2014-2015

In this report we share our experiences in a humble way to say thank you to everyone who has been involved and to celebrate our successes.
The past year has been very busy and it gives me great pleasure to share with you some of our successes and achievements.
Responding to the challenges facing the NHS we have managed to maintain a positive financial position and deliver our cost improvement plans.
This has been achieved by maintaining a rigorous focus on our culture, values and the quality of our existing services.
My thanks go to all those who work hard to make a positive difference.
Paying attention to customer experience and our continuous service improvement plans has seen
NHIS become leaner and more agile than ever before.
Our Organisational Futures project lead by NHIS staff has streamlined processes, clarified lines of command and refined the way we work.
I look forward to the coming year and the opportunities it brings.
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We will continue to focus on our ongoing programme of improvements while encouraging and supporting our staff.
We will look to explore how working with our partners will help support the development of new care models.
Next year we will be at the forefront in supporting new models of care, providing differentiated IT services while attracting new business and retaining our existing partners and customers.
We will also welcome any opportunities to extend and develop services wherever we can add value and guarantee high quality service delivery.
With your support, together we will Transform
Care through Technology.
Yours sincerely,
Eddie Olla
Director, Nottinghamshire Health Informatics
Service

Director’s welcome
The organisation
Service to be proud of
Review of the year
Our projects
New patient administration system
Pilot paves the way
Electronic Prescription Service
Video conferencing facilities
Online functionalities benefitting all
Mobile working for community workers
Financial statements
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6
15
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17
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13
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Nottinghamshire Health Informatics Service provides information, communication and technology services (ICT) across the NHS and health community in Nottinghamshire,
Derbyshire and Leicestershire totalling an area of 834 square miles.
We are funded by eight partner organisations located across Nottinghamshire and are hosted by Sherwood Forest Hospitals NHS Foundation Trust at their King‟s Mill site in
Sutton in Ashfield.
Staff are also based at three other sites, Laurel House in Mansfield, Byron Court in Arnold and Standard Court in Nottingham, allowing the service to be more accessible and responsive to our customers.
We provide the expertise and capability to effectively deliver national and local ICT requirements. And like technology, we don‟t stand still. We are continually researching and innovating, as we are passionate about providing technologies that enable our customers to do things better, or to do better things.
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Delivering excellence in innovative technology solutions with the health and wellbeing of the patient and integrated care at the heart of everything we do.
Or put simply – transforming care through technology
The numbers….
148 whole time equivalent staff employed by NHIS
799
sites supported
834
square miles covered by NHIS
13,121 users supported
1,069,900 patients cared for by our customers
Sherwood Forest Hospitals NHS Foundation
Trust
Mansfield and Ashfield Clinical Commissioning
Group
Nottingham West Clinical Commissioning
Group
Rushcliffe Clinical Commissioning Group
Newark and Sherwood Clinical Commissioning
Group
Nottingham City Clinical Commissioning Group
City Care
Nottingham North and East Clinical
Commissioning Group
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Every single customer matters to us and we want to deliver a service that we can be proud of.
During the financial year we created our customer promises and embed them firmly into our organisation.
Throughout January our Business
Relationship team attended practice manager forums for each clinical commissioning group to find how we can improve our service to them at a CCG level.
Following these forums the team then commenced a programme of visits to each individual practice to understand and resolve any current problems they may be experiencing and also to learn about the future
ICT requirements for the practice. By the end of March the team had met with 72 out of 148 practices, with the remaining visits scheduled throughout the first quarter of 2015/16.
These meetings have given us a clear understanding of each and every customer and are allowing us to tailor our support to meet their needs. But it doesn‟t stop there, these visits will be part of a regular programme to ensure that we continue to meet their needs as they adapt and change in the future.
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We promise:
To listen to our customers and learn
To keep IT simple
To be courteous and professional at all times
If we get it wrong for any reason we will fix it for you
To tell you what we are doing, why and when.
Giving sufficient notice if possible
To deliver our services in accordance with your expectations
We provide bespoke services as well as standard packaged solutions such as:
Absence management package
Choose and Book support
Data warehousing
Desktop support
Electronic prescribing
RA management
SystmOne implementation and support
PACS support
Telephony services
Video conferencing
Web design and hosting
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Our service desk answered
calls
We received
customer orders with a total value of
Provided services for
customers
sickness absence rate
of staff received an appraisal
records processed in our data warehouse
rows of data processed by our data warehouse every single second of the year that‟s equivalent to
rows for every working second!
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Head of Technical Solutions, Mike Press has been selected to be a member of the
Customer Advisory Board for American software company VMware.
VMware provides cloud and virtualisation software and services to companies around the globe. The company approached individuals to form a customer advisory board to advise them on trends, strategic direction and business priorities within their respective industries.
The Customer Advisory Board has been discussing new desktop architecture, mobile platforms and new means to collaborate and share content throughout an organisation thereby improving business mobility.
Membership of this advisory board will benefit both Nottinghamshire Health Informatics
Service and our customers as it allows us to share best practice, shape solutions and gain an insight into future business mobility.
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As part of our commitment to quality and standards in IT Training, we are the only NHS training provider in the local area to have been accredited Bronze level for our training standards by the Health and Social Care
Information Centre (HSCIC).
This accreditation process gave us the opportunity to benchmark and standardise our training delivery against national standards.
We are working hard to achieve the Silver award during the re-accreditation process in
2015/16
In addition, the Project Implementation and
Training Manager is a member of the National
HSCIC Training Standards Review Group and provides expert feedback and advice regarding the current NHS training standards and reviews what needs to be implemented for all
NHS training services in the future.
Two members of our patient benefits team were given the opportunity to work with the
Health and Social Care Information Centre
(HSCIC) as benefits analysts in a secondment role.
Jenny Cooper and Heather Marshall worked with HSCIC from January to March 2015.
During this time they were able to develop their benefits realisation knowledge and skills. They also gained experience of using the new
Benefits Assessment and Realisation Tool
(BART) which has been rolled out nationally to track value for money throughout a project cycle and beyond.
This experience has provided Jenny and
Heather with valuable knowledge and skills to assist with their roles within the NHIS and all the organisations we support
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Our Business Information Support Unit has developed an intranet based application for use by our customers‟ analysts.
The application consists of a comprehensive data dictionary written by the team, data quality information and useful supporting information. Users are able to browse tables within the dictionary to understand what information is contained within each column, what business rules have been applied, if there are any constraints on the data and also what the column was called in the old legacy database.
The dictionary also contains information about the different views available and indexes.
The data quality part of the application allows
CCGs to review the amount of data processed each month as it allows them to easily review how many rows have been uploaded per month for their CCG and track this over time. This functionality is proving extremely valuable to our customers as it allows them to focus on analysing the data as they no longer need to run these checks on the data quality.
If the data loading process identifies poor quality or missing data then this is flagged and the CCG‟s are able to discuss the issues with the relevant health care providers.
Further functions will be added to the data quality aspect of the application during
2015/16.

Our data warehouse was significantly upgraded during the year to ensure that we continue to offer our customers a high level of service into the future.
The data warehouse captures data that assists commissioning, finance and public health analysts to produce statistical reports enabling our customers to make informed decisions about local health services based on previous patient related activity.
We spent time scoping and then creating the new data warehouse environment and we are proud of the results. Our new servers provide a fast, stable and robust environment for our consumers‟ data.
In addition to this we rewrote our data loading procedures to make our processes more automated, this has had the largest impact to our Secondary User Service
(SUS) data. The SUS data is currently uploaded fortnightly, using the data loading package in the old warehouse environment it takes one week to extract, transform and load the data whereas using the rewritten data loading package for the upgraded warehouse the data can be extracted, transformed and loaded in just two days! This allows our customer to access the data in a timelier manner.
We also replaced any person identifiable information within the data with artificial identifiers, creating pseudonymised datasets to prevent possible identification of individuals.
By the end of June 2015 we will have migrated all data to the new warehouse and we are working with our customers to ensure that the new environment is fit for purpose by end of August 2015 so that the old environment can be decommissioned.
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After many months of planning we launched a new patient administration system (PAS) for our partner Sherwood Forest Hospitals which was our largest project of the year.
The Trust selected Medway PAS, provided by System C / McKesson, following a rigorous procurement process to replace their previous system which was out of date and no longer met their needs. We worked with System C/Mckesson to ensure that that the new system offered more functionality and flexibility therefore allowing the Trust to provide better and more efficient patient care.
The new PAS system has enhanced the Trust‟s ability to share data across operational systems and business units within the Trust and the wider healthcare community
Implementing a new patient administration system for an acute trust is a large operation. It involved moving 950,000 patient records! There were no issues with the data migration load to
Medway as the data quality of the patient records was of a high standard. We have always prided ourselves on the data quality support we offer our customers and this highlighted the quality of our work.
received training.
transferred to the new system.
the length of time we used to deliver training to all the end users.
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of ‟Go live‟ support and out of hours cover were provided.

Patients across Nottinghamshire will soon be able to access their full medical records on line following a successful pilot in eight GP practices across the county.
Nottinghamshire Health Community commissioned a project to pilot the use of patient on line access after the Department of Health (DH) published the information strategy, „The power of information: putting us all in control of the health and care information we need‟. The strategy stated that by 2015 all general practices would be expected to offer their patients online access to their records.
Eight practices, which represented a cross section of CCGs, administration systems and practice profiles, took part in the six month pilot that would shape how future access and processes may be delivered.
We worked closely with the practices to ensure that patients could access their records securely.
During the evaluation of the pilot the patient benefits were clearly evident. Patients felt more involved in their own care and were able to:
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 review their medical history without contacting the practice view their test results online
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 print off their information to take to hospital appointments manage their condition with information obtained through online access, reducing the number of visits to the practice.
The pilot demonstrated huge potential for managing long term conditions patients in a different way that reduces the number of routine visit to a practice.
“I find that it helps me to accurately recall how long I have had a particular condition. I find that trying to guess how many months or years I've experienced any such condition, is wildly inaccurate”
Patient comment
“It’s really helpful and reassuring to be able to see my records”
Patient comment
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The Electronic Prescription Service (EPS) enables GPs and Nurse prescribers to send prescriptions electronically to the patient‟s pharmacy service, making the prescribing and dispensing process more efficient and convenient for patients and staff.
EPS allows GP practices and dispensers to trace prescriptions from the GP signature to the point when the patient collects the item/s and removes the possibility of prescriptions becoming lost.
The system uses a standardised drug dictionary which improves prescription accuracy, reduces prescription queries for the dispenser and reduces the risk of patients receiving the wrong medication.
GP practices who have implemented EPS are seeing benefits of the system. GPs are able to bulk sign electronic prescriptions at a time which is convenient to them and repeat dispensing is quicker with EPS. Prescribers can also cancel prescriptions and issue revised ones without the patient having to return to the practice, freeing up valuable appointment slots. The practices are now printing fewer prescriptions and they are reporting that their workload is decreasing as they no longer need to contact patients to remind them that their prescription is ready.
Patients also benefit from EPS as they no longer need to visit the practice to collect their prescription and are able to collect their medicine from a dispenser close to where they live, work or shop.
EPS is being rolled out to all 148 GP practices in Nottinghamshire. By the close of the financial year 74 practices were using EPS with the remaining practices due to implement the system in
2015/16.
Practice: John Ryle Medical Practice
List size: 6,500
What did the staff think?
Despite their positive attitude towards change not all of the practice staff were looking forward to the change. The senior partner had reservations about the “legality of the system” and could not envisage how the process could function without paper. A prescribing clerk thought it would involve a significant amount of “computer learning” and it would be an overly complicated process.
Now they report that “the system was very easy to learn and has made a real difference”. The senior partner now thinks that the system is “absolutely brilliant “.
“Go for it-, all staff like it– and it will save you time”
Marion Tongue- Practice Manager
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We worked closely with Sherwood Forest Hospitals to modernise and expand their existing video conferencing facilities in a cost effective way.
Consultants regularly need to travel between the Trust‟s hospital sites and to other hospitals in the region to attend meetings. The Trust wanted to increase efficiency and reduce travel costs so looked to improve their video conferencing facilities to ensure they met this need.
Previously video conferencing was only available in the Trust‟s lecture theatres at King‟s Mill Hospital and the board room at Newark Hospital which restricted its use and flexibility.
The new system uses equipment from Cisco Tandberg and a Vidyo platform. A NHIS technician created and installed additional encryption to ensure all calls benefitted from 128bit encryption. To ensure it offered the convenience and flexibility required, software was added to some of the consultants computers allowing them to use the facilities from their offices.
The system has proved invaluable to the consultants as they can share images on their desktops such as radiology scans with others to decide the most appropriate surgical approach.
A mobile system has also been introduced that can be used in operating theatres to stream footage of operations to teaching sessions within the
Trust and nationwide.
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GP practices across Nottingham City and Nottinghamshire County are now offering their patients online access to appointments, repeat prescriptions and their personal summary care record following a yearlong project by the
Nottinghamshire Health Informatics Service (NHIS).
Online access offers many benefits to general practices including reducing the pressure on reception desks and telephone lines, supporting improved business processes, decreasing non-attendance rate and increasing patient satisfaction.
Offering online services also brings immediate benefits to patients including convenience, patient autonomy, involvement in their own healthcare particularly in the management of long-term conditions, and improved patient safety, such as identifying errors in medication list.
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Community healthcare workers and patients in Nottingham are benefitting from new mobile working solution.
CityCare provides NHS community health services across Nottingham City and a large proportion of their services are delivered in the patient‟s home. Healthcare workers would see a number of their patients before returning to the office to update the patient‟s medical records. CityCare were keen to utilise the latest technology to allow their staff to update the patient‟s medical record, order equipment and any other additional support whilst they were with the patient, delivering benefits for both staff and patients.
Nottinghamshire Health Informatics Service worked with CityCare to design a clinical solution that was tailored specifically to their needs and was then piloted with the community rehabilitation team.
Staff were given tablet devices with a windows 8 operating system, 3G connectivity and the clinical SystmOne mobile working application allowing healthcare workers to access the medical records securely in any location. This solution was piloted from July to September and feedback showed that users liked the mobile working solution but felt that a larger tablet would improve usability.
The pilot highlighted many benefits for both CityCare‟s community rehabilitation teams and their patients. Mobile working has allowed the organisation to provide a more streamlined and professional service as staff can complete all the paperwork in one go with the patient ensuring that the information is high quality and accurate. Patients are able to view up to date images of the equipment available to them allowing them to make informed choices about which option will be most suitable for them and staff can answer any queries on the status of appointments instantly.
Patients are now being seen more quickly as staff spend less time returning to the office and duplicating work.
The project was rolled out to 200 CityCare staff using the same tablet device and our training team provided full training. Quick reference guides, E-learning training and a helpline were offered to support the implementation. Staff from our Service Desk also received training on this new mobile working solution to ensure that they could continue to offer a high level of service and support to CityCare and our partners. A new larger device will be delivered as part of the larger rollout to more than 650 users.
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Nottinghamshire Health Informatics service achieved a financial surplus position of £424k for
2014/15. This has been achieved whilst operating within a challenging environment as our customers are facing continued pressure to reduce costs.
Our financial achievements have been with an NHS context that includes increased demand, higher expectations, financial constraints, increased competition and greater scrutiny.
During 2014/15 we delivered our cost improvement plan generating savings of 4.8% , this was achieved thanks to the support and dedication of everyone within the organisation.
FINANCIAL STATEMENT 2014/15
Income Budget
£9
Expenditure
£5 £6
£8
£7 £8
Millions
£9
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