SOUTH WARWICKSHIRE NHS FOUNDATION TRUST
Meeting
Board of Directors
Date
29 June 2011
Subject
ICT Strategy 2011-14
Enclosure
E
Nature of item
For information
For approval
For decision

Decision
required (if any)
The Board is invited to consider and approve the ICT Strategy 2011-14
General
Information
Report Author
Lead Director
Received or
approved by
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Date
Resource
Implications
Revenue
Capital
Workforce
Use of Estate
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Freedom of
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(if yes, give
reasons)
Final/draft format
No
Ownership
Trust
Duncan Robinson, Associate Director of ICT
Jane Ives, Director of Operations
Draft
Intended for release Yes
to the public
ICT Strategy 2011-2014
Warwickshire ICT Services – A Division of South Warwickshire NHS Foundation Trust
Foreword
This document is delivered pursuant to the Information Governance and Security Policies agreed by South
Warwickshire NHS Foundation Trust.
Confidentiality
All Information contained in this document is confidential to South Warwickshire NHS Foundation Trust or to
other intended recipients. If you are not the intended recipient please destroy all (hard and soft) copies of this
document.
Configuration
Author
Owner
Duncan Robinson
Configuration ID
Draft Date
Title
Version
ICT Strategy 2011-2014
0.5
Final Date
Approved Date
08/03/16
Distribution
Role
Name
Organisation
Location
Copies
Amendment Record
Issue
Status
Version
Date
Actioned By
Description
Draft
0.1
08/03/16
Duncan Robinson
Initial draft
Draft
0.2
22/05/11
Duncan Robinson
Early review comments incorporated
Draft
0.3
02/06/11
Duncan Robinson
Comments from ICT Services Senior Management Team
Draft
0.4
13/06/11
Duncan Robinson
Comments from Director of Operations
Draft
0.5
20/06/11
Duncan Robinson
Comments from the Chairman
References
Ref
Document Name
Document Number
Version
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Ref
Document Name
Document Number
Version
Glossary
Abbreviation
Description
AMD
Associate Medical Director
CAF
Common Assessment Framework
CIP
Cost Improvement Programme
DoF
Director of Finance
DoN
Director of Nursing
EDRMS
Electronic Document and Records Management System
EPR
Electronic Patient Record
LHC
Local Health Community
LRC
Lorenzo Regional Care
MD
Medical Director
NPfIT
The National Programme for IT
QIPP
Quality Innovation Productivity Prevention
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Table of Contents
Executive Summary ............................................................................................................................. 1
Foreword from the Director of Finance .............................................................................................. 3
Foreword from the Medical Director ................................................................................................... 3
1
Introduction ................................................................................................................................. 4
1.1
Aims and Purpose ...................................................................................................................4
1.2
Scope ......................................................................................................................................4
1.2.1
1.3
2
Information Strategy ......................................................................................................5
Vision ......................................................................................................................................5
Strategic Context ........................................................................................................................ 6
2.1
LHC Context ............................................................................................................................6
2.2
SWFT Business Plan and Objectives .......................................................................................7
3
Current Landscape ..................................................................................................................... 8
3.1
Infrastructure and Hardware..................................................................................................8
3.2
Operating Systems and Back Office Software ........................................................................8
3.3
Line of Business Systems ........................................................................................................9
3.3.1
National Programme for IT .............................................................................................9
3.3.2
Other Key Departmental Systems ..................................................................................9
3.4
Telecommunications ........................................................................................................... 10
3.5
SWOT Analysis ..................................................................................................................... 10
4
Stakeholder Requirements ...................................................................................................... 12
4.1
What Patients Want ............................................................................................................ 12
4.2
What Clinicians Want .......................................................................................................... 12
4.3
What Management Wants .................................................................................................. 13
4.4
What ICT Services Wants ..................................................................................................... 13
What’s Currently in Train ......................................................................................................... 15
5
5.1
Current Trust Initiatives and Projects .................................................................................. 15
5.2
Local Health Community Initiatives and Projects ................................................................ 17
5.3
National Initiatives and Projects.......................................................................................... 18
6
Proposed Trust Initiatives and Projects ................................................................................. 20
6.1
Overview.............................................................................................................................. 20
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6.2
Enablers ............................................................................................................................... 20
6.3
Quick Wins ........................................................................................................................... 21
6.4
Tactical Implementations .................................................................................................... 22
6.5
Strategic Programmes ......................................................................................................... 24
6.5.1
ICT Services Expansion................................................................................................. 24
6.5.2
Patient-Centric Information ........................................................................................ 25
6.5.3
Clinical Portal ............................................................................................................... 25
6.5.3.1
Patient Portal ............................................................................................................... 26
6.5.4
Clinical Timeline ........................................................................................................... 26
6.5.5
Electronic Document and Record Management System (EDRMS) ............................. 26
6.5.6
Local Digital Transcription ........................................................................................... 27
6.5.7
Wider System Integration............................................................................................ 27
6.5.8
The National Programme for IT (NPfIT) ....................................................................... 27
6.5.9
LIMS Re-Procurement.................................................................................................. 28
6.5.10
Electronic Prescribing .................................................................................................. 28
6.5.11
Increased Mobile Working .......................................................................................... 28
6.5.11.1 LHC Collaboration on Community Mobile Working .................................................... 29
6.5.12
Tele-Health .................................................................................................................. 29
6.5.13
Carbon Management................................................................................................... 29
6.5.14
ICT 24/7/365 ................................................................................................................ 29
6.5.15
Trust-Wide Communication ........................................................................................ 30
6.6
Improvement through Innovation....................................................................................... 30
6.6
Proposed Implementation Timelines .................................................................................. 32
6.7
Cost Benefit Realisation....................................................................................................... 33
6.8
High Level Risk Matrix ......................................................................................................... 47
Appendix A – ICT Services Goveranance and Structure ............................................................... 48
Appendix B – SWOT Analysis Detail ................................................................................................ 50
Table of Figures
Figure 1 - Building Blocks to Success ................................................................................................... 20
Figure 2 - Clinical Portal ....................................................................................................................... 26
Figure 3 - Interactive Treatment Timeline........................................................................................... 26
Figure 4 - ICT Services Division High Level Governance ...................................................................... 48
Figure 5 - ICT Services Senior Management Team .............................................................................. 48
Figure 6 - Projects and Service Development...................................................................................... 49
Figure 7 - ICT Operations ..................................................................................................................... 49
Figure 8 - SWOT Strengths mapped to Opportunities ........................................................................ 50
Figure 9 - SWOT Weaknesses mapped to Threats .............................................................................. 51
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Executive Summary
The last four years have seen impressive performance from South Warwickshire NHS Foundation
Trust. Having agreed and delivered a plan addressing previous financial issues it has gone on to
achieve Foundation Trust status before vertically integrating Warwickshire Community Health
Services in April 2011. Despite all of this organisational change the Trust has kept its focus firmly on
the delivery of high quality patient care while continuing to drive efficiencies through the
organisation.
This ICT strategy looks to affirm the work already underway while scanning solutions to fit the
future road map the Trust intends travel along. There are a significant number of initiatives
currently in train and these are documented alongside the proposed work for the next 3 years.
In bringing this together information has been gathered via surveys, interviews, group sessions,
focus groups, work undertaken nationally and within the wider LHC and via desk-based research.
During this information gathering exercise clarity around certain key principles was formed:

Staff see large amounts of waste, duplication and inefficiency and are keen to address this –
initiatives including the Productive Ward and Productive Theatres are prime examples

There has been a cultural shift within the organisation in the acceptance of the need to do
more electronically in order to address duplication issues together with the provision of
information on demand

The Trust has an increasingly IT-savvy workforce courtesy of in-house ICT training together
with the consumerisation of products previously seen more in a business context. The
Government’s vision to have a computer in every home is already a reality with alternative
form factors such as smartphones and tablets or slates, together with the ubiquitous iTunes
/ Android Market / BlackBerry AppStore
The Trust is driving through agendas of cost reduction together with care provision in the
appropriate setting and to achieve these goals wholesale transformation is required. Key tactical
solutions such as electronic requesting and devices at the point of care need to compliment more
strategic initiatives such as electronic document management and Hospital Heartbeat in enabling
the Trust to realise the potential efficiencies it requires to remain “fit for purpose”. ICT on its own is
not the answer however; ICT must act as an enabler to the Trust in delivering its key objectives. Key
to everything are the Trust staff and the information they collect and utilise, as “…information
persists long after the hardware used to manipulate it” (Christine Connelly, CIO DH).
Offered within this strategy therefore are four levels of deliverable, each building on the latter:




Enablers
Quick Wins
Tactical Solutions
Strategic Solutions
There are several strategic solutions already in train; at least two of which are Local Health
Community (LHC) based and as such require wider collaboration. For certain others, while the
strategy is clear the final deliverable is less so, requiring further debate at a national level.
In re-stating the need to employ increased collaboration and partnership working with other health
and social care providers, while also undertaking a significant transformation programme following
the TCS transfer, revised methods of working coupled with increased electronic information sharing
takes on a heightened importance both internally and within the LHC. Seamless information
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exchange with the (GP) commissioners is central to the enhanced delivery of quality patient care
within the LHC health “system”, with the Trust needing to ensure it’s driving this agenda rather than
reacting to it. This strategy therefore looks to complement a wider LHC IT Strategy also being
refreshed at this time, with Warwickshire ICT Services ideally places to ensure the successful
delivery of both.
Re-focussing on the Trust, the strategy looks to push through a more innovation-led organisational
culture; realising efficiencies through both technology and process change leading in turn to
increased patient safety and empowerment through more reliable care pathways and supporting
clinical processes. Technological change is rapid and continual, providing constant exploration
opportunities. Working more closely with clinical and operational colleagues in active horizon
scanning and the adoption where appropriate of best practice from public and private sectors, ICT
Services will iteratively build upon the existing, highly robust infrastructure and working
environment to ensure the Trust has options on the leading edge of the technology curve.
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Foreword from the Director of Finance
The NHS and indeed the whole public sector is facing some tough financial times over the current
Parliamentary cycle. In 2011/12 this has already resulted in a reduction of at least 1.5% in the tariffs
paid to acute hospitals under Payment by Results which has led to a cost improvement target in
excess of 4%. Given the current forecasts from the Department of Health and Monitor it is
anticipated that a minimum requirement of 4.6% is required over the next 4 years – this will place
significant challenges on the trust to both maintain financial stability and continue to fund capital
developments.
To complement this all new developments have to be, as a minimum, self-financing and ideally need
to support the Trust in the delivery of its cost improvement targets over the coming years. The ICT
strategy is a fundamental cornerstone to be an enabler to improve productivity, efficiency and
clinical effectiveness.
Mr David Moon
Director of Finance
South Warwickshire NHS Foundation Trust
Foreword from the Medical Director
Our Information and Communication Technology Strategy is helping to improve outcomes for
patients at SWFT.
Clinicians have been heavily involved in the development of our ICT systems, and in helping with
successful implementation. Clinicians and managers have identified key areas where ICT can
support clinical care, and have successfully deployed these in the prevention of deep venous
thrombosis and pulmonary embolus, in electronic referral for radiology and laboratory tests, in
coordinating care as patients move between hospital wards and in improving communications with
GP’s.
With the transfer of Community Services, we will use ICT to develop more integrated care between
hospital and community. This will be central to our transformation programme for people with longterm medical conditions, older people and people with musculo-skeletal problems.
I strongly welcome the publication of this Strategy.
Professor Ian Philp
Medical Director
South Warwickshire NHS Foundation Trust
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1
Introduction
1.1
Aims and Purpose
In refreshing the ICT Strategy for the Trust there is an aim to provide visibility around both current
and future ICT requirements which support the Trust’s stated aims and objectives in its delivery of
healthcare to the highest quality for its patients.
ICT underpins many of the clinical and corporate processes within the Trust and as such acts as an
enabler to all patients and staff both directly through key systems and indirectly via the facilities and
opportunities it creates. The current economic climate requires the NHS to save circa £20bn by the
end of 2013/14; at a local Trust level the Trust plan is to levy a recurrent CIP of between 4% and
5.5% which is lower than the NHS average but typically higher than the Trust has previously looked
to deliver. By building on ICT already present within the Trust while also implementing key tactical
and strategic solutions and initiatives, the Trust and the wider local health community (LHC) aims to
collaborate to remove its share of the £20bn from the local health “system”, and this strategy
embraces that aspiration.
The drivers for this strategy are taken from the Trust objectives and business plans together with
the wider national agenda, and include:






1.2
QIPP (Quality Innovation Productivity Prevention)
Business Transformation
Cost Improvement
Multi-Agency Collaborative Working
Opportunities Through Technology
Improvements in care quality
Scope
At the time of writing this strategy a wider, (Arden) Commissioning Cluster-based IM&T strategy is
also being refreshed. Transforming Community Services (TCS) has also just taken place seeing the
Trust become a larger, vertically-integrated healthcare delivery organisation.
The intended scope is therefore:
i)
To provide a strategy addressing the ICT needs of that newly integrated Trust by
a. Building on existing infrastructure, technology and systems
b. Improve information capture and presentation through the introduction of new
technology and processes
c. Support the removal of duplication and waste from the system
d. Create an innovative culture through learning and opportunity
ii) To align with the output from the LHC strategy refresh
In undertaking TCS the Trust has adopted a model of adopt, adapt, transform with an aggressive
transformation programme having just started. Within the programme a Technology work stream is
present which will undertake two main tasks:
i)
To deliver 3 identified strategic projects
a. Telehealth
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b. GP Communications
c. Community Mobile Working
ii) To underpin the other work streams within the programme, acting as an enabler to their
ultimate success through timely and accurate information sharing via strong infrastructure
and new technology
1.2.1 Information Strategy
During 2010/11 the Trust procured a third party Business Intelligence solution from InSource to
replace the various existing in-house developed solutions. The InSource solution comprises a suite
of tools atop a corporate data warehouse which will require all subsequent Trust systems – either
procured or developed in-house – to be capable of integrating into, or order to realise the concept
of truly corporate information.
As such the Information Strategy per se falls outside the scope of this ICT Strategy however ICT
Services must ensure all technology deployments meet this integration and corporate BI reporting
requirement.
There is further crossover in the identified requirement to upskill staff in the use of new or existing
tools to ensure such tools are utilised to their maximum potential, in turn leading to optimal benefit
realisation through increased efficiency within the working environment.
1.3
Vision
There is no single vision at play but more a series of key aspirations:

To employ innovation and technology in pursuit of the Trusts objectives to provide patient
care to the highest standards

To create a paper-light environment where clinical and corporate information is captured
and shared electronically, thereby removing duplication and waste while reducing the
carbon footprint of the Trust and the staff working within it

To support the ability of the Trust to deliver the highest quality patient care in the most
appropriate setting

To support staff in their daily roles whether clinical or corporate

To create a culture at ease with the technology and systems at its disposal

To enable the timely and accurate capture and sharing of key Trust information through the
integration of new and existing systems

To support the delivery of the right care, first time, every time

To support the delivery of care in the right setting

To utilise technology to link patients to their care teams and care teams to each other

To support the delivery of care customised around the personal needs of the patients and
delivered for their convenience creating the best possible outcomes and experience
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2
Strategic Context
“…Strategies and processes alone are not sufficient to drive
the degree of change we are seeking....the NHS should focus
on tackling the behaviours and cultures in the system that
stand in the way.”
Sir David Nicholson KCB CBE
2.1
LHC Context
In understanding the LHC (and therefore the National) context, work on the LHC IM&T Strategy
refresh (based on the ICT Strategy produced March 2010) is being utilised so as not to reinvent the
research wheel with regard to the National Context. The following is extracted from the Arden
IM&T Plan, which is part of the output from the LHC IM&T Strategy refresh exercise.
The vision for collaborative IM&T within the Arden Cluster includes key areas of emphasis, as
follows:

Moving care closer to home

Giving patients greater control, choice and access

Commissioning for quality and outcomes

Delivering integrated services across different organisations

Supporting specialist pathways to concentrate care in fewer specialist centres, whilst
generalist care moves closer to home

Improve early intervention services

Driving efficiencies through increased use of self-care and lifestyle management techniques
…
To deliver the vision and objectives there is an implicit and fundamental need to change the culture
of collaborative IM&T development and delivery in Arden, to one where:

Patients are placed at the heart of information provision

Clinicians and clinical transformation teams are given the opportunity to take much greater
levels of ownership of IM&T, through enhanced clinical and service engagement

IM&T is deployed with a principle of ‘connect all’ rather than ‘replace all’

IM&T providers are commissioned as integrated enablers of the service, not to provide
‘boxes and wires’ per se
There are various resultant initiatives within the Arden IM&T Plan which significantly overlap with
planned developments within the Trust strategy and as such the Trust will align with and adopt
where appropriate to ensure wider collaboration while reducing development costs.
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A prime example is the development of a Patient’s Health Portal to provide patients with access to
their health data. NHS Worcestershire are partnering with NHS Local to deploy patient record and
self-care tools which will include feeding Microsoft Health Vault (to be used as the main front-end
patient portal). UHCW and Coventry GPs will lead on an Arden Cluster project to explore these
facilities within the LHC with the Trust and Warwickshire GPs able to follow on shortly after.
The full Arden IM&T Plan will be presented to the LHC IM&T Programme Board in June 2011.
2.2
SWFT Business Plan and Objectives
The Trust publishes an annual business plan and associated objectives and this ICT strategy supports
all aspects of this iterative strategic planning process through learning and education, improved
information sharing, reduction in waste and duplication and as such enabling increased productivity
leading to improved patient safety and outcomes.
The full plan is available on the Trust web site (www.swft.nhs.uk), however the headline items
include:





Maintaining and Improving Productivity
A focus on Quality
The Use of Technology
Developing an Integrated Service
Developing the Trust Workforce
The ICT Strategy aims to create a more ICT-empowered workforce, more able to utilise the tools
already to hand while investing in the right systems to enhance productivity and performance while
improving patient safety and rehabilitation.
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3
Current Landscape
“If I were running Apple, I would milk the Macintosh for all it’s
worth — and get busy on the next great thing. The PC wars are
over. Done. Microsoft won a long time ago.”
Steve Jobs, CEO Apple Computers, 1994
(in the period after he’d left and before he’d returned)
This section sets out the ICT currently deployed by ICT Services within the vertically integrated postTCS Trust.
3.1
Infrastructure and Hardware
IT services are provided across some 85 sites supporting South Warwickshire Foundation Trust
including its Community Health Services. In addition to this IT services are also delivered to 76
General Practices across Warwickshire.
There are currently three data centres situated at Warwick Hospital, Westgate House and the Royal
Leamington Spa Rehabilitation Hospital. As part of the transformation work following TCS, the data
centre at Westgate House will support primarily Warwickshire PCT with the centres at Warwick
Hospital and the Royal Leamington Spa Rehabilitation Hospital forming the core data infrastructure
for SWFT and WCHS.
Server and storage infrastructure is provided in the majority by Dell Computers and comprises of
163 servers of which 38 are virtual servers (a number of virtual servers reside on one physical
server) and work is in progress to virtualise a further 30 servers, all supporting the wider Trust
strategy around reducing its carbon footprint. These are linked to storage arrays totalling 68
terabytes of capacity. Data backup is run to automated tape libraries and also to high speed SATA
disk farms.
Main sites are linked using leased Ethernet extension lines from Virgin Media Business and branch
sites are linked using secure virtual private networks running over the NHS N3 network. The
Warwick Hospital data centre has two physically separate connections into the N3 network for
redundancy and also has a direct internet access link to reduce traffic traversing the N3 connections
and to support high quality remote working.
Connected to the core infrastructure are around 2,600 desktop computers and notebooks
(excluding GP’s) and a large number of mobile devices.
3.2
Operating Systems and Back Office Software
The standard desktop operating system in use is Microsoft Windows XP. Restrictions around
nationally provided systems have so far precluded moving to the latest release of Windows 7.
Server infrastructure is predominately Windows Server 2008R2 with some legacy Windows Server
2003 machines still in service.
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Microsoft Back Office suites include; SQL Server 2005 and 2008, SharePoint Server 2007 and 2010,
Office Communications Server, Internet Information Server 6.0 and Exchange Server 2010.
Productivity software is currently a mix of Microsoft Office 2003, 2007 and 2010 and we are hoping
to be able to standardise on Office 2010 during this calendar year.
Remote working facilities are provided using Juniper Secure VPN appliances and mobile email is
supported through a hosted BlackBerry environment and for Smartphones via Windows ActiveSync.
Endpoint security is supported by a combination of Sophos and Websense software. This provides
traditional anti-virus and malware protection as well as securing access for USB storage devices and
carrying out website filtering to protect the network and system users against external threats.
Perimeter security is provisioned using Cisco PIX firewalls and intrusion detection appliances.
IT service delivery uses the AdventNet Operations Manager suite which in addition to providing the
IT Service Desk incident management tools also supports change and problem management and
holds a full hardware and software asset management database. IT operations service delivery data
is made available via an intranet based portal that shows the status of all business critical systems in
real time plus the capacity of the IT Service Desk team. Call centre facilities for the IT Service Desk
are provided using Nortel Business Communication Manager 50 Contact Centre.
3.3
Line of Business Systems
The Trust Patient Administration System (PAS) is provided under the National Programme for IT by
Computer Sciences Corporation Alliance (CSCA) and is an iSoft iPM system, presented to users via
Citrix thin client sessions. Implemented within the North West (and) West Midlands (NWWM)
cluster as an interim solution in advance of Lorenzo Regional Care solution, the Trust has been
running iPM since December 2006. At the time of writing the Trust’s intention remains to upgrade
to Lorenzo Regional Care when it becomes available and when the Trust believes it is fit for purpose.
3.3.1 National Programme for IT
The Trust has taken a number of NPfIT solutions, including:

iPM PAS

ORMIS Theatre Management

HSS RIS (Radiology Information System)

GE PACS (Picture Archive and Communications System) incorporating the Centricity Web
Viewer

ScanTrack IMS (HSDU Instrument Management System), due to go live June 2011
The Trust remains committed to NPfIT however only on the basis the products are fit for purpose
and continue to offer value for money and a collaborative informatics capability.
3.3.2 Other Key Departmental Systems
The largest clinically focussed system in use is Sunquest ICE which provides Pathology and Radiology
reports through a web based interface. A JAC Pharmacy TTO/Discharge system has been rolled out
across the trust to provide a means of electronic prescribing and production of patient discharge
letters and a system from Service Heartbeat is currently being piloted across A&E, MAU and several
wards with a view to a full roll out during summer 2011.
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The Trust is a stakeholder within the Coventry & Warwickshire Pathology Network and as such takes
the GE Ultra Laboratory Information Management System (LIMS) from University Hospitals Coventry
& Warwickshire NHS Trust. The solution is sunsetting (nearing “end of life”) which has led to the
commencement of a LIMS Replacement Project with a requirement to procure and implement
across the network by December 2013.
The Electronic Staff Record (ESR) is nationally provided solution via McKesson for HR and Payroll
provided in a similar manner to PAS. The Trust Finance solution is eFinancials from Advanced
Business Solutions, which ICT Services have very little support involvement as it’s provided by the
supplier.
3.4
Telecommunications
With the exception of data networks, Telecommunications within the Trust currently sits outside
the domain of ICT Services however a planned move to migrate all technical aspects of telecoms
management to ICT Services will take place during 2011/12. This will present additional
opportunities to the Trust including:




Potential for multiple switchboards / PBX installations rationalisation
Rationalisation of mobile communications contracts, networks and handsets
Streamlining of telecoms procurement and management processes
Integration of additional, supportive technologies such as Office Communicator and Live
Meeting, leading ultimately to a total unified communications environment
Unified communications will facilitate significant efficiencies within the Trust through the ability to
easily and readily communicate with staff regardless of their location via existing data networks
while saving time and expenditure through virtual rather than physical meetings where feasible.
3.5
SWOT Analysis
A SWOT Analysis was undertaken with input from senior clinicians, senior management and
Executives to better understand how the organisation sees ICT Services. The detail is contained
within appendix B, but the emergent themes are as follows.
Stengths




Weaknesses
ICT Staff – level of knowledge and
experience
ICT Staff – responsiveness
Infrastructure
Service Delivery
Opportunities



Expansion beyond just SWFT ICT service
delivery
Increased clinical engagement
Collaboration within the LHC and wider
around key initiatives such as Local Health
Records



Infrastructure at non-NHS sites used by
Community Health Services
Periodic lapses in clinical engagement
National Programme for IT (NPfIT) systems
Threats



Lack of recurrent funding going forward
Loss of key staff through professional and
career development opportunities
ICT Outsourcing or ICT Services being taken
over
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Analysing the SWOT responses and looking at transforming strengths into opportunities while being
mindful of weaknesses and potential threat situations, respondents see a clear opportunity to
expand ICT Services, either through (in)formal collaboration or merger, thereby exploiting identified
strengths around staff, infrastructure and strong service delivery, while negating the potential
threat of funding cuts, takeover or outsourcing and the associated loss of key staff.
There needs to be a greater emphasis on developing stronger links with clinicians to ensure systems
delivered within the Trust will add demonstrable value to their working environment and not simply
be seen as superfluous or redundant. Systems already in place (national or local) should be
exploited to their maximum potential with more IT-literate staff capable of better utilising the data
held within such systems, transforming it into meaningful, valuable information.
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4
Stakeholder Requirements
Employing various methods of information capture including surveys, one to one meetings and
group sessions with representatives of all key stakeholder groups, this section looks to document
their requirements.
4.1
What Patients Want
There is a significant amount of published material relating the needs and wants of patients, much
of it generated not by patients themselves but by the Government (DH), the Commissioners and the
healthcare providers, often to justify their own business strategies.
Patients of course want high quality healthcare delivered in safe, clean surroundings by qualified
professionals. “No decision about me without me” and “care closer to home” are two mantras
emanating from DH strategies such as “Equity and Excellence: Liberating the NHS”, which discuss
“…increased control over their own care records.” and while not every patient wants direct access
to their electronically held information, they do want to know it is accurate, secure and forms a
sounds basis for their on-going care.
Certainly more information should be readily available to patients to assist them in their healthcare
decision-making and this strategy supports such initiatives both for SWFT and also within the wider
LHC and via channels such as NHS Local (http://nhslocal.nhs.uk/).
The Government is keen to offer increased choice to patients and within the Trust this will be
supported through the publication of key performance data together with a partnership approach
to elective healthcare with GPs via Choose & Book.
The Trust is already working to improve access for patients via initiatives including SMS text
reminders for outpatient clinic appointments, self-attending kiosks including surveying and wayfinding and improved communications via a refreshed Trust web site. Next steps include increased
use of technologies such as tele-heath to enable more patient care in the home, a potential for
smartphone apps for patients with long-term conditions such as diabetes and a patient portal
providing online interaction between patients and the Trust.
4.2
What Clinicians Want
The DH talks about an NHS Information Revolution1 and discussing clinician’s needs within the Trust
it is clear there has been a cultural shift towards the increased use of systems and technology to
enable timely and accurate information sharing.
In the existing health system within the Trust clinicians experience a lack of patient visibility and
widespread duplication regarding information gathering. Non-electives admitted via A&E will have
had information about them and their presenting conditions collected several times by different
clinicians in different settings. Diagnostics test requests are paper-based providing little or no
tracking capability and there is currently no alerting configured to indicate the corresponding test
result is available; potentially crucial if the result is time critical.
1
Equity and Excellence: Liberating the NHS
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The Trust PAS offers little or no clinical benefit and as such clinicians do not use it. Conversely
applications such as PACS and ICE offer real clinical benefit and have therefore been embraced.
These systems, combined with other departmental systems and tactical in-house developed
solutions, have contributed to the culture change mentioned previously.
Clinicians therefore now support the introduction of technological solutions that are robust, easy to
use, efficient and enable them to capture and review salient patient information at the point of
care. They want more widespread information sharing, throughout the Trust and with primary care
colleagues, and as such are supportive of solutions which are capable of delivering this.
4.3
What Management Wants
With a requirement centrally to remove £20bn from the system by 2014, translating to SWFT
looking to deliver 4% - 5.5% CIPs recurrently over this period, all Trusts are tasked with doing more
with less. Therefore the Corporate Trust wants to maximise efficiency while taking out cost where
possible. Qualitative benefits are balanced with quantitative, cash-releasing benefits demonstrating
ROI over increasingly short time periods. There is a recognition that while invest to save projects
may prove necessary, benefits need to be tangible and delivered within the originally stated
timeframe.
Existing corporate ICT has been, or is being upgraded in areas such as the Electronic Staff Record
(ESR) Employee Self-Service, electronic staff rostering, invoice scanning within Finance and
electronic purchasing, however there is more to do, not least in sweating existing ICT assets.
Linking corporate and clinical are implementations such as electronic document management which
will enable the Trust to greatly improve processes through the on demand delivery of information at
the point of need while also significantly reducing paper and its associated physical processing and
storage.
A more ICT-skilled workforce will further improve corporate efficiency and assist with cost
improvement. Transforming corporate information into corporate business intelligence before
making it more widely available will add further efficiency capability through visibility and
accessibility.
4.4
What ICT Services Wants
ICT Services wants to support the Trust via the creation of a more ICT-savvy workforce through
innovation and best use of available and new technology. While we strive to provide a robust
environment to underwrite business as usual, we run a programme of continual improvement for all
ICT infrastructure while horizon scanning to bring new technologies to bear.
Under the now terminated CfH Enterprise Wide Agreement frameworks, ICT Services took
advantage of products including various Microsoft Technologies, Safeboot for device encryption,
Integrated Identity Management and Single Sign-On with implementations of IIM and SSO to be
complete by the end of Q2 2011.
ICT Services wants to empower all of its users to become more embracing of technology; more
technically adept and self-supporting when they encounter problems. We would achieve these
goals via a blend of technology and learning; making better use of existing technology while
introducing supportive new tech and in parallel up-skilling all users so maximum efficiency and ROI
is realised.
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ICT Services wants to expand and take on ICT service delivery for other health and private sector
organisations, thereby generating greater economies of scale while underwriting longer term
sustainability.
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5
What’s Currently in Train
5.1
Current Trust Initiatives and Projects
At the time of ICT Strategy refresh there are already a large number of initiatives and projects in
train and at various stages of completeness, as detailed below. These are either ICT projects or are
projects heavily supported by ICT.
Initiative / Project
Description
Lead
eRostering
Electronic Staff Rostering solution Ann Pope
from Allocate Software
Complete By
Hospital Heartbeat Phase 1 completed in A&E and EAU Mel Duffy
Phase 2 in Medical Wards to be
reviewed in June
June 2011
Scantrack IMS
Replacement HSDU Sterile Services Mark Rowlands
equipment management system
courtesy of NPfIT
June 2011
Acute Flow
Programme
Series of projects to improve patient Mel Duffy
flow within the Trust through Lean
techniques
May 2012
Cutting the Cost of
Frailty
Initiative to be piloted in Stratford to Ian Philp
reduce admissions and also LOS of
admitted frail and elderly patients
August 2012
Status Manager
Validation and
Decision Support
Updates to the existing in-house Linda Holland
developed 18 Week RTT Status
Manager system
September 2011
Outpatient Clinic
Appointment
Reminders
In-house development to send Jane Ives
appointment reminders via SMS text
messages
June 2011
Outpatient Clinic
Self-Attending
Kiosks
In-house development to trial Jane Ives
patient self-attending kiosks in the
main Outpatients reception area
Dec 2011
Electronic Clinic
Outcome Forms
In-house development to capture Jane Ives
clinical outcome and 18 Week RTT
information electronically
September 2011
(in-house)
An alternative approach via one of
the EDRMS providers would see this
delivered as part of the EDRMS itself
December
(EDRMS)
Integrated Identity Management Phil Johns
solution to take an electronic feed
from ESR to automatically update
July 2011
IIM
2011
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Initiative / Project
Description
Lead
Complete By
Microsoft Active Directory, instantly
creating new users, capturing
movers and removing or disabling
leavers.
A further series of scoped initiatives and projects, some the result of formal procurement exercises
started previously, are set to implement during 2011/12 as detailed below.
Initiative / Project
Description
Lead
Implementation
Start Date
EDRMS
Electronic Document and Records Duncan Robinson
Management System. Business Case
for preferred solution to be
presented to Board of Directors in
June.
September 2011
Local Digital
Transcription
Procurement and implementation of Fiona Langworthy
a digital transcription workflow
management solution for the
Medical Secretariat, enabling greater
efficiency,
faster
document
turnaround times and vastly reduced
outsourced transcription.
July 2011
SSO
Single Sign-On rollout to commence Phil Johns
June 2011
September 2011
Outpatient Clinic
Management
Portal
In-house development to trial a web Jane Ives
portal enabling consultants to
manage patients within outpatient
clinics sessions including the
completion of electronic clinic
outcome forms
September 2011
(in-house
development)
An alternative approach via one of
the EDRMS providers would see this
delivered as part of the EDRMS itself
December 2011
(via EDRMS)
Tele-Health
Within the Technology work stream Tim Berry
of the Transformation Programme
this project will introduce tele-health
solutions supporting care in the
home
May 2011
GP
Communications
Within the Technology work stream Nigel Brook
of the Transformation Programme
this
project
will
reinforce
relationships with Primary Care
through enhanced, personalised
electronic GP communication
May 2011
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Initiative / Project
Description
Community
Mobile Working
Within the Technology work stream Duncan Robinson
of the Transformation Programme
this
project
will
deliver
a
computerised solution supporting
community mobile working
May 2011
Transformation
Underpinning
Within
the
Transformation Various
Programme ICT will ensure other
work streams are underpinned with
all
identified
technology
requirements
May 2011
ORMIS Upgrade
Major upgrade of the existing NPfIT Michael Cox
theatres management system to
version 5, exploiting far more of the
existing system functionality
July 2011
Electronic
Requesting for
Radiology
Project to implement the existing ICE Mel Duffy
electronic requesting capabilities
across the Trust for radiology
May 2011
5.2
Lead
Implementation
Start Date
Local Health Community Initiatives and Projects
There are a number of key LHC initiatives including the following:
Initiative / Project
Description
Lead
Implementation
Start Date
Local Health
Record
Project to pilot an electronic health Tim Berry
record built on the Graphnet
platform in Stratford and in
Coventry, with a third pilot
attempting to utilise data from both
November 2010
Electronic
Requesting for
Pathology
Project to initially scope the Neil Anderson
feasibility of providing electronic
requesting for Pathology within the
Coventry & Warwickshire Pathology
Network for both the stakeholder
acute Trusts and also for the Primary
Care community
September 2011
Electronic
Documents to GPs
Project to manage the installation of Robin Turton
the DocMan EDT solution at each of
the Warwickshire GP practices to
accept electronic documents from all
LHC provider organisations either
from DocMan itself or from other
solutions such as the UHMB solution.
June 2011
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Initiative / Project
Description
Lead
Simple Tele-Health Pilot of the Simple Tele-Health Tim Berry
solutions utilised in Stoke.
5.3
Implementation
Start Date
July 2011
National Initiatives and Projects
The NHS Informatics Review (2008) which followed Lord Darzi’s report identified the “Clinical 5” –
the minimum clinical functionality “…to make a system acceptable…”, which included:





A Patient Administration System (PAS)
Order Communications and Diagnostics Reporting
Letters with coding (discharge summaries, clinic and Accident and Emergency letters)
Scheduling (for beds, tests, theatres etc.)
e-Prescribing
All of the above2 are present within the Trust and have been for a number of years, however full
order communications is being rolled out during 2011/12 and full e-Prescribing is yet to have an
agreed start date.
The NHS Operating Framework for 2010/11 sets out the key health informatics themes to support
transformation of health services, and in particular to focus on Quality, Innovation, Productivity and
Prevention (QIPP): connecting all, supporting new models of care, impacting transaction costs and
integrated planning and performance.
In the supporting Informatics Guidance the four main thrusts above are further developed within an
ICT context, in particular the move from “replace all” to “connect all” and the introduction of the
Interoperability Tool Kit (ITK).
The DH has produced a refreshed Information Strategy but is yet to produce an ICT Strategy.
Christine Connelly (DH CIO) confirmed the rationale for this order of production by arguing
“…Information persists far longer than the tools used to manipulate it…”
The drivers for the Information Strategy are:
i)
To provide information for patients
a. To enable patients to control their own decision-making, including:
i. Outcomes
ii. The amount and level of treatment they might expect given their condition
iii. Access to their own records
b. Give patients a voice to help shape services
ii) To bridge the gaps between different parts of the “NHS system”
a. The NHS is a set of many things that need to join up
b. Effective Information Flow
i. Tools and protocols such as the Interoperability Tool Kit (ITK) to enable data
to be exchanged within the NHS system
iii) To drive further efficiency across the system
a. Provide people and organisations with better information to enable improvement
from within
2
The Trust has implemented electronic discharge prescribing in advance of full e-prescribing
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b. Enable them to benchmark themselves against their peers
c. Learn from others to develop best practice
The last point above supports a concept proffered by the NHS Institute for Innovation which talks
about “Islands of Effectiveness”, which are typically examples of individual best practice within an
organisation. While many organisations may have small areas of excellence, these will often be
surrounded by other areas requiring far more attention to bring them up to standard. The ultimate
goal would be to join up the islands, creating a single territory.
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6
Proposed Trust Initiatives and Projects
6.1
Overview
As is clear from the volume of initiatives and projects in train, the Trust is currently undergoing a
significant amount of change and any strategy introducing further change must be cognisant of this
to avoid change fatigue. Key techniques include demonstrating a clear vision, employing strong
communication, deploying short-term or quick wins and building on existing successful change.
In realising a vision of creating a more ICT-enabled and smarter-working culture there is a need to
underpin the final product
set with enabling products,
skills,
processes
and
initiatives.
In line with this ICT Services
has already procured key
products and technologies
including
NDL’s
reverse
screen-scraping technology
Figure 1 - Building Blocks to Success
to automate key tasks while
providing “write back” capabilities to systems which don’t readily accept inbound interface feeds,
and Single Sign-On to counter any temptation to share logins/passwords while increasing access to
data and information.
Focussing further on the enablers, the Trust has existing systems and technologies that could be
better utilised were staff to receive additional or refresher education and training, thereby enabling
the Trust to sweat those technology assets rather than replacing them at additional cost.
6.2
Enablers
The following enablers will need to be in place to support the wider strategy. These include back
office software products together with a user education and training initiative.
Many staff within the Trust would benefit from increased knowledge of existing systems such as the
Microsoft Office suite as more efficient usage in these areas delivers a direct efficiency gain to the
Trust as a whole. For example, meetings scheduled using Outlook , incorporating Meeting
Workspaces will result in fewer meetings being cancelled due to a lack of attendance visibility, while
also providing a more efficient and streamlined approach to the distribution of meeting papers and
the assignment of tasks.
Enabler
Description
Data manipulation tool enabling automation of key data driven tasks
NDL awiDX
10 desktop licenses already procured
UHMB Document
Distribution
Automated electronic document capture and distribution solution created by
University Hospitals of Morecambe Bay
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Enabler
Description
Module
In-house delivered refreshers and new short courses on a range of Trust
systems to raise the level of ICT skills making the staff more efficient in their
usage of existing tools
Education &
Training
Increased deployment of wi-fi
ICT Infrastructure
Deployment of Clinical Workstations in ward areas
Migration to Windows 7 and Office 2010 where appropriate
Single Sign-On
6.3
Enable users to securely access all authorised Trust computer systems without
having to remember multiple usernames and passwords. This also acts as a
building block for a clinical portal application, bringing together information
for a patient from multiple systems within the correct clinical context.
Quick Wins
Building on the enablers in 6.2 the Trust should look to generate engagement to the wider ICT
Strategy through a series of quick wins.
Initiative
Quick Win
Guerrilla Training
ICT Training to make targeted visits to all wards and departments to offer
immediate Q&A and learning opportunities for staff. Staff would also have
the ability to schedule visits from the ICT Training in the same manner.
Where staff require more in-depth training then an immediate booking on to
the relevant ICT Training course can also be made there and then.
eLearning Portal
Supplementing existing ICT Training, a publicly available web-based eLearning
portal allied to the Trust’s main web site would provide access to all relevant
Trust-based and third party (e.g. Microsoft) learning resources
ICT Support Services to produce a user self-directed support web portal
offering the following:
Self-Directed User
Support

A wizard-based approach to problem resolution where the user is
asked a series of quick and very straightforward questions to assist in
resolving their issue

A searchable knowledge base containing information on previous
support requests and their resolutions

A series of short “How To” eLearning videos covering common
support and training issues within the Trust

Links to trusted, external content which may also offer assistance

A pro forma to enable the entry of their support request directly into
the ICT Service Desk system should the above items fail to resolve the
issue
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Initiative
Quick Win
Password Resets
Circa 34% of ICT Service Desk requests relate to user account management
and in particular resetting passwords. With IIM and SSO we will look to
implement user-driven password resetting
Ideas and
Innovations Portal
A web-based portal where staff can enter ideas or describe potential
innovations within the Trust while others can readily view this content and
rank it, with the most popular ideas rising to the top of the pile.
Conceptually this is known as crowd surfing or the wisdom of the crowds, with
the important aspect being the facility to capture ideas and therefore drive
innovation from anywhere within the Trust.
Visible Outlook
Calendars
Set the default permissions for all Outlook calendars so they’re visible (read
only) to the entire organisation unless inappropriate so to do (i.e. HR staff
calendars). Staff would mark any private items as private so although staff
can see there’s an appointment they cannot see the underlying detail.
Clinical ICT Forum
A “strategic quick win”, create a senior clinical ICT forum to include Associate
Directors of ICT and Information & Performance together with MD, AMD and
DoN representation, to meet quarterly.
SCR Adoption
The Trust should adopt usage of the Summary Care Record (SCR) in areas
including A&E, Pharmacy, Medicines Management and key community teams.
Room and Hot
Desk Booking
The existing Trust Room Booking system should be amended to:
 Remove the manual approvals process
 Include ALL Trust meeting spaces
 Include all Trust hot desk spaces
 Offer a wizard-based approach to booking – i.e. I need a room on this
date / time for this many people, or what hot desks are available
tomorrow?
Hot desks entries should have full descriptions of their locations and facilities
Configure Sunquest ICE so consultants receive targeted alerts when key
abnormal results are received.
ICE Alerting
6.4
Tactical Implementations
Building on the enablers and quick wins, a series of tactical implementations will be undertaken
which will deliver real benefit while aligning with the wider strategic vision of the Trust.
Initiative
Description
Outpatient Clinic
Management
Portal
Mentioned above as a likely 2011 implementation, this would provide full
clinic session management for a consultant taking attendance confirmation
from PAS when the patient arrives, providing a structured, ordered view of
patients in the waiting areas, provide links to ICE, PACS and to the original
(scanned) referral letter before offering the consultant an electronic outcome
and 18 week RTT form. Data captured here would be automatically updated
on PAS via NDL.
More importantly this implementation would foster the requisite clinical
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Initiative
Description
engagement and trust in ICT to enable other similar initiatives to be delivered.
Microsoft Office
Communications
Server
Implement OCS across the wider Trust to achieve the following:
 Improve efficiency through visibility and contactability
 Save time and money through reductions in telephony costs
 Save time and money through reductions in travel time and cost
Digital Pens
and/or Slates for
Assessments
Undertake a pilot in the use of digital pen and slate (e.g. Apple iPad,
BlackBerry Playbook, Samsung Galaxy Tab) technology to complete
assessments such as Early Warning Scores, VTE and falls, thereby enabling
Hospital Heartbeat to place “on hold” all further activities until it has evidence
a particular assessment is present electronically.
(see also Hand
Held Devices at the
Point of Care)
The digital pen approach allows the paper-based approach to continue while
bridging the gap between paper and digital, however slates offer a more
strategic approach to mobile data capture.
RMANI Referral
Management
In-house development to capture and control the flow of inbound patient
referrals in an electronic manner, thereby providing far greater visibility to the
process as a whole while significantly reducing the time taken to locate the
referral within the correct specialty and have a new appointment generated
for the patient.
eCLINCH
Following on from the proactive management of referrals, the Trust should
implement a solution that makes the existing CLINCH leave requesting process
electronic. This would provide workflow in terms of the leave requesting
process together with a forward view of the impact of that leave (i.e. clinics
the requestor would need to have covered by a colleague or rescheduled)
thereby providing all parties (Trust included) with greater visibility and
capacity management capability.
LTC Apps
Patients with long term conditions should be able to utilise their own
technology to send (tele-) health observation data to the Trust, either via a
patient portal or via an application (app) on their phone.
Hand-Held Devices
at the Point of
Care
The Hospital Heartbeat implementation has already seen the successful
utilisation of mobile phones as clinical support tools. Further hand-held
devices such as smartphones and slates (e.g. Apple iPad or similar) should be
piloted to better understand their potential for the capture and presentation
of information at the point of care, both in an acute and a community setting.
CPAS Referral
Management
Maternity
Support a trial with West Midlands Ambulance Service (WMAS) in which
referrals to Warwickshire Community Services received within the WMAS hub
are entered directly on to PAS by WMAS staff to streamline the referrals
process into the various neighbourhood teams.
More strategically a centralised referral function to support CPAS data entry
should be established, either solely to support community or to be integrated
with the existing SWFT referrals function. Without this community staff will
continue to spend large amounts of time undertaking administrative CPAS
tasks rather than providing frontline patient care.
A previously aborted NPfIT implementation of the Evolution Maternity
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Initiative
Description
Information
System
Information System has left the department working in a solely paper-based
manner. A procurement of a Maternity Information System outside the
National Programme should therefore be undertaken, supporting both the
patients of South Warwickshire and also the Trust in achieving CNST level 3.
Speech
Recognition
Software Trials
The Trust already successfully utilises the Dragon Naturally Speaking™
package within Radiology and with the procurement of a local digital
transcription solution, the Trust can look to implement trials with willing
consultants of the Dragon software in a clinic environment, reducing the
workload on the Medical Secretariat while continuing to manage clinical
correspondence and any associated voice files.
ICT Services has previously procured the Sunquest ICE Electronic Requesting
module however earlier initiatives to implement this within Radiology stalled
mid-way through. Further to the work the Acute Flow Programme is
undertaking and following changes in how the Royal College of Radiologists
perceive electronic requesting solutions there is a renewed appetite to
implement it within the Trust.
Electronic
Requesting
In parallel a wider LHC project to review the technical requirements to enable
Pathology requesting across all Pathology Network stakeholders will also
commence, with drivers coming from each of the acute Trusts and from the
Primary Care community.
Once the Trust has adopted electronic requesting for Radiology and Pathology
services other clinical and clinical support services should also be enabled for
electronic requesting.
6.5
Strategic Programmes
The Trust has already identified what it sees as a number of strategic programmes to be delivered
over the next 12-36 months that will significantly change the way both clinical and corporate areas
function. A greater emphasis on the availability of information securely and on demand has already
emerged courtesy of the pilots for solutions such as Hospital Heartbeat and more intrinsically the
Acute Flow Programme initiative. Strategic ICT solutions must therefore both support and further
drive such initiatives.
6.5.1 ICT Services Expansion
Securing long-term sustainability through continued high quality service delivery coupled with a
plan for growth sits high on the internal ICT Services Division strategy. While not losing sight of
Trust service delivery, small contracts have already been secured with local private sector
companies for small-scale ICT provision in specific areas. Of greater importance however is the
desire to significantly expand ICT Services Division within the LHC, with potential opportunities
identified with George Eliot Hospital NHS Trust the Coventry IT Collaborative.
Although the strategy of the division, without external organisational support this wider expansion
will not prove possible, however with a challenging economic climate this would prove to be a
mutually beneficial option for all parties.
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6.5.2 Patient-Centric Information
Currently patient information is collected by both administrative and clinical staff across the Trust
however typically the more electronic element of this information capture and processing is via the
non-clinical staff. Clinical support functions such as Reception staff, Outpatient Booking, Referral
Management, Elective Admissions and more generally the Medical Secretariat all work
electronically whereas, with the exception of the data available via medical devices, many clinicians
still rely on a paper-based environment.
Resultant from this, information is typically only available to a single clinician in a single location
rather than to any clinician with a legitimate relationship to the patient in any location. A common
consequence of this is the duplication of key information capture as the patient moves through the
Trust within their pathway.
Building on this, certain information captured within the Trust is deemed transient and as such is
only kept for short periods of time, however clinical audit functions would benefit from having
access to this information were it available. Examples include patient handover notes, hospital at
night intervention notes and ward round notes.
As handover and ward round notes are transient documents, when a patient transfers wards within
the Trust this information is discarded by the current process. Capturing and storing this
information electronically provides an holistic view of the entire patient journey, but to successfully
achieve this the right form factor devices running the right software applications are required.
Technology improvements are generating increasingly malleable form factors, where iPad style
slates come complete keyboard docks and next generation smartphones have entire netbook docks,
providing both keyboard and screen running from the CPU and operating system on the phone,
ultimately making the ubiquitous mobile phone the only real computer a person needs.
The form factor has to be complemented by the software running on it and with the increasingly
large manufacturers app stores together with the software development kits provided for their
operating systems, sourcing such software is becoming far less of an issue.
Similarly cost is becoming less prohibitive to enterprise rollout, with budget slates retailing at less
than £80, offering a potential 4 tablets per ward rollout across the Trust for less than £7k, although
cost must be tempered against performance and utility.
6.5.3 Clinical Portal
Building on the tactical deployment of an outpatient portal, to provide clinicians with salient, timely,
accurate patient information on demand at the point of care, a Trust-wide clinical portal will be
implemented. Accessible via the Intranet, this web-based portal will offer seamless routes to
information collated from a rich variety of sources such as scanned documents, patient letters and
clinical correspondence and departmental systems. It will also provide clinical data capture
capabilities in areas including assessments, contemporaneous notes and observations plus clinical
outcome recording. Finally it will link with other key solutions including a CQUIN Dashboard and
Hospital Heartbeat to provide an entirely holistic view of the patient and the information supporting
both their immediate and long term care.
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Figure 2 - Clinical Portal
6.5.3.1 Patient Portal
Further integration with more departmental systems and medical devices would form a subsequent
development phase. Once the portalised environment is established a separate patient view could
be offered however as there is a wider collaborative project with NHS Local to deliver a Patient
Health Portal the Trust should wait to see the efficacy of this initiative before considering whether
to adopt or develop a Trust-specific patient portal.
6.5.4 Clinical Timeline
Embedded within the clinical portal will be the construction of an interactive treatment timeline
similar to that used
previously within the 18
Week
RTT
Status
Manager
solution,
providing
a
visual
representation of the
patient’s
treatment
history and allowing a clinician to deep dive into any of the presented treatment events for more
detail.
Figure 3 - Interactive Treatment Timeline
6.5.5 Electronic Document and Record Management System (EDRMS)
A stated intention of the Trust is to procure and implement a full EDRMS solution including an onsite scanning bureau. A full business case including the preferred solution is due to be presented to
the Board of Directors in summer 2011. EDRMS will fundamentally change many of the existing
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clinical and corporate processes as information is held and presented electronically, bringing the
Trust closer to a vision of a paper-light and ultimately paperless environment.
Dependent upon the final solution procured by the Trust, the EDRMS solution will either be
embedded within the Trust clinical portal or will form the basis of it, so as to seamlessly provide
scanned or digitally captured patient information at the point of care. The timeline below shows
EDRMS commencing prior to the Clinical Portal development because of the need to run an initial
EDRMS Procurement Project prior to implementation, however based on the final procured solution
the two timelines may be as one.
EDRMS will be used within both clinical and corporate areas to halt the voracious demands for
continued physical paper storage and their associated costs thereby ultimately freeing up existing
space on campus while offering opportunities to re-deploy or rationalise existing staff.
6.5.6 Local Digital Transcription
The Trust has already committed to purchasing a digital transcription and document workflow
management solution. Utilising existing voice recording technologies the output letters and
documents will feed into the EDRMS solution, while also flowing out to Primary Care via an
automated distribution mechanism described above within the Enablers section, increasing
efficiency while removing cost.
6.5.7 Wider System Integration
During 2010/11 the Trust procured the NDL application integration solution to facilitate greater
information sharing between systems. Where systems are able to interface data they will do so
however other key Trust systems don’t offer bi-directional interfacing which is where the NDL
solution scores. Writing data captured by Hospital Heartbeat and/or via the outpatient selfattending kiosks back to PAS are uses currently being worked up however this technology can also
be used to bring related patient data from disparate systems together for presentation in a clinical
context.
Widening the scope the Trust needs to align with LHC-based health and social care partners by
sharing information such as trusted assessments and care planning. Common Assessment
Framework (CAF) funding should be utilised where possible and appropriate given Warwickshire is
one of the 9 CAF Demonstrators in England.
6.5.8 The National Programme for IT (NPfIT)
As stated previously the Trust operates a number of NPfIT solutions and is committed to remain
with the programme on the basis that existing solutions remain covered by national rather than
local funding agreements and the solutions are fit for purpose. As such the Trust will look to
implement the Lorenzo Regional Care solution when it becomes available and following a review of
its functionality and efficacy. That said, a Lorenzo implementation within the Trust is unlikely to
commence until 2012/13 at the earliest, with a 12-18 month implementation timeline.
In the interim the Trust will remain with the iPM PAS and will look to upgrade to MR5 to ensure it
operates the most up to date version. Departmental NPfIT solutions such as ORMIS and IMS will
follow similar upgrade paths as appropriate, with ORMIS undertaking a significant upgrade from
MR1 to MR5 around 2011 Q4, once the Trust Theatres refurbishment project has completed and
will enable instrument tracking to patient-level.
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The national contract held by CSC for the provision of RIS/PACS in the North West (and) West
Midlands (NWWM) Cluster is due to terminate in its current form in June 2013 although there is an
option for a possible one year extension to 2014. Resultant from this is a large-scale exercise to
review options around the re-procurement of a PACS service however this presents an opportunity
to significantly widen the scope to move towards a full vendor neutral imaging archive solution
capable of satisfying all Trust clinical imaging requirements.
6.5.9 LIMS Re-Procurement
The Trust is a stakeholder in the Coventry & Warwickshire Pathology Network, utilising a single
laboratory information management system (GE Ultra) hosted by UHCW. As GE has confirmed the
product is sunsetting the network is embarking upon a LIMS re-procurement exercise, with a
subsequent implementation programme due to conclude in December 2013. As the Trust is
committed to Pathology Network then continued involvement and driving through the reprocurement is an imperative.
6.5.10 Electronic Prescribing
In looking to improve safety while also addressing issues of quality and capacity in the production of
the patient drug and discharge summary the Trust has invested in the JAC electronic discharge
prescribing module of the JAC Pharmacy system. Clinical benefits have already been realised
through the use of the prescribing aspects of this system, not least in patient safety improvements
and the streamlining of the Pharmacy data entry process now the prescription data flows directly
into the main JAC system.
Full electronic prescribing is the next step as this will not only demonstrate those same patient
safety improvements as seen for discharge prescribing but will also improve Pharmacy stock control
while providing increased visibility as to the ward-based drugs currently being prescribed, which
again would benefit clinical audit processes such as the Global Trigger Tool.
6.5.11 Increased Mobile Working
The post-TCS Transformation Programme Technology work stream includes a project on the
evaluation, procurement and implementation of a mobile working system to support the needs of
community-based staff. Although this is being seen as a Community Health-driven initiative, teams
within the acute Trust such as SWATT would also benefit significantly from this approach.
ICT Services support staff working from circa 85 locations in and around Warwickshire and although
a review of existing buildings for the Trust is being undertaken within the Transformation
programme, providing enhanced mobile working solutions will be required before buildings
rationalisation can be realised.
With an increase in captured electronic information and the ability for staff to access this in a secure
and timely manner the Trust has opportunities to explore more remote and home-based working
for sections of staff including previously centrally-based corporate along with the more traditional
frontline community-based clinical staff. A proposal therefore would be to implement a second
dedicated 100MB internet connection to be used solely for mobile working via VPN, providing
excellent performance while leaving the existing 100MB Trust based connection to handle Trustbased traffic.
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6.5.11.1 LHC Collaboration on Community Mobile Working
Within the LHC there is an identified requirement to appraise suitable solutions for both Coventry
and Warwickshire Community Health Services within the contexts of their post-TCS vertically
integrated environments. Initial options scoping work has already been undertaken and this should
be adapted and built upon to enable both community health services to evaluate suitable options.
One further consideration is the potential for an LHC-wide patient record system (i.e. Lorenzo,
Cambio, US Veterans Association). The Arden Plan includes an option to review any such
opportunities and the Trust should look to collaborate in that work, although collaboration carries
the risk of slowing the Trust’s programme.
6.5.12 Tele-Health
Another post-TCS Transformation Programme Technology work stream project, the Trust will
implement a series of tele-health measures to support existing initiatives such as long term
conditions management in both inappropriate admission prevention and early discharge.
ICT Services will work with third party tele-health solutions providers and stakeholders including
Virtual Ward patients and staff including GPs in North Warwickshire.
 Patients discharged from Virtual Ward with tele-health support for 3 months
 Patients discharged to District Nurse care with tele-health support
Patients identified by the Bupa Healthdialog Risk Stratification tool as being in guideline 1 – 5

Community Matrons Caseload – to be agreed
Potential future/other areas of focus will include:


Patients discharged from acute hospital with telehealth support for agreed timeframe
Hypertension Management at GPs
6.5.13 Carbon Management
The Trust is committed to a programme of on-going carbon reduction focussing on all areas of Trust
working. ICT is wholly aligned and supportive of this programme and during 2011/12 will look to
increase its efforts in this regard, including:





Enhancing the existing virtual server architecture
Replacement of ward PCs with single form factor units which have a smaller desktop
footprint, use less power and generate less heat
Investigating the use of centralised fax software thereby removing the need for distributed
fax machines (and safe havens)
Ongoing rationalisation of the printer estate in favour of multi-function devices
Adopting and actively promoting best practice from within
6.5.14 ICT 24/7/365
ICT Services provides a Service Desk on working days between 8:00am and 5:00pm together with an
on-call engineer available to the acute Trust for the remaining out of hours periods. To date
business critical systems utilised by the Trust have typically been straightforward in their
architecture and as such have been able to be supported in this manner.
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With a move towards greater reliance on electronic solutions to capture, transport and present
patient-centric information, ICT Services will need to provide additional support capability both
within and out of hours to ensure the Trust continues to function as safely and efficiently as its
revised strategic clinical and business focus requires it to do. ICT Services will look to deliver this via
a combination of enhanced technology and process change where available however there will also
be a requirement for additional baseline funding.
6.5.15 Trust-Wide Communication
While the Trust develops a separate and more targeted Communications Strategy, ICT Services
would support this through various co-ordinated approaches, including:



Building on the Office Communicator deployment to create a total Unified Communications
environment
Utilisation of expert social sites including YouTube and FlickR for video and image content
management and deployment
Provision of an enterprise social networking facility such as Yammer to supplement more
traditional communication methods such as email
With more internet-based content being stored and accessed, the Trust will need to review its
existing internet connectivity with a view to increasing bandwidth.
6.6
Improvement through Innovation
The primary business focus for the Trust is on the safe and efficient delivery of the highest quality
patient care. In achieving this the Trust and its workforce must participate in a programme of
continual improvement, where existing processes and systems sit alongside business process
redesign and the espousal of emergent technologies. Although the Trust is not a technology
business per se, it employs significant amounts of technology in its daily operation and as such has
the potential to drive out momentous efficiency gains. The adoption of new technologies often
comes at a higher price however being at the leading edge also offers the maximum return on that
investment both financially but equally as important in changing the mind-set of the workforce to
one that positively thrives on innovative change, albeit within a framework of strong clinical and
corporate governance.
The proposed creation of a Clinical ICT Forum and the adoption of an Innovation & Ideas Portal will
provide the Trust with multiple routes into a culture more comfortable with the utilisation of new
technologies and approaches. ICT Services is constantly horizon scanning to identify opportunities
through technology however there needs to be collaboration with senior clinicians to exploit areas
of expertise where ICT Services are only at the periphery and by doing so drive through their
adoption within the wider Trust.
Staff need conduits to enable ideas to flow. They also need conduits to inform the Trust, potentially
anonymously, on what isn’t necessarily working as well as it could be. Within Google staff are given
free time within the standard working week to progress their own private projects, the only proviso
being they will, at some point, present these projects to the company as potential ideas to progress
further. Called “20% Time”, Google has benefited from numerous ideas and concepts generated by
this approach and are quoted as saying they that in difficult markets rather than scaling this time
back they would increase it.
While Google’s business model differs greatly from that of the Trust, the underlying concept is
sound – invest in the workforce by providing protected time either for learning or for investigation
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and both the individual and the Trust as a whole will benefit. The Innovation & Ideas Portal will
facilitate not just the capture of ideas and potential innovations but will enable the Trust as a whole
to review and comment on that idea, providing valuable feedback and also scoring it. Often
referred to as “crowd surfing” or the “wisdom of the crowd” this idea scoring approach will see
popular ideas rise up the pile towards the top and while popularity isn’t necessary the best measure
of potential, it does provide a strong steer as to whether an idea has potential and is likely to be
well received.
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6.6
Proposed Implementation Timelines
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6.7
Cost Benefit Realisation
Item
Benefits
Risks / Issues
Indicative Costs

Overhead in Web Development
Team having to programme the
NDL software
£3.5k Revenue

UH Morecambe Bay solution
requires testing in SWFT LHC
Overhead in supporting this inhouse developed product
£1.5k Capital

Staff won’t be released or will
not be able to secure sufficient
time to attend any training
Baseline Pay Budgets

Funding constraints may stretch
the replenishment programme
Baseline Non-Pay Budgets

Should staff share smartcards
their Trust and personal email
Licenses via the previous Novell
EWA
Enablers

NDL Application Integration



Document Transmission



Education & Training


ICT Infrastructure



Single Sign On
Enables applications to share
data
Introduces workflow into
existing processes
Provides back office task
automation, freeing staff time
Transmits electronic
documents to third parties
such as GPs
Introduces workflow into
existing processes
Route documents to multiple
locations securely in real time
Up-skills the existing Trust
workforce making them more
efficient
Reduction in calls to ICT Service
Desk
Ensures desktop and server
real estate provides optimal
performance for staff
Increased workforce
productivity
Supports Trust green agenda
Negates the need for staff to
remember multiple usernames

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Item
Benefits
and passwords
 Improves security by negating
account/password sharing
 Improves security through
strong passwording
 Potentially increases the
number of systems available to
staff
 Enabler to a wider clinical
portal
Risks / Issues
will be available to whomsoever
they have shared with
Indicative Costs
Implementation undertaken inhouse by ICT Operations

Would still need to liaise with
the patient as often patients
stop taking prescribed
medication over time
Access provided via the National
Programme for IT

Adoption will require strong
leadership and communication
Baseline Pay Budgets

Users may become frustrated if
they are unable to recall
personal information used
within the password reset
process
Included within the Single Sign On
and Integrated Identity
Management software
Quick Wins
SCR Adoption

Common Document Templates




Password Resets



Provides A&E and Pharmacy
staff with allergy and
prescribed medication
information courtesy of the
patient’s GP system
Provides all Trust staff with a
consistent set of templates
from which to work
Standardises information
capture and output
Reinforces the Trust’s identity
Enables staff to quickly reset a
forgotten password or locked
out account without the need
to bring in ICT Services
Increases staff performance
Reduces account sharing
Reduces ICT Service Desk
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Item
Clinical ICT Forum
Guerrilla Training
eLearning Portal
Room & Hot Desk Booking System
Amendments
Benefits
overhead
 Engages senior clinicians with
ICT Services and vice-versa
 Provides opportunities to
horizon scan then trial
 Provides clinical
communications channels
 Ensures ICT is aligned with
clinical need
 Addresses immediate issues
 Does not require time away
from the working environment
 User-directed
 Provides real user engagement
through education & training
 Provides reliable training needs
assessment data
 Provides a single location from
which a multitude of training
material is available
 Internet-based so open to staff
and the general public if they
require it
 Demonstrates Trust
investment in staff and
engagement with its wider
patient cohort
 Refreshes an existing, tired
Trust system
 Provides greater visibility as to
Risks / Issues
Indicative Costs

Clinicians may not see the value
in another forum
Clinicians may not be able to
commit the time to another
forum
Baseline Pay Budgets
Demands of the existing ICT
Training schedules may not
always facilitate the team going
to the staff
Staff may have issues ICT
Trainers aren’t immediately able
to resolve without further,
classroom-based training
Overhead for ICT Training Team
to keep this portal up to date
Baseline Pay Budgets
Not all rooms and/or hot desks
will be made available to the
system
Baseline Pay Budgets





Baseline Pay Budgets
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Item
ICE Alerting
Ideas & Innovation Portal
Self-Directed User Support
Benefits
Trust resource availability
 Removes the manual
processing requirement
 Includes Hot Desk availability
and booking
 Offers a wizard-based
approach to locating and
booking a room/hot desk
 Offers selective alerts to key
clinicians based on the value of
a test result
 Enables rapid response to
abnormal test results on a
proactive basis
 Ensures selected test results
are not missed
 Conduit for all staff to capture
and present ideas to the Trust
 Facilitates peer review and
voting/scoring
 “Wisdom of the Crowd”
 Promotes an innovation
culture
 Engages staff with the Trust
through ownership
 Empowers the user to resolve
their issues without the need
for ICT Services intervention
 Provides an education and
training opportunity for the
Risks / Issues
Indicative Costs

Requires additional ICT Services
resource in the form of a Clinical
Systems Administrator
£30k Revenue
AfC 5 mid-point plus 23% on costs
Subsequent years subject to
inflation and AfC drift

Lack of take-up
Baseline Pay Budgets

Users will bypass this and go
straight to the ICT Service Desk
Baseline Pay Budgets
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Item
Benefits
user
 Reduces the overhead on the
ICT Service Desk
Risks / Issues
Indicative Costs

Insufficient admin resource
within WCHS to undertake it
The Trust Admin Review may
impact on the provision of a
central referral management
function
Staff may still opt to travel to
meetings
Staff may continue to use
existing landline telecoms
Baseline Pay Budgets
Costed per delivery so if activity
increases so does cost
Software as a Service (SaaS)
model so impacted by internet
connectivity issues
Year 1 £43k Revenue
Year 2 £35k Revenue
Year 3 £36k Revenue
Tactical Implementations

CPAS Referral Management



Microsoft Office Communicator




Maternity Information System



Streamlines the front-end CPAS
referral and patient data entry
Frees up community clinician
time for patients
WMAS may undertake this in
certain locations
Increases staff efficiency
through colleague visibility and
availability via presence
Reduces telecommunications
costs by utilising existing data
networks
Reduces travel costs by
meeting virtually at your desk
Increases performance by
removing travelling time from
meetings
Removes a barrier to the Trust
reaching CNST level 3, offering
significant premium discount
Highly flexible system the
development of which the
Trust is still able influence
Full clinical reporting
User-friendly and intuitive





£16k Capital
(based on projected deliveries)
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Item
OPD Clinic Management Portal
Benefits
 It removes paper from the
system and allows prompt and
accurate searches for data
relating to a patient.
 It will improve governance and
reduce risk within the
department
 It will allow audits for trends to
be carried out quicker and
more frequently
 No capital outlay
 Integration with Badger
Neonatal will eliminate
duplicate data entry and
remove the risk of input error
 The system can be used to
check that clinical coding is
correct
 Electronic control of the flow
of patients within a clinic
session
 Presents clinician with relevant
information (e.g. Referral
Letter or previous Clinical
Letters) in context at click of a
button
 Presents electronic Clinic
Outcome Form
 Updates PAS and back office
systems automatically without
Risks / Issues
Indicative Costs

Baseline Pay Budgets

Clinicians may not engage with
electronic working – will require
strong leadership
Requires NDL software to be
present to update PAS
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Item
Digipens and Slates Trials
Benefits
current manual intervention
 Provides immediate data
capture and sharing potential
 Removes transcription
duplication and possible errors
 Can leave copies of paperwork
with patients as required
 Interfaces can slot captured
pen data into multiple source
systems

RMANI Referral Management




eCLINCH


Secure electronic storage of all
referrals
Immediate access to all
referrals on demand
Ability to route the referral
immediately to the correct
specialty and consultant
Potential to remove
days/weeks from the initial
Referral Acceptance process
Ally to RMANI in providing
workload and capacity visibility
Reduces CLINCH decisionmaking time
Provides both the Trust and
the clinician with the impact on
capacity of the proposed leave
Risks / Issues
Indicative Costs

Galaxy Tab 16GB Wifi+3G £333+VAT
iPAD 2 16GB Wifi+3G £416+VAT


Potential for lost or damaged
items
Need to ensure a path to scale
up usage should trials prove
successful
Increased Choose & Book usage
will add an additional step into
the RMANI process in that the
referral will need to be printed
and scanned or simply attached
if a separate referral letter was
attached to the C&B referral

Server License £10k
Digital Pen £125
Client Access License £220 per user
Digital Paper production costs are
initially included within the Server
License however additional and/or
more complex designs would attract
more cost.
Baseline Pay Budgets
Baseline Pay Budgets
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Item
Long Term Conditions Apps
Devices at the Point of Care
Benefits
 Highlights clinics and key
patients therein requiring
rescheduling
 Makes entire CLINCH process
transparent
 Offers patients an alternative
to appointments at the Trust
 Enables patients to interact
with clinicians more loosely
and remotely yet provide more
observational data
 Leverages existing patient
technology (smartphones e.g.
iPhone)
 Provides efficiencies through
technology
 Demonstrates Trust utilisation
of current social technologies
and thinking
 Immediate capture and sharing
of all patient-related clinical
data
 Builds up the full patient
picture without having a mix of
paper and electronic notes
 Provides workflow capability
 Supports audit initiatives
including the Global Trigger
Tool
 Provides information on
Risks / Issues
Indicative Costs

Not all relevant patients will
have a smartphone capable of
running such apps
Not all relevant patients will
want to use apps in this way
Need to ensure strong
authentication and security
Some Apps already available via
iTunes or Android Market
Potential for loss and/or
damage
Infection Prevention procedures
to be enhanced to cope with
new PoC devices (e.g. iPads)
Acute Setting would not require 3G,
therefore could simply opt for the
Wifi only versions of kit




Baseline Pay Budgets if write apps
in-house
RIM Playbook 16GB £333+VAT
Galaxy Tab 16GB £249+VAT
iPAD 16GB £333+VAT
ASUS Transformer £317+VAT
Could also review whether these
could be used for Hospital
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Item
Benefits
demand at the point of care

eRequesting






Speech Recognition Software Trials


Replaces the existing paperbased requesting systems with
a single interface
Stops requests being lost or
not processed through
illegibility
Enables requests to be tracked
to provide increased visibility
Reduces duplicate test
requests
Reduces the need for manual
keying into recipient systems
(e.g. CRIS, ULTRA)
Enables tests to be requested
immediately
Reduction in the amount of
transcription undertaken by
the Medical Secretariat
More control over the
resultant output by the
dictating clinician
More immediate production of
correspondence
Risks / Issues

Overhead in support requiring a
Clinical Systems Administrator
role
Indicative Costs
Heartbeat or whether the HH
phones could be used here
Additional Capital circa £6k
Requesting Revenue circa £3k
Full ICE Orders & Requests Revenue
circa £16k
ICT Services currently pays this from
Baseline Non-Pay Budgets




Many clinicians won’t spend the
time to adequately train the
software to make their speech
accurately recognisable
Accents could prove to be an
issue
Additional noise cancelling
microphones/headsets would
be required in busy areas
Clinicians may find it a step too
far
Premium License £150
Professional License £500
Strategic Implementations
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Item
Hospital Heartbeat
EDRMS
LIMS Re-Procurement
Benefits
 Provides real-time patient flow
management information
 Provides a backup to the
existing clinical process
 Provides visibility in all settings
its being used
 Enables the Trust to operate a
“pull system”
 Provides electronic patient
information on demand which
is currently only available in
paper form
 Negates the need to file and
pull paper casenotes
 Negates the need to track
casenotes
 Addresses the physical storage
issues including cost of storage
 Enables clinicians to work in a
more efficient manner
 Providers an opportunity to
redesign existing processes
 Supports other initiatives (e.g.
Clinical Portal)
 Enables the redeployment
and/or reduction of Trust staff
in the longer term
 Opportunity to procure a
solution more staff want
 Opportunity to have a more up
Risks / Issues
 Not all wards covered by the
system
 Financial ROI is long term
 Cultural issues around
acceptance
Indicative Costs
Capital circa £120k


Cost
Significant business process
redesign
£360k - £850k dependent upon
chosen solution


Costs
Lengthy procurement process
Capital Costs circa £2.2M
Additional Revenue Cost £72k
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Item
PACS Re-Procurement
NPfIT Upgrades
Tele-Health
Benefits
to date solution
 Opportunity to procure a total
image storage and
management solution
 Opportunity to procure a
vendor neutral archive
platform
 Opportunity to store and view
all Trust imaging from a central
repository via a single image
viewer (where appropriate)
 Option to procure as an LHC
network (with GEH and UHCW)
to reduce costs and share
images
 Ensures systems are at latest
supported versions
 Additional functionality not
present in previous versions
 Enhanced integration between
NPfIT solutions (e.g. IMS to
ORMIS to PAS)
 More informed patients able to
self-manage effectively
reducing the burden on the
Health economy
 Reduced cost of travelling and
improved capacity to manage
increased case load in
community staff
Risks / Issues
Indicative Costs



Cost
Lengthy procurement process
Uncertainty as to the NPfIT
position
Network procurement Circa £5M
Trust standalone procurement Circa
£2M



Upgrade project overruns
Software fitness for purpose
Staff need to make themselves
available for testing
Trust without the systems
during the upgrade downtime
Baseline Pay Budgets
Previous take-up of tele-health
has been patchy
Capital circa £50k
Rollout circa £16k
Revenue circa £15k


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Item
Mobile Working
Local Digital Transcription
Clinical Portal
Benefits
 Utilises patients own mobile
phones for greater sense of
patient ownership
 Reduction in the number of
emergency admissions from
the cohort and concomitant
cost savings
 Improves efficiency of mobile /
peripatetic staff
 Electronically captures and
shares information
immediately on demand
 Supports lone working
 Enables improved building
utilisation and ultimately
rationalisation
 Greater flexibility for staff who
are able to work either at
remote or home locations
 Reduction in outsourcing and
associated costs
 Increased visibility of workload
and demand
 Integration with EDRMS and
Electronic Document Transfer
 Opportunity to re-engineer
existing business process
 Reduced letter production
turnaround time
 Presents clinicians with all
Risks / Issues
Indicative Costs

Possibly cultural barriers to
adoption
Loss or damaged kit
Increase in technology and
telecoms costs
Laptops circa £330+VAT
Slates circa £333+VAT

Still a requirement to outsource
Licensing and Rollout £61k
Additional hardware circa £30k

In-house development will
Baseline Pay Budgets


Additional dedicated Internet
connection
Capital circa £4k
Revenue circa £19k
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Item
Wider System Integration
ePrescribing
Benefits
relevant patient information
from a single point
 Intelligent behind the scenes
linkage of data from multiple
systems based on the patient
context
 Offers web-based forms to
capture and present back
further patient data
 Basis of an EPR
 If developed in-house the Trust
can shape the EPR to its needs
 Constantly evolving
 Provides a single view of data
from multiple systems
 Integrates data from systems
within and external to the
Trust (e.g. Social Care via CAF
and Primary Care)
 Supports the Trust and LHC
EPR visions
 Automates tasks previously
undertaken manually
 Increased visibility on
prescribing patterns within the
Trust
 More accurate stock control
and management
 Increased clinical safety
Risks / Issues
present large overhead to the
Web Development Team
 Constantly evolving
 May not be able to contextually
link all Trust systems without
the need for additional userentered search data
Indicative Costs

May be some
interface/integration costs
Constant monitoring overhead
to ensure data is available and
contextually correct
Baseline Pay Budgets for the inhouse written integration
Cost
Significant process redesign
Capital Costs
Project management and file
building - £20k
Peripherals - £36k



Interface costs to Primary Care to be
garnered as part of the wider
business case production process
Revenue costs
JAC prescribing module annual user
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Item
Benefits
Risks / Issues
Indicative Costs
licence and subscription to decision
support (e.g. FirstDataBank) – £50k
Rolling replacement programme for
PCs and batteries – £10k
System manager and specialist
application team of training and
support staff including on call –
£200k
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6.8
High Level Risk Matrix
The following high level risk matrix describes more general risks to the strategy not covered within
the specific initiatives3.
ID
Category
Description
L
I
LxI
Mitigation
1
Financial
There will be insufficient
funding to implement key
aspects of the strategy
3
5
15
Work with Finance to
identify additional funding
sources
Operational
Key aspects of the strategy
won’t be implemented
leading to a fragmented ICT
landscape
2
5
10
Ensure sufficient early
clinical and operational
engagement is fostered
Operational
There is too much
organisational change
currently impacting on the
Trust to enable it to
undertake further change
12
Deliver strong, frequent and
consistent communication so
staff understand the road
map
2
3
3
4
Engage with staff at the
earliest opportunity
4
Operational
Changes made courtesy of
the strategy won’t stick
2
4
8
Deliver consistent
communication
Undertake reviews during
and subsequent to any
bedding in periods.
3
5
NPfIT,
Financial
The Government will cancel
the NPfIT programme
leaving Trusts to procure
disparate systems requiring
additional funding
6
NPfIT,
Financial
Lorenzo Regional Care will
not be rolled out leaving the
Trust to invest in local
solutions to bridge gaps
2
5
10
Announcement expected
imminently
3
5
15
Announcement expected
imminently
A full risk matrix template is available within the appendices
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Appendix A – ICT Services Goveranance and Structure
SWFT ICT Services Division sits within the Executive Portfolio of the Director of Operations.
Figure 4 - ICT Services Division High Level Governance
As described earlier, ICT Services providers ICT service delivery to stakeholders including:




South Warwickshire NHS Foundation Trust (SWFT)
Warwickshire Community Health Services (now integrated into SWFT)
NHS Warwickshire
All 76 Warwickshire GP Practices
Governance therefore includes both internal reporting through the Operations Directorate and also
external SLA reporting via a quarterly ICT Stakeholder Board, with the Arden Cluster’s CIO
representing both the Cluster itself and the Warwickshire Primary Care community.
Comprising two main functional areas with a
strategic management team, this is set to expand
during 2011/12 with the inclusion of the
management
of
all
of
the
Trust’s
telecommunications.
The structure below represents the position prior
to that inclusion as sustainability at that point
would require additional baseline resource.
Figure 5 - ICT Services Senior Management Team
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Figure 6 - Projects and Service Development
Figure 7 - ICT Operations
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Appendix B – SWOT Analysis Detail
The following figures present the SWOT responses following their aggregation (de-duplication) and
their transformation (i.e. where strengths are paired with opportunities and equally weaknesses are
set alongside potential threats to be addressed).
Figure 8 - SWOT Strengths mapped to Opportunities
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Figure 9 - SWOT Weaknesses mapped to Threats
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