifetime of this strategy the IT Department will work towards gaining accreditation, including ISO9000. The IT Service Desk operates 08:00 – 18:00 Monday to Friday (except bank holidays). Outside of these hours there is an IT Manager-on-call to handle emergencies or urgent situations. The IT Service desk at present handles up to 3,200 calls per month. During the strategic period as systems develop and reliance on IT support grows these arrangements will be reviewed and enhanced according to business need and affordability.
16.7
Business Applications
16.7.1 Electronic Staff Record
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Information Management & Technology Strategy: 2011 - 2016 ___________________________________________________________________ The Trust has implemented the (national) Electronic Staff Record system (ESR). ESR is used for payroll, to support recruitment and other Human Resources processes, and to provide workforce information and training records. The Trust will develop its use of the ESR system and implement other features such as establishment control, interfaces to other applications and “self -service” (direct use of ESR by managers and staff). The “self -service” function will need to be piloted and processes developed before a full implementation can proceed. 16.7.2 Learning Management System The Trust has invested in a system to manage training courses and mandatory training – both general and IM&T training. The system integrates with the Electronic Staff Record and provides on-line booking of courses. There is further work need to realise all the benefits of this investment and this will be undertaken in the first year of the strategy. 16.7.3 Financial systems The Trust has used its current general ledger / accounting system (eFinancials) for some time. During the life of this strategy the Trust will test the market and replace or renegotiate the existing contract. Developments in financial management such as service line reporting and payment by results may require new systems. The systems currently used for asset tracking and reference costs need to be reviewed and possibly replaced. 16.7.4 Electronic Rostering Roster Pro – a system for rostering nursing shifts – has been implemented. Interfaces will be established to ESR (primarily for payroll) and the Data Warehouse (for reporting). Further work on benefit realisation is taking place. The intention is to extend the use of the system to all staff for scheduling absences.
16.8 Training & Development The realisation of the benefits from the investment in information management and technology often requires changes in working practices and cultural change. The modernisation of the NHS will see the move to a knowledge and information culture. These initiatives will be supported by appropriate training. Much IM&T training is delivered in classroom style training sessions. As the level of IT literacy increases the trust will adopt alternative or complementary training methods, for example, e-learning and self-learning packages, thus offering a much more blended approach. The following IM&T training is provided: Basic IT literacy and use of standard applications : Levels of IT literacy have increased in the Trust in the last few years. Training in basic IT skills and MS Office
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Information Management & Technology Strategy: 2011 - 2016 ___________________________________________________________________ applications (such as Word and Excel) will be provided to complement the NHS Essential IT Skills (EITS) programme. Use of clinical and other critical systems : RiO is the clinical record in the Trust. As it is an electronic record training in RiO is mandatory and has to be completed (and the course passed) before access is given to the system. RiO training is in accordance with job role. Training is also provided for IAPTus – the system used by psychological therapy in primary care services. Recently an e-procurement system has been implemented and access to the Summary Care Record rolled out. Training was provided for these implementations and will be provided on an on-going basis for new members of staff. Training is mandatory for all Trust critical systems. Using Information to Manage: In order to improve the use of information to manage performance in the Trust training will be developed for managers and clinicians in the use of data and analytical techniques. Training is also provided in the use of the Pulse EIS tool. Training in data capture to support initiatives such as Payment by Results will be undertaken to improve the quality of data capture in data items such as HoNOS. Knowledge Management: The better application of knowledge in decision-making processes (clinical and non-clinical) is expected to deliver better health outcomes for the Trust?s clients and carers . The Trust will develop training in the use of knowledge and KM techniques. IM&T Staff Development: The demands placed upon IM&T staff are ever changing – technology changes at a rapid pace and as the general Trust workforce becomes more IT literate IM&T staff will require more specialist skills in order to provide the right level of support. The recruitment and retention of such staff will largely depend upon a suitable professional development programme to be in place. The Trust will ensure that each member of the IM&T staff has an active personal development plan and participates in continuous professional development.
16.9
Information Governance
Information is a vital asset to an organisation, for example in the provision of care and the efficient management of services and resources. Information governance is the proper management of that information in terms of protecting it, holding it securely, complying with the law, ensuring confidentiality (for personal data), ensuring availability to those who need it and when they need it, and for personal data collected with the informed consent of the individual.
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Information Management & Technology Strategy: 2011 - 2016 ___________________________________________________________________ In the Trust information governance is seen as an essential component of providing quality services – quality healthcare. There are a number of initiatives and legislation that are relevant to Information Governance. These include: The Data Protection Act BS7799 (ISO17799) (the information security standard). Data Accreditation Caldicott (the standard for handling patient-based information) Data quality monitoring Controls Assurance The Freedom of Information Act Human Rights Act NHSIA Security Policy NHS Statement of Compliance 16.9.1 Information Governance Group The Information Governance Group is responsible for information governance in the Trust, supported by working subgroups: Health Care Records IT Security, and Information Management, with annual work plans. The Medical Director is the Caldicott Guardian and the Director of Finance is the Senior Information Responsible Owner (SIRO). The Information Governance Manager is responsible for the development, implementation and monitoring of information governance policies and procedures. In particular this strategy will address the following: Ensure regular audits are undertaken, feedback is provided and outcomes are reviewed Apply information sharing agreements, building upon the Agreements that are in place Continue to monitor and respond to risks. Keep policies for critical systems under review and ensure integration with Trust-wide contingency plans Ensure take of information governance training Ensure that data quality is sufficient for purpose Implement pseudonymisation.
17.
Resourcing the Strategy
17.1 Investment in IM&T does create some cash-releasing benefits, but often the benefits are in terms of improvements to the quality services. The appropriate level of investment in IM&T will enable the Trust objectives to meet its objectives.
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Information Management & Technology Strategy: 2011 - 2016 ___________________________________________________________________ 17.2 On average NHS organisations spend 2.2% of their total turnover on IM&T. Other service industries, such as retail and the financial sector spend approximately 5% of turnover. The Wanless Report (2002) recommended that the NHS needed to spend 4% of turnover in order to achieve efficient and effective working. 17.3 The actual / budgeted spend on IM&T as at January 2011 is shown in the table below.
Total Trust Income Total IM&T Spend % Turnover 2003/04 £142M £2,117k 1.49% 2008/09 £176M £2,876k 1.63% 2004/05 £155M £2,481k 1.60% 2009/10 £180.2M £3,282k 1.82% 2005/06 £153M £2,688k 1.76% 2010/11 £175.1M £2,970k 1.70% 2006/07 £161M £3,870k 2.40% 2011/12 £188.5M £2,751k 1.45% 2007/08 £176M £3,181k 1.81%
Total Trust Income Total IM&T Spend % Turnover Notes:
Actual spend to 2009/10; budgeted/projected spend for years 2010/11 and 2011/12. The IM&T spend in years 2006/07 and 2007/08 includes costs associated with the implementation of RiO.
17.4 As with many other NHS organisations, the Trust uses national systems – RiO, the Electronic Staff Record for example – and the support costs are not met from Trust budgets. With the shift from national systems to local systems the Trust will need to plan to take on these support costs. 17.5 The implementation of RiO was estimated to cost £2.4m, spread over three financial years. The project has been funded by strategic capital, with the £152k full year revenue costs being met by the Trust. 17.6 The implementation of this strategy may require additional IM&T staff from time-to-time in order to deliver on projects, or to provide on-going support. 17.7 Business cases will be developed for IM&T investments which will detail any revenue consequences. Where possible the increase in operational IM&T costs will be funded by savings enabled by the investment. 17.8 The availability of funds will largely determine whether this Strategy can be delivered.
18.
Review of Strategy
The Strategy will be formally reviewed annually by the IM&T Strategy Group. Following the review the IM&T Programme (the programme that implements this Strategy) will be revised accordingly. It is expected that this strategy will require rewriting in approximately 4 years time.
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Links with Other Strategies 19. Relationship with Workforce Strategy
19.1 The successful implementation of technology often involves changes in working practices with possible job redesign. The workforce will need to adapt to exploit the benefits that new technology brings. 19.2 The implementation of the IM&T Strategy involves a substantial programme of training. The need to increase the level of IT literacy is a strategic priority for both strategies. Other training priorities are in knowledge management, the use of information, the use of the Trust intranet, and the awareness and application of information governance. The Trust will invest in eLearning applications and move away from classroom training in order to provide training in a more cost effective way. 19.3 There are opportunities to improve the management of staff information: many directories of staff are held independently for many purposes. Moving to a primary source of workforce information which populates secondary staff directories will increase data quality and improve the efficiency of business processes. 19.4 The Trust needs to exploit the Electronic Staff Record to its full potential to support business processes. 19.5 There are opportunities to improve the availability of summary workforce data to support effective decision making. By bringing together workforce data with other data sets it will be possible to undertake more detailed analysis and for the Trust to understand better its productivity. 19.6 The development of a Knowledge Management culture in the Trust supports the concept of a learning organisation, invests in our workforce and will minimise the risk of an environment where mistakes are repeated, good practices are ignored, and people feel disconnected and undervalued.
20.
Relationship with Estates Strategy
20.1 The Trust has a substantial programme to rationalise and develop its estate into modern care facilities. Information Technology supports modern buildings in enabling improved environmental control, improved security and increased energy efficiency. 20.2 The redevelopment of the Trust?s estate will involve the relocation and the renewal of the IT infrastructure.
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20.3 The design of new buildings needs to take account of IT not only in terms of providing space for computers, networks and server rooms, but also in terms of new working practices that have come about because of computerisation. 20.4 Investment in the IT infrastructure and mobile technology will contribute to modern working environments enabling a more effective use of the Trust?s estate. This approach is complementary to the Estate Strategy which calls for a reduction in the proportion of overall Trust expenditure that is spent on estate facilities. 20.5 The implementation of both strategies will be aligned to ensure the maximisation of benefits to the organisation.
21.
Relationship with Clinical Services Strategy
21.1 The introduction and development of electronic care records and clinical tools (the Care Record Service – RiO) enables the development of clinical services but also implies changes in working practice. 21.2 The benefits of RiO include improvements to patient experience, clinical safety and quality of care. 21.3 The introduction of mobile technology will support an increasingly mobile clinical workforce, enabling more efficient services and productivity gains. 21.4 Improvements in the availability and range of information to support decision making achieved by exploiting the Data Warehouse and “Pulse” will enable the performance of clinical services to be better monitored and managed. 21.5 Similarly, a wide range of clinical data and information will be available in electronic format to better support clinical governance and research. 21.6 An improvement to knowledge management in the Trust will greatly benefit clinical services enabling the sharing of best practice, shared learning, decision support and the putting of results of research into practice. 21.7 Strong leadership in clinical services is needed to support the implementation of the IM&T Strategy, particularly in respect of changing working practices and benefits realisation. 21.8 A greater level of IT literacy amongst clinical staff and support staff will be required to deliver this strategy. Whilst IT literacy has improved greatly over the last 5 years there is still a requirement for a large amount of training.
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Information Management & Technology Strategy: 2011 - 2016 ___________________________________________________________________ 22. Relationship with Communications Strategy
22.1 The implementation of the IM&T strategy needs to be underpinned by good communications in the Trust. 22.2 The development of Knowledge Management will require the development of the Trust?s web site and intranet, and in particular the development of tools to aid communication, for example, for virtual groups. 22.3 The development of the Data Warehouse, data sets, and information analysis will provide more information to support communications about the Trust, and the mar keting of the Trust?s services. 22.4 The Trust will publish more information about its services, outcomes and performance to inform service users, carers and the public to enable more choice and accountability.
Appendices A. B. C. D. IM&T Strategy Implementation Plan Knowledge Management Capability Self Assessment Development Path for RiO Glossary
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Information Management & Technology Strategy: 2011 - 2016 ___________________________________________________________________ Appendix A: IM&T Strategy High Level Implementation Plan
2011/12 2012/13 2013/14 2014/15 2015/16
Electronic Care Records Explore integration of medical devices RiO Release 1 (core) ePrescribing (RiO) RiO Results Reporting RiO Release 1 (other non-mandatory functionality) RiO Release 2 (core) RiO Release 2 Results Ordering RiO Release 2 (other non-mandatory functionality) NHS Spine: Summary Care Records RiO Replacement Integration with Social Care and other partners Knowledge Management Electronic Document Management Collaboration tools – knowledge sharing Replacement Intranet Collaboration tools – document flows Develop other supporting tools & techniques Explore and implement decision support systems Promote the cultural change Train staff in use of knowledge / KM techniques Support communities of interest Effective Use of Information Develop geographical analysis (GIS) Develop use of business analytics Develop clinical and performance dashboards Develop analysis to support Payment by Results Develop analysis for Service Line Reporting Reporting for new commissioning arrangements Support clinical research and development Information for service users and carers Information for the public Data Quality: NHS Numbers - maintain coverage Review and improve data collection for RiO Improve Clinical Coding Technology for More Effective Woking Collaboration tools: streamline processes Telecare / telemedicine, initiatives Client self assessment / monitoring apps Client communication apps. eLearning RFID applications
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2011/12 2012/13 2013/14 2014/15 2015/16
Unified Communications Fax e -mail integration (FAX server) Video Conferencing Building Management System CCTV over IT network Integration of systems IT Infrastructure Upgrade of server rooms to industry standard Implement test domain Implement fail-over servers for critical systems Virtualisation (server optimisation) Virtualisation (server hardware optimisation) Server application software refresh Virtualisation (desktop optimisation) Rationalise printing and reprographics Replace Windows XP with Windows 7 Replace Server Operating Systems Refresh PCs / mobile devices / laptops / printers Address Network Single Points of Failure WiFi Quality of Service (network traffic) Complete VoIP / IP Telephony PBX / Voicemail upgrades Single Number Tel Refresh Network equipment Refresh Telephony equipment Support building programme (refurb./ new) IT Service and Support: ITIL v3 -review Review service scope, coverage, hours of operation, SLAs IM&T Service accreditation Achieve ISO9000 standard Review Service Desk system; possibly replace Business Systems Review & procure new finance system Upgrade MS Office Implement AT-L Learning Management System Develop the use of Electronic Staff Record Information Governance Secure Outbound e-mail Single-sign-on Review and improve IT security Review Information Sharing agreements Review / develop policies and procedures
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2011/12 2012/13 2013/14 2014/15 2015/16
Monitor and manage risk Undertake audits and reviews Training, Awareness & Communication Support eLearning ePrescribing implementation training RiO Release 1 training (core and non-core) RiO Release 2 training (core and non-core) Knowledge Management tools - awareness Training Core systems (on-going) AT-L Learning Management System Information skills for managers, clinicians Mandatory training for Information Governance IM&T specialist skill training Establish clinical champions Establish a Clinical Reference Group Develop a communication plan Raise awareness of IM&T - benefits, IG Supportive change management programme Communications to support the Strategy
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SW London & St George?s Mental Health NHS Trust Information Management & Technology Strategy: 2010 - 2015 ________________________________________________________________________________________________________ Appendix B. Knowledge Management Capability Self Assessment The IM&T Strategy Group assessed the current level for each of the five KM practices (marked with an “X”). It then selected target scores for the first 12 months of the IM&T Strategy for the two most important practices (marked with an “O”).
Learning before, during and after
? ? ? Prompts for learning built into business processes. People routinely find out who knows and talk with them. Common language, templates and guidelines lead to effective sharing. Learning before, during and after is what we do things around here. “Customers” and partners participate in review sessions.
KM Strategy
Leadership Behaviours
? Leaders recognise the link between KM and performance. The right attitudes exist to share and use others? know-how. Leaders reinforce the right behaviour and act as role models. KM is everyone?s responsibility; a few jobs are dedicated to managing knowledge. “Knowledge sharing is power”. Leaders set expectations by “asking the right questions”. And rewarding the right behaviours. ? ?
Networking
Clearly defined roles and responsibilities. Networks and Communities have a clear purpose, some have clear deliverables, others develop capability in the organisation. Networks meet annually.
Capturing knowledge
? Knowledge is easy to get to, easy to retrieve. Relevant knowledge is pushed to you. It is constantly refreshed and distilled. Networks act as guardians of the knowledge.
?
? ?
Clearly identified intellectual assets. KM Strategy is embedded in the business strategy. Framework and tools enable learning before, during after.
Level 5
? ?
? ?
? ? ? ?
? ? Discussions ongoing about organisation?s intellectual assets. A\KM strategy exists but is not linked to business results. A clear framework and set of tools learning is widely communicated and understood.
? ?
? ?
Networks are organised around business needs. Networks have a clear governance document. Supportive technology is in place and is well used.
? ?
? ? ?
Just-in-time knowledge is current and easily accessible. One individual distils and refreshes it, though many contribute. That individual acts as the owner.
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KM Strategy
? There is no framework or articulated strategy. Some job descriptions include knowledge capture, sharing and distillation. People are using a number of tools to help with learning and sharing.
Leadership Behaviours
? ? ? KM is viewed as the responsibility of a specialist team. Some leaders talk the talk but don?t always walk the walk! Some managers give people the time to share and learn, but there is little visible support from the top. ?
Networking
People are networking to get results. Networks and communities are created. People can choose to participate.
Learning before, during and after
? People can easily find out what the company knows. Examples of sharing and using are recognised. Peers are helping peers across organisational boundaries. People learn before doing and programme review sessions. They capture what they learn for others to access. In practice few do access it. People are conscious of the need to learn from what they do but rarely get the time. Sharing is for the benefit of the team.
Capturing knowledge
? Networks take responsibility for their knowledge; collect their subject?s knowledge in one place in a common format. Searching before doing is encouraged. Little or no distillation. Teams capture lessons learned after a project. Teams look for knowledge before starting a project. Access to lots of knowledge, though not summarised. Some individuals take the time to capture their lessons in any number of cupboards and databases. They are rarely refreshed, few contribute, even fewer search.
Level 3
? ?
?
? ? ? ? ? ?
?
? ? Ad hoc networking to help individuals who know each other. ? ?
Level 2
? ?
Most people say sharing knowhow is important to the organisation?s success. People are using some tools to help with learning and sharing. A few people express that know-how is important to the organisation. Isolated people with a passion for KM begin to talk and share how difficult it is. ?
?
?
? ?
KM viewed as a management fad. Leaders are sceptical as to the benefits. Leaders think networking leads to a lack of accountability. “Knowledge is power”.
? ? Knowledge hoarders seem to get rewarded. ?
Level 1
?
© Copyright Knowledgeable Ltd 2006.
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South West London & St George?s Mental Health NHS Trust Information Management & Technology Strategy: 2010 – 2015 __________________________________________________________________ Appendix D: Glossary
Below, is a summary of terms and abbreviations used in or associated within this document.
BS7799
British Standard for information security also adopted as an International Standard ISO17799. Caldicott Named after the author of a report on patient information flows, generally applied to actions on implementing the report?s recommendations. CAMHS Child & Adolescent Mental Health Services Cedar Software Supplier of eFinancials - Finance system Choose & Book A national computer system which is used to book new appointments in hospital outpatients clinics and other secondary healthcare services. The system also provides choice of date, location, consultant and hospital etc. CMIS See InteHEALTH® CPA Care Programme Approach, a systematic approach to assessing, planning for, and reviewing care requirements for mental health service users CRS / NHS CRS Care record Service - electronic clinical records, or electronic health and social care record Data Warehouse A computer system that is capable of handling large and complex data sets and has the ability to join different data sets together. It is used to support analysis of data and/or the transmission of data between different data sources. eCPA An electronic system recording and supporting CPA eGIF Electronic Government Interoperability Framework – a set of technical standards for data, communication, applications and security. eSMTP Extended Simple Mail Transfer Protocol. A technical standard for sending and receiving data. ESR Electronic Staff Record. A national computer system for maintaining employment records and payroll for NHS staff. ETP Electronic Transfer of Prescriptions. A system for electronically transferring prescriptions from the prescriber to the dispenser. Initially the system will be used by General Practitioners (GPs) and high street pharmacies. In years to come prescribers in secondary health care services (hospitals etc) will also use the system. Excel Brand name of Microsoft?s s preadsheet package. Health Informatics A term used to describe IT, information management, telecommunications, knowledge management, library services that support health services.
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South West London & St George?s Mental Health NHS Trust Information Management & Technology Strategy: 2010 – 2015 __________________________________________________________________ HoNOS Health of the Nation Outcome Scale –a method of recording dependency for mental health service users (patients). There are variations for specialist mental health services, for example, HoNOS-CA for child and adolescent mental health services. Human Resources (workforce) International Classification of Diseases, version 10. An international classification system using a set of codes to record cause of death and illnesses/conditions. The codes enable the analysis of mortality and morbidity at locally, nationally and globally. Information Communications & Technology. A term used to describe IT and telecommunication services. Similarly to “IM&T” but a narrow definition. Information Management & Technology – a term incorporating IT services, information management, IT training, telecommunications and related services. Informatics professional (see above). A term used to describe IT, information management, telecommunications, knowledge management, library services. The management of data and information in respect of ensuring its safekeeping and ensuring confidentiality of personal information. The Trust?s legacy patient administration and data collection system for inpatient, outpatient and community based services (adult). Also known as CMIS. Pharmacy stock management system See Knowledge Management A term encompassing the concepts of sharing knowledge, accessing knowledge, learning, sharing learning, decision support and networking. Local Area Network. A self contained data network local to a site (i.e. that does not use any public infrastructure). Legacy system for CAMHS in the Trust. Mental Health Mental Health Minimum Data Set. A nationally defined data set for recording information about mental health care episodes. The NHS national network for electronic communication. Generally all NHS sites have a connection that enables access to national computer systems, sending and receiving e-mail and access to the internet. Public advice line on conditions, treatment and NHS services. Unique identifier for all citizens for NHS use only. Overseas visitors have pseudo NHS Numbers.
HR ICD10
ICT
IM&T
Informatician Informatics
Information Governance InteHEALTH®
JAC KM Knowledge Management LAN MAISY MH MHMDS
N3
NHS Direct NHS Number
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South West London & St George?s Mental Health NHS Trust Information Management & Technology Strategy: 2010 – 2015 __________________________________________________________________ NHS Spine A national computer system that has three components (PDS, SDS and PSIS) provides directories of citizens, NHS staff, NHS organisations and a summary health record. The NHS Pine is the system that allows the Care Record Systems to link up nationally. See also PDS, SDS and PSIS. The main gateway or portal on the internet to information on the NHS and its services. The web address is www.nhs.uk. National Service Framework. Service standard for NHS services. National Strategic Tracing Service, for tracing NHS Numbers for patients / service users. (See NHS Number). Codification system for clinical procedures, version 4. Codes for operations and other clinical procedures to enable analysis of data. Patient Advice & Liaison Service – a service to assist patients and service users in their use and access to services Primary Care Trust. Personal Demographic Service. A component of the NHS Spine, a national directory of citizens containing basic details such as name, address, NHS Number, date of birth, and GP registration. See also NHS Spine. A legacy computer system used to manage the Mental Health Act requirements in the Trust. Personal Spine Information Service. Also known as the Summary Record or Summary Healthcare Record. A component of the NHS Spine, an up-to-date summary of information and key events in a patient?s life, e.g. allergies, operations, conditions. See also NHS Spine. The name of a management reporting tool that enable the analysis of data and information reports for management and research purposes. The Pulse uses the product HyperCube® supplied by the Sollis Partnership. The Trust?s intranet that provides access to local Trust information, for example news, directories and policies. Radio Frequency IDentification. An emerging technology that enables the tracking of objects or people via a wireless network. The brand name of an electronic care record computer system. In London RiO is the Care Record Service (CRS) system for mental health and community health services. See also CRS. Spine Directory Service. A component of the NHS Spine, a set of national directories of GPs, NHS organisations and NHS staff. See also NHS Spine. Service Level Agreement. A formal agreement between two or more parties which sets out agreed levels of providing a
nhs.uk NSF NSTS OPCS4
PALS PCT PDS
Protocol PSIS
Pulse
Quick RFID
RiO
SDS
SLA
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South West London & St George?s Mental Health NHS Trust Information Management & Technology Strategy: 2010 – 2015 __________________________________________________________________ particular service and how the arrangement is to be managed. A unique plastic card with a magnetic strip that can be used to access computer systems and which contains personal information. Similar to a credit card, an example is the Oyster card used on London Transport. Simple Mail Transfer Protocol A thesaurus of conditions, symptoms, treatments and drugs. It is supported by an invisible coding structure (in the background computer code) that enables that the transfer of clinical information from one computer system to another. A method of providing care interventions (advice, monitoring etc) remotely by using telecommunications and information technology. A method of providing medical interventions (advice, diagnosis etc) remotely by using telecommunications and information technology. Voice over Internet Protocol. A technical standard that enables voice (telephone calls) to be transmitted over data networks – LANs and WANs. (See LAN and WAN). Wide Area Network. A self contained data network local to an organisation that comprises of LANs joined by dedicated connections across the public infrastructure. See also LAN. Brand name of Microsoft?s word processing package. Extensible Mark-up Language – a technical standard used to mark-up text or pieces of information for exchange and/or analysis.
Smartcard
SMPT Snomed CT
Telecare
Telemedicine
VoIP
WAN
Word XML
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