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Document control sheet
Document Title |
Local Health Community and NHS Hampshire Informatics Plan |
Version |
3.3 |
Status |
Approved. Presented and supported at Board Seminar. Approved by Management Board |
Author |
Jenny Nash , CIO, NHS Hampshire (M: 07967 839382) |
Date Created |
19 Jan 2008 |
Date Last Updated |
15 Feb 2009 |
Contact details |
||
Main point of contact |
Telephone number |
Email address |
Jenny Nash |
07967 839382 |
[email address] |
Contents
Purpose of Document
This document details the Informatics Plan for NHS Hampshire, commissioners of health services for the residents of Hampshire. The document contains several key sections:
Strategic context
About the Local Informatics Community
Informatics Planning
Projects - pan-Hampshire projects, providers commitments and national requirements
Enabling - technical, governance, funding, resources
This Informatics Plan addresses the national and local requirements and priorities, including the NHS Informatics Planning 2009/10 requirements.
The Informatics Plan is frequently requested under FOI, by staff and by our partners to understand Informatics and can therefore be read independently of the business Operational Plan.
Relationship to NHS Hampshire Operational Plan: Specific elements or précis of this plan are included in the NHS Hampshire Operational plan so that the link between services and informatics are clear irrespective which document is read. This document is also included as a chapter of the NHS Hampshire Operating Plan.
Strategic Context
Hampshire NHS Strategy
The aim of NHS Hampshire is to enable the people of Hampshire to live longer and healthier lives
The Trust's strategy is based around:
Dealing with the effects of an ageing population
Helping people make healthier lifestyle choices and reducing health inequalities across Hampshire
Improving the pathway of care for patients
Making more efficient use of resources
Improving quality, focusing effort on the three key areas of patients safety, patient experience and clinical outcomes
Improving the ways we engage with patient and the public
Developing stronger partnerships
The refreshed NHS Hampshire Strategy, Healthy Horizons, identifies five strategic goals to achieve our vision and aims:
Reduce health inequalities by targeting initiatives on those areas of greatest need that would yield greatest impact.
Transform the pathways of care for the `big killers' to improve health outcomes
Improve the pathways of care for patients with long term conditions, focusing resources on early intervention and care closer to home
Recycle an increasing proportion of our funding each year to deliver a sustainable healthcare system particularly with the ageing healthy population
Continuously improve the quality and outcomes of the services we commission
The key issues emerging from the analysis of needs are:
An ageing population
Health inequalities in deprived areas and vulnerable groups
Major illness - cardiovascular disease and cancer
Lifestyle and modifiable risk taking behaviour
Ensuring best start in life and reducing health inequalities of children and young people
Hampshire NHS Informatics Plan
The NHS Operating Framework for 2008/09 identified the need for sustained focus on Information Management and Technology (IM&T) in the NHS to deliver better, safer care and support health service priorities and reform.
The emphasis was and remains on local ownership and leadership driving a local IM&T agenda that meets a defined set of national expectations and exploits the National Programme for IT (NPfIT).
The NHS Informatics Planning 2009/10 builds on the previous guidance and emphasises the development of informatics capacity and capability:
By building on the LHC structures developed in recent years, the NHS can develop informatics capacity and capability to provide and share relevant information to support all aspects of patient care.
Local planning that incorporates components from the National Programme for Information Technology (NPfIT) and other solutions is required to underpin the delivery of the information needs of service plans.
Robust planning processes, including the development of knowledge, skills, resources and technical infrastructure, will provide greater flexibility and enable informatics to respond to, and better support, service changes in the future.
This Informatics Plan ensures that the Informatics community - providers and commissioners, locally and collectively - delivers an informatics programme that supports the expected service transformations and enables NHS Hampshire to deliver the ambitions of:
World Class Commissioning
Vision for Implementation of High Quality Care for All
Local Priorities
The underpinning technology (networks, servers, business applications) needs to be:
robust
flexible
timely - often available in advance of confirmed service changes to enable rather than restrict service innovations (e.g. WAN strategy and plan in place as data links can take six months to install)
`Industry standard' tools are being used pr planned to support improved ways of working e.g.
single sign-on (increases security and reduces stress where staff are using multiple applications)
secure shared networks (allows any time, any place, working and multi agency working - demonstrated at Aldershot Centre for Health and Fareham Reach)
remote access (allows any time, any place, working and provides business continuity - as demonstrated by “business as usual” despite many staff having to work form home/local office during snow storms in February 2009, and the `flu virus in December 2008/January 2009)
Wireless networking to support “information at the bedside”
Interim solutions are being implemented and or purchased/developed until national systems such as Care Record Service are available in the South to deliver continued benefits to patients and clinician, e.g.
Replacement of Southampton University Hopsitals NHS Trust Pateint Administration System (PAS)
Development of the Hampshire Health Record
Implementation of GP diagnostic order and results solutions (Anglia ICE)
To retain the simple strategic informatics messages the informatics vision has two key priorities:
Supporting delivery of care. Ensuring that the right information is available at the right time for health and social care staff to make informed decisions, irrespective of organisational boundaries (meeting Darzi and local priorities)
Supporting business/service decision making. Ensuring that NHS Hampshire staff have easy to access, easy to use information and business support tools to allow them to make informed clinical and service decisions (Meeting and enabling competencies of World Class Commissioning)
A key enabler for supporting clinical and social care decisions in the right place at the right time is the Hampshire Health Record (see Section 5.1) which is continually being developed and improved to meet the needs of a comprehensive patient record:
Ensuring that NHS Hampshire staff have information available and processes in place to make informed clinical and service decisions is being achieved through the development of business intelligence (BI) tools and processes. The Information Improvement Programme (see Section 5.13) details how this meets the vision:
By 2010 all Information required to make informed business decisions will be:
Easy to Access e.g. via web
Easy to understand e.g. dashboard, scorecards, mapped - all with (appropriate) drill down to anonymised patient level data to support care pathways.
Pertinent e.g. alerts to staff/roles via e-mails and workflows
Included in applications e.g. Invoice Validation, Predictive Modelling
The Local Health Community
Hampshire County is relatively unusual in having three Commissioners, three Community Services, two mental health providers, five key acutes and three key councils. In an initial response to the National Programme for IT four Local Health Communities were created, but given a history of collaboration, the common Hampshire Health Record project and a number of Shared ICT services, much informatics planning and sharing has continued to be pan-Hampshire.
In 2009/10 after increasing joint working, Hampshire County Council will play a significant role in the Informatics plan. A joint bid for the Common Assessment Framework (CAF) involving NHS Hampshire, Hampshire Partnership NHS Trust and Hampshire County Council plus voluntary agencies to the Department of Social Care has been successful and awarded significant funding. This will allow the development of the Hampshire Health Record, significant change work, sharing of information to enable improvements in the delivery of joint health and social care to Hampshire's residents.
This Informatics plan has been developed and agreed in principal with the key providers of Health and Social Care, including:
Basingstoke and North Hampshire NHS Foundation Trust
Southampton University Hospital NHS Trust
Portsmouth Hospitals NHS Trust
Winchester and Eastleigh Hospitals NHS Trust
Frimley Park Hospital NHS Foundation Trust
Hampshire Partnership NHS Trust
South Central Ambulance Service NHS Trust
The three Community provider arms of the PCTs
Hampshire County Council
[During March 2009 conference calls or meetings have been arranged to go through the final plan with each Chief Executive]
Informatics Planning
Supporting Delivery of Care - High Quality Care for All
Supporting Delivery of Care requires each trust to have sound clinical support systems complimented by pan-Hampshire sharing of information.
Trust-based systems are needed to capture and make available high quality data as a by-product of the delivery of care. We need to make patient event information to any (authoirsed) clinician so that, no matter where or when the patient is seen, the best clinical decision can be made. We are achieving this by:
e-messaging critical information between key providers of care e.g. pathology and radiology and discharge letters directly from trusts to GPs
sending key information from local systems to the Hampshire Health Record to provide a broader patient record, irrespective of organizational boundaries
Building on the success of 08/09 (significant increase in the information available in the HHR) to ensure that in 09/10 the benefits of having HHR to supporting unplanned care and shared care are realised.
The Health Informatics Review confirmed the
“ ……..the core objective for the NHS Care Records Service: “to provide for each person a comprehensive electronic record for their health and care”.
The collaborative pan-Hampshire project Hampshire Health Record (HHR) aims to address this need for Hampshire patients making it a key enabler to improving the care provided to patients, especially where there care is provided across multiple organizations.
The “HHR analytical system” an anonymised set of the HHR data, provides a rich source of information to enable the PCT to meet many of the World Class Commissioning competencies. The HHR supports modeling, delivery and monitoring of care pathways and is a potentially powerful data source for research and answering hypotheses on care/services.
The HHR is continually improving and the ambition is to include data from all providers of care (including social care) to Hampshire residents. As information is collated and shared by each provider in real-time (or close to real-time) so the HHR provides a more comprehensive record. (see 4.1.1 Hampshire Health Record)
Sharing data requires systems to provide as wide a coverage as possible and for the source data to be complete and accurate:
Within Primary Care, practices achieved their IM&T DES in March 2008 demonstrating their commitment to capturing high quality clinical data, 98% of GPs have signed up to GPSoC (System of Choice) and GP IG SoC (Information Governance Statement of Compliance)
Acute providers have developed or implemented interim solutions to support improvements such as clinic letters and electronic ordering and results to ensure some progress while negotiations for acute systems through the National Programme for IT continue
HPCT Community Services has implemented CICS - a Community PAS which records all patient contacts and paves the way for the implementation of CRS - TPP, where more clinical information will be captured
HPCT Dental Service is implementing Digital IT systems to support digital x-ray and patient notes.
Supporting Business/Service decision making - enabling the PCT to become World Class Commissioners (WCC)
NHS Hampshire recognised a need for information early on, the ambitions of World Class Commissioning where information and business intelligence (BI) directly or indirectly underpins World Class Commissioning competencies has reinforced this need.
In 2007/08 the PCT established a new single Information team pulling together information staff from contracting, “central returns” returns and public health and repatriated “Commissioning” information staff from shared services to ensure the information team was a single cohesive unit and embedded within the business.
In 2008/09 the Information Department formally separated into two units to support the planned Autonomous Provider Organisation (Hampshire Community Health Care - HCHC) and Autonomous Commissioner Organisation (NHS Hampshire). The HCHC Information Team is largely a ingle unit based in the HCHC HQ. NHS Hampshire's Information team is based in NHS Hampshire HQ supporting all aspects of information for the commissioning cycles with staff working closely in a multi-skilled team to address work areas such as managing contracts, supporting demand management schemes. There are nominated information leads for each of the HQs work areas, such as:
Contracting
Service Redesign
Demand Management
Health Needs Analysis
Performance
Processing and Central Returns
NHS Hampshire worked closely with the SDSS (PCT Alliance Strategic Decision Support Service) to ensure that best practice is shared between PCTs, which tools are developed/purchased to meet the ambitions World Class Commissioning and that information is used for decision making - “Turning Information into Improvements”
Information staff are developing the skills and confidence to move from their historical roles of counting activity presenting information as Excel reports to other departments to working closely with business decision makers on understanding, identifying ways of solving business issues and monitoring progress. An important step change in the development of the team and services has been the identification of Performance Point and the Microsoft `stack' that allows us to present information in more meaning full ways.
The MS tool box of SQL, Report services, SharePoint and Performance point (Business Intelligence tools) have been chosen and are now being developed and all areas of the PCT and supported by information analysts, data and tools to enable the PCT to be World Class Commissioners.
An Information Improvement Programme is in place to ensure information is developed and support clinical and service decision making (see Section 6).
Governance Arrangements
With the implementation of the NPfIT programme four Local Health Community Boards were established across Hampshire (South-East, South-West, North and Mid - Hampshire) each reflecting the `local' community largely based around the main acute hospital.
With the extended contract reset process and the termination of the SPfIT contract with Fujitsu these Local Community Programme Boards have largely been disbanded and less formal pan-Hampshire LHC programme management arrangements have been established.
Focus has shifted to managing the transition of live sites/services or planning for new services with the remaining Local Service Providers: BT and/or CSE.
The CIO of NHS Hampshire works closely with the Directors of IM&T and Chief Executives ofHampshire of provider services to ensure that there is a common understanding of providers' preferred options, impact on community planning and any potentials for joint working to share resources, skills etc.
The Chief Executives are also provided with information and discuss the SPfIT planning through SHA briefings.
There is no single pan-Hampshire LHC Board.
Technical Governance
Providers are largely supported by Shared Services arrangements supported by a pan-Hampshire Inter-HIS Steering Group, so there is significant joint technical planning and enabling projects that are managed through the Inter-HIS Group, reporting to the respective Shared Service Management Boards.
CRS
Hampshire will have a mixed economy of national solutions. This is understood and accepted by the Chief Executives. Winchester and Eastleigh Hospital Trust is live with CRS - Millennium and their CE (Martin Wakeley) chairs the Live Sites group.
The National Programme for IT does not provide a single shared record service that supports community, mental health, primary and acute sectors. It has therefore been agreed in Hampshire that each provider should adopt the Care Record Service that provides the best fit for the organisation, recognising the needs of the local community and the need to maintain and develop the Hampshire Health Record.
Informatics Planning
The Informatics Plan is agreed in principle and shared with each of the Providers
Each provider (including HCHC) has an established IM&T Board (normally chaired by the Chief Executive) (meetings are monthly or bi-monthly depending on provider)
Primary Care has an IM&T Board - chaired by a GP
There is a Pan-Hampshire Informatics Operational Steering Group
There are regular review discussions between NHS Hampshire's CIO or Chief Executive with provider Chief Executives where there are key decisions or issues (e.g. Preferred CRS, Shared Services review)
The CIOs of NHS Hampshire and SHA on behalf of their Chief Executives have continued to work with Heads of IM&T and Provider Chief Executives to ensure all parties remain informed of developments within SPfIT and that local decisions are made recognising the need of the individual provider and the local community.
Within NHS Hampshire Informatics projects normally have their own project Board, with the majority having at least one executive representative. The project papers are available on the intranet and exceptions or key issues reported to the Management Board.
All Informatics projects are linked back to the PCT's strategic goals to ensure that staff understand the importance and link back to the Trust's broader strategy:
The CIO gives a bi-annual (or as required) IM&T update to the Trust Board.
A schematic of relationships for Informatics planning and operational management follows:
Informatics Planning -Relationships
How the Informatics Plan supports the Darzi work stream
Darzi work streams |
Staying Healthy |
Maternity and New Born |
Children's Health |
Planned Care |
Mental Health |
Long term Conditions |
Acute Care |
End of Life Care |
Patient Focused |
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Local Projects |
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Hampshire Health Record |
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e-path and rad results |
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e-discharge |
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Child Heath Information System |
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Common Assessment Framework |
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Choose and Book |
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NHS Hampshire Web |
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National Projects |
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Summary Care Record |
Not planned for 2009/10 |
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Electronic Prescription Service |
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NHS Choices |
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GP2GP (transfer of GP records) |
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GPSoC (GP System of Choice) |
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Data Quality and Information Governance |
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Information Governance |
Enabler for Information sharing |
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NHS Number/Pat. Demographics |
Enabler for Information sharing and single record |
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Pseudonymisation of patient data |
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Clinical 5 |
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PAS |
An enabler for all services |
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Order Comms |
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Letters & Coding |
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Scheduling |
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e-prescribing |
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How the Informatics plan supports our strategic goals
Informatics Projects |
Reduce health inequalities by targeting initiatives on those areas of greatest need that would yield greatest impact |
Improve the pathways of care for patients with long term conditions, focusing resources on early intervention and care closer to home |
Transform the pathways of care for the `big killers' to improve health outcomes |
Recycle an increasing proportion of our funding each year to deliver a sustainable healthcare system particularly with the ageing healthy population |
Continuously improve the quality and outcomes of the services we commission |
Patient Focused |
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Local Projects |
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Hampshire Health Record |
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e-path and rad results |
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e-discharge |
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Child Heath Information System |
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Common Assessment Framework |
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Choose and Book |
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NHS Hampshire Web |
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National Projects |
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Summary Care Record |
Not planned for 2009/10 |
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Electronic Prescription Service |
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NHS Choices |
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GP2GP (transfer of GP records) |
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GPSoC (GP System of Choice) |
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Underpinning transformation |
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High Quality Care for All |
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World Class Commissioning |
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Technical Infrastructure |
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Data Quality and Information Governance |
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Information Governance |
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NHS Number/Patient Demographics |
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Pseudonymisation of patient data |
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Clinical 5 |
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PAS, Order Comms, Letters & coding, scheduling and e-prescribing |
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Local Area Agreement
The Informatics Plan supports the PCT's Local Area Agreement indicators.
NI indicator |
56 |
112 |
120 |
123 |
8 |
142 |
134 |
39 |
139 |
20 |
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Childhood |
Reducing teenage pregnancy |
Improve life expectancy reduce in equalities |
Supported by reducing smoking prevalence 16+ |
Reducing Obesity through adult participation in physical activity |
Independent living for vulnerable people |
Support for older people and reducing emergency bed days |
Reducing alcohol harm related hospital admissions |
Info support for older people |
Reducing alcohol related assault with injury |
Smoking cessation |
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Patient Focused |
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Local Projects |
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Hampshire Health Record |
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e-path and rad results |
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e-discharge |
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Child Heath Information System |
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Common Assessment Framework |
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Choose and Book |
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NHS Hampshire Web |
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Electronic prescription service |
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Timetable
Patient Focused Information
The Hampshire Health Record
The Hampshire Health Record (HHR) was further developed made more robust during 2008/09. The HHR currently combines information from acute and primary care and is used to support decision making where the local primary record may not have the latest information from another provider or where staff do not have access to the patient's primary record (e.g. emergency and out-of-hours services)
The HHR pulls/receives a subset of the organisations information to build a patient record that is currently used in emergency and out-of-hours services where up to date information is required.
The vision of supporting Pathways of Care is largely being delivered by the HHR and e-messaging:
The HHR is a strategic and tactical solution, fully supported by the PCTs and acute providers, the project has:
Clear and shared objectives between providers and PCT (also documented in this the LHC plan)
Joint formal budget (2008/09 = £333,500)
Shared full-time operational manager
Part-time specialist and clinical support
Each PCT and provider has identified full or part-time HHR project managers
An analytical database has been developed (with funding from SHA and DoH) to demonstrate how the information from the HHR supports not only direct care to individual patients but also provides strategic planning information for PBCs (Practice Based Commissioners) and PCTs to support service and clinical decision making.
Governance of HHR
The HHR Operational Board overseeing HHR, HHR Analytical Server and e-messaging has representatives from:
each of the 3 commissioners (PCPCT, SCPCT, HPCT)
each of the acute and community providers
Local Medical Council
Patient representative (Patient rep resigned in autumn 2008 as he moved out-of-area and a new patient rep to be identified)
Specialist and clinical support
Supported by HHR Operations Manager and Trust HHR Project Leads
Supporting service and clinical decision making
In 2008 an HHR Analytical Server was set up through a DoH sponsored project to demonstrate information supporting Practice Based Commissioning. The HHR, currently held in XML format, is converted and fed to an SQL data base (HHR Analytical Server) making analysis much easier. The data is combined with SUS (acute Secondary Usage Service) data to provide a rich activity and clinical data-set.
The pilot project to investigate and demonstrate how the HHR and SUS data can support service and clinical decisions focused on the diabetes pathway. The “Diabetes” pilot project demonstrated variances across PBC and practices and between acute providers. The success of the project coupled with the PCT's Information Improvement Programme has meant that an “Information to Support Care Pathways: Quality & Outcomes - dashboards ” project was initiated in January 2009 working with the SDSS to demonstrate the pathway metrics and presentation of information required to enable improvements in decision making about Diabetes and stroke.
The PCT and local community is beginning to see the planned benefits of the HHR, easier and greater access to information to support deliver of care, clinical and service decision making.
Inclusion of Social Care
A major project for 2009/10 is the Common Assessment Framework - a joint project between Hampshire County Council, NHS Hampshire, Hampshire Community Health Care, Hampshire Partnership NHS Trust and other voluntary providers to support careers and service users. The project is one of nine that have received support from the DoH and will support a challenging transformation programme, using Hampshire Health Record (directly or its concept) to share health and social care information (see http://www.dh.gov.uk/en/News/Recentstories/DH_094254).
Key objectives include using shared information between services and with clients to improve the quality of services provided and the service user/carers experience. Sharing will result in an “ask once, use many” rather than “ask once and then again and again” culture.
The current status and 2009/10 plan for HHR and e-events is:
Area |
2008/09 Position |
Plan 2009/10 |
Patient coverage |
50% of Hampshire residents |
90% of residents |
Providers |
Acute and primary care information |
Include Community Care and Social Care contacts |
Content (e-events) |
Diagnostics - path & rad results SUHT, PHT, WEHT (some) |
All Providers |
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Clinical correspondence |
All providers: minimum of discharge letters (Contractual requirement) |
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A&E attendances SUS Data in HHR as well as analytical server to be replaced by IP and OP attendances and outcomes |
Used by |
A&E - PHT and SUHT |
A&E - All providers |
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Some out-of-hours (OOH) |
All out-of-hours (OOH) service |
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Community staff |
Analysis |
Analytics Server developed and pilot reports produced |
Excellent presentation of information, dashboards and drill down to support: |
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Pilot to show how information can support PBC |
Promote and roll out analytics to PBCs |
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Some Diabetes pathway reports |
Stroke and Diabetes pathways - dashboards and scorecards |
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Integral part of Quality and Outcomes programme |
Summary Care Record
National Requirement:
Individual NHS organisations working collaboratively within local health communities should plan for the roll-out of the Summary Care Record (SCR) across LHCs with a focus on urgent care settings. Learning lessons from the Early Adopter Programme, national roll-out will have commenced during 2008/09, once compliant software is available. SHAs will agree the timeline for implementing the SCR with PCTs as commissioners, and full roll-out of the SCR will be demonstrated in LHC plans. Roll-out will be based on a two year window for the full deployment of SCR from the date on which all GP systems in the PCT are compliant. PCTs will manage compliancy of GP systems in accordance with their primary care informatics strategy and to bring forward the benefits offered by SCR.
Summary response:
The HHR provides a (local) equivalent of the Summary Care Record - storing information from GP systems. However, HHR accepts feeds from all GPs systems, contains acute activity and clinical correspondence and community contacts will be included in 2009. HHR therefore includes at least the information that could be fed (by some GP systems) to the Summary Care Record. With NHS focus on the Summary Care Record (SCR) it is important that the similarities and values of HHR and SCR are noted:
The Summary Care Record will initially contain only information from iSoft GP systems and provides a “front page” of medication, diagnosis etc, similar to HHR
The HHR contains more information than the SCR currently holds
New patient information on HHR is about to be launched and promoting both SCR and HHR could be confusing, need to have clear plan before promoting SCR
NHS Hampshire is committed to feeding the SCR but are not planning to do so in 09/10
NHS Southampton have expressed a desire to be a “fast follower”.
There has been a considerable level of resource and commitment to develop the Hampshire Health Record (HHR) which offers a local shared record. The focus for NHS Hampshire and the Local Community will therefore remain on the HHR for 09/10.
NHS Hampshire continues to work with SHA and CfH to remain informed of the progress and requirements to implement the SCR in Hampshire.
Preparation for SCR is similar to the HHR and therefore NHS Hapsmhire continues to work on data quality and engagement with locality managers and practices. Links have also been established with HealthSpace representatives in light of a potential plan to integrate the HHR with HealthSpace to establish a patient view of a localised shared record.
NHS Hampshire has completed the SCR readiness assessment checklist, which is used to give an indication of its readiness to implement the SCR.
All NHS Providers (including the PCT provider function and General Practice) |
Comment |
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All GP practices in Hampshire achieved, the IM&T DES (data quality) by March 2008. Staff training and clinical engagement is focused on HHR and not on SCR. Lessons learned from CRS deployment was to carefully manage timeliness of engagement and training. These work streams will not commence until a confirmed decision to implement SCR has been made |
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All practices are on GPSoC systems. EMIS (# of practices) - does not feed SCR IPS (# of practices) - does feed SCR Healthy Soft (# of practices) - does not feed SCR The PCT may promote TPP as the preferred GP system to support greater integration with Community and a single community/GP/child Health solution |
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The Collaborative HHR project has a communications work stream which ensures that patient information and leaflets on HHR is available in GP practices and emergency/out-of-hours depts/services. When the decision to implement SCR is taken a similar pubic engagement programme will be established (Appendix A - patient leaflet) |
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HHR is being used in A&E, out-of-hours and a work-stream to improve access by community staff is in underway. The HHR is supported by the Local Medical Council (LMC), presentations are being made to APACs and acute trusts to ensure HHR is used to support emergency care and/or where care has been transferred between providers and notes are not readily available (e.g. community staff) |
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The pan-Hampshire project team is working with A&E services to ensure HHR is available and easy to use. Single sign-on (live and being rolled out in HCHC, PHT, SUHT) will make HHR (and then SCR) easier to access as users will not have to additionally log in to HHR |
PCT Commissioners |
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The collaborative Pan-Hampshire HHR Operational Group is chaired by SCPCT and has representatives from all stakeholders, NHS Hampshire CIO attends. The project is resourced by all stakeholders and the annual budget (approx £350k) funds the maintenance and significant developments HHR and SCPT (through SDSS) has also funded (£50k) a project to analyse and present information from HHR to support care pathways, service and clinical decision making. The information is pseudonymised and phase 1 projects are stroke and diabetes. [SHA - Sarah Bright, has said the analysis is the most comprehensive and useful she has seen in South Central] |
HealthSpace
HealthSpace is a national initiative to provide patients with the ability to:
access to their clinical record (initially those held on SCR)
create their own links
join forums
NHS Hampshire is actively exploring HealthSpace (through SHA and direct links to CfH) as this may provide secure access not only to the national SCR but to local solutions, including HHR. This would provide an immediate benefit to patients who would be able to access a meaningful health record.
There is a risk of inappropriate access and the mechanisms for safeguarding our data through the national HealthSpace portal needs to be clearly understood. NHS Hampshire will continue to work closely with Connecting for Health (CfH) during 2009/10 on both SCR and HealthSpace projects but they are unlikely to be given priority status until 2010/11.
Care Record Service
Most providers are actively engaged with one or both LSPs and planning for the implementation of a CRS.
The current plans are:
Trust |
Preferred Care Record Service |
Status |
Basingstoke and North Hampshire NHS Foundation Trust |
Discussing with both LSPs |
At options appraisal stage |
Frimley Park Hospital NHS Foundation Trust |
CSC Lorenzo |
Renewing PAS contract for three years, will implement Lorenzo once “tried and tested” and delivering benefits. |
Portsmouth Hospitals NHS Trust |
CSC Lorenzo |
Implement 2010/11 - if provides required functionality |
Southampton University Hospitals NHS Trust |
Internal solution - potentially move to CSC Lorenzo |
Replacing current PAS |
Winchester and Eastleigh Hospitals NHS Trust |
Millennium |
Live |
Hampshire Community Health Care |
TPP |
Plan to be operation with first services August 2009 |
Southampton City Community Services |
TPP |
Plan to be operation with first services August 2009 |
Portsmouth City Community Services |
RIO (as provides mental health and community services) |
Plan to be operational August 09 |
Hampshire Partnership NHS Trust |
RIO |
Plan to be operational with first services October 2009 |
South Central Ambulance Service NHS Trust NHS Trust |
NA |
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Implementation of CRS is dependant on CfH/SPfIT obtaining Treasury approval and contracts with LSPs agreed. Sites planning to go live in 2009/10 have worked with suppliers to ensure they are ready to implement.
Electronic Prescription Service (National Requirement)
National Requirement:
Electronic Prescription Service (EPS) Release 2 will enable the benefits of the service to be fully realised. It enables electronic prescriptions to be sent, the nomination by patients of a preferred pharmacy, electronic cancellation of prescriptions and electronic repeat dispensing. Prescribers can only use EPS if they are in a PCT listed in Directions issued by the Secretary of State, which allows PCTs to authorise their contractors to use the Electronic Transmission of Prescriptions service.
Informatics Plan:
A primary care technical project support officer continues to coordinate EPS R1 roll-out with support from the Primary Care Information Team. EPS R1 is live in 110/147 practices with the remaining practices awaiting delivery of compatible software (iSoft and Emis PCS). The percentage of prescriptions produced electronically continues to improve but work continues to ensure EPS becomes “business as usual”.
An EPS Operational Group has been established with representatives from the LPC, SHA, CfH and the relevant PCT departments. In 2009/10 this group will shift focus to EPS R2 preparation activities including:
Set up Project Board and stakeholder governance (LPC, LMC)
Develop communications plan and policy for ensuring principles of nomination adhered to
Develop contingency plans across the community, should any aspect of the service fail
Undertake business change in GP practices and support Pharmacies
Agree process for updating smartcard policy for pharmacists, registering of other dispensing staff, and provision of out of hours services
An additional resource requirement has been identified to support R2 including, Project Manager, Business Change/Transformation Lead, Pharmacy Lead and GP lead.
PCT Commissioners |
Informatics Plan |
Note: PCT Commissioners will need to identify when they wish to start deploying the live service, which will determine when they need to be listed in the Secretary of State Directions. They should take into account the need for detailed preparations to be progressed in advance of live operations. |
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EPS R1 lead identified, R2 lead to be appointed |
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Included in outline plan |
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Will be completed as part of project plan |
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Will be completed as part of project plan |
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Will be completed as part of project plan |
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Will be completed as part of project plan |
NHS Choices
National Requirement: Patients will be provided with clear information on the quality of care. Easy to understand, service specific, comparable information will be available online on many aspects of service quality. The NHS Choices website will provide more information about all primary and community care services so people can make informed choices.
All NHS Providers |
Informatics Plan: |
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Confirm in provider plans |
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Confirm in provider plans |
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Confirm in provider plans |
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Confirm in provider plans |
PCT Commissioners |
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The Primary Care Contracting and Communications teams are leading this work, resources are being identified to provide support to ensure consistency, style and content across all providers. Working closely with the contracting team a Lead will be identified to validate information on local health and social care. |
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The new NHS Hampshire web site (to be launched April 2009) will include NHS Choices and Your Thoughts. The new web site is an operational project with existing Board, team and funding. The Primary Care Contracting and Communications teams are leading this work, resources are being identified to provide support to ensure consistency, style and content across all providers. |
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Local Plans to support Patient Choice and lead healthy lifestyles: Supporting patients to lead healthier lives will continue to be underpinned by improved presentation of and increasing range of information to patients via the internet. The New NHS Hampshire website (launch April 2009) is patient-focused and provides online and interactive information to help with Quit Smoking, weight loss/obesity, healthy life styles. The OBC for the Web project (intranet and internet for both HCHC and NHS Hampshire is approved and is available in Appendix A - Web Project OBC |
GP2GP (GP to GP) record transfer
Requirement:
GP2GP enables the safe and timely transfer of General Practice electronic health records, providing the General Practice clinician with access to the patient record at the first consultation with a new patient. This brings significant benefits to patient care. Developments in supplier products during 2009/10 will allow more record transfers, delivering increased benefits for LHCs.
GP Systems of Choice
National Requirement:
GP Systems of Choice is a framework of existing suppliers of GP clinical IT systems, through which these suppliers will rollout National Programme services and provide resilient hosted services to General Practice.
PCT Commissioners |
Informatics Plan |
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Over 95% of practices are now included in the national GPSoC Framework agreements ensuring the bulk of system maintenance costs are covered by CfH. As a consequence funds have been reallocated to further develop GP IT including improved support and training. Approximately 85% of practices have now signed the PCT-Practice Agreement ensuring both parties have clear responsibilities with regards to GP IT and there is mechanism in place to ensure the PCT will meet its service level responsibilities. This has been achieved through close engagement with key stakeholders including practices, support providers and the LMC. Work continues to ensure the remaining practices sign-up by March 2009. |
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Capital funds to support GPSoC continue to be allocated to large scale infrastructure projects in line with the General Practice IT Infrastructure Specification. Projects include a large scale (800 PCs) replacement programme, Novel Zenworks implementation and the deployment of intelligent network monitoring. |
Clinical 5
The “Clinical 5” is the functionality clinical stakeholders identified as essential functionality that would result in them seeing informatics solutions as being valuable in conducting day-to-day business.
The five key elements, the “Clinical 5” for secondary care are:
A Patient Administration System with integration with other systems and sophisticated reporting
Order Communications and Diagnostics Reporting (including all pathology and radiology tests and tests ordered in primary care)
Letters with coding (discharge summaries, clinic and Accident and Emergency letters)
Scheduling (for beds, tests, theatres, etc)
e-Prescribing (including `To Take Out' medicines).
Introduction of the clinical 5 is important to support:
clinical decision making
improvements in clinical care
routine collection of clinical rich information as a by product of care
- all of which will allow the commissioner and provider to review quality, outcomes and effectiveness.
All providers have plans to deliver the Clinical 5, either through use of existing systems, development or procurement of new systems or through the national CRS.
Choose and Book using Direct Booking
The PCT has identified Choose and Book (CAB) as a key enabler for 2009/10. Unfortunately CAB across Hampshire has not achieved high levels of directly booked appointments.
A project manager to take a whole systems approach will be appointed and work with all providers, primary care and the SHA to ensure that all outstanding issues are resolved to enable the community to achieve a target of 70% of all GP referrals result in appointments being booked via CAB by March 2010, 85% by March 2011 and 95% by March 2012.
The Provider Contracts reflect this ambition.
Child Health Information Systems
As a result of the reconfiguration of PCTs in 2006, NHS Hampshire is supported by four key Child Health Information systems based at:
Portsmouth City PCT
Southampton City PCT
Basingstoke and North Hampshire NHS Foundation Trust
Winchester and Eastleigh Healthcare NHS Trust
Key providers of information to the Child Health System(s) are maternity units (discharge notifications), GPs, Health Visitors (HV) and School Nurses.
Hampshire Community Services employ most of the HVs and School Nurses, working within the Children's Directorate. A Child Health module is available in CRS - TPP and NHS Hampshire plan to use this as the single NHS Hampshire solution. Integration with primary and acute care for Immunisations and Vaccinations and maternity discharge letters to support health visitor visits will greatly improve the provision of services to children.
With SCPCT also taking TPP and Child Health there will be significant coverage for children across Hampshire.
A review of Child Health services has been undertaken and plans to transfer services are being developed and should be implemented in parallel to TPP for HVs and School Nurses from August 2009.
Common Assessment Framework
People are increasingly being given the power to choose and commission their own care and support services through recent reforms outlined in Putting People First. Each person's individual circumstances and the way in which they want to live their life are fundamental to helping to choose services and support better suited to meet their needs. If a person has complex or long-term care and support needs there has been a frustration in patients repeating their story to different parts of the system.
The Common Assessment Framework provides a mechanism to reduce or eliminate the unnecessary repeating of information and standardise the process for data capture across multiple care agencies.
NHS Hampshire is a main partner (along with Hampshire County Council, Hampshire Partnership NHS Trust and several voluntary organisations) in a successful bid to receive funding from the Department of Health to develop and implement new approaches to integrated working and data sharing between agencies, as part of the Common Assessment Framework for Adults Demonstrator Site Programme (http://www.dh.gov.uk/en/News/Recentstories/DH_094254).
Sharing information between different members of a care team enables a comprehensive picture of an individual's circumstances and care history to be built up over time. This in turn will enable health and social care workers working as part of integrated multi-disciplinary teams to provide the most effective response to a person's needs.
Benefits to patients of such a holistic assessment and care planning process supported by IT are expected to include:
Enabling people to live independently for longer through earlier and more holistic assessment and care planning prior to discharge from hospital. This should reduce the need for unscheduled admissions through improved co-ordination of community care and by hospitals having information available on the care being provided in the community
Improved care for people with longer-term conditions and complex care needs by ensuring all staff involved have up to date assessment and care plan information
Improved quality of care through a more holistic view of needs leading to more appropriate services being put in place and through individuals not being asked the same questions repeatedly
A more joined up sense of the care being received which will help to reassure patients that all their care needs are being met
The project is expected to benefit practitioners on a number of levels, including:
Providing clinicians with a more holistic picture of an individual's needs and care plan, which will enable more effective and appropriate care to be provided
Increasing efficiency for professional staff through reductions in reassessment of individuals and time spent on associated administration (e.g. copying, faxing, phoning)
Improving the referral process from health to social care and vice-versa through reducing inappropriate referrals and increasing reliability and efficiency
Improving public health information on the health and care needs, in particular in relation to older people through the availability of aggregate analyses
Reducing length of stay and delayed transfers of care through earlier and more holistic/overview assessment and care planning prior to discharge
Reducing unscheduled admissions through improved co-ordination of community care and by hospitals having information available on the care being provided in the community
Improvements to the processes of capturing, recording and availability of information in a 'do once and share' model will be supported by:
Existing technology (i.e. HHR)
New technology (i.e. digital pens, online forms)
Introduction of shared processes across health and social care
Widening access to data (i.e. mobile working by practitioners)
Review of and (where necessary) improvements to:
information sharing protocols
information sharing processes
security and accessibility of data
Through the early identification of pilot sites and the inclusion of end users throughout the project, the work will ensure that the right information is available, in a secure and confidential way, to not only practitioners providing care, but also the patients receiving the care.
Working with Connecting for Health and the Department of Health the findings from this work (along with eight other selected sites across the country) will be used to inform both local developments and further national guidance.
Bid for CAF Demonstration Site is provided in Appendix A
Maximising the benefits of PACS data sharing
The Picture Archiving and Communications System (PACS) enables images such as x-rays and scans to be stored electronically and viewed on screens, creating a near filmless process and improved diagnosis methods.
Radiology departments use the PACS System to create and view images and radiology reports. The radiology reports and copies of the images are then passed to the requestor. In many cases these reports and images are sent to clinicians in Primary Care as physical print outs through the mail.
Hospital clinicians can view reports and images using the PACS Viewer service. This is an online service that provides access to the entire PACS Store of images and reports for a patient.
A small number of GPs have been given access to their local PACS Store using the PACS Viewer system. These GPs have almost instant access to images and reports as they are created and, whilst they are not expected to make any radiology diagnosis as a result of this direct access, the access allows them to view images (including historical images) on the screen in their surgery as soon as they require them.
The GP access currently uses a variety of access routes and mechanisms, which will be reviewed in terms of security and usability. Working with Connecting for Health and the local PACS Stores the feedback from and assessment of these access methods will guide and inform a wider roll out of access by Primary Care clinicians to the PACS Viewer.
Acute Trusts are expected to start sending radiology reports electronically to GPs, but this will not include images. The increased use of the PACS Viewer in Primary Care settings will provide clinicians access to not only the report, but also the images.
The image is then available during consultations and can also be discussed in real-time between GPs and other clinicians based at different sites (e.g. hospital consultants).
The increase in access to the images, as well as the ability to consult on images and reports will have a positive impact on the level of care given to patients being treated by Primary Care clinicians.
Prison Health IT
NHS Hampshire commissions NHS Portsmouth to provide the health services at the trusts immigration and offender sites (HMP Winchester and Haslar Immigration removal Centre),
NHS Hampshire retains ownership and responsibility for the IT.
HMP Winchester is currently using InPS Vision and Haslar IRC is using HealthySoft as their respective clinical systems/PAS.
The National Programme proposes to adopt TPP SystemOne as the national prison system and the South Central SHA is leading early discussions with PCT representatives. This is a good strategic fit given HCHC's plans to implement TPP but NHS Hampshire does not do not plan to deploy TPP for prisons during 2009/10
Information Improvement Programme
In addition to providing patient-centric support systems NHS Hampshire must also be able to plan the services used to deliver care and monitor the delivery and outcomes of care provided to ensure that our pathways of care are effective, efficient and delivering the best outcomes.
Collecting, sharing and monitoring information at a pathway level across providers is a major Informatics challenge requiring the:
Collection of activity and clinical information at all points of care
Sharing of information across providers
Presentation of information in a meaningful way to support patient care
Presentation of information in a meaningful way to support services and clinical decision making at patient, service and population level to ensure that services are commissioned to meet the needs of the population and that the commissioned services/ pathways deliver the expected quality and outcomes.
The Information Improvement Programme plans ensure that information is presented in a meaningful way to support decision making:
Support NHS Hampshire in achieving WCC competencies
Link staff and services with PCT Alliance's SDSS and emerging Commissioning Enablement Service
Support improved Contract Management through Invoice Validation
Support Quality and Outcomes by providing tools for the collection of data from providers (e.g. web based Quality Support Tool developed and tested ready for use by Providers from April 2009)
Care pathways - information to support clinical decision making including which services to refer to by combining and presenting SUS, primary and community data
Service redesign - use of MOM (Map of Medicine) and identifying and using national aggregate data (e.g. royal colleges) to compliment detailed local data collection - support strategic planning and decision making
Information from a wide number of sources are used and national tools for benchmarking are used.
Supporting tools such as Map of Medicine are also being used and focus is being put on these “free to use” tools in 09/10.
The technical architecture for delivering the core of the Information Improvement Programme is the Microsoft stack of Performance point, SharePoint, Reports services and SQL that the PCT implemented in October/November 2008
Linking users to information is critical to ensure success and delivery of business intelligence (BI). “Show and Explore Sessions” have recently started and will be further developed to ensure that decisions makers, information and information analysts are linked.
Information received a low score on the WCC assessment and work to improve use of information and key objectives of the 2009/10 plan are:
WCC COMPETENCY |
MEASURE |
Objective |
Plan |
4. Lead continuous and meaningful engagement of all clinicians to inform strategy and drive quality, service design and resource utilisation |
Clinical engagement Dissemination of information to support clinical decision making Reputation as leader of clinical engagement |
Improving PBCs satisfaction with quality, format and frequency of information
Supporting Care Pathways - Stroke and Diabetes
Demand/threshold management |
Continue monthly PBC Information forums - proving successful. Good feedback on PBC tool Master classes in use of PBC tool and NHS information tools -e.g. supporting benchmarking Feedback and identification of areas that could be reviews (show and explore sessions) Stroke and Diabetes pathway information - dashboards and drill down (HHR and SUS) to support clinical decision making - building on the successful work November to January on Diabetes pathway Information staff more closely aligned with clinical decision making groups (Demand/threshold Management information to support pathways Easier access to SUS and HHR data to support decision making (Performance Point) CAB to support threshold and demand management Continued support of Prior approvals (web based from) |
5. Manage knowledge and undertake robust and regular needs assessments that establish a full understanding of current and future local health needs and requirements |
Analytical skills and insights Understanding of health needs trends Use of health needs benchmarks |
Improve access to and understanding of information to support decision making |
Improve access to and ease of use of information to support decision making: Use Microsoft technology “stack”:
Hold “Show and explore” sessions to join decision makers and information staff - explore tools available, what information might mean, explore what questions need to be asked. Ensure that if decisions are being made in the absence of information that this gap is reported, recorded and resolved. Ensure clear and documented link between information used to support decisions link |
6. Prioritise investment according to local needs, service requirements and the values of the NHS |
Predictive modelling skills and insights Prioritisation of investment to improve population's health Incorporation of priorities into strategic investment plan |
Improve modelling skills to ensure we are commissioning the right services to meet the needs of residents
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Introduce and improve modelling skills and tools Working with SDSS on predictive modelling tool Sharing best practice and knowledge- working with Oxford and Bucks PCTs Local modelling tool to be developed further and made more robust. |
9. Secure procurement skills that ensure robust and viable contracts |
Understanding of providers economics Negotiation of contracts around defined variables Creation of robust contracts based on outcomes |
Deliver of Invoice Validation system that systematically and routinely checks information against a number of `rules' to ensure that Contract team spend time managing contracts rather than analysing and monitoring activity |
Invoice validation system has been partly developed and will be live for April 2009. Routinely checking against the rules collated across the nine PCTs and alerting Contract Managers to issues will free time for better contract management. Locally or through CES we plan to move to clinical invoice validation |
The Information Improvement Programme can be found in Appendix E .
Underpinning Service Transformation
Enabling local service transformation
The NHS Informatics Review Implementation Report will identify actions to deliver informatics enablement of service transformation in line with High Quality Care for All: The NHS Next Stage Review (NSR).
PCT and practice-based commissioners of NHS services will need to ensure that all health informatics developments necessary for the success of local implementation plans for the NSR are clearly identified, widely consulted on, and understood and appreciated by those they are to serve; also that providers serving their health communities are fully engaged and committed to delivering the relevant outcomes and outputs, reinforced through service contracts where appropriate.
PCT Commissioners |
Plan |
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OD plan includes dependencies on informatics-enabled transformation
Include here as well |
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Organisational Development for/from Informatics included in main body of Operational Plan |
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Local Health Community Plan includes in Capability & Capacity see Section 7.2 Financial Plans are provided in Appendix D |
Organisational Development
The Organsiational development plan reflects the development needs o f individual and organization as a whole. The impact of the Information Improvement plan and support of Demand management are shown below. Not: costs marked with * and are in the OD plan the “costs per area” are included in Informatics Work Plan
OD |
Description |
Informatics enablement |
Costs per Area |
1 |
Clinical engagement
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Clinical engagement is supported by provision of information that is presented in an easy to use and meaningful way to support service and clinical decision making. The Informatics team (IT and Information) work on specific project and general projects that are then available for developing work areas: 2008/09 Information to support PBCs: Web tool that provides easy to use and `drillable' SUS and financial data at locality and GP level. (A "Dr Foster plus” solution) it has been well received by PBCs. Information to Support Care Pathways Data from Hampshire Health Record (See enabling strategies - informatics Plan) was transferred to an analytical server, combined with SUS and used to by pilot GPs/localities to support Diabetes care Pathways NHS Choices NHS Choices is being used to provide “signposts” to support GPs understand what services are provided and where. 2009/10 Information to Support Care Pathways Two projects to present care pathways data for Stroke and Diabetes were agreed in January 2009. Performance Point (PP) will be used to improve presentation of data and support GPs, PBCs and localities in decision making. This is a joint project with Southampton City PCT and includes NHS Hampshire's Medical Director, SCPCT's Public Health Director, GPs and acute clinicians. It will build on the Diabetes work undertaken in 2008 and the Stroke work undertaken with Buckinghamshire and Berkshire through the PCT Alliance Strategic Decision Support Service. The Project Managers to support PP, diabetes and Stroke are in place. Additional Pathway support to meet the Plan will be required in 2009/10 and is estimated at £10k per pathway Information to support service redesign There is significant clinical engagement via the service redesign work and this is an area that Information provides significant support with 1wte analyst, access to the PCT version of the PBC tool and looking at the new Invoice validation tool to see how data can be presented to support service redesign. Similar views on activity information as provided through Invoice Validation will be made available so that all clinicians and teams within NHS Hampshire have an easy to use way of interrogating SUS and Community Data to give pathway as well as service level views to investigate and predict current and potential service models. OD Requirements: Technical Training of Informatics staff: £20k - in IT capital/revenue plan Development of PP solutions (£50k) new funds - in IT capital/revenue plan Workshops and training for users £5k* Included in OD plan (initial external support and then internally supported) |
£5k |
2 |
Use of joined up data collection and analysis to improve decision making
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2008/09 Community System rolled out so that Community services now have a Community PAS and are collating activity. Prior Approval web based forms for all providers developed to support turnaround and PH initiatives. Similar initiatives can be supported in 2009/10 Quality & Outcomes Web-based data collection forms made available to Providers to support collection and online RAG rating 2009/10 Quarter 1: Community data will be added to the NHS Hampshire data warehouse and available for analysis alongside SUS i.e. there will be access to OP, IP, A&E and Community data sets to support analysis. PP will be used to provide users with the ability to “slice and dice” acute and community data in virtually any way. Predictive Modeling is a key area for improvement. Tools to model impact of changes to population and location of services are available and used but better tools to support contract modeling are to be developed April - September 2009. Show and Explore - the power of information is in supporting decision-making. Decisions are rarely made by a single person but historically information has been analysed and shared on a 1:1 basis. Show and Explore sessions (have started with Demand Management programme) will ensure that all staff involved in projects see the data, discuss and start to explore the “what if/why?” With improved access to information, information will be issued at the initiation of any project with quick and easy access to baseline information, agreement of measures of success and early identification of metrics required to support work that are not currently collected so that IT (e.g. web-based forms) can support work. OD requirements Community Data Set Feed (£5k) Primary Care feeds - PM and technical £20k Mental Health Data set (5k) (cost of receiving MHDS - cost of producing will lie with HPT) Capability and capacity exists within team assuming funding of other areas. |
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3 |
Development of a fit for purpose OD and HR approach for commissioning, including Performance Management and Talent Management
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2009/10 The Information Improvement Programme has chosen PP as its strategic solution as it combines Performance tools (Dashboards and scorecards) linked to the underlying data. Currently the majority of performance reports are produced and presented in excel and a major objective of 2009/10 is to transfer “as is” solutions and provide training to individual departments such as Performance team Quality and Outcomes to ensure that they are able not only to use the Performance tools but build and flex them to meet their changing needs. The objective is to make PP to “Presentation of Information” as Word is to “a written policy” i.e. it will be a devolved solution that users are able, with light-support, self-develop. OD requirements: Consultancy to support transfer of existing reports to new environment. (£20k) Training of users in new tools (£10k*) Increased Support in Year 1 to provide pro-active and highly reactive service to support the new technologies (£30k*) |
£40k |
4 |
Project management skills and processes
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2008/09 The IM&T team has supported the OD team in the development of PM training plans. The approach is to be a mix of LEAN and Prince which should be seen as complementary not mutually exclusive. |