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Contents
Executive Summary
Appendices
Executive summary
This strategy for Health Informatics has been developed to support and inform the overall strategic direction of Cambridge University Hospitals NHS Foundation Trust.
The strategic direction is ambitious and therefore this strategy is one that declares an intent that Health Informatics should make a much greater contribution to the clinical and commercial success of the organisation and the services it provides for patients and local people.
The Trust's aim is to be renowned as an organisation of innovation and excellence in health and care through the achievement of the following strategic priorities:
Improving the experience of patients
Improving patient care and safety
Ensuring clinical excellence and effectiveness
Valuing our staff and partners
Striving for innovation in all we do.
The environment in which the Trust operates, and intends to achieve its objectives, is undergoing rapid change.
The NHS has introduced recent structural reforms to create a “patient focussed” commissioner driven NHS. Strategic Health Authorities and Primary Care Trusts have been re-organised to focus on delivering transformational change rapidly and effectively.
In addition, there are a range of key national drivers for change that need to be taken into account, including the need to:
Demonstrate continuous improvement towards the 24 standards laid down in the seven domains of the `Standards for Better Health' framework
Incorporate the main themes from the Operating Framework for 2008/09
Maximise opportunities presented through the National Programme for IT Local Ownership Programme (NLOP) whilst not being held back waiting for delayed elements of the programme.
In order to meet its strategic objectives, the Trust needs to be able to have a robust and reliable base of information on which it can draw upon to respond to, and make decisions about:
The health and lifestyles of the local population
The patient's experience
The accessibility of services
The demand for health care services
The capacity of health care services
Service improvement
The efficiency of resource usage
The effectiveness of health care interventions.
These requirements have a number of implications for the Health Informatics agenda. It is clear that there needs to be a shared vision with all stakeholders. Many of the main areas of progress involve change management, or process transformation, projects underpinned by information. As such, it will be vital that stakeholders are actively engaged, and are participative, in this change.
The breadth of data needed by the Trust is much greater than ever before and an increasing amount of this data will not be able to be collected by the Trust itself. There is a need for greater sophistication in the analysis of information and a strong promotion of the use of information, all of which requires that the underlying data quality is of the highest standard.
The Vision for Health Informatics
The definition of Health Informatics is:
“The knowledge, skills and tools that enable information to be collected, managed, used and shared to support the delivery of healthcare and to promote health and wellbeing.”
The vision of Information Systems and Analysis in support of the Trust mission is `To provide information and service intelligence to empower clinical and managerial colleagues'. Within this context empowerment means having the right information available when it is needed to work effectively and efficiently.
Collecting, managing and sharing information, however, doesn't in its own right provide all the support required to underpin the strategic priorities of the Trust.
In order to use this information to achieve the improvements required, it is vital that work is done to review and transform processes of care and patient pathways as part of a major change management programme.
Integrated Care Pathways (ICPs) will be a critical element of the Trust addressing its strategic priorities. An ICP aims to have:
The right people
Doing the right things
In the right order
At the right time
In the right place
With the right outcomes
All with the attention to the patient experience
And, crucially, to compare planned care with the care actually given.
Such pathways, underpinned (and made viable) by information, will provide a patient-centred, clinically driven, evidence based outcome oriented, flexible tool. This will reduce the need for paperwork yet provide better support for clinical governance. It will become accepted as standard that information is recorded at the point of care not sometime afterwards.
Thus the vision for Health Informatics over the next 3 to 5 years is that knowledge, skills and tools will continue to be developed to enable information to be collected, managed, used, and shared to support the delivery of health care by the Trust.
Themes to Support the Informatics Vision
The Trust has already spent time with stakeholders gaining ownership for the strategy work and developing the Trust's thinking around the key themes upon which the strategy and implementation plans will be based. A number of key themes have emerged for this three year timeframe that underpin the informatics vision, as follows:
Systems Development
Continuing to build on current programmes and activities to implement systems to provide support for clinical and administrative processes across the Trust. Identification and procurement of systems to replace the current HISS. In addition, to develop clinical decision support and to provide information at the point of care
Single point of collection, multiple use
Manage the data and information required by the Trust so that it is collected only once (in full), used many times, and has value added to it. Provide information in the location and at the time it is required to help enable clinicians and managers to improve both patient care and safety, and the patient experience
Data Security
Continue to develop and maintain a robust plan for data security and information governance across the Trust
Infrastructure
Continue the plan currently underway to roll out wireless across the Trust, to complete the consolidation of servers, and to begin replacement of PCs with `thin client' technology. Plan the strategic replacement of the core network
Developing People
Create an outline plan for workforce development to support the informatics agenda both within and without Information Systems and Analysis
Development of a Customer Focused Service
These six work plans actually combine to provide the activities required to support the Trust's strategic objectives. However, it is not immediately apparent how they will unite to underpin the development of patient pathways, and the redesign of processes of care.
A key element of this Informatics Strategy is to create a project that pools resources into a designated area to demonstrate the vision of a patient pathway through the integration of the activities in these work plans.
Going Forward
The vision for Informatics, and thus the strategy, will continue to evolve over time. However, the activities detailed in the five work plans will provide the basis for delivering the strategy over the next three years.
As already noted, a crucial role for Health Informatics is to be the enabler of patient pathways by underpinning the transformed processes. This will start to happen during the lifetime of this plan. It is key, however, that one or two important pathways are mapped and supported by Informatics early to both kick start the work and also to act as a showcase to enable clinical staff to understand the benefits that accrue from such a project.
This project will be much about communicating, and getting buy-in for, the vision for Informatics. It will also need to engage actively with clinicians, management, and the patient pathway team to demonstrate the vision as a reality and to energise staff throughout the Trust to support further progress.
Introduction
Purpose of this Document
This document sets an agreed vision for informatics at Cambridge University Hospitals NHS Foundation Trust (CUH) for the forthcoming five years. Strategic themes are supported by detailed workplans for the next three years to 2009/10 supporting delivery of this strategy.
The Informatics Strategy therefore sets out:
The current and emergent information needs of the Trust and the degree to which they are being met by existing data sources and information services
The contribution that is required from information systems to provide the information (including those systems provided by NHS Connecting for Health)
The information systems development plan that is needed to close gaps in the information needed by the Trust
The shape of technology and the communications structure that will be needed to deliver these systems
The way that information and IT support functions need to be shaped and organised to gain the optimum benefit from technology.
Structure of this Document
The structure of this document is as follows:
Section 2 discusses the relevant contextual issues for Cambridge University Hospitals NHS Foundation Trust and the implications of these for Informatics
Section 3 describes the overall Informatics agenda including the external influences on the Trust
Section 4 outlines the vision for Informatics and the key themes that underpin the strategy to deliver this vision
Section 5 identifies the strengths and weaknesses of the existing Informatics environment and the priorities for action
Section 6 outlines the work programme for the next three years.
The Definition of Health Informatics
There are a wide range of definitions used to explain Health Informatics. However, they all have in common the practice of the recording and communication of information in support of the provision of healthcare.
A generally accepted definition within the NHS is:
“The knowledge, skills and tools that enable information to be collected, managed, used and shared to support the delivery of healthcare and to promote health and wellbeing.”
The real breadth of Health Informatics is briefly explored in section 4.2, together with an expansion of this definition.
Context
The Strategic Direction for CUH
The Trust is moving forward with the implementation of its 2020 Vision. The southern sector development forum and the creation of new research facilities on the site form an exciting and ambitious site-development plan. As this work progresses there will be a crucial requirement to invest appropriately in the infrastructure to underpin these new developments.
In 2006 the Board of Directors agreed a medium-term strategy to determine strategic priorities for the period to 2010/11.
The Trust has thus defined its detailed approach to addressing its mission by focusing on the overall theme of Innovation and excellence in health & care.
The Trust's aim is to be renowned as an organisation of innovation and excellence in health and care through the achievement of the following strategic priorities:
Improving the experience of patients
Improving patient care and safety
Ensuring clinical excellence and effectiveness
Valuing our staff and partners
Striving for innovation in all we do.
National Drivers for Change
The NHS has introduced recent structural reforms to create a “patient focussed” commissioner driven NHS. Strategic Health Authorities and Primary Care Trusts have been re-organised to focus on delivering transformational change rapidly and effectively.
There are a number of key national drivers for change that need to be considered:
Operating Framework for 2008/09
The 2008/09 NHS Operating Framework continues the process of establishing IM&T planning and investment within the mainstream of NHS planning and seeks to establish the information and IT architecture needed to deliver world class patient care, envisaged in Professor Lord Darzi's NHS Next Stage Interim Report; `Our NHS our future'.
The Operating Framework is supported by national IM&T planning guidance and a set of supporting toolkits developed to support the local 2008/09 IM&T planning process.
The main themes drawn out by the NHS Operating Framework for 2008/09 for IM&T are as follows:
Local Strategic Solutions
Patient Administration Systems and 18 weeks Referral to Treatment
Information Governance and Data Quality
Patient Demographics and the NHS Number
Secondary Uses Service
Measuring Benefits Delivered
Maximising the benefits of PACS data sharing
Fulfilling current deployment commitments
Summary Care Record and Healthspace
Electronic Prescription Service
Choose and Book using Direct Booking
The Trust has a role to play in the community-wide governance arrangements to support the Local Health Economy in its production of an inclusive IM&T plan that effectively supports the delivery of high quality services for patients and provides front-line staff with the tools and information they need to provide these services. The strategic themes identified above are therefore considered in this document.
National Programme for IT Local Ownership Programme (NLOP)
In recognition of the intention within the Operating Framework to drive local ownership of Information Technology, and following the National Audit Office recommendations in the 2006 report “The National Programme for IT in the NHS” new models of governance for the Connecting for Health programmes have been implemented.
The National Programme for IT Local Ownership Programme (NLOP) seeks to devolve the responsibilities around implementation activity from NHS Connecting for Health to Strategic Health Authorities as a means of ensuring the pace of local delivery is optimised.
Arrangements are now in place within the North, Midlands and East (NME) forming an NHS NME Management Board and the creation of the NME Programme for IT responsible for the local deployment of systems across this geography.
What is clear is that CUH needs to continue to build, and to maintain, a direct relationship with the Local Service Provider (Computer Sciences Corporation). It needs to be able to communicate its requirements to the LSP and be confident that it understands the capability, functionality and benefits of the different services available through NMEPfIT.
Healthcare Standards
As an Foundation Trust it will still be important that CUH is able to demonstrate clearly to commissioners and the Department of Health, continuous improvement towards the 24 standards laid down in the seven domains of the `Standards for Better Health' framework. These domains are:
Safety.
Clinical and Cost Effectiveness.
Governance.
Patient Focus.
Accessible and Responsive Care.
Care Environment and Amenities.
Public Health.
Information needs arising from this requirement are considered a part of this strategy.
Implications for Informatics
The local and national drivers draw out some key implications for Informatics development:
Informatics should be used to monitor and drive improvements in the quality of services. This means that the Trust should focus on the internal indicators of quality in addition to the few that are required nationally. There are limits to the improvements in quality that can be gained from manual, paper-based patient records. Higher quality services can only develop if information systems are introduced to guide and audit clinical decisions
Informatics can be used to assist improvements in patient safety by having key information (both from the patient record and from a broad medical knowledge base) available at the point of care and backed up by clinical decision support software
Informatics can be used to support new and improved ways of working and thereby drive improvements in workflow, productivity and effectiveness
Informatics should help CUH to exchange information and support joint working with agencies and organisations in the local health and social care system
Informatics can be used to evaluate which services could be extended to increase the scope and reach of services provided by the Trust through remote or off-site working
Informatics can be used to promote the Trust's ethos, style, quality and outcomes so that patients choose to use CUH as their provider of choice
Informatics can be used to promote research. Supported by appropriate governance and consent arrangements, the meta data can be used to support local audit and research activities.
The Informatics Agenda
Overview
Section 2 outlined the context for the use of information in the Trust, and noted some of the key external influences and constraints impacting on it. Through an examination of this context, taken together with the strategy of the Trust, it is possible to draw out the key information themes that need to be considered in the development of the overall Informatics strategy for the next three to five years.
In macro terms, the Trust needs to be able to have a robust and reliable base of information on which it can draw upon to respond to, and make decisions about:
The health and lifestyles of the local population to be able to continuously assess the appropriateness of the range of services that the Trust provides. The Trust will need to look at the changing health of the population and not only be able to react to them as necessary, but also to use developing tools to predict changes thus better equipping the Trust to meet these needs. While it could be argued that the prime responsibility for understanding health needs rests with the commissioners (PCT and practice-based), the Trust will need to promote itself, `market' and develop new services to attract income and deliver a better patient experience. To do this effectively, it needs to know the characteristics of the different populations that use its services. Such population-based data can also be used to inform research activities.
The patient's experience to capture and analyse the experiences of patients and the treatments that they have received, to respond to an individual patient event or complaint and to also provide a stimulus for service improvement. The NHS is increasingly interested in the patient's experience of the whole care pathway and not just the individual events that occur in a particular setting. The 18 week waiting time target is a crude but real example of this trend and many organisations are ill-prepared for this type of indicator. It could be argued that media has driven the introduction of new indicators for cleanliness, infection rates, privacy etc. and again, the NHS has struggled to introduce the data collection regimes to respond. In the future, it will be important for CUH to determine what patient experience it wants to provide and to use information to monitor the extent to which this has been achieved, before external demands for information force the issue in a less planned manner.
The accessibility of services to be able to ensure all patients are able to access the services they need within nationally agreed waiting times. The Trust will want to ensure that different population groups are not disadvantaged and that patients are informed and helped to make informed choices about the health care they need, providing an equality of access. Qualitative and quantitative information should be provided to GPs, potential service users, carers and the local media about patient experience, waiting times, outcomes, use of evidence-based medicine and new medical technologies to help ensure people identify the Trust as their `provider of choice'
The demand for health care services to be able to plan the capacity required within the different services provided by the Trust, and in doing so to meet the expectations of patients as they better understand the options open to them. There is evidence that some PCTs are using tools such as predictive modelling to make real progress in reducing the demand for inpatient services. CUH will need to closely monitor the progress made by Cambridgeshire and other PCTs and practice-based commissioners as well as to use modelling techniques itself to predict the impact of different scenarios. A good understanding of this referral base will be a significant factor in determining the most appropriate mix of services the Trust decides to offer.
The capacity of health care services to be able to make informed decisions about the available and `used' capacity of health care services. The Trust will want to be able to understand where bottlenecks in workflow exist and how additional capacity can be freed through their removal. There is a need for as much real time information as possible on the available capacity as well as to have information on the capacity needed in the future to cover expected demands while achieving the standards for quality, waiting times and access. The population growth in the Cambridge area over the next ten years is well documented. It will be important that the Trust has an accurate a set of information on the underlying patterns of this growth, as soon as possible.
Service improvement, over time, to evaluate the case for changing service provision or pathways to gain improvements in clinical, quality or financial terms. As well as being able to model the likely impact of new developments, there is a need to be able to set baselines and to then evaluate the success of service improvement programmes against the intended outcomes. The Trust needs to be able to access national and international sources of evidence and best practice and be able to critically appraise whether these would be beneficial. Much of this will be achieved outside the timescale of this strategy but, nevertheless, needs the foundations set within it
The efficiency of resource usage to be able to assess and make decisions about the efficiency of resource utilisation - estate, workforce, finance and Informatics. There is a need to evaluate the impact in productivity and/or activity from a change in the resources applied. Indeed, demands of `Payment by Results' will promote the need to understand the economics of individual services provided by the Trust. It will be vital to understand which services are economic and which are uneconomic and the different options that exist for responding appropriately in each case. We need to be able to determine the most appropriate setting and the desired `inputs' and `outputs' for each of the services it provides and to be able to monitor the workflow and financial variations from this preferred situation and why they occurred.
The effectiveness of health care interventions to support clinical governance and clinical audit initiatives with information about clinical `inputs' and the outcomes for different patient cohorts. There is also a need to ensure that the treatments being used are effective and based upon solid and robust evidence.
The National Programme for IT in the NHS
CUH will continue to carefully monitor the progress of Connecting for Health in their delivery of the National Programme for IT in the NHS, predominantly through its involvement with the NME Programme for IT. The Trust expects to benefit from an increasing number of opportunities that can be gained through the successful deployment of Care Record Service (CRS) functionality. The significant delays in the availability of the Lorenzo CRS solutions give the Trust no option but to explore the possibilities of alternatives for parts of the CRS functionality.
Where possible, NMEPfIT solutions will be taken, but where these are not able to sufficiently support the needs of the Trust in a timely manner then alternative solutions will be assessed and, if the requisite business case is compelling, will be procured.
Either way, the functionality introduced through the implementation of a care record service will provide a range of opportunities:
It can deploy advanced and secure clinical decision support systems thereby provide higher quality and more efficient services to its patients
It has the potential to support and develop clinical services on a more flexible basis using the benefits of integrated wide area networking and telecommunications
It can encourage information sharing across the whole care pathway, improving the quality and effectiveness of communications between the members of the clinical team supporting a patient
It can benefit from National procurements and the use of Enterprise-wide Agreements where the products are shown to be the most advantageous.
It is also important to note, though, that the significant and ongoing delays in the delivery of the CRS have had a real impact on the ability of the Trust to progress with a procurement to replace the key legacy systems. The Trust has, however, continued to develop functionality to enhance its Informatics capability through the innovative use of local systems and through continuing to build on the legacy systems.
Nevertheless, given the commitment from Connecting for Health to see that the CRS is delivered, it is important that the Trust looks to take advantage of proven solutions wherever possible, but to take locally chosen systems where this is not the case.
The Trust is committed to securing benefits from strong and informed partnerships with the Local Service Provider, other IM&T service providers and Informatics Services in the local health communities.
It will want to form direct relationships with these organisations and be able to shape the services they provide through dialogue and a mutual understanding of clinical and service drivers.
How Informatics can support the key Stakeholders
The potential benefits of a solid Informatics strategy will only become a reality if the service is able to meet the needs of a variety of stakeholders.
The key stakeholders are:
Clinicians
Patient and the Public
Corporate Information users
Commissioners and the Local Health Community
The Department of Health and Monitor
A brief scenario of how Informatics will support each of these groups is given in the follow paragraphs.
Clinicians need information at the bedside, collated from the wide range of clinical systems and presented together with decision support tools and clinical knowledge to assist in their provision of care. They also need to have, over time, access to information that informs them of the status of the wide range of resources required, such as specific trained staff, hospitals facilities, drugs and other equipment.
Patients and the Public need access to information that is relevant to their particular needs but that is easily understood and which can, in appropriate circumstances, be amended and/or interacted with to support their care experience. They also need good information on the services provided by the Trust in order to make informed decisions as to how to interact with the NHS locally.
Corporate information users need timely, comprehensive, quality information in order to run the organisation effectively on a day to day basis and in order to be proactive in planning the future shape of care delivery. Crucial to the Informatics strategy is the articulation of capturing and manipulating data to provide such information; the availability of business `or service' intelligence at the bedside.
Commissioners and Local Health Communities not only need to drive through IM&T Plans which provide a holistic view of the use of IT and Information in their geography, but also need to have an exchange of information with the Trust in order that they can commission services most effectively. It will also be important for the Trust to have as good a picture as possible of the changes being driven through in the move to make NHS care more local, in order that it can best plan to maximise its value in this environment.
The Department of Health and Monitor need to received timely provision of performance information from the Trust and also need new initiatives to be managed effectively. As mentioned previously, these can provide a significant challenge to all organisations but those that manage these best are likely to win out both in terms of their share of activity and in terms of central support.
The needs of each of these groups obviously overlap, and it is clear that certain basic functions must be performed to support the day to day running of the Trust, but the Informatics strategy must blend these into a cohesive plan on a year by year basis ensuring the interdependences are correctly sequenced. This plan is underpinned by a set of individual work streams where tangible delivery plans are scoped, costed, and resourced.
The aspirations of this Informatics Strategy cover a five year period with the contingent work plans focused on a three year planning window. Not all of the previously mentioned aspirations for Informatics can be achieved in that timeframe, but all should start to be addressed within it.
Implications for the Strategy
There are a number of key implications that can be drawn from the overview of the Informatics agenda:
There is a need for there to be a shared vision with stakeholders within and beyond the Trust for the effective use of information.
This sharing needs to extend to action as most of the potential benefits that will accrue in the efficiency and effectiveness of patient care will be through process transformation underpinned by information. Successful process change requires that clinicians and management are actively supportive and involved in the change management
The breadth of data needed by a modern Foundation Trust is much greater than ever before and an increasing amount of this data will not be able to be collected by the Trust itself. There is now a much greater need to establish common information sets with commissioners about the health and well being of the population, for example. Other information requirements are based upon the whole pathway experience of which the `Cambridge University Hospitals' experience is part - albeit a significant one
There is a need for greater sophistication in the analysis of information to support the achievement of the Strategic Direction. Predictive modelling, simulation, statistical sampling and health event linkage techniques are examples of more complex analytical tools that will be needed to assess and evaluate current and future success
There is a need to focus more on the internal requirements for information, to think about these on a broader basis and not be limited by existing information systems capabilities. The Trust must determine how it will value information that it doesn't currently have - this will enable it to evaluate the merits of investing in population lifestyle surveys or patient satisfaction studies
Good information use requires good data quality. The Trust currently manages its data quality well, achieving a 98% HES position, an 84% score on the Information Governance toolkit and as a national lead on the implementation of version 4.4 OPCS coding. It will, however, need to keep up its work to maintain and build on continued improvement year-on-year in the quality of data. This is of particular relevance given the increasing requirement for near 'real-time' coded and priced commissioning data sets from commissioners. The improvement in data quality (within the context of the overall approach to information governance) will need to be monitored for:
The efficiency and security of data flows
The accuracy of data
The consistency of data
The availability of data
The timeliness of data
The security and confidentiality of personal data.
The Trust's information requirements are not defined by the external demands for information. The Trust will not be able to respond fast enough to new information demands introduced by the Department of Health or Monitor. The 18 week waiting target has demonstrated that the lack of information systems to collect performance indicators demanded by the public and the media will not diminish the enthusiasm of the Centre to introduce them. CUH has identified its own balanced scorecard of performance measures that it needs to address its own requirements. In the future we need to refine these metrics and have confidence that any external demands are likely to be a subset of them.
There is a need to focus on the widest definition of information to include access to sources of knowledge, evidence, best practice, benchmarks and opinion.
The Trust needs to promote the use of information across the organisation. The Systems and Analysis team cannot be expected, or ever be able, to meet all these information requirements. It will be increasingly important to boost the information tools available across the organisation and for the information team to drive the development of such an information `culture'. The use of more sophisticated knowledge management tools will be important to create content-relevant information for users and provide assurance that documents such as policies and procedures are easily available and accessed.
There is a need to critically evaluate the levels of service and support the Trust requires for its key IT systems.
The Vision for Informatics at CUH
The Vision for Informatics in the Trust
Given the strategic themes outlined in Section 3, the vision of Information Systems and Analysis in support of the Trust mission is `To provide information and service intelligence to empower clinical and managerial colleagues'. Within this context empowerment means having the right information available when it is needed to work effectively and efficiently.
Realising the Vision for Informatics
The definition of Health Informatics put forward in section 1.3 was:
“The knowledge, skills and tools that enable information to be collected, managed, used and shared to support the delivery of healthcare and to promote health and wellbeing.”
This is no trivial task. Advancing health informatics has been listed as one of the 21st century's greatest challenges by a panel of leading engineers and scientists. The 14 `Grand Challenges in Engineering' were unveiled at the American Association for the Advancement of Science's annual meeting in early February 2008. The panellists said; “There is now a consensus that a systematic approach to health informatics - the acquisition, management and use of information in health - can greatly enhance the quality and efficiency of medical care and the response to widespread public health emergencies.”
All clinicians, whatever their specialism or area of practice, find it increasingly hard to keep up with the latest developments. There is just too much information. Yet at the same time, they are facing new demands that they base their clinical decisions upon only the most recent evidence and guidelines.
All users of the NHS want a flexible, accessible service that responds quickly to their needs, that uses the best available treatments and that wastes none of its valuable resources. This can only be achieved through excellent communications and by using accurate data to improve current performance and to plan new services.
Collecting, managing and sharing information, however, doesn't in its own right provide the support to underpin the strategic priorities of the Trust.
In order to use this information to achieve the improvements required, it is vital that work is done to review and transform processes of care as part of a major change management programme.
The six workplans that are detailed in Section 6 and in the Appendices expand the individual activities that make up this informatics strategy. However, whilst these individual actions actually combine to provide the underpinning required to effect patient pathways, this is not immediately apparent from a review of them.
Patient Pathways
Over time all clinical processes within the Trust (and those that reach outside) will be reviewed as part of a change management project undertaken by the clinical pathways team. These processes and pathways can only be transformed, however, with the appropriate underpinning of information.
It is important that a small number of patient pathways are chosen initially to demonstrate the gains to be made. These need to be pathways that are both most available for change and also where the impact will be easily visible, for example acute admissions, or getting ready for discharge.
They also need to be in an area where the staff are already aware of the benefits. An example of a potential initial project would be the Stroke pathway. Several of the elements of the work plans are supportive of such a development taking place in the next twelve to eighteen months.
The detail of how such a project could be started is given in Section 6.4. The intention behind this project is to pool resources into a designated area to demonstrate the vision.
Integrated Care Pathways (ICPs) will be a critical element of the Trust addressing its strategic priorities. An ICP aims to have:
The right people
Doing the right things
In the right order
At the right time
In the right place
With the right outcomes
All with the attention to the patient experience
And, crucially, to compare planned care with the care actually given.
Such pathways, underpinned (and made viable) by information, will provide a patient-centred, clinically driven, evidence based outcome oriented, flexible tool. This will reduce the need for paperwork yet provide better support for clinical governance. It will become accepted as standard that information is recorded at the point of care not sometime afterwards.
Themes to Support the Informatics Vision
To realise this vision it is vital that the key strategic principles, and constraints, which shape and define it are identified.
These include the external influences such as the National Programme for IT, and the various drivers internally in the Trust. Key to these is the experience of, and benefits to, the various primary stakeholders. Some scenarios were drawn as examples of these in section 3.3.
The Trust has already spent time with stakeholders gaining ownership for the strategy work and developing the Trust's thinking around the key themes upon which the strategy and implementation plans will be based. A number of key themes are emerging for this three year timeframe that underpin the informatics vision, as follows:
Systems Development
Single point of collection, multiple use
Data Security
Infrastructure
Developing people
These themes are reviewed at a more detailed level in the following sections.
Systems Development
For the Trust to materially improve patient care and safety whilst at the same time ensuring clinical excellence and effectiveness it will be vital that Informatics is able to provide access to a very broad range of information in a broad range of locations.
Having this information available in the right place, at the right time, and in the right form will enable clinicians and managers to be far more empowered in reviewing the position of the Trust and the range of services provided.
Information providing an understanding of the health and lifestyles of the local population together with models of potential demand for healthcare services will allow decisions to be made as to what and how services are delivered by the Trust.
Using Informatics to Support Clinical Decisions
The Trust recognises that there is a limit to the improvements in patient safety and clinical standards that can be made by combinations of people and paper. Advanced clinical information systems will increasingly be as important as advances in medicines and medical equipment to the success of clinical interventions and the delivery of the very highest standards of care. The Trust is therefore committed to:
Enabling real-time clinical use of electronic patient records from individual portable, wireless devices to integrated electronic patient records:
Access to clinical correspondence
Clinical noting and electronic document management
Order communications and results reporting
Scheduling
Care pathways
Clinical decision support using evidence based medicine
Alerting
Electronic prescribing
The remote use of clinical information systems and other tools by clinicians working in their homes, GP surgeries and other delivery sites supported by CUH teams
The continuous improvement in the use of clinical information tools through the core CRS product, interfaced `best of breed' departmental systems and bespoke web portals where these are required.
The Trust will want to encourage local GPs, patients and carers to use elements of CUH's clinical information architecture to improve the success of the care pathway and provide a better patient experience.
Service and Workflow Improvement
The Trust is committed to driving improvements in the efficiency and effectiveness of services through the use of the electronic care record functionality, integrated with additional local systems:
Driving improvements in clinical services through closer alignment of IT systems to clinical governance strategies
Reducing the importance of paper records and driving improvements in clinical services
Ensuring that electronic patient records are the predominant source of information
Making efficient use of resources, such as theatres and clinics, through effective use of booking and scheduling
Providing a catalyst for improving the quality and value of clinical and performance data and evolving an information culture that promotes the use of information throughout the organisation
A three year work plan to support this theme can be found at Appendix reference 1.
Single Point of Information, Multiple Use
Use of Information
CUH is committed to the development of a comprehensive data warehouse under the control of the Trust to deliver analysis, dashboards, clinical and performance tools internally and externally to local GPs, social services, patients and the public.
CUH will want to focus on its own information requirements and it will want to regularly report achievements against these self imposed targets on the Internet and in local media.
It is recognised that data quality is a crucial factor in success. Work needs to continue be done to build on the current strengths in coding and to focus on data quality throughout the Trust.
Information will need to be managed for patients and the public in a way that meets the increasingly broad needs of a fast growing multiethnic local community. This will include the provision of information in several languages.
Management of paper records
As noted earlier, the Trust recognises that there is a limit to the improvements in patient safety and clinical standards that can be made by combinations of people and paper.
However, until there is a fully operational Care Records Service there will be a need to actively support the care process by making access to paper based records as efficient as possible. Indeed for some time to come access to electronic versions of paper based record history will continue to be of value.
The Trust has already made good progress in providing electronic medical records to clinicians. In each case, notes of the latest patient's episode are available at the point of care, with the rest of the notes searchable.
A three year workplan to support this theme can be found at Appendix reference 2.
Data Security
Particularly in the light of recent national events (such as the loss of 25m child benefit records by Revenue and Customs), it is vital that the Trust is able to demonstrate that its management of patient records is secure. These external events mean it is more important than ever not just to provide a secure environment and set of processes, but also to be easily able to demonstrate this to patients and the public.
An Information Governance (IG) policy framework needs to be in place so that the Trust is able to meet the obligations set out on behalf of all NHS organisations in the Care Records Guarantee (CRG).
As infrastructure is deployed it must continue to support the, often cross cutting, principles of empowered clinicians and managers being able to easily use the data they legitimately require whilst providing all data and information on a `right to know' basis only.
Role Based Access Control (RBAC) will need to be implemented across systems to maximise the ease of use, especially for clinicians, whilst ensuring data is only provided on a `right to know' basis. This will be particularly important, and quite challenging, alongside the move to implement a `single sign-on' capability.
Agreed protocols need to be in place for sharing patient data with other NHS organisations and with non-NHS organisations.
A three year workplan to support this theme can be found at Appendix reference 3.
Infrastructure
The Use of IT
The Trust will ensure all staff have reliable access to basic IT infrastructure that allows them to benefit from:
Appropriate access to information technology, networking and telecommunications to enable them to be as productive as possible and contribute fully to the achievement of corporate goals
Technology `refresh' so that desktop personal computers are replaced every 4 years or so and, as feasible, migrated to a thin client technology. Laptops and other mobile computing tools are likely to be refreshed more frequently
Secure information technology, and demonstrable security of the information held on it
Office-based and/or remote network access to application systems, partner networks, the internet, NHS Net and information held on them (depending on the role and requirements) of the user
Support arrangements that resolve problems that they have with this technology in a predictable timeframe that does not impact significantly on their work and ideally without technicians needing to be present
Training, development and support that enable them to use IT effectively and realise the benefits for improving health and health care services.
A work plan to support this theme can be found at Appendix reference 4.
Developing People
The implications of this strategy for the staff working within and without the Information Systems and Analysis team are significant and include the developing concept of 24/7 IT support for key IT systems.
The development of skills in the use of new analytical techniques and population health and market analysis will be required.
A number of the projects proposed in this strategy will be large and complex. Further investment in project management and process redesign skills will be required to support these projects, not necessarily in the Information Systems and Analysis team.
Successful project implementation is largely dependent on the nature and quality of user, primarily clinical, engagement. Identification and resourcing of clinical leads for key projects such as the implementation of new IT systems, will promote the chances of success and increase the likelihood of realising patient benefit.
A work plan to support this strategic theme can be found at appendix 5.
The Work plans enable the Strategy
The objectives in these themes, when realised, will enable the Informatics vision to provide information and service intelligence to create empowered clinical and managerial colleagues. The work plans detailing the activities for delivery need to build on current strengths, tackle weaknesses and address the requirements outlined above to meet the needs of stakeholder groups and to support the Trusts strategic priorities. These factors are examined in Section 5, with the individual work plans themselves detailed in Section 6.
Current Informatics Architecture and Plans
Introduction
This section considers the existing Informatics architecture used by CUH and identifies the key issues and priorities for the future.
In overall terms, there is a good engagement in the Informatics agenda by the Board, Executive Team and clinical leaders throughout the Trust and this has enabled CUH to deliver a solid information provision considering the age of some of its information systems and the lateness of the national Care Records Service provision.
The Trust has had a track record of success and innovation and the introduction of PACS and electronic medical records have been particularly beneficial to the organisation. The Trust acknowledges the vision of CfH for the delivery of the National Programme for IT and it is determined to use the opportunities within the programme, where timely and proven, to drive improvements in the efficiency and quality of the services provided.
The Information Team has provided very good output from the patient-based information systems and is effectively developing QlikView as a powerful analytical and reporting tool. The development of this `Business or service Intelligence' environment together with the growth of the data repository will have a major impact on the ease of access to information and the value gained by Trust staff.
There is an obvious `can do' mentality in the Informatics team. This, together with a grounded approach, has led to a strong set of current work plans. It will be important to ensure each of these is developed and interlinked as part of the work plans for the next three years, and is clearly able to be shown to support the overall Informatics Strategy, which itself is shown to support the strategic priorities of the Trust.
The Trust recognises that there is considerable benefit in developing the existing systems already in place, in particular in support of patient safety, effectiveness of patient care and Trust efficiency.
The Trust intends to move forward as fast as possible with the procurement of integrated electronic care records. It will work closely with the Local Service Provider (LSP) to influence the development of the Lorenzo suite of applications, but will regularly review this against other possible solutions so that, following a full business case process, the Trust can procure systems that offer the most improved functionality. Given the current capability provided by the existing systems in the Trust, it is likely that Order Communications will be the most urgent element of a Care Records Service to procure.
The PACS system has proved to be a major success and it is extremely popular with clinicians.
Strengths
The Information Systems and Analysis team has several strengths including:
The strength and depth of the team
A natural innovative style
A flexible approach
The positive external perception
Track record for delivery
The Information Systems and Analysis team needs to build on its current strengths to:
Maintain innovative methods of providing:
Information at the bedside
Measurement of key quality metrics
Measurement of outcomes
Better support of clinical and consultant groupings
Information in real time
Information for use in predictive modelling
Provide patient access, including the ability for them to update their own information
Provide IT systems that
Are used and recognised as adding value
Support the improvement of patient safety
Capture and record data once, and allow its use many times
Concerns and Weaknesses
While the Trust remains committed to playing a full role in the National Programme for IT, the delays and uncertainty in deployment dates have impacted on the confidence in the Care Record Service.
The Trust has achieved a great deal from its patient administration systems and there is a clear need to demonstrate that this can be built upon to provide a fully electronic care record. The Trust will continue to carefully review and assess the Lorenzo suite of products provided by the LSP, but at the same time consider other offerings that might be able to more closely meet the needs and timescales of the Trust. A full business case would be required for the Trust to procure any significant solution in place of Lorenzo.
The longer the existing HISS solution has to remain in place, as a result of the delays in the delivery of Lorenzo or the identification of other suitable offerings, the greater the risk is that the current legacy system will be maintained by the supplier to a level able to reflect the regular changes (both technical and standards based) required to continue the satisfactory management of patient records and the provision of national returns and datasets.
There is an increasing need to accelerate the programme to replace existing desktop equipment. It will be important to roll out as many thin client solutions as possible, but this requires the infrastructure to be in place to do so. However, with the appropriate funding this replacement programme provides the opportunity to introduce leading edge technology.
In order to build confidence with patients and the public that CUH should be their choice for the provision of care, there needs to be an extension to the range of data collected. This is increasingly important as the growth in population in the local health economy both continues at it current rate and also with the diversity currently experienced. For example, the ethnicity of patients will be a crucial data element to capture in order to better tailor support information.
The Information Systems and Analysis team acknowledges that there are areas of weakness that must be focused upon:
Recognising that substantial expertise is held within a small set of individuals
Needing to spread this expertise through training
Data security, which is understood as a key topic but there isn't felt to be sufficient depth of expertise to provide comfort. Policies and procedures are required to empower managers to handle their own Information Governance
How to develop the team to continue to ensure it has the requisite links with senior Trust management and clinicians
How best to handle the heavy workload across the team whilst trying to minimise stress levels for the individual.
Leadership of Informatics
The Trust needs dedicated Informatics leadership to drive the implementation of this Informatics strategy, building relationships internally with stakeholders, and forming productive and beneficial external partnerships with:
Local Commissioners (PCTs and practice-based commissioners)
Neighbouring NHS partners and local authorities
The Local Service Provider
Related research organisations
Other external service providers.
The Trust strategic direction will continue to require the development of stronger and closer partnership working with other providers within the health community as clinical networking expands.
Any interim leadership in Informatics must retain and develop links with external organisations as well as maintain the internal links. This is particularly so for the relationship with the Local Service Provider for CRS (Computer Science Corporation). The key objective for the Trust will be to maintain and drive from a strong `informed client' view of what is needed and why.
CUH should be assertive but also collaborative to ensure that the LSP and other service providers fully understand the requirements and ambition of the Trust. As a successful Foundation Trust, CUH should continue to expect a responsive and supportive relationship with the LSP independent of the SHA.
The Three Year Work Programme
Overview
This section details the work plans being put in place to underpin the Informatics Strategy for CUH over the next three years.
Each of these work plans builds upon the strengths, address the weaknesses, and make progress towards the realisation of the vision for Informatics that is set out in previous sections.
While the detailed actions within the plans are identified in the tables in the Appendices, this next section summarises each work plan with its main objectives.
The Key Work Programmes to support the three year Informatics Strategy
The strategic priorities for Informatics in CUH over the next three years are focused through a set of five work programmes. A brief summary of these programmes is given in Table 6-1. The detail, on a year by year basis, of each work plan is given in the Appendices.
Table 6-1 Summary of the key Work Programmes
|
Work Programme |
Brief description |
1 |
Systems Development See Appendix ref 1 |
Continue to build on current programmes and activities to implement systems to provide support for clinical and administrative processes across the Trust. Identification and procurement of systems to replace the current HISS. In addition develop clinical decision support and the provision of information at the point of care |
2 |
Single point of collection, multiple use See Appendix ref 2 |
Manage the data and information required by the Trust so that it is collected only once (in full), used many times, and has value added to it. Provide information in the location and at the time it is required to help enable clinicians and managers to improve both patient care and safety, and the patient experience |
3 |
Data Security See Appendix ref 3 |
Development of a robust plan for data security and information governance across the Trust |
4 |
Infrastructure See Appendix ref 4 |
Continue the plan currently underway to roll out wireless across the Trust, to complete the consolidation of servers, and to begin replacement of PCs with `thin client' technology. Plan the strategic replacement of the core network |
5 |
Developing People See Appendix ref 5 |
Outline plan for workforce development to support the informatics agenda both within and without Information Systems and Analysis |
6 |
Customer Service See Appendix ref 6 |
Develop the plan for a customer focused IT service for all users within the Trust |
How the Work Plans underpin the Trust Priorities
As was noted in section 2.1, the Trust's aim is to be renowned as an organisation of innovation and excellence in health and care through the achievement of the following strategic priorities:
Improving the experience of patients
Improving patient care and safety
Ensuring clinical excellence and effectiveness
Valuing our staff and partners
Striving for innovation in all we do
In summary terms, the objectives and activities within the five work plans underpin each of these priorities as follows (albeit not completely implemented over the period of this strategy):
Improving the experience of patients
It is our vision that as patient pathways are agreed and implemented, supported by the appropriate information systems, patients will notice a major difference in the way they are managed. They will only be asked for their information once, they will be better informed of what is happening to them, they will find multiple events better coordinated, and each care worker they interact with will be fully up to speed on both their records and their progress through their pathway.
The IT infrastructure will provide wireless capability across the site allowing patient information to be accessible anywhere and everywhere the patient is.
Information will be accessible, both inside and outside the hospital site, providing patients and the public with valuable background to their treatment and more generally to health issues.
Patients will clearly see that their own information is, on the one hand, in front of each clinician as care is provided, whilst on the other hand not accessible by anyone else.
Improving patient care and safety
Care Protocols and Pathways will ensure that agreed standard processes of care are followed. This will dramatically reduce the possibility for clinical error and will ensure the best evidence-based treatment regimes are followed.
The implementation of ePrescribing will mean that drug dosages and contra-indicators will be constantly reviewed, resulting in both a more efficient usage of drugs and also more effective regimes of care.
Electronic communications on discharge will provide the appropriate information to Primary and Community care in a timely way to enable the best reception of the patient once they leave the Trust.
Ensuring clinical excellence and effectiveness
The well recognised and accepted clinical expertise and knowledge held within the Trust will be used to refine and develop care pathways to further improve clinical outcomes.
By constantly improving pathways and methods of care provision based on evidence of previous activity will ensure clinical excellence is provided in a way that is also the most effective for the usage of resources across the Trust.
Valuing our staff and partners
The Developing People work plan looks at how to train people from every specialty in the Trust in the use of information. Together with high profile communications, staff will be clear as to how to most effectively use the available information to most effectively do their job.
Staff will feel better empowered through their knowledge of the available information and patients will recognise that they are both treated as individuals and also are valued by their carers.
Striving for innovation in all we do
The Information Systems and Analysis team is clear that it will not implement systems and services that have not yet been proved to work appropriately in a similar environment. However, they are constantly looking at developing technologies.
It is intended that the Trust will use tried and tested systems in an innovative way, maximising the advantage of such technologies whilst minimising the risk of their use. This is a vision; it will take time to implement. However, testing combined technologies together in one clinic area will allow us to `trial' in a `live laboratory' the benefits and pitfalls of our approach. We will need commitment, tenacity and resource to make this happen.
Instigating the first cross-cutting Pathway project
Section 4.2 outlined the importance of patient pathways in enabling the Trust to realise its strategic priorities. A crucial role for Health Informatics is to be the enabler of these pathways by underpinning the transformed processes. This will start to happen during the lifetime of this plan. It is key, however, that one or two important pathways are mapped and supported by Informatics early to both kick start the work and also to act as a showcase to enable clinical staff to see and critique the benefits that accrue from such a project.
This project will need to be driven by the Information Systems Board, and require active involvement and committed time from members of the Board on behalf of their teams. Whilst Health Informatics provides the fundamental information to underpin the pathway this is a process transformation project. As such it is crucial that the patient pathway team, together with the local clinical operations are fully and actively involved.
The project will need an Executive Sponsor and will need strong operational and clinical leadership.
Careful selection of the first project is required. Key criteria will be
Where an ICP(s) is already in operation, either on paper or electronically.
A clinical team is committed to implementing the project, including the provision of dedicated human resource.
The pathway has an `emergency front door' to test integration with ED and EAU
There is support from community teams to engage in the project and test processes for communication external to the organisation at discharge
A discreet physical location for specialty patients to allow for the deployment of a wireless network, RFID and mobile computing.
Opportunities for process outcome and clinical outcome improvement
6.4.5 Any decisions regarding the choice of specialty will be taken in consultation with clinical directors, the ISPB and Directors.
General work to support a pathway such as this is already contained in the individual work plans, but a specific project plan would be required over an above this version of this strategy.
Appendices
The following appendices detail the five work plans that support the Informatics Strategy as follows:
1. Systems Development
2. Single Point of Collection, Multiple Use
3. Data Security
4. Infrastructure
5. Developing People
6. Customer Service
Each work plan has a section for the year 2008/98 and then a second section covering the following two years (2009/10 and 2010/11).
7. Glossary
Cambridge University Hospitals NHS Foundation Trust Strategic Informatics Plan |
||
Ref |
Work Plan (Year 1) |
Outputs and Deliverables 2008/09 |
1 |
Systems Development
|
New Systems
Current Systems
JCIS/Cancer Programme Objectives
|
Cambridge University Hospitals NHS Foundation Trust Strategic Informatics Plan |
|||
Ref |
Work Plan (Years 2 and 3) |
Outputs and Deliverables 2009/10 |
Outputs and Deliverables 2010/11 |
1 |
Systems Development
|
New Systems
|
|
Cambridge University Hospitals NHS Foundation Trust Strategic Informatics Plan |
||
Ref |
Work Plan (Year 1) |
Outputs and Deliverables 2008/09 |
2 |
Single Point of Collection Multiple Use |
The ability to have accurate information available at the right time, in the right place, will be a key component in the drive to develop services, work more efficiently and promote clinical effectiveness. Data Completeness
Business Intelligence
Data Warehouse
Patient Level Costing
Staff Development See developing people. |
Cambridge University Hospitals NHS Foundation Trust Strategic Informatics Plan |
|||
Ref |
Work Plan (Years 2 and 3) |
Outputs and Deliverables 2009/10 |
Outputs and Deliverables 2010/11 |
2 |
Single Point of Collection Multiple Use |
Business Intelligence
Data Warehouse
Patient Level Costing
Staff Development
|
Business Intelligence
Data Warehouse
|
Cambridge University Hospitals NHS Foundation Trust Strategic Informatics Plan |
||
Ref |
Work Plan (Year 1) |
Outputs and Deliverables 2008/09 |
3 |
Data Security (Information Governance) |
Information Governance
- Data Protection - Records: Preservation, Retention and Destruction - Confidentiality of Personal Health Information - Removable Media Policy written - Encryption of Removable Media Procedure written - All above compliant with national directives and requirements in relation to information governance and NHS Litigation Authority. - All above policies and procedures for Board approval March 08
- Full programme to start April 08
|
Cambridge University Hospitals NHS Foundation Trust Strategic Informatics Plan |
|||
Ref |
Work Plan (Years 2 and 3) |
Outputs and Deliverables 2009/10 |
Outputs and Deliverables 2010/11 |
3 |
Data Security (Information Governance) |
Including work on national directives:
- Prepare a strategy - Implementation plan - Audit compliance
- more use of e-MR - imaging more documents resulting in only one FCE in a paper format |
|
Cambridge University Hospitals NHS Foundation Trust Strategic Informatics Plan |
||
Ref |
Work Plan (Year 1) |
Outputs and Deliverables 2008/09 |
4 |
IT Infrastructure
|
Infrastructure and Resilience
|
Cambridge University Hospitals NHS Foundation Trust Strategic Informatics Plan |
|||
Ref |
Work Plan (Years 2 and 3) |
Outputs and Deliverables 2009/10 |
Outputs and Deliverables 2010/11 |
4 |
IT Infrastructure |
|
|
Cambridge University Hospitals NHS Foundation Trust Strategic Informatics Plan |
||
Ref |
Work Plan (Year 1) |
Outputs and Deliverables 2008/09 |
5 |
Developing people |
Developing people with the Informatics function
Developing people without the informatics function
|
Cambridge University Hospitals NHS Foundation Trust Strategic Informatics Plan |
|||
Ref |
Work Plan (Years 2 and 3) |
Outputs and Deliverables 2009/10 |
Outputs and Deliverables 2010/11 |
5 |
Developing people |
Developing people with the Informatics function
|
Developing people with the Informatics function
|
Cambridge University Hospitals NHS Foundation Trust Strategic Informatics Plan |
||
Ref |
Work Plan (Year 1) |
Outputs and Deliverables 2008/09 |
6 |
Customer service |
Developing a customer focused IT service
|
Cambridge University Hospitals NHS Foundation Trust Strategic Informatics Plan |
|||
Ref |
Work Plan (Years 2 and 3) |
Outputs and Deliverables 2009/10 |
Outputs and Deliverables 2010/11 |
6 |
Customer service |
Developing a customer focused IT service
|
Developing a customer focused IT service
|
7. Glossary
A&E Accident & Emergency
BI Business Intelligence
CfH Connecting for Health
CRG Care Records Guarantee
CRS Care Record Service
CUH Cambridge University Hospitals NHS Foundation Trust
EAU Emergency Assessment Unit
ED Emergency Department
e-MR Electronic Medical Records
FCE Finished Consultant Episode
HES Hospital Episode Statistics
ICPs Integrated Care Pathways
IG Information Governance
IM&T Information Management & Technology
ISPB Information Systems Programme Board
JCIS Joint Clinical Information System
LSP Local Service Provider
MDS Minimum Data Set
NICE National Institute for Health & Clinical Excellence
NLOP National IT Local Ownership Programme
NME North, Midlands & East
NMEPfIT North, Midlands & East Programme for IT
OCS Order Communication System
OPCS Office of Population Censuses and Surveys
PACS Picture Archiving and Communication System
PAS Patient Administration System
PCTs Primary Care Trusts
PLC Patient Level Costing
PKI Public Key Infrastructure
RBAC Role Based Access Controls
RFID Radio Frequency Identification
SHA Strategic Health Authority
SLA Service Level Agreements
SLR Service Line Reporting
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Addenbrooke's and the Rosie Hospitals - Innovation and Excellence in Health and Care
CUH Informatics Strategy
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Informatics Strategy
Cambridge University Hospitals NHS Foundation Trust
CUH Informatics Strategy
CUH Informatics Strategy
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