Contents

1.0 Current Position 3

2.0 Drivers 11

3.0 The Vision for IM&T 16

4.0 Tactics 17

5.0 The Direct Impact of IM&T on Quality 19

6.0 Financial Implications of the Strategy 23

7.0 Implementation 26

8.0 Key Performance Indicators 29

9.0 Summary 301.0 Current Position

Introduction

High quality information underpins sound decision making at all levels within the Organisation. Information and Information Technology are key to the delivery of high quality patient care and central to the delivery of health reform. IM&T enables patients to maximise their choices and supports the delivery of the most efficient and effective service structures. This Strategy sets out how the Trust intends to develop Information Management and Information Technology (IM&T) to support the achievement of the Trusts vision `to be a first choice provider of mental health and substance misuse services and to make a positive contribution to the provision of learning disability services.

Information Management and Technology departments within a healthcare setting traditionally consist of three components;

The Trust's IT department is currently resourced, with a team of permanent and contract staff, to deliver business as usual functions such as IT equipment procurement, registration authority role allocation, application management (provision of and maintenance of clinical IT systems) and managing new projects. Infrastructure is commonly outsourced in NHS IT Departments and within Derbyshire Mental Health Trust this is also the case.

Information Management involves the provision of services which enable the effective collection and subsequent use of electronically captured Health Service information to support decision making and facilitate delivery of healthcare and promote health

The Trust's Information Management Service has been provided by an in-house team since retraction from Derbyshire Health Informatics Service (DHIS) in April 2007. Over the last two years the team has developed into an established service provider enhancing the value of routinely captured service data by informing decision making and changes to operational practice.

Records Management, or Information lifecycle management, is the effective management of clinical and corporate records and information to support high standards of clinical care, policy formulation and managerial decision making. The Records Management department develops, provides and supports a range of policies, procedures, processes and services which are used by the Trust to manage records through all phases of their lifecycle, from creation to destruction. The processes also provide a framework in which the Trust can ensure compliance with current legislation, National codes of practice and external and internal and external audit, such as NHSLA, Standards for Better Health

Trust records and information are our corporate memory, providing evidence of actions and decisions taken and representing a vital asset to support daily functions and operations. They protect the interest of the Trust and the rights of service users, staff and members of the public. .

Historically Derbyshire Mental Health Services NHS Trust has adopted a number of configurations that support the delivery of IM&T services. This has been a function partly of the number of mergers that have occurred resulting in the current Trust formation but also as a reflection of the adhoc development of mental health care around new service initiatives driven centrally as a result of the National Service Framework (DoH 1999).

Between 2007 and 2008 the three core functions within IM&T were managed within separate Directorates in the Trust (and previously in earlier structures), this led to the core functions developing disparate approaches to IM&T based problems and being separated from the core function of the Trust.

In 2008 the Trust recognised the need to link the three functions back together but importantly to embed IM&T as a central part of Operations, ensuring that the ownership of IM&T issues such as data quality, application requirements, records management and information governance were owned within clinical and operational services rather than being imposed onto them.

Applications

The Trust uses a variety of clinical, non-clinical and supporting software applications. Most recently the strategy for clinical applications has been to implement those delivered by Connecting for Health (CfH) and the National Programme for IT (NPfIT). In 2006, this lead to the replacement of 8 separate systems in the North of the county with the National Care Records Systems based on iSoft's iPM. The Trust has just embarked on a project to upgrade its iPM to Lorenzo and replace two further patient administration systems (CareNotes & Psychotherapy) and to develop the clinical content of Lorenzo as part of the electronic care record to improve patient safety and experience and clinical effectiveness.

The Trust currently has 23 systems spanning clinical, non clinical and corporate functions, appendix A shows the full list by name.. The table below demonstrates the current split

Data Quality

The Trust has established a data quality management framework developing and implementing best practice in the management of data quality. As a result there is an improving trend in the quality of Trust data however a change is required to achieve data capture improvements at the point of data collection to improve timely data recording and prevent waste arising from error reporting and correction.

Facilitation of real time data recording through supportive technology such as the use of Digi-pens has been shown to improve timely data inputting significantly in 2008-09.

Derbyshire Mental Health Services NHS Trust is one of 73 provider Trusts nationally out of 341 (Top 21%) with ALL mandatory returns submitted on time i.e. `0' total missed returns deadlines. 79% of Trusts missed at least one deadline with the worst performing Trust missing 40 deadlines.

Use of Paper Records

Paper records still represent a relatively large part of the Trust clinical and corporate record, and will continue to do so until appropriate electronic solutions are identified. Some clinical information is being recorded on our electronic systems but this is not possible on a Trust-wide basis due to different electronic systems and paper copies are usually required to ensure that the complete record can be accessible to clinical staff. The paper record is, and will continue to be for at least two years, essential in ensuring comprehensive clinical records until the clinical content of Lorenzo is further developed..

Whilst a lot of information which should be retained in the corporate record can be held electronically (currently on shared drives) there are also examples of corporate record types which still need to be retained in paper format, for example legal documentation, those records which need to demonstrate a signature etc. This will change as electronic solutions are identified but will need to be retained in accordance with the Trust Retention, Preservation and Destruction Schedule to ensure that the corporate record is complete and available.

Paper records will therefore need to be maintained in effective filing structures and systems from the time of their creation to their eventual destruction.

Information Governance

The Trust is fully committed to operating within a robust Information Governance framework embedded throughout the organisation to ensure confidentiality, security and quality of all its information assets. This can be demonstrated by year on year improvements achieved through the implementation of the Information Governance Toolkit standards.

Comparative East Midlands results also indicates that Derbyshire Mental Health Services NHS Trust (RXM) is performing well with no `0' scoring standards in 2008-09.

The national average for Mental Health Trusts is 76%. The graph below shows Derbyshire Mental health Trust performs above the national average with respect to the information governance toolkit scores.

Outsourcing

The Trust's IT infrastructure is provided and maintained through a service level agreement (SLA) with the Derbyshire Health Informatics Service (DHIS). DHIS was formed three years ago from the former North Derbyshire Health Informatics Service and the IT side of Derwent Shared Services. DHIS provide the Trust with:

Although the bulk of Information Governance Services are managed within the Trust, some Information Governance support is outsourced to Derbyshire Health Informatics Service. This mainly constitutes Information Governance training provision and some elements of Information Security management with respect to incident investigation.

Derbyshire Health Informatics Service provides two clinical information system trainers as part of the Service Level Agreement exclusively for the Trust in addition to providing basic IT training and Microsoft application training.

In addition, off-site storage of paper records is currently outsourced to two providers.

Technology Landscape

The Trust owns approximately 1200 desktop and laptop PCs. These are a mixture of manufacturers due to the changing contracts provided by the Re-Source hub in recent years. Currently the preferred supplier is hp. The past 5 years has seen a significant increase in the number and standard of the machines in use through an extensive replacement programme. It is recognised though that some machines are still considered old and in need of replacement.

Within DHIS, the Trust owns a number of servers to hold its file systems, email, and various applications. These are standalone systems currently, but DHIS are currently undertaking a Storage Area Network (SAN) project which will enable server virtualisation to be used. The Trust signed up to support this project along with other DHIS customers in 2008.

Computer Networks in use across the Trust Estate have traditionally been VPN connections in the south of the county and fixed lines within the north. With the introduction of the national N3 network, the Trust obtained N3 connections in all its major sites to provide access to the national IT systems. On behalf of their customers, DHIS are currently implementing a Community of Interest Network (COIN) in conjunction with CfH and BT N3 This will replace the fixed lines in the north of the county initially and some of the major links in the south which should result in superior speed and reliability of connections in all Trust locations.

External Assurance

The IM&T Department uses the East Midlands Internal Audit Services (EMIAS) to provide assurance about many of its services and projects. Within the past two years, EMIAS, have investigated and reported on:

2.0 Drivers

Derbyshire Mental Health Services NHS Trust Board has identified 4 Strategic Objectives that are used to define the drivers for the IM&T Strategy

This report builds on Professor Lord Darzi's Next Stage Review by describing how Informatics is supporting the delivery of better, safer care of patients, improving the NHS through better research, planning and management, and empowering patients to make more informed choices about health and care.

The “Darzi challenge to IM&T” identified five functional elements that focused on hospital care that software solutions should deliver to meet hospital clinicians' needs (“Clinical 5”). The Darzi East Midland's list focused on community and primary care and amalgamated with the “Clinical 5” to produce a clinically driven list of IM&T imperatives on a pan-healthcare basis. The list has subsequently become known as the “Clinical 13”.

The following are the challenges that require the Trust to form partnerships and develop local accountability:

The NHS National Programme for IT (NPfIT), is an initiative by the Department of Health in England to move the NHS towards a single, centrally-mandated electronic care record for patients and to connect 30,000 GPs to 300 hospitals, providing secure and audited access to these records by authorised health professionals. The DH agency NHS Connecting for Health (NHS CFH) is responsible for delivering this programme. In due course it is planned that patients will also have access to their records online through a service called HealthSpace. NPfIT is said by the NHS CFH agency to be "the world's biggest civil information technology programme".

The NHS Operating Framework for 2009/10 outlines the need for information enabled service transformation. This Informatics Planning Guidance 2009/10 sets out Department of Health's expectations of providers of NHS funded care in respect of informatics planning.

The expectations have been grouped into three components:

Cost and volume based contract targets have been agreed with the Lead Commissioner as part of the revised 2009-10 block contract. This new contracting approach provides an incentive to the Trust to deliver increased activity and will also reward marketing efforts which result in an increase in demand beyond the limit set in a block contract. In order to avoid the risks associated with such an approach it is essential for the Trust to remain well informed of progress through regular monitoring of actual activity against expected targets so that early remedial action can be taken where necessary.

As part of the revised contract the Trust has agreed with its commissioners that it will adopt early the Clinical Quality and Innovation Framework. This part of the contract will result in a further £500k income into the Trust on achievement of 10 quality based key performance indicators. It is essential that a reporting framework is in place to ensure regular monitoring of performance by managers and for routine reporting against this target set to commissioners.

A Payment by Results (PbR) approach for Mental Health is underway nationally to develop a currency which will be a common set of units for contracting for mental health services in 2010/11. A common assessment tool which groups service users into twenty-one different clusters based on their needs or characteristics is likely to be agreed as the national approach. The tool will contain the Health of the Nation Outcome Scales (HoNOS), as well as additional items to allow allocation to the clusters. Changes to the Mental Health Minimum Data Set (MHMDS) to support mental health PbR is also expected.

Improvements in the collection of relevant data items such as HoNOS and their accurate reflection in the MHMDS is essential to ensure that the Trust maximises on the potential to increase income delivered through increased activity sensitive to levels of care intensity.

World Class Commissioning (DoH 2008) has required commissioning bodies to introduce competition and choice into local healthcare communities. This has resulted in commissioners offering services for tender through formal processes. To ensure that Derbyshire Mental Health Services NHS Trust remains competitive it is essential that formal processes are in place to gather intelligence in a systematic way about competitor Organisations both statutory and non statutory that supports benchmarking and verification processes as well as supporting the successful outcome of tender applications.

Derbyshire Mental Health Services NHS Trust is a responsive organisation to local need. The Integrated Business Plan 2009 demonstrates that there are 5 service developments in the base case and 11 service developments in the upside scenario over the next 5 years that will require IM&T support to be delivered with respect to infrastructure, working practices and performance monitoring.

The Trust is continually striving to improve patients experience and to increase positive treatment outcomes whilst managing the use of resources efficiently. This has led to a number of redesign projects such as the Adult pathway redesign project (section 3.21 Integrated Business Plan 2009). In order to maximise the benefits from projects such as this it is essential that IM&T Services are flexible and responsive to altered need and new ways of working, for example supporting clinical staff to access information whilst not at base.

Service lines are an NHS foundation trust's equivalent of a commercial company's business streams. They are the units from which the Trust's services are delivered, each with their own focus on particular mental health treatment products (conditions/procedures) and their

own specific workforce. Each unit also has clearly identified resources, including support services, staffing and finances. Derbyshire Mental Health Services NHS Trust has already implemented some parts of service-line reporting (SLR), which provides the financial and operational picture for each service, this is being augmented currently by the adoption of the Integrated Management Reporting Tool. Service Line Management (SLM) takes the service line concept to a higher level, providing an Organisation structure and management framework within which clinicians and managers can plan service activities, set objectives and targets, monitor their service's financial and operational activity and manage performance. SLM relies on the production of timely, relevant information that provides the financial, workforce and activity picture for each service line and enables management and leadership teams to carry out analysis of the relationship between activity and expenditure.

3.0 The Vision for IM&T

The delivery of the vision will require achievement of the following key vision components:

delivers high levels of information security.

4.0 Tactics

The Vision will be delivered through the deployment of 6 key Tactics:

The application of the 6 tactics can clearly be demonstrated in the table below that details high level programmes of work that support the strategy delivery:

5.0 The Direct Impact of IM&T on Quality

Quality is best described using three domains (Derbyshire Mental Health Trust Quality Strategy 2009)

The 6 tactics described above linked with the planned implementation detailed in table 1 demonstrates clear benefit in each of the three quality domains as can be demonstrated using the following diagram

IM&T Supporting Quality - Case Studies

Over the past 8 months the Trust has delivered a number of projects that have had a significant impact both upon clinical quality as well as supporting the management of business obligations by delivering timely, accurate and flexible reporting. The following are two such examples where the Trust has broken new ground:

6.0 Financial Implications of the Strategy

The following table details the planned expenditure over the life of the strategy. The Revenue and Capital expenditure is affordable within the envelope laid out in the long term financial model (May 2009). Capital spending is used to deliver improvement projects such as the implementation of a new software application. In line with Trust procedure capital spend is reviewed and prioritised annually.

The projects detailed in the high level programme of work on page 18 will have a positive impact upon the efficiency of the Organisation. The table below details the impact of the schemes:

The figures shown in this table relate only to either software or infrastructure savings and direct data inputting savings. Other departments within the organisation will be able to release significant efficiencies through altering working practices.

National Programme for IT benefit realisation

Benefits will be realised from the full implementation of a range of computer systems/services linked to NPfIT such as

A component part of each implementation is to maximise efficiency within the Organisation as a whole, for example, reducing the number of servers required and reduction in software licences. In addition, adoption of the above systems will promote alterations in skill mix and capacity requirements within clinical services

New ways of working

A project is being commenced to review processes and structures within the IM&T department in light of opportunities created by technological innovation and application of lean thinking. This will ensure the department's contribution to the organisational cost improvement requirement.

Best Value Infrastructure SLA

The development of robust service specification that clearly details the services required from an outsource supplier will allow a tender process to be undertaken in a very competitive market place. This coupled with the overall shrinking in volume of outsourced requirements will result in improved value for money. The implementation of the single Community of Interest Network (COIN) across the whole local health community takes advantage of the economies of scale brought by Connecting for Health.

Agile Working

The Trust has embarked upon a process of rolling out `agile working'. This is a project whereby staff are assessed within their job role to understand what type of accommodation/base best suits their role and their personal circumstances. Staff members will be designated

Agile working has been proven in both the Public Sector and Commercial companies to increase staff satisfaction, increase productivity through reducing time spent travelling to and from a permanent base and to reduce the required floor space in buildings due to the reduction in desks by moving away from each staff member having their own desk (as at present in many cases) to a culture of `hot desking'. This approach requires increased IT support to staff members to maximise flexibility by way of multi building IT system access, increased use of web and phone conferencing and use of single contact numbers following uptake of Voice over Internet Provider (VOIP) as well as more flexible technical helpdesk support. At present clinical staff must continue to return to an office base to update clinical records within the CPA standard however once the clinical information system is updated through the implementation of Lorenzo which is an electronic patient record in 2012 this will become less of a requirement. The efficiency impact of this working practice change will be to significantly reduce requirement for staff to travel about the County

Application Integration

Technologies such as Blue Prism and IMR allow for automated data transfer and manipulation thus driving efficiencies through reducing the need for manual handling of data. Removal of data handling also increases data quality by reducing human error

7.0 Implementation

The IM&T based departments will undergo a structural review under the leadership of the General Manager for IM&T during mid 2009/10. This review will ensure that they have the capacity and capability to deliver the Trust's strategy. An essential part of the review will be the delivery of a robust implementation plan to support the strategy.

The departments will be structured in such a way that supports the efficient delivery of two key functions

This means different things for each component team.

For Information Technology in summary it includes:

For Information Management this means:

For Record Management this means:

All new projects will be managed using an applied project management tool such as Prince2. New projects will be owned by the department that is requesting the new application with a link being established to support the department from the Information Technology/Management Team as appropriate. Projects will be supported through a number of clear phases:

Appendix 2 shows the IM&T new project management process

8.0 Key Performance Indicators

The key performance indicators (KPI's) linked to Information Management and Technology are derived from a range of national, local and Trust based requirements. The KPI's are divided into 6 core areas:

Each core area has detailed key lines of enquiry behind them numbering 30 in total. The detail behind these key lines can be seen in appendix 3

The strategy over the next 5 years will increase the performance of the Trust against the set 6 KPI's to turn all core areas green as shown below:

A determining factor for the achievement of the last three key performance indicators above is the trajectory agreed with the Strategic Health Authority for the implementation of the single electronic record linked to the National Lorenzo solution, with a current agreed `go live date of 2012/13.

Reporting Timetable

The components of the IM&T strategy will report as follows:

9.0 Summary

The Trust has undergone significant changes in the way it uses information technology to support the delivery of high quality data for internal and external stakeholder use.

The strategy details approaches that will ensure Information management and technology services supports the delivery of high quality efficient and effective services, through adoption of detailed vision components and the deployment of appropriate strategy tactics

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Technology Supporting Quality

Trust Vision for IM&T

To Provide:

The Right Information

At the Right Time

To the Right People

To Support the Delivery of High Quality Clinical Care

Tactics to Deliver the Vision

The Trust is developing new services and revising business process to support the achievement of the 4 strategic Objectives The Trust will adopt new applications in line with this strategy as those systems become available and are deemed to be Fit for Purpose

Reliable, accurate data collection is closely aligned to lean and efficient systems. Staff need to be supported through a number exercises linked to pathway redesign (chapter 5, Integrated Business Plan 2009) and business process re-engineering. This process is essential to deliver best fit IT solutions and behaviour change

The need for the development of adaptive and relevant reporting solutions that provide Organisational insight is essential to the delivery of the strategic vision. Intelligent reporting requires analytical sophistication to proactively discover and understand emerging trends and historical patterns in routinely available information with an eye to predicting and improving business and operational performance.

The world of IT is a fast moving one with developments and innovations in technology being delivered continually. Technology will be matched to the changing and evolving services delivered by the Trust, to improve the business processes of the Trust and enable the patient experience to be one of quality.

Over the life of this strategy there will be an increased need for staff at all levels within the Organisation to become familiar with direct data input, management of information and use of new technology as well as appropriate use of support systems such as email and the intranet.

Many companies have the capability and the drive to deliver the information technology infrastructure for our Trust. A key tactic will be to maximise the use of competition to drive up effectiveness, level of service provision and drive down cost to deliver value for money

Patient Safety

Clinical Effectiveness

Patient Experience

`The Digi-Pen Revolution'

The Trust in common with other Mental Health Trusts has had difficulty with data collection, specifically, timeliness, accuracy and quality. This presented a number of serious problems in accurately reporting activity to commissioners along with potential clinical risks associated with delays in recording contacts, for instance a clinician may not record a visit in the electronic record in a timely way for a number of reasons and this could result in a clinician elsewhere in the mental health system who sees the patient the next day but who does not have access to the paper record not realising the patient was seen the day before

The Trust has implemented a solution known as the `digi-pen'. It is a data capture technology which utilises a pen with an internal camera and CPU, which captures pen strokes entered onto dot matrix paper which mirrors traditional diary sheets that are filled in by a clinician on completion of clinical activity. This encrypted data is sent to a mobile phone via Bluetooth where it is again encrypted and sent via the internet to a host server. This in turn sends again encrypted data directly to the Trust's core information system, populating the relevant fields. Any incorrect entries are sent to a holding station where there are corrected by administrators before being fit to enter the system. The clinician needs little training as the solution replicates existing practices simply utilising a different pen. The technological complexity takes place away from users and allows corrections and reporting without any further user involvement.

Clinicians are not required to return to base to update electronic systems with activity details. This creates ownership from clinicians and develops capacity from reduced travel which supports increased clinical quality for example reduced waiting lists. The data entered is contemporaneous to the event being recorded, thereby addressing timeliness and meaningful reporting, whilst supporting improved risk management as clinicians have real-time data about when a patient was last seen.

Clinicians are very positive about the digi-pen, they feel they have been invested in with a technology which works for them as well as the organisation. In addition it has stimulated clinicians enthusiasm for new technology and there have been a number of examples where clinicians have proposed alternative uses for this technology that will further improve Organisational efficiency as well as clinical effectiveness.

Integrated Management Reporting

The Problem

Lack of timely information to manage services effectively due to disparate sources of information delivered piece-meal at differing timescales.

The Solution

Integration of all business relevant information - Human Resources, Financial Resources and Service Activity - into a single source using Business Intelligence software from which reports on all relevant information, viewable at different organisational levels, are readily accessible by managers as and when they need it.

The Benefits

Facilitation of effective service management to deliver high quality patient care: