Paper ID: HIS-09-032
BARN
R ET
E ,
T EN
E FIEL
E D
L AND HA
H RI
R NG
N E
G Y
E
Y HEA
E LT
L H INFORM
R A
M TI
T CS
C SER
E V
R I
V CE
C
EN
E ABLI
L NG
G STR
T ATE
T G
E Y
Y
APRI
R L
L 09 TO
T MA
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A C
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H 20
2 12
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Table of contents
1.
INTRODUCTION ............................................................................................................4
2.
STRATEGIC CONTEXT....................................................................................................5
2.1. HIGH QUALITY CARE FOR ALL ...............................................................................5
2.2. HEALTH INFORMATICS REVIEW ..............................................................................6
2.3. WORLD CLASS COMMISSIONING ............................................................................7
2.4. HEALTH CARE FOR LONDON .................................................................................7
2.5. KEY INFORMATICS PLANNING THEMES...................................................................8
3.
LOCAL CONTEXT...........................................................................................................9
3.1. BEH CLINICAL STRATEGY.......................................................................................9
3.1.1.
CLINICAL STRATEGY RECOMMENDATIONS ............................................9
3.2. PRIMARY CARE STRATEGY ...................................................................................10
3.3. OTHER CONSIDERATIONS....................................................................................10
4.
DELIVERING THE VISION, DEFINING THE STRATEGY......................................................11
5.
STRATEGY AIMS AND OBJECTIVES................................................................................12
5.1. PATIENT FOCUSED INFORMATION .......................................................................12
5.2. UNDERPINNING SERVICE TRANSFORMATION........................................................13
5.3. DATA QUALITY AND INFORMATION GOVERNANCE ..............................................14
6.
BEH HIS STRATEGIC WORK PROGRAMMES ....................................................................15
7.
ALIGNMENT TO OBJECTIVES AND GAP ANALYSIS..........................................................16
7.1. ROBUST ARRANGEMENTS TO PROTECT PATIENT DATA ........................................16
7.2. A METHOD FOR DOCUMENTING AND COMMUNICATING EVIDENCE BASED CLINICAL
PATHWAYS TO SUPPORT BOTH COMMISSIONING AND CLINICAL PRACTICE. .................17
7.3. AN INTEGRATED PATIENT RECORD SHARED ACROSS ALL HEALTH AND SOCIAL
CARE SETTINGS...........................................................................................................17
7.4. THE NEED FOR COMPREHENSIVE AND ACCURATE INFORMATION AND OUTCOME
DATA TO SUPPORT COMMISSIONING...........................................................................17
7.5. THE NEED FOR PATIENTS TO BE ABLE ACCESS INFORMATION TO SUPPORT THEIR
HEALTH AND HEALTHCARE. ........................................................................................24
7.6. THE NEED FOR A FAULT TOLERANCE INFRASTRUCTURE TO SUPPORT 24/7
HEALTHCARE DELIVERY...............................................................................................24
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7.6.1.
BENEFITS ............................................................................................25
7.6.2.
STRATEGIC FIT ...................................................................................25
7.6.3.
EXISTING RESILIENT INFRASTRUCTURE ................................................26
7.6.4.
PROPOSED FAULT-TOLERANT INFRASTRUCTURE .................................28
7.6.5.
USER SUPPORT....................................................................................29
7.6.6.
APPROACH .........................................................................................30
8.
ENABLING THE STRATEGY ...........................................................................................31
8.1. MANAGING THE PROGRAMME .............................................................................31
8.2. FINANCING/ RESOURCING THE STRATEGY ...........................................................31
8.3. STAKEHOLDER AND STAFF COMMUNICATION .....................................................32
8.3.1.
THE PATH TO COMMITMENT...............................................................32
8.3.2.
KEY MESSAGES....................................................................................32
8.4. RISK / CHALLENGES FOR SUCCESS.......................................................................34
8.5. REALISING THE BENEFITS.....................................................................................34
9.
ORGANISATIONAL DEVELOPMENT ...............................................................................35
9.1. BEHHIS STAFF DEVELOPMENT..............................................................................36
10. PERFORMANCE MONITORING ......................................................................................37
10.1. NATIONAL ..........................................................................................................37
10.2. LOCAL ................................................................................................................37
10.3. INTERNAL ...........................................................................................................37
11. APPROVAL PROCESS ....................................................................................................37
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1.
1
INTR
T O
R DUCT
C I
T ON
Barnet, Enfield and Haringey Local Health Community (BEHLHC) recognises the significant
role that Health Informatics will play in modernising the NHS.
Barnet Enfield and Haringey Health Informatics Service (BEHHIS) is the major provider of
Health Informatics Services to
• Barnet, Enfield And Haringey Mental Health Trust
• NHS Barnet
• NHS Enfield
• NHS Haringey
BEHHIS is part of NHS Enfield which acts as the Host Trust. The organisation has its own
governance structure reporting via the BEHHIS Stakeholder board to the Host Trust board.
BEHHIS has made considerable progress in working with stakeholders to deliver National
Programme for IT (NPfIT), London Programme for IT (LPfIT) initiatives and local strategic
developments.
This document will help the BEHHIS to
• Be clear about the scope of strategic Informatics developments through
o Establishing clear development paths.
o Defining where and when developments will take place and how they will be
managed.
o Understanding the financial impact and how developments will be resourced.
o Identifying and ensuring the benefits are realised.
• Share a vision, aims and objectives and explore what they will mean for the
development of Informatics by:
o Being clear about how Informatics will improve services for patients.
o Setting out how informatics will support individual Trust strategies.
o Provide a framework for strategic investment decisions.
• Undertake the governance role of Informatics agenda by:
o Establishing clear governance arrangements for the implementation of the
strategy.
o Setting out the arrangements for monitoring outcomes.
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2.
2
STR
T ATE
T G
E I
G C
C CO
C NTEX
E T
X
The NHS Operating Framework for 2009/10 outlines the need for local Informatics Planning
with board level ownership and support to deliver information enabled service
transformation.
Informatics planning for 2009/10 is set in the context of the NHS Next Stage Review report
High Quality Care for All, the Health Informatics Review and the drive to achieve World Class
Commissioning Standards.
2.
2 1.
1
Hi
H gh
g
h Qua
u l
a ity
y Ca
C r
a e for
o All
The immediate steps identified by this review are:
• Every primary care trust will commission comprehensive wellbeing and prevention
services, in partnership with local authorities, with the services offered personalised
to meet the specific needs of their local populations. Our efforts must be focused on
six key goals:
o Tackling obesity
o Reducing alcohol harm
o Treating drug addiction
o Reducing smoking rates
o Improving sexual health
o Improving mental health
• A coalition for Better Health, with a set of new voluntary agreements between the
Government, private and third sector organisations on actions to improve health
outcomes. Focused initially on combating obesity, the Coalition will be based on
agreements to ensure healthier food, to get more people more physically active and
to encourage companies to invest more in the health of the workforce.
• Raised awareness of vascular risk assessment through a new ‘Reduce Your Risk’
campaign. As we roll out the new national programme of vascular risk assessment
for people aged between 40 and 74, we will raise awareness through a nationwide
‘Reduce Your Risk’ campaign – helping people to stay healthy and to know when they
need to get help.
• Support for people to stay healthy at work. We will introduce integrated Fit for Work
services, to help people who want to return to work but are struggling with ill health
to get back to appropriate work faster.
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• Support GPs to help individuals and their families stay healthy. We will work with
world-leading professionals and patient groups to improve the Quality and
Outcomes Framework to provide better incentives for maintaining good health as
well as good care.
We will give patients more rights and control over their own health and care. We will:
• Extend choice of GP practice
• Introduce a new right to choice in the first NHS Constitution
• Ensure everyone with a long-term condition has a personalised care plan
• Pilot personal health budgets
• Guarantee patients access to the most clinically and cost effective drugs and
treatments.
2.
2 2.
2
He
H al
a th
t
h Inf
n or
o mat
a i
t cs
c Re
R view
The Health Informatics Review was commissioned by the NHS Chief Executive and the
Department of Health Permanent Secretary to:
• Assess the supply of, and demand for, information across the NHS and
Social care, so that the data collected can be used to provide valuable and
relevant information
• Make sure that, five years after the commissioning of the
National Programme for IT, the framework for the NHS Care Records Service and
the Secondary Users Service (SUS) is in line with recent, current and potential
future policy
• Make sure that the governance of informatics within the NHS and the
Department of Health (DH) is clear and appropriate and supported by the right
management structure
The term ‘informatics’ has been used to cover information, technology, processes, analytical
tools and techniques, governance and the skills needed to use all of these to improve
healthcare.
This review has been taking place alongside the NHS Next Stage Review (NSR) and reflects
the informatics requirements of that review. Groups of staff, patients, carers and the public
have been looking at clinical pathways and new ways of providing care. There are needs to
support access and choice, the involvement of patients and the public and to meet
increasing expectations. These make this the appropriate time for a review of information
requirements and how information is provided. The review is also timely because of
technological advances and the rise of the importance of information to society in general.
Good informatics services are vital to delivering the health and social care services we hope
for and the only way of knowing how well we have delivered. By focusing on high quality
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informatics services, we will improve patient experience and enable NHS staff to make better
use of information to improve the quality of care.
2.
2 3.
3
Wor
o ld Cl
C as
a s Com
o m
m i
m ssionin
i g
The world class commissioning programme will transform the way health and care services
are commissioned. It will deliver a more strategic and long-term approach to commissioning
services, with a clear focus on delivering improved health outcomes. World class
commissioning will deliver:
• Better health and well-being for all:
o People will live healthier and longer lives
o Health inequalities will be dramatically reduced.
• Better care for all:
o Services will be evidence-based and of the best quality
o People will have choice and control over the services that they use, so they
become more personalised.
• Better value for all:
o Investment decisions will be made in an informed and considered way,
ensuring that improvements are delivered within available resources
o PCTs will work with others to optimise effective care.
2.
2 4.
4
He
H al
a th
t
h Car
a e for
o Lon
o d
n on
Health care for London is an ambitious ten year plan to transform health and healthcare in
the capital. Led by London’s 31 PCTs Healthcare for London will deliver world class health
care for all Londoners.
The programme consists of a number of related projects which have been organised to
transform the health and healthcare of London, the projects include;
• Maternity
• Children and Young People
• Stroke
• Long Term Conditions
• Local Hospitals
• Unscheduled care
• Mental Health
• Polyclinics
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• Major Trauma
2.
2 5.
5
Ke
K y
y Inf
n or
o ma
m t
a i
t cs
c Pl
P an
a n
n i
n ng
g Th
T e
h me
m s
The NHS Operating Framework for 2009/10 outlines the need for local Informatics plans to
address the following key themes:
• Developing Information led rather than systems led planning, that is integral to local
service plans for delivery of the SHA vision for achieving High Quality Care for all and
World Class Commissioning Competencies.
• Establishing robust LHC structures and governance arrangements for Informatics
planning that are inclusive of all key organisations and deliver informatics
developments to support patient pathways across health and social care settings.
• Ensuring that Informatics capability and capacity is expanded at all levels to make
available knowledge skills and resources to support long term visions.
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3.
3
LO
L CA
C L
L CO
C NTE
T X
E T
The BEHHIS Enabling strategy has been derived from the business visioning work that has
been undertaken within the BEH Clinical Strategy and the associated local Trust strategies, in
particular the Primary Care Strategy.
3.
3 1.
1
BEH
E
H Cl
C ini
n ca
c l
a Str
t ate
t gy
g
Barnet, Enfield and Haringey Primary Care Trusts (PCTs) have been working together to plan
safer and stronger services for these three boroughs, and the residents of Hertfordshire who
use these services, since mid-2006. This collaborative working has resulted in the
development of the Barnet, Enfield and Haringey (BEH) Clinical Strategy which sets out a
vision for change in local health service provision.
The proposals within the Clinical Strategy were consulted on from 28th June to 19th October
2007 and the views of respondents were sought in a series of questions accompanying the
consultation proposals. The proposals focussed on changing the distribution of services
between Barnet Hospital (BH), Chase Farm Hospital (CFH) and North Middlesex University
Hospital (NMUH) mainly in response to safety and quality issues and the PCTs plans to bring
services closer to people’s homes. We also consulted with those residents of Hertfordshire
who use BEH services. Residents of Barnet, Enfield, Haringey and Hertfordshire also use a
variety of acute hospital services, other than those focussed on in the Clinical Strategy, and
there were no proposals within the Clinical Strategy to change access to these other
providers.
3.
3 1.
1 1.
1
Cl
C ini
n ca
c l
a str
t ate
t gy
g
y reco
c m
o me
m nd
n at
a i
t on
o s
n
The BEH Clinical Strategy Project Board recommends the adoption of Option 1, with the
following steps:
• The establishment of appropriate implementation management arrangements.
• An independent, clinically-led review to determine which types / volumes of
inpatient elective surgery should be accommodated on the Chase Farm site. Key
stakeholders including representatives of patients and the public will be involved
in this process and decisions will be made on the basis that elective surgery
wherever taking place must be safe, deliverable and sustainable.
• Transfer of Womens’ and Children’s inpatient services from Chase Farm Hospital
will take place once the PCTs are satisfied that there is adequate capacity at Barnet
Hospital and North Middlesex University Hospitals.
• Changes to A&E services at Chase Farm Hospital will take place when the PCTs are
satisfied that there is capacity at Barnet Hospital and North Middlesex University
Hospital and also that community and primary care services would be able to
accommodate changes in patient flows.
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• The establishment of a Transport Working Group to make recommendations for
change to help address transport issues.
• That work continues on the EIA Implementation Plan and it becomes an integral
part of the implementation process.
3.
3 2.
2
Pr
P ima
m r
a y
y Ca
C r
a e Str
t ate
t gy
g
The key features of the Primary Care Strategy include:
• Redesigning the Model of Care
• Care closer to home
• Fewer sites, larger fit-for purpose premises
• Commissioning and Procurement
• Engaging patients and stakeholders
3.
3 3.
3
Oth
t e
h r Co
C ns
n iderat
a i
t ons
n
The NHS Plan (July 2000) introduced the Government’s intention to link the allocation of
funds to hospitals to the activity they undertake. It stated that in order to get the best from
extra resources there would be major changes to the way money flows around the NHS.
Hospitals would be paid for the activity they undertake and this is a system of Payment By
Results (PbR).
The aim of PbR is to provide a transparent rules based system for paying Trusts through
activity adjusted for casemix; Health Resource Groups (HRGs).
Payment by Results has been introduced incrementally into the NHS since 2005/06, with a
new version of HRGs being introduced in 2009/10 which introduces the concept of
unbundling to support the principles enshrined in Our Health Our Care Our Say and the
development of Autonomous Provider Organisations.
Work continues on developing currencies for use in commissioning for Mental Health
services for adults and older people. The ultimate goal is the creation of a national tariff for
these currencies.
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4.
4
DELI
L VE
V R
E I
R NG
G TH
T E
H
E VI
V SION, DEF
E INING
G TH
T E
H
E ST
S RA
R TE
T G
E Y
The strategy provides a framework for the provision, collection and management of
Information using appropriate technology and processes. The aim is to provide a rolling
programme to address:
• The many and dynamic national drivers and must do’s.
• The local imperatives both within the BEHHIS partnership and the individuals
stakeholder Trusts.
• The use of ICT as an enabler to assist the Trusts to work more efficiently and
effectively.
Much has been achieved locally to date to deliver individual Trust’s existing ICT strategies.
The BEHHIS enabling strategy will coexist with the individual trust strategies and plans.
Over the next three years there will be three categories of work associated with the BEHHIS
Enabling Strategy. The vision for each of these strategy categories is as follows:
• Pati
t en
e t
n
t F
o
F cu
c s
u sed
e I
nf
n o
f rm
r ati
t on
o
BEH HIS will work to make available immediate access to routine and high quality patient
focussed information which allows seamless care across organisation boundaries.
• Und
n er
e pi
p nn
n i
n ng
n
g S
er
e v
r ice
c
e T
rans
n fo
f rm
r ati
t o
i n
BEH HIS will ensure that the strategy is backed up by focussed and up to date enabling
processes, including policies and procedures, learning and development and programme and
project management practice, etc.
• Data
t Q
u
Q a
u li
l ty
t
y a
nd
n I
nf
n or
o m
r ati
t on
o
n G
o
G ver
e na
n nc
n e
c
BEH HIS will have in place the necessary Informatics related tools and training to enable
improving the quality and safety of patient care through better data quality and Information
governance.
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5.
5
STR
T ATE
T G
E Y
Y AIMS
M AND
D OBJE
J C
E T
C I
T VE
V S
E
5.
5 1.
1
Pat
a i
t ent
n
t Foc
o us
u ed Inf
n or
o m
r at
a i
t on
o
Patien
e t F
ocu
c sed
e In
I forma
m tion
o
Aim
Obje
j cti
t ves
1. Developing information led rather
a) Integrate Health Informatics
than systems led planning.
initiatives into local service plans for
delivery.
2. Whenever possible BEH HIS will
a) BEH HIS will always consider/
support integration models of
participate in joint working focused
working e.g. health and social care.
on securing integrated solutions.
b) Within valid business cases and
associated project parameters
individual Trust EPRs will be
integrated with partner solutions.
3. Collaborate with national
a) All BEH HIS developments will be
initiatives and programmes to ensure aligned with nationally defined
that BEH Informatics developments
programmes and expectations at all
are informing and informed by
times.
national standards in patients
focused information.
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5.
5 2.
2
Un
U d
n erpinn
n i
n ng
g Service
c Tr
T an
a s
n for
o ma
m ti
t on
o
Un
U der
e p
r in
i nin
i g Ser
e v
r ice T
e ra
r ns
n forma
m tio
i n
Aim
Obje
j cti
t ves
1. A proactive management
a) A valid business case/ justification
approach to ensure that resources
will always be in place for all new BEH
and finances are in place to
HIS developments.
implement and maintain local service
transformation.
b) BEHHIS work programme will be
delivered using the principles of
Managing Successful Programmes
and Prince2 project management
framework.
2. Ensure there is an appropriately
a) 100% of BEHHIS staff will be
ICT trained workforce.
offered core and where appropriate
system specific ICT training.
b) Training model and methods will
be tailored to the staff members
personal development needs.
3. Ensure the Information systems
a) A plan to achieve level 4 of the
infrastructure is modern, fast, robust, NHS Infrastructure Maturity Model
resilient and capable of supporting
will be presented via the Fault
the strategy.
Tolerance Business Case.
4. Collaborate with national
a) All BEHHIS developments will be
initiatives and programmes to ensure aligned with nationally defined
that the LHC Informatics
programmes and expectations at all
developments are informing and
times.
informed by national standards in
b) High priority areas will be
patients focused information.
managed
as per national expectations
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checklist:
• Enabling local service
transformation
• Governance, capability and
capacity
• Benefits and costs
• Technical Infrastructure.
5.
5 3.
3
Data
t
a Qua
u l
a ity
t
y and
n Inf
n o
f r
o ma
m ti
t on
o
n Gov
o erna
n n
a c
n e
c
Data
t Qu
Q ali
l ty
y a
nd
n In
I forma
m tion
o G
over
e n
r an
a ce
Ai
A m
Ob
O jec
e t
c i
t ve
1. Make timely, accurate and
a) Increasingly clinical and
comprehensive information available
managerial decision makers will
to the LHC to assess performance
routinely use the available
and facilitate good decision making
tools/associated information to
based on reliable data for
inform decisions.
management and service
transformation.
2. Collaborate with national
a) All BEH HIS developments will be
initiatives and programmes to ensure aligned with nationally defined
that the BEH HIS developments are
programmes and expectations at all
informing and informed by national
times.
standards in patients focused
information.
b) High priority areas will be
managed as per national
expectations checklist:
• Information Governance.
• Pseudonymisation of patient
data
NHS number and patient
demographics.
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6.
6
BEH
E
H HI
H S STR
T A
R TE
T G
E I
G C
C W
ORK
R
K PR
P O
R GRAM
A M
M E
M S
E
In order to realise the strategic vision, aims and objectives a full programme of work will be
required. An indicative outline work programme for 2009-2011 includes:
Patien
e t F
ocu
c sed
e In
I forma
m tion
o
2009 2010 2011
Provide Strategic advice, Programme and Project Management re
Priority areas as required:
Summary Care Record
*
*
*
Electronic Prescription Service (EPS)
*
*
*
NHS Choices
*
*
*
GP Systems of Choice (GPSoC)
*
*
*
Un
U der
e p
r in
i nin
i g Ser
e v
r ice T
e ra
r ns
n forma
m tio
i n
2009 2010 2011
Enabling Local Service Transformation
*
*
*
Governance, Capacity & Capability
*
*
*
Benefits and Costs
*
*
*
Technical Infrastructure
*
*
*
Data
t Qu
Q ali
l ty
y &
Inf
n o
f rma
m ti
t on G
ov
o er
e na
n n
a ce
2009 2010 2011
Information Governance
*
*
*
Pseudonymisation of Patient data
*
*
*
NHS Number and Patient Demographics
*
*
*
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7.
7
ALI
L GN
G ME
M N
E T
T TO OBJE
J C
E TI
T VE
V S
E AN
A D GA
G P
A ANALYS
Y IS
The key Information requirements identified through our strategic engagements are:
• Robust arrangements to protect patient data
• A method for documenting and communicating evidence based clinical pathways to
support both commissioning and clinical practice.
• An integrated patient record shared across all health and social care settings.
• The need for comprehensive and accurate information and outcome data to support
commissioning.
• The need for patients to be able access information to support their health and
healthcare.
• The need for a fault tolerance Infrastructure to support 24/7 healthcare delivery.
7.
7 1.
1
Rob
o us
u t
t ar
a ran
a g
n e
g me
m nts
t to
o prot
o e
t ct
t pat
a i
t ent
n
t data
t
BEHHIS has arrangements in place to ensure that all our staff receive Information
Governance training. Staff are required to attend refresh training annually in line with
Informatics Planning Guidance.
BEHHIS also has a specialist Business Continuity and Security manager post which
provides support and guidance to our stakeholder Trusts.
The commitment to deploy LPfIT systems as available means that smartcard access is
widely deployed and systems data is stored in secure data centres.
BEHHIS will continue to support each stakeholder in there submissions of the
Information Governance Toolkit.
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7.
7 2.
2
A
A me
m th
t o
h d
o for
o docu
c m
u e
m nti
t ng
n
g an
a d
n com
o mu
m n
u i
n cat
a i
t ng
g evidence
c
e bas
a ed cl
c ini
n ca
c l
a
path
t w
h a
w ys
y to
t
o sup
u por
o t
t both
t
h co
c mm
m i
m ssioni
n ng
n
g an
a d
n cl
c ini
n ca
c l
a prac
a ti
t ce
c .
BEHHIS is exploring the use of Map of Medicine and will work closely with pathway
designers to enable service transformation.
7.
7 3.
3
An
n int
n e
t gr
g at
a e
t d pat
a i
t ent
n
t recor
o d sha
h r
a ed ac
a r
c os
o s al
a l he
h al
a th
t
h an
a d
n soc
o i
c al
a ca
c r
a e
setti
t ng
n s
g .
Continued commitment to the N/LPfIT deployment roadmap and seizing enabling
service transformation opportunities e.g. Polyclinic Developments to work more closely
with other health and social care organisations will allow the integration of patient
records in the life time of this strategy.
7.
7 4.
4
Th
T e
h ne
n ed for
o co
c m
o p
m rehe
h ns
n ive an
a d
n ac
a c
c u
c r
u at
a e
t inf
n or
o mat
a i
t on
o an
a d
n ou
o tc
t om
o e
m dat
a a
a to
t
o
sup
u por
o t
t co
c mm
m i
m ssion
o i
n ng.
g
Barnet, Enfield and Haringey Health Informatics Service has existed since 2001 to
provide Information services to its partners. In 2008 Enfield and Haringey PCTs further
invested in the service to provide an enhancement to the original service offerings
known locally as ‘Intelligent Commissioning’.
Drivers for change to improve information provision include:
•
WCC competencies
•
Creation of Commissioning Support for London
•
Healthcare for London
•
Our Health Our Care Our Say
Different Models for Informatics Provision have been discussed with our stakeholders:
•
Central Analytical Function
•
Co-location
•
Embedding
– Single/ groups of analyst
– Multi disciplinary teams
Page 17 of 37
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The Scope of Commissioning Support for London (CSL) has been considered in the
development of this strategy. The Scope of CSL is currently confirmed as:
•
Data management
•
Validation
•
Modelling
•
Analysis
•
Reporting
For Acute Services only. This will be expanded and extended over the lifetime of this
strategy which will impact the provision of services locally.
The proposed business model for Information Services is shown below:
LEGEND
ESSENTIAL COMPONENTS FOR SERVICE RE-DESIGN
INNER WHEEL
- CSL ACTIVITIES
HEALTH ECONOMY
MIDDLE WHEEL –
HIS ACTIVITIES
LOCAL
A
P
CU
RO
T
COVERING ALL NON ACUTE DATA,
E
V
I
+ ADDED LOCAL KNOWLEDGE
ALL SOURCE DATA
DE
INDEPENDENT
RS
AND ENHANCEMENTS TO
INC. ENHANCING
Data
CSL INFORMATION
Intelligent
ACUTE INFORMATION
Management
commissioning
OUTER WHEEL
CSL
AC \UTE
HEALTH ECONOMY
C
DATA
O
SECTORS
Y
S
M
ACUTE
R
S
E
M
A
E E
Data
R
R
IC
V
U
IM
I
A
T
Modelling
Modelling
management
Data
C
N
R
C
E
I
P
C
A
T
S
validation
Y
R
P
GATEKEEPER
&
&
ACUTE DATA
provider of
& ACUTE DATA
Data
knowledge and
validation
evidence
Reporting
P
P
R
O
I
CSL acute
C
M
L
A
Y
A
Reporting
Assured
3RD
data
C
R
R
data
L
E
Y
Analysis
I
N
I
&
CS
ACUTE
DATA
Local and
Enhancement
non acute
&
through local
data
Analysis
P
ACUTE
knowledge
RESC
DATA
RI
LOCAL
BING
AUTHORITY
Added local
b
knowledge
SECTORS
and evidence
Page 18 of 37
HIS ENABLING Strategy v0.2.doc
Data
AVAILABLE FROM
Data management
RESPONSIBILITY FOR
management
Data
D
a t
a
CSL
LOCAL
ACTION
valida
v t
alio
dn
ation
LCS to proactively chase Acute
Assur
A e
s d
s
ud
r a
e t
da
data
DATA MANAGEMENT
Providers re non or late
Local
Local enhancement
DATA PROCESSING FOR SLA PURPOSES -
submissions and application of
enhancement
SUS APC / OP / A&E De- duplication
National rules.
X
Analy
A s
nis
alysis
National PbR Rules
Data Quality monitored in line with
X
Local PbR Rules
national rules
Repo
Rrt
e in
p g
orting
X
PbR / Non PbR
LCS to implement local rules and
X
unbundled HRG4 prices
Mode
Mlli
o n
d g
elling
DATA PROCESSING FOR PBC & LOCAL
PURPOSES -
HIS to provide local rules agreed at
Intelligent
X
Intelligent commissioning
Technical meetings to LCS to
commissioning
SUS APC / OP / A&E De- duplication
X
National PbR Rules
implement. HIS need to implement
X
Local PbR Rules
locally also to ensure cohesion
X
PbR / Non PbR
between SLA & PBC data. HIS to
Deriving Additional Fields
X
monitor application of these in
Critical Care
X
accordance with agreements.
HIS to use other data sources to
DATA PROCESSING OTHER DATASETS
X
build up holistic view of whole
Prescribing
X
health economy performance and
QOF
X
complete patient pathway
RIO
X
SCAS
Programme info out of scope of
GUM
X
LCS
SITREPS
X
Patients on Programmes
X
Out of scope
Births & Deaths
X
Direct Access
X
Choose & Book
X
Waiting Lists
Local Enhancements & Assurance eg practice
X
mergers
Data
AVAILABLE FROM
Data management
RESPONSIBILITY FOR
management
Data
D
a t
a
CSL
LOCAL
ACTION
valida
v t
alio
dn
ation
Assur
A e
s d
s
ud
r a
e t
da
DATA MANAGEMENT CONTINUED
data
CSL monitor adherence of data to
Local
national standards and communicate
Local enhancement
DATA QUALITY
enhancement
issues with Acute Providers and SUS
SUS / APC / OP / A&E / PBR
X
Analy
A s
nis
alysis
HIS monitor data quality in line with
SUS / APC/ OP / A&E / PBR & Other
specifications from Schedule 5’s.
Repo
Rrt
e in
p g
orting
datasets
Adherence to data quality levels
X
during processing.
Mode
Mlli
o n
d g
elling
Local Enhancements & Assurance
Where data is incomplete, estimates
eg practice mergers
are made to allow reporting to
Intelligent
Intelligent commissioning
continue.
commissioning
Maps local knowledge onto data to
ensure most accurate position is
SUBMISSION OF STATUTORY DATA
reported.
MHMDS
X
SUS / HES
Out of scope
X
GUM
X
ARCHIVE
Archiving of all datasets
X
Datasets available for previous
X
financial years with costs and rules
applied
Page 19 of 37
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Data
AVAILABLE FROM
Data management
RESPONSIBILITY FOR
management
Data
D
a t
a
CSL
LOCAL
ACTION
valida
v t
alio
dn
ation
Assur
A e
s d
s
ud
r a
e t
da
data
DATA VALIDATION
HIS to validate to ensure adherence to
Local
Collection of acute monthly
local and national rules.
Local enhancement
enhancement
Where discrepancies are identified HIS
summary & patient level HRG data
X
to act and communicate these to
Analy
A s
nis
alysis
IP / OP / A&E PbR & Non PbR
Acute Providers to ensure data is
inpatients
corrected at source
Repo
Rrt
e in
p g
orting
Evidence supplied counting &
Mode
Mlli
o n
d g
elling
attribution
Intelligent
GP Attribution
Intelligent commissioning
CSL to contact Acute Providers to
commissioning
X
ensure data is corrected at source
Patient on Programmes
Evidence supplied, counting and
X
HIS to provide to PCT and PCT to act
attribution
Analysis of top level data quality
(DQ) reports & resolution with
X
CSL to liaise with Acute Providers
providers
Analysis of non DQ reports eg
specialities with multiple
?
X
HIS Provides information to
admissions, OP while IP etc
PCT/Agency and PCT acts
Takes responsibility for ensuring
providers submit on time, offers
X
To ensure compliance with Schedule 5
assistance & receive time frame for
rules. HIS to provide information to
resolution
Agency and Agency acts.
Data
AVAILABLE FROM
Data management
RESPONSIBILITY FOR
management
Data
D
a t
a
CSL
LOCAL
ACTION
valid
v a
a t
liio
d n
ation
Assu
Arsesd
u d
reat
d a
data
ASSURED DATA
Local
HIS performs these checks to ensure
Local enhancement
enhancement
SUS Data is checked for
that national and local rules have been
completeness & any major data
X
correctly applied and alerts CSL where
Analy
A s
n iaslysis
quality issues before data is made
there are discrepancies for their
action.
Repo
R r
e ti
p n
o g
rting
available to analysts.
Mode
M ll
o in
d g
elling
If issues occur they are either
HIS make estimates but liaise with CSL
resolved immediately or estimates
to ensure that CSL communicate with
Intelligent
X
Intelligent commissioning
are created to ensure an incorrect
Acute Providers to ensure data is
commissioning
picture will not be reported to the
corrected at source.
PCT.
Any SLA monitoring report
summary figures checked for
X
HIS validates CSL information on
accuracy & compltnss pre reports
behalf of PCTs / Agency. HIS report
go PCT
back issues to CSL/Agency for their
resolution.
Impact of poor quality of data is
X
HIS issue health warnings where poor
made aware to customer for their
data quality could impact on accurate
request.
analysis.
Practice allocation and
X
performance figures checked re
HIS to check and alert PCT to Data
PBC pre publication.
Quality issues
Monitoring of adherence to
Schedule 5
X
HIS informs Agency and Agency acts
Page 20 of 37
HIS ENABLING Strategy v0.2.doc
AVAILABLE FROM
Data
Data management
RESPONSIBILITY FOR
management
ACTION
Data
D
a t
a
CSL
LOCAL
valid
v a
a t
liio
d n
ation
Assu
Arsesd
u d
reat
d a
data
LOCAL ENHANCEMENT
Local
HIS to investigate significant
Local enhancement
PBC Reporting where practices have
enhancement
anomalies against budget and PCTs to
closed / merged etc data edited.
X
act.
Analy
A s
n iaslysis
Applies local rules to data to ensure
accuracy at Practice level.
Repo
R r
e ti
p n
o g
rting
Mode
M ll
o in
d g
elling
Works with providers to derive local
HIS works with Agency & providers,
rules to be applied to SUS data.
agreements reached at Technical
Intelligent
X
Intelligent commissioning
Attends SLA technical meetings for
meetings.
commissioning
input into work around local provider
based issues.
Attends PCT meetings for an
HIS and PCT jointly agree priorities and
understanding of local issues &
X
action plans for resolution.
priorities which can steer analysis and
information priorities.
Meets GP Practices to discuss local
HIS provides realistic interpretation of
info reqs and difficulties for PBC.
X
performance against budgets and
Applies understanding of local perf
provides knowledge of the impact of
against national and local targets,
performance targets on budget
local initiatives & WCC comps to
performance. PCT / PBC to act on
analysis.
information.
Demand Management provides advice
HIS advises PCT on applying
regarding what can be effectively
X
measurable targets to budget baseline
measured.
position.
AVAILABLE FROM
Data
Data management
RESPONSIBILITY FOR
management
ACTION
Data
D
a t
a
CSL
LOCAL
valid
v a
a t
liio
d n
ation
HIS to assure Agency of accuracy and
Assu
Arsesd
u d
reat
d a
data
ANALYSIS
advise of baseline / coding anomalies
Local
which could affect performance.
Local enhancement
enhancement
Identification of key areas of SLA
X
Agency to act on findings.
over performance.
Analy
A s
n iaslysis
Once data has been assured HIS to
Repo
R r
e ti
p n
o g
rting
Identification of key areas of PBC
X
provide analysis of key areas of
over performance.
overperformance along with an
Mode
M ll
o in
d g
elling
understanding of causes. PCT / PBC to
act on evidence.
Intelligent
Analysis of activity changes
Intelligent commissioning
commissioning
individual over performance areas
HIS provides local assurance and
in PBC & SLA assessing activity
evidence around activity shifts and PCT
changes, shifts, discussion with
X
/ Agency to act on this information.
providers to assure true reflection.
Analysis of divergence from
HIS to investigate and PCT / Agency to
national & local targets
X
act.
investigation to establish causes.
Tracking & investigating trends &
CSL to provide an benchmarking data
indicators for sig changes f/fup,
X
X
but HIS to investigate at an SLA and
PBC level and advise Agency / PCTs to
C2C, A&E atts, emergency
act.
admissions, readmissions.
HIS to provide analysis and alerts of
Analysis of patient pathways and
X
discrepancies from NICE guidelines.
Agency to act on Acute element, PCT
demand management initiatives.
to act on complete pathway.
Page 21 of 37
HIS ENABLING Strategy v0.2.doc
AVAILABLE FROM
Data
Data management
RESPONSIBILITY FOR
management
ACTION
Data
D
a t
a
CSL
LOCAL
valid
v a
a t
liio
d n
ation
CSL to provide top level information
Assu
Arsesd
u d
reat
d a
data
REPORTING
with data handled as agreed at
Local
Summarised SLA monitoring reports –
Technical meetings. HIS to assure and
Local enhancement
enhancement
X
collated for all SLAs.
Agency to act on assured findings.
Analy
A s
n iaslysis
Pan London benchmarking information of
X
HIS to assure accuracy of findings.
metrics and activity levels.
Agency to act.
Repo
R r
e ti
p n
o g
rting
PBC Budget reports & Demand Mgt.
X
HIS to provide budget information
Mode
M ll
o in
d g
elling
PBC validation reports (locally defined).
X
including locally defined Demand
PBC evidence for local practice initiatives.
Management targets. PCTs to act.
Intelligent
X
Intelligent commissioning
commissioning
Patients at Risk of Readmission identified to
X
HIS to provide assured information.
community matrons.
PCT and Community services to act.
Trends in metrics such as F/FUP rates &
X
X
CSL to provide first information, HIS to
activity levels.
investigate at SLA and PBC level and
Agency / PCT to act.
Admissions for LTC
X
HIS to provide evidence and PCT to
act.
Admissions for preventable of high profile
X
HIS to provide evidence and PCT to
causes eg Alcohol weighted by QOF.
act.
Quantifying PCT pops UoR across providers
X
HIS to provide evidence and PCT to
A&E / Unscheduled care by PC.
act.
Ad hoc info to PH / Commissioning teams.
X
HIS to provide evidence and PCT to
act.
Patient pathway to produce costed pathway.
X
Reporting on performance of PCT re national
HIS to provide evidence and PCT to
targets.
X
act.
AVAILABLE FROM
Data
Data management
RESPONSIBILITY FOR
management
ACTION
Data
D
a t
a
CSL
LOCAL
valid
v a
a t
liio
d n
ation
Assu
Arsesd
u d
reat
d a
data
MODELLING
Local
Local enhancement
enhancement
Validates and provides acute
baseline information to use as the
HIS to provide evidence to allow PCT
Analy
A s
n iaslysis
basis of modelling for SLAs, PBC
to determine priorities and allow
confident decisions to be made and
Repo
R r
e ti
p n
o g
rting
budgets, CSP/WCC initiatives,
X
risk effectively measured. HIS to
CSP/WCC overall acute activity &
provide evidence PCT to act.
Mode
M ll
o in
d g
elling
values, Operating Plan and some
Intelligent
elements of JSNA.
Intelligent commissioning
commissioning
Models activity required to meet
HIS to provide evidence to allow PCT
waiting list targets and other
to determine priorities and allow
targets as required for the purpose
X
confident decisions to be made and
risk effectively measured. HIS to
of SLA creation / CSP / WCC.
provide evidence PCT to act.
Models impact of activity shifts
HIS to provide evidence to allow PCT
to determine priorities and allow
within the whole health economy
X
confident decisions to be made and
eg shifts from Acute to Primary
risk effectively measured. HIS to
care settings.
provide evidence PCT to act.
Provides local evidence around
HIS to provide evidence to allow PCT
Policy assumptions and provides
X
to determine priorities and allow
Board level narrative around risk eg
confident decisions to be made and
Polyclinics provides increased
risk effectively measured. HIS to
provide evidence PCT to act.
access and therefore demand for x
years.
Page 22 of 37
HIS ENABLING Strategy v0.2.doc
AVAILABLE FROM
Data
Data management
RESPONSIBILITY FOR
management
ACTION
Data
D
a t
a
CSL
LOCAL
valid
v a
a t
liio
d n
ation
Assu
Arsesd
u d
reat
d a
data
INTELLIGENT COMMISSIONING
Local
Local enhancement
enhancement
In depth analysis of current
application of particular patient
HIS to provide evidence to allow PCT
Analy
A s
n iaslysis
pathways, research into current
X
to determine priorities and allow
confident decisions to be made and
Repo
R r
e ti
p n
o g
rting
services provided for local
risk effectively measured. HIS to
population and with
provide evidence PCT to act.
Mode
M ll
o in
d g
elling
recommendations as to value for
Intelligent
money eg maternity review.
Intelligent commissioning
commissioning
Could work closely with Public
HIS to provide evidence to allow PCT
Health to produce gap analysis
X
to determine priorities and allow
from JSNA and stocktake of
confident decisions to be made and
risk effectively measured. HIS to
commissioned services.
provide evidence PCT to act.
Provides complete process for data
HIS to provide evidence to allow PCT
assurance, local enhancement and
to determine priorities and allow
in depth analysis to allow whole
X
confident decisions to be made and
system reporting to be developed
risk effectively measured. HIS to
to enable PCTs to make confident
provide evidence PCT to act.
decisions.
Consideration needs to be given during the lifecycle of the strategy to local Informatics
Provision – Central or Local?
• Both have a role to play in providing high quality information services to PCTs.
• Local informatics provides PCTs with flexible service and assurance that data is being
handled in accordance with local agreements.
• Local informatics service holds central service accountable through informed client
role.
• Patient pathways can be developed locally as have access to broader range of datasets.
• Central service provides an element of core data with local service providing extra
layers of intelligence to provide knowledge for confident decision making.
Page 23 of 37
HIS ENABLING Strategy v0.2.doc
7.
7 5.
5
Th
T e
h ne
n ed for
o pat
a i
t ent
n s
t to
o be ab
a le
e ac
a c
c e
c ss inf
n or
o ma
m ti
t on
o to
o sup
u por
o t
t th
t e
h ir he
h al
a th
t
h
an
a d
n he
h al
a th
t c
h a
c r
a e.
BEHHIS will work with our Stakeholders Trusts re the introduction of HealthSpace. There
are some requirements which will not be met by the provision currently planned by
NPfIT and therefore BEHHIS will work with stakeholders through the Local Health
Community Board to define key work streams for local consideration.
7.
7 6.
6
Th
T e
h ne
n ed for
o a
a fau
a l
u t
t t
ol
o eran
a c
n e
c Inf
n ras
a tr
t uct
c u
t r
u e to
t
o su
s ppor
o t
t 24
2 /7
/
7 heal
a th
t ca
c r
a e
delivery.
y
The purpose of technology is to design, implement and support the applications, tools,
controls and infrastructure required to provide users with access to their electronic
information.
Over the last three years technology services have matured from providing basic services to
providing standardised services; provided clinicians with electronic access to patient
information; improved network uptime from 80% to over 93.5%; improved telephone support
from providing call logging to providing first-line support; and (with the completion of the
desktop and server refresh project and the remote access project) provided a standardised,
flexible desktop and access to applications and information when not connected to the
Trusts' unified network.
During that time requirements and expectations have changed. With the delivery of RiO the
dependence on technology services has increased significantly. Now clinicians, not just
administrators and management, are dependent on technology services; therefore services
need to be available 24 x 7 instead of just 9 to 5, Monday to Friday, and downtime affects
clinicians ability to provided effective care; therefore any unplanned downtime needs to be
reduced to hours instead of days.
The technology vision for the next three years is to mature from providing standardised
services to providing optimised services; close the gap between obligations and
expectations; move from supporting systems to providing services and access to electronic
information to the whole health community; improve system uptime from 93.5% to 99.9%;
increase support services to fulfil the need for 24x7 and extended hours support; and move
from being able to provide disaster recovery to providing business continuity.
The vision for technology
Page 24 of 37
HIS ENABLING Strategy v0.2.doc
• Move from supporting systems to providing services.
• Move from resilient systems to fault-tolerant services.
• Consolidate all services across two data centres.
• Provide logically separate environments on top of a unified physical infrastructure.
• Provide data warehouse and data mining services to support informatics.
7.
7 6.
6 1.
1
Bene
n fits
t
Realisation of the vision will provide the following measurable benefits:
• Availability will be improved from 93.5% (two days of unplanned downtime a month)
system uptime to 99.9% (one hour of unplanned downtime a month) service uptime.
• The impact of a failure will be reduced from potentially affecting all users to affecting no
more than 50 users.
• There will be no call charges for internal calls and calls to other mutually connected
telephone systems including mobiles.
• Recovery time following a catastrophic failure will be improved from weeks to 24 hours.
• 80% of calls will be resolved on first contact.
Realisation of the vision will provide the following immeasurable benefits:
• Support informatics requirement to underpin the implementation of service
transformations.
• Flexibility to quickly respond to changing requirements and expectations
• User satisfaction from providing a reliable, cost-effective service that meets expectations
• Robust security enabling multiple customers to be logically separated while sharing a
single infrastructure.
7.
7 6.
6 2.
2
Str
t at
a e
t gi
g c
c Fit
The Vision has been aligned with:
• NHS Operating Framework
• NHS Informatics Planning Guidance
• NHS Health Informatics Review
• NHS Guidance on Preparing Local IM&T Plans
• Cisco NHS Network Architecture Blueprint
Page 25 of 37
HIS ENABLING Strategy v0.2.doc
7.
7 6.
6 3.
3
Exi
x sti
t ng
g Re
R silient
n
t Inf
n r
f as
a tr
t uc
u tu
t r
u e
St. Ann’s Hospital
Edgware Community
Wenlock House
Hospital
Chase Farm Hospital
Internet
N3
Telephone Network
(PSTN)
Figure 1: Existing Resilient Network
The existing resilient infrastructure supports a wide range of systems at numerous sites;
however there are some limitations to the existing infrastructure including:
• Although there is a network ring linking the main sites ensuring an alternative network
connection should one of the network links between these sites fail; most of the smaller
sites only have a single network link.
• Although the systems are of high quality ensuring that they do not fail often and when
they do fail can be repaired or replaced quickly; they are not fault-tolerant i.e. every
failure causes an outage.
• Systems are located at the sites where they are required ensuring performance and
availability is not impacted by slow or unreliable network site links; however the physical
separation makes it difficult to support and results in massive duplication of systems at
each site.
Page 26 of 37
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• Most sites have there own telephony solution, which again makes it difficult to support
and results in massive duplication, is not fault-tolerant, and does not provide free calls
between sites.
• Many sites rely on N3 connections; however they are not as reliable as claimed, because
they have no backup links and although they are currently free LPfIT will start charging
for them in future.
• The primary data centres at Wenlock House and Edgware Community Hospital do not
have fault-tolerant facilities, and have reached their capacity. The data centres and
computer rooms at the other sites are generally not suitable.
• The primary data centres are also the network hubs; therefore it is incredibly difficult to
move a data centre, since it also requires moving all the network links connecting to the
network hub.
• The current infrastructure requires all users connecting to the network to be trusted,
connected to multiple physical separated networks or complicated security controls.
Page 27 of 37
HIS ENABLING Strategy v0.2.doc
7.
7 6.
6 4.
4
Pr
P op
o os
o ed Fau
a l
u t-Tol
o eran
a t
t Inf
n ra
r s
a t
s r
t u
r c
u tu
t r
u e
r
Large Sites
or Campuses
Medium Sites
> 250 Users
50 – 250
Small Sites
Users
<50 Users
Single
Network
Connection
Shared Dual Network
Connectivity
Dual Network
Connectivity
Network
Network
Hub
Hub
Fault Tolerant
Fault Tolerant
Data Centre 1
Data Centre 2
Shared Services Load Balanced
between Data Centres
Internet
N3
Telephone Network
(PSTN)
Figure 2: Proposed Fault-Tolerant Infrastructure
The proposed fault-tolerant infrastructure will provide a standardised range of services to
any site or customer, which will include the following benefits:
• Fault-tolerance: All services will be provided across two fault-tolerant data centres via
two separate networks, ensuring that any single system failure will not cause an outage.
The limitation is that a single failure can affect up to 50 users connected to a single
network switch; however this can be addressed later by providing an alternative network
connection to each user, for example via a wireless network.
• Reduced Management: Two network hubs provide all sites – including the data centre
sites – with only two (for fault-tolerance) network connections, and similarly reduces the
number of connections to the Internet, N3 and the Telephone Network to two, for
Page 28 of 37
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automatic fail-over, and easier control and management.
• Data Replication: Data will be replicated between the two data centres to allow for load-
balanced and fault-tolerant services to be provided from both or either data centre.
• Increased Security: Virtual networks allow multiple customers to share the same physical
network while remaining logically separated.
• Increased Flexibility: Virtual networks also allow the physical network to be quickly
extended or integrated with other existing networks.
• Centralised Services: All services will be provided centrally (from both data centres) to
simplify support, allow for centralised capacity management, and provide economies of
scale allowing for enterprise level systems to be provided to all users that will
automatically fail-over to the other data centre should any component fail.
• Consolidated Telephony: Telephony will be consolidated allowing for a single shared
telephone directory, enhanced telephony services and free call charges between all
connected sites and to other similarly connected NHS Trusts and mobile providers via N3;
and automatic fail-over of inbound (and outbound) lines in the event of a telephone link
failure.
7.
7 6.
6 5.
5
Us
U er Sup
u por
o t
User support needs to be improved in the following areas:
• Call answer time: Currently the SLA requires calls to be answered on average in 180s;
whereas customers expect 90% of calls to be answered within 10s.
• Call resolution time: Currently there is no SLA against resolution time; although the HIS
has set itself targets to resolve 90% of calls within the following times: Priority 1: < 1
working day, Priority 2: < 2 working days, Priority 3: < 5 working days, Priority 4: < 20
working days, Priority 5: As agreed; whereas customers expectations are that all calls are
resolved with 1 – 2 working days. Similarly customers expect 80% of calls to be resolved
on first contact.
• Service availability: Currently support is available from 9:00 – 5:30 with the Contact
Centre available from 8:00 – 18:00; whereas there is a requirement for 24x7 user support
– particularly for RiO; and extended hours support for Neighbourhood Health Centres
(Polyclinics).
User support service improvements will be achieved through:
• Call Volume Reduction: Systems will be standardised via the Desktop and Server Refresh
project to minimise the different types of calls, and by using Problem Management to
identify and eliminate common calls.
• Call Resolution Time Reduction: Through remote support, support teams will be able to
connect to and administer all systems remotely eliminating the need to schedule a time
with and travel to the user.
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• Self Help: Users will be able to resolve calls themselves by, for example, restoring deleted
files and directories through version control; resetting password through a web based
tool; automated user account creation and disabling through links with HR systems.
• Training: Contact Centre staff will be trained to ensure that they can resolve 80% of calls.
Deskside Support staff will be trained to allow them to provide Problem Management:
identify and eliminate common calls; and maintain the standardised environment.
Application Support will be trained to provide support for the complete range of
applications including the packaging, testing and distribution of new desktop
applications.
7.
7 6.
6 6.
6
Approac
a h
c
The benefits will be delivered through a community programme consisting of multiple
projects over the next 2 – 3 years:
• Desktop and Server Refresh (In progress)
• Remote Access (In progress)
• Network and Telephony Fault Tolerance
• Data Centre Consolidation
• Data Warehouse
• Data Replication
• Virtualisation
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8.
8
ENABLI
L NG
G THE
H
E STR
T A
R TEG
E Y
G
The Health Informatics Strategy and its associated programme of work cannot succeed in
isolation. Consideration must be given to the enabling entities
• Managing the Programme
• Financing/ Resourcing the Strategy
• Stakeholder Communication
• Risks/ challenges for Success
8.
8 1.
1
Ma
M na
n g
a i
g ng
g th
t e
h Pr
P ogr
g am
a me
m
The programme of work associated with the Strategy will be governed and managed to MSP
standards by the HIS Board. The HIS board comprises: representation from all Stakeholder
Trusts.
Programme governance will be assured through Information Governance functions and
independent audit.
Utilising ICT successfully involves applying a process of business change and understanding
key roles and responsibilities necessary to implement the process successfully. Seamless
engagement of Health Informatics staff and end users is required to ensure completion of
the business change lifecycle. All projects forming part of the Health Informatics Programme
will follow the project management principles of Prince2.
8.
8 2.
2
Fina
n n
a c
n i
c ng/
g
/ Re
R sou
o r
u ci
c ng
g th
t e
h Str
t at
a e
t gy
Funding for the Health Informatics Strategy will be sought from Stakeholder Trust via both
capital and revenue streams. In line with good practice BEH HIS will look for efficiencies that
release resources to fund a portion of the costs.
The national IM&T investment survey indicates that over recent years the stakeholder Trusts
have been relatively low investors in ICT than the national average.
Insert data when released
To respond to the challenging Health Informatics Agenda additional new funding will be
required to finance the ICT programme and the associated support arrangements.
Insert data from capital plan when agreed
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8.
8 3.
3
Stak
a e
k hol
o der an
a d
n
d Sta
t f
a f
f Co
C mm
m u
m n
u i
n ca
c t
a i
t on
o
Communications will be, as far as possible, relevant to particular staff groups and will
include elements of ‘what’s in it for me’ to ensure ownership of the strategy. In this way,
stakeholders/staff will move through the process of awareness to commitment.
8.
8 3.
3 1.
1
Th
T e
h Pa
P th
t
h to
o Co
C m
o mi
m tm
t e
m nt
The strategy has three elements aimed at taking stakeholders to the required levels of
engagement in order to create the conditions for successful implementation of
programme.
These are:
• A GENERA
R L
A AW
A AR
A E
R NES
E S
S element which will take stakeholders to a general level of
awareness of the enabling strategy.
• An INVO
V L
O V
L E
V ME
M NT
T element for those affected by the strategic aims and objectives
• A COM
O M
M I
M TM
T E
M NT
T element for key stakeholders/staff which will take them to full
commitment needed for successful delivery of the strategic programme.
8.
8 3.
3 2.
2
Ke
K y
y Me
M ssage
g s
There is a need to ensure that the key objectives of the strategy are realised by reinforcing
the objectives through a series of key messages for each of the stages of stakeholder
engagement. In the context of the proposed approach to engagement described above,
these key messages can be expressed as answers to the following questions:
General awareness for all BEH Health Community staff
• What is the strategy?
• Why is it being implemented?
• What does it hope to achieve?
• Who will it affect?
• How is it going to be implemented?
• What are the timescales?
• What will be the benefits?
Involvement: Specific messages for those that are involved:
• When is it going to happen in our patch?
• How can we prepare for any changes in service?
• Who will be affected?
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• What will it mean for those affected?
• Who will be responsible for what?
• Are there any risks?
Commitment: Messages to engage the key stakeholders/staff:
• Why should I (we) make the strategy one of our priorities?
• Why should we support the strategy?
• What is the impact of the strategy on the health community e.g. Trusts, PCTs and
other healthcare organisations and agencies?
• How will the strategy affect the way ICT/ healthcare is delivered?
• Are there any risks?
• How will it affect me?
The required outcomes of the three elements of the strategy for the defined stakeholder
groups are as follows:
Target audiences
Awareness
Involvement
Commitment
All staff within BEH
• Are aware
community
• Feel informed
• Understand the “big
picture”
• Feel reassured
• Appreciate the need for
change
• Show a positive attitude
Staff working in Services
• Are aware
• Are confident that the
• Are enthusiastic
undergoing transformation
• Feel informed
strategy wil deliver real
• Are supportive
• Understand the “big
benefits,
• Actively endorse when
picture”
• Have realistic
appropriate
• Feel reassured
expectations of benefits
• Are positive about
• Appreciate the need for
• Are clear about their role,
working in different ways
change
what they have to do, and
• Feel actively engaged in
• Show a positive attitude
when
the Programme as
• Feel a part of the overal
appropriate
service transformation
process
Boards, Directors, Heads
• Are aware
• Are confident that the
• Are enthusiastic
of Service, OneHIS Senior
• Feel informed
Programme wil deliver
• Are supportive
Managers.
• Understand the “big
real benefits
• Pro-actively endorse
picture”
• Are aware of timescales
when appropriate
• Feel reassured
• Have realistic
• Are working in different
• Appreciate the need for
expectations of benefits
ways where appropriate
change
• Are clear about their role,
• Are ful y engaged
• Show a positive attitude
what they have to do, and • Are actively leading
when
• Have assigned the
• Feel a part of the overal
Programme a high priority
service transformation
process
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8.
8 4.
4
Ri
R sk
k /
/ Ch
C a
h l
a leng
n e
g s for
o Suc
u c
c e
c ss
There is a potential risk that any strategic document may fail to address its stated aim. To
ensure fitness for purpose a risk analysis has been carried out and can be summarised as
follows:
Risk
Mitiga
g tio
i n A
ctio
i n
The strategy may not be sufficiently
• The
strategy
has
been
comprehensive
constructed as part of BEH HIS
business planning process.
• The BEH HIS board has overseen
the development of the strategy.
The strategy may not meet local
• A critical driver for the strategy is
requirements
the aims and objectives of the
stakeholders Trusts
• Consultation
about
strategy
content has taken place with key
stakeholders.
The strategy may not address
• The strategy author and various
national/ London wide drivers
contributors
are
active
members/participants
in
national/ London NHS bodies.
• The strategy has been reviewed
by informed independent sources.
8.
8 5.
5
Re
R al
a ising
g th
t e
h Bene
n fi
f ts
t
BEHHIS work programmes will deliver many opportunities for the stakeholders to support
changes in working practices. However, the role of Health Informatics will only be to provide
the enabling knowledge, tools and skills. It will be the responsibility of individual services to
deliver the service changes if benefits are to be realised.
BEHHIS wish to demonstrate the link between benefits delivered by new information,
communication and technology enabled business change projects and wider stakeholder
policy priorities, business objectives and service delivery outcomes.
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BEHHIS will utilise benefit management planning to introduce a level of accountability for
managing and demonstrating the achievement of benefits. In developing the benefits plan
the capture of baseline measures at the commencement of the strategy work programmes is
critical for tracking the achievement over the strategy lifecycle.
The basic assumption of the benefits management process is that for each identified benefit,
there are a series of tasks or actions that have to be undertaken in order to achieve that
outcome.
Benefits governance will be through seeking:
• Strong commitment at stakeholder executive level
• Ownership of the benefits management plan
• Robust recording and reporting of benefits at all levels involved in the execution of
the strategy.
9.
9
ORG
R A
G NISATI
T ONAL
L DEVE
V L
E OPME
M N
E T
T
At the inception of the expanded BEHHIS to include Barnet PCT services in 2007 an
organisational structure was adopted which was fit for purpose but maximised continuity
and allowed rapid progression through the configuration progress to minimise uncertainty
and change for staff. This worked very well for our first full year of operation in 2008/09 but
will require review during the lifetime of this strategy.
The management structure is currently designed on all powerful, functional directorate
basis. This reflects the need to carry out a number of functions for ourselves as well as
serving our stakeholders.
Over the last year two years we have evolved our BEHHIS governance systems. Key changes
include:
• Being explicit about the governance role of the Host Trust.
• Expanding the stakeholder sub committees of the HIS board to include finance,
SLA and Audit/Risk.
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Throughout the years, the focus for all BEHHIS operations has always been, and will continue
to be, through our core strategy and, as stated in our mission statement, - delivering
outstanding service to our customers. This is embodied in our business plan: by identifying
six key objectives required to satisfy this strategy, we are able to monitor, and demonstrate,
our levels of achievement against these aims. The basis for the way BEHHIS operates is
shown through alignment of the following:
A organisational development plan in support of this strategy will detail how our
organisational development goals underpin our strategic plans. Ultimately, BEHHIS will know
if it is a thriving organisation which our stakeholders value through measuring our success
via both the strategy and organisational development plan.
9.
9 1.
1
BEH
E HI
H S Sta
t f
a f Develop
o m
p e
m nt
t
The rapid pace of change in IT requires a correspondingly high level of training to
ensure that staff are able to make best use of new hardware and software. The
structured environment for service and project management also requires staff to have
appropriate training to participate effectively.
With Information Services BEHHIS has already made good use of the National Health
Informatics Career framework as an early adopter. It is planned that as this tool
becomes more mature BEHHIS will utilise it further to support workforce planning.
As part of World Class Commissioning, the Department of Health with Exeter University
are developing a programme – Teaching Operational Research for Commissioning
Health (TORCH). BEHHIS have been approached to be a pilot for this innovative course
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which will see industry standard predictive models applied within the health arena. This
will be our main focus in 2009/10 with further roll out of actuarial skills over the
lifetime of this strategy.
10.
0
PER
E F
R ORM
R A
M NCE
C
E MO
M NITO
T RI
R NG
N
There are three levels of monitoring associated with this strategy:
10.
0 1.
1
Nati
t on
o a
n l
a
The Informatics Planning Guidance national expectations will be used for the first level
monitoring. Performance within this framework is currently overseen by the NHS
Information Executive Group. Quarterly reports are submitted via NHS London in
support of that agenda.
10.
0 2.
2
Loc
o a
c l
a
Local reporting will be managed bi monthly through the HIS Board via the BEHHIS
business plan reporting cycle. Minutes of the HIS board are available to the Host Trust
Board meetings.
10.
0 3.
3
Int
n e
t rnal
a
Progress on the strategy will be monitored through BEHHIS Finance and Performance
Committee which meets monthly.
11.
1
APPR
P O
R VA
V L
L PR
P O
R CE
C S
E S
Final draft to HIS Board for sign off at a partnership level June 2009.
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