ICT DEVELOPMENTS IN GREATER GLASGOW
NHS BOARD
Joanne Frame: GGNHSB ICT Culture Change Programme Manager
Katie Thomson: GGNHSB Electronic Patient Record (Stroke) Project Manager
Janice Watson: GGNHSB Electronic Patient Record (Heart) Project Manager
16/01/06
ICT DEVELOPMENTS IN GREATER GLASGOW NHS BOARD
1.0 INTRODUCTION
Currently very little patient information can be shared electronically across Glasgow.
There have been some small-scale initiatives but these have resulted in a lot of
duplication of both effort and data. This results in a system, which is slow, inefficient,
error prone and often inaccessible. Problems include:
•
•
•
•
•
•
Lengthy delays in patient treatment as the paper based record can only be held
and viewed by one person at a time (and is not infrequently mislaid)
Time consuming replication of patient demographic data across numerous
separate systems increasing chances of error and causing inefficient use of
staff time
An inability to share patient data across the acute receiving hospitals and
between primary and secondary care, resulting in problems of continuity of
care when a patient is discharged or transferred to another hospital within
GGNHSB
Requirement for filing of results after the patient care episode is complete
Inaccurate, incomplete or missing audit data requiring resource intensive
collection procedures
Limiting the opportunity for rationalizing/improving services across Glasgow
due to separate patient databases.
This all adds to patient delays in registration, appointments and overall care and is an
inefficient use of NHS staff time.
As a result, when GGNHSB developed its ICT strategy for 2004-7 it put forward a
vision which would ‘improved access to easy to use, more fully ‘joined up’ patient
information through the creation of an electronic, integrated care record, available
wherever and whenever required’. The Board recognised however that in order to do
achieve this vision, this meant not only getting the technical environment ‘fit for
purpose’ but crucially also getting the clinical and cultural environments in. place as
well i.e. ‘getting the eAttitude and eTechnology right as fundamental to delivering the
effective eClinician’.
As a result, a number of processes (technical and otherwise) are currently being
developed in tandem to facilitate this vision. In addition to these processes, there are a
number of National Initiatives currently taking place which are key to the strategy.
2.0 LOCAL INITIATIVES
2.1 Technical
•
•
Clinical portal – single log-in access to multiple, disparate information
systems with common look and feel
Disease/speciality specific systems e.g.
o electronic patient records (EPRs) for stroke (in-patient and TIA clinics)
•
o EPR for heart in-patients
o EPR for Allied Health Professionals (AHPs) e.g. occupational therapists,
dieticians, podiatrists, community nursing etc
IT systems for ACAD centres (Ambulatory Care And Diagnostics) for
outpatient and day case/surgery services
2.2 Non technical initiatives (eAttitude and culture)
•
•
•
•
Information quality programme
Patient consent, confidentiality and data protection issues
Implementation of Glasgow’s own ‘PRINCE lite’ project management
methodology (Executive Leadership and Management of Projects - ELMP) to
support project managers (including setting up of a Programme Office,
Programme Steering Group, training programme and website)
Culture change team to deliver relevant training and support to clinical and
non-clinical staff and to support strategic change projects (such as ACAD)
2.3 National Initiatives
•
•
•
•
•
•
•
•
Single patient identifier (CHI)
SCI Store (demographics, bloods, labs, pathology, letters etc)
SCI gateway – electronic GP referrals
PACS (Picture Archiving and Communications systems) for archive and
retrieval of medical images e.g. X-rays, MRIs, cardiological images etc
Generic Clinical System (GCS)
ECCI (clinical letters)
National datasets
National coding systems
3.0 WHERE ARE WE NOW?
3.1 Clinical Portal
The Clinical Portal allows clinicians access to patient data stored on disparate
information systems via a single log-in, presenting the user with a single interface
with a common look and feel. GGNHSB is currently investigating a suite of products
from the Orion software system
3.2 Culture Change and ELMP Project Management
NHS Greater Glasgow has ambitious plans to modernise services, support clinical
staff and improve patient care with the introduction of new technologies. The
successful delivery of these plans requires major change in the way all staff work in
combination with creating a culture that is enthusiastic and confident about utilising
IT systems and new ways of working. Consequently, there has been recent and
significant local investment in the development of a Culture Change Programme that
sits alongside, and is a fundamental cornerstone to, the implementation of the panGlasgow ICT Strategy.
The NHS Greater Glasgow Culture Change programme has been effective in
establishing processes to support the above.
To date, the Culture Change Programme has:
•
•
•
•
•
•
•
Designed and implemented ELMP, the Glasgow-wide project management
methodology (based on PRINCE) and embedded the use of a Programme
Management culture into ICT and related programmes. This has included the
development of and delivery of an accredited training programme, covering
project management and continuous improvement (based on the Lean Sigma
methodology); supplemented with support through a Coaching and Mentoring
Programme and special interest workshops for project managers.
Implemented a web-based Virtual Programme Office (based on Microsoft
Share point Server), to support multi-team/multi-site project teams.
Provided development and support for the Programme Steering Group and
ICT Programme Board to ensure effective management of the programme
management process.
Developed a Communication Strategy for the ICT programme and is
developing a Communication Plan to provide a common framework for
encouraging improved communication across the Programmes of work, thus
addressing one of the significant risks to successful delivery of projects.
Trialled and deployed an innovative tool for communication, in the form of
Communication and Learning Maps, to assist in getting complex messages
across to a wide range of health service staff, supporting a range of projects.
Initiated the development of a number of Continuous Improvement
Champions
Provided a unified statistical process for transparency of project risks and
status
In addition, the programme (which is currently in Phase IV of development) plans
to provide the following deliverables by March 2006:
•
Communications
Communications and Learning Map deployment, in support of key streams of
work: Information Quality, ECCI, Clinical Portal, PACS and ACAD ICT.
This includes the production of a set or learning maps for priority projects and
the support of the deployment for this approach.
•
Programme Office
•
Project Culture and Skills Development
o Structured evaluation of the utilisation of the Programme Management
methodology and Toolset
o Review of Programme Office applicability to wider remit than mainly
the ICT Programme, within the NHSGG restructure.
o Provide Training programme (14 separate courses) for up to 200
members of staff, delivered by internal project management staff.
o Suite of Project Management and continuous Improvement training
courses aligned to Key Skills Framework (KSFs)
o Deploy and support of Project Management Workshops for all Project
Managers
o Provision of Basic ICT Training for up to 1000 staff, jointly funded
with OD.
•
Continuous Improvement
•
Continuous Improvement Champions (sustainability)
•
General Coaching and Mentoring Programme
o Extended utilisation of Continuous Improvement tools across the
organisation, as required by specific programmes of work.
o Black Belt support to key programmes of work, as required.
o Development of 10 Lean Sigma Black Belts
o Development of 20 Lean Sigma Green Belts
o Recruit and develop additional coaches and mentors
o Ensure coaching and mentor service is available to all project
managers that require it
o A Coaching & Mentoring Programme aligned to NHS Agenda for
Change Key Skills Framework
3.3 Clinical Information Systems
3.3.1 Methodology
The approach taken in developing both stroke and CHD clinical information systems
was to build up a multidisciplinary clinical team ideally with representatives from
both North and South Glasgow Divisions (historically both Divisions have been
autonomous and have developed their technical, clinical and cultural processes
separately) whose remit would be to define and agree the requirements for a single
pan-Glasgow patient information system. Each working group is coordinated by a
project manager, who reports to a project steering group. In addition, each project has
a project sponsor who acts as champion for the project. Both projects employ ELMP
project management methodology making use of highlight and risk reports to the
Programme Steering Group (which oversees all ELMP based ICT projects) to
communicate progress.
3.3.2 Stroke
Phase I of the Stroke electronic patient record consisted of a scoping exercise to
determine current existing systems (electronic and paper) and to define needs and
priorities for a clinical information system. This was carried out through interviewing
staff and implementation of an ‘Open Space’ event. Phase II of the project gained
agreement of a Glasgow data set for stroke documentation which covers 8 hospitals
and 9 professional groups including inpatient, outpatient, supported discharge and
primary care sections of the documentation.
The current phase of the project (Phase III) is the development of the electronic
screens from the paper documentation as well as piloting the electronic patient record
within one hospital site,
3.3.3 Heart
Phase I of the CHD electronic patient record consisted of a scoping exercise to
determine current existing systems and to define needs and priorities for a clinical
information system. This was carried out through interviewing staff and
implementation of an ‘Open Space’ event which all cardiology staff were invited to
attend. The CHD project is currently in Phase II which has commenced with defining
the requirements for a pan-Glasgow in-patient record which will serve all the acute
receiving hospitals in GGNHSB (namely Glasgow Royal Infirmary, Western
Infirmary, Southern General Hospital, Victoria Infirmary and Stobhill General
hospital). In addition to this, there are complementary parallel initiatives taking place
such as procurement of an ECG management systems for electronic storage and
retrieval of ECGs and PACS storage and retrieval which includes, as part of its remit,
coronary angiogram images. In addition, a pan-Glasgow cardiac rehabilitation
electronic record will be piloted within the next few months. In-patient requirements
are expected to be defined by mid 2006.
4.0 ISSUES, CHALLENGES AND LESSONS LEARNED
•
CHI – availability, cross boundary patients etc.
•
Conflicts between national and local developments
•
Constantly changing environment (e.g. parallel National datasets projects, role
of Golden Jubilee hospital, restructuring of IT services, Agenda for Change
(e.g. restructuring of IT services) introduction of ACADs
•
Data quality issues
•
Project Management discipline in the NHS
•
Articulating service needs
•
People
•
SCI Store
•
Patient confidentiality issues