To deliver world-class quality care to patients in a safe and consistent fashion and utilising best practice, knowledge about treatment options will require us to use increasingly sophisticated decision support systems.

By 2013 decision support systems will help us deliver world-class quality care to our patients. Patient care pathways will be supported and tracked electronically from first contact through diagnosis, treatment and all aspects of care, to discharge and final feedback. The care pathways for the majority of patient sessions can be predicted based on standard NHS care pathways with differentiating improvements by UCLH. The patient will be fully supported in understanding her/his care plan, and in making choices where these are appropriate. We will provide more robust protection for our patients: clinical staff will be alerted on a patient by patient basis of potential harm from drugs, infections or child safeguarding issues.

To manage the complexity of service delivery we need to ensure that we have in place the information systems and technology to provide real-time information flows that support the real-time care of patients, whether they have attended for outpatient appointments and require diagnostic tests with results reporting straightaway or whether they have attended A&E in the middle of the night and need admitting. The Trust needs to move to a world where information flows align with patient flows and where the services needed - whether to order a test, book an appointment or check bed state - are capable of being ordered and enquired on straight away.

Workflow software will help make us an increasingly efficient and effective organisation, helping staff work through complex processes with minimal errors, flagging up errors, identifying bottlenecks, and learning from historical performance. Patient-level costing will be an integral part of our workflow, and will help us drive up the value of our services.

We will capture and review patient satisfaction information in order to constantly improve the delivery of our services to patients. By 2013 UCLH will be a “learning organisation”. There will be systematic processes in place to review patient satisfaction and general Trust performance, including admin and clerical processes, and to assess consequent requirements for improvements to standards, processes, information, training, R&D and technology. Training of Trust staff in these areas and ICT will be a priority. The simulation of processes in 2013 will be in widespread use, for training and change management.

We will have a paperless [clinical] environment, with all images stored on PACS, electronic note-pads for clinical notes and all paper sent to the Trust scanned on to an integrated electronic patient record. We will use electronic tagging and tracking for physical objects where it will improve security, safety, stock control and availability.

The prime source of patient information for the Trust in 2013 will be the EPR (electronic patient record) which will be maintained as a virtual single electronic record by UCLH. Information from the Trust EPR will be extracted as necessary to feed any National Programme Health Networks or patient-specified information repositories, such as an NHS ID card or a personal record maintained by the patient on the Internet

Relevant information on the Trust EPR will be accessible through a single gateway used by Trust staff, partners, GPs, patients, and their relatives. General information such as outcome statistics will be available to support patient understanding of care offerings and choice.

High priority will be given to the provision of transparent information for GPs, PCTs, commissioners, referrers, suppliers, partners, and regulators.

Facilities will be provided to support the disabled or non-computer literate. Call centres, clinicians, patients and relatives will all have appropriate access to the Trust EPR. Paper records will only be the primary source of information in exceptional circumstances: for specified elements of care records such as consent forms, and for other aspects of care records created prior to 2013.

Delivery of this Vision will support the principles enshrined in the NHS Constitution and in particular will help ensure the highest standards of excellence and professionalism both in ICT services and in supporting wider delivery of services across the Trust.

Mrs Agrawal enters the hospital and, as someone comfortable using IT, checks in at a booth using her UCLH token. Non IT-literate patients are assisted with checking in by care co-ordinators.

On screen: Good morning, please enter your password.

Mrs Agrawal: ******** [individually chosen password containing letters and numbers which, along with her token, confirms her identity]

On screen: Good morning, Mrs Agrawal. Your appointment with Dr Adams is confirmed for 11.30. As you will have noticed we have had to change the doctor you're seeing and your appointment time. This is due to staff illness. Apologies for the inconvenience this may cause you - would you like to give us feedback on this change? If so please enter your feedback in the box below.

Mrs Agrawal: I am inconvenienced by this change of time, and disappointed not to be seeing the same doctor I've seen before - this appointment was arranged specifically for me to discuss progress with Dr Kumar.

On screen: Thank you for the feedback. Please enter a satisfaction rating using the buttons below.

Mrs Agrawal: [clicks `Dissatisfied' radio button].

On screen: Thank you. Your feedback is appreciated and, where possible, process changes will be made to ensure this doesn't happen again. Please check the following demographic details are correct, and amend any that have changed on screen. Click `Save' when you've finished.

Mrs Agrawal: [updates Next of Kin Phone Number and clicks Save].

On screen: Thank you. Your new Next of Kin Phone Number has been updated on our records. Would you like to enter updates to your personal health information?

Mrs Agrawal: [updates weight to reflect continued weight loss, and confirms she's still a non-smoker].

On screen: Would you like a print out of your weight loss graph?

Mrs Agrawal: [clicks Yes].

On screen: Thank you. It is printing now, along with your attendance confirmation and a map showing you where your clinic is today. Dr Adams has requested you give a blood sample for testing before the appointment and she is expecting you at 11.30. The location map shows where you can give a blood sample on your way to clinic. If you have difficulty finding the clinic, plug your token into any of these booths and it will update your location map. When you get to the clinic, please scan your token at the booth at the entrance to let Dr Adams know you've arrived.

Mrs Agrawal removes her token, and ends her session at this booth.

[If a visitor / patient has neither token nor NHS number the booth will take them through registration and give a personal visitor token to track progress through the hospital. The token will only allow access to relevant areas (a necessary security precaution in 2013) and will sound a library-style alert if removed from the hospital buildings.]

Mrs Agrawal arrives at the clinic location for her 11:30 appointment with Dr Adams to discuss her skin condition. She scans her token and enters her password.

On screen: Good morning, Mrs Agrawal. Your blood sample has been received by the lab, and your test results will be available for your appointment with Dr Adams. Please take a seat. A care co-ordinator will be over to see you shortly.

Mrs Agrawal removes her token and takes a seat. Robert, the care co-ordinator, comes over with a portable computer.

Robert: Hello. I'm Robert, Care Co-ordinator for this clinic. Can I scan your token please - to confirm I've got the right person and to bring up your records?

Mrs Agrawal: Hello. [hands over token]

Robert: Thanks. Right, Mrs Agrawal? I see you've already updated your demographic and personal information and you've had your blood tests. Excellent. Dr Adams will call you through shortly. Your personal ID for this appointment is 56 - and you can see on the screen over there that you're next to be seen.

Mrs Agrawal: Thank you.

Had Mrs Agrawal not already checked in via a booth, Robert the Care Co-ordinator would have taken her through the demographic checks and organised her pre-appointment tests. While waiting Mrs Agrawal uses an information point booth to email her brother and to record a complaint about the state of the women's toilets in the waiting area. Dr Adams is ready to see her.]

Dr Adams: Morning, Mrs Agrawal. I've got your records here on screen, and see that you also attend the Whittington hospital. We have a partner agreement with them that allows me to access their records about you if you're agreeable - is that OK?

Mrs Agrawal. Yes, that's fine.

Dr Adams: Can I ask you to enter your password in a moment, so the system records you've given consent to access your records. Thanks

Mrs Agrawal: [enters password]

Dr Adams: Thank you - your information is now available. As you can see I can view your Whittington records in one screen and your UCLH records in the other. During the consultation I'm going to make notes and enter information on this `tablet' as if I were writing in a medical record. Please let me know if you find this disruptive.

[The consultation continues and Dr Adams enters diagnosis and treatment options, moving on to prescribing a new drug].

Dr Adams: The system has alerted me to a possible conflict between the drug I was going to prescribe and one you're already taking. It has suggested a different drug option instead. I'm printing an information leaflet about the alternative drug for you.

Mrs Agrawal: OK, thank you.

Dr Adams: I'd like to see you again in two weeks, to check your progress with this drug. The system is suggesting 11.30 again, two weeks today - is that OK for you?

Mrs Agrawal: Yes, that's fine.

Dr Adams: I'm printing a letter with the appointment details, and sending your prescription details to pharmacy. You can collect your prescription from one of the dispensing machines on the ground floor using your token, or from Pharmacy directly. Do you have any further questions?

Mrs Agrawal: No, that's it. Thank you for your help, doctor. See you in two weeks.

[As Mrs Agrawal leaves, Dr Adams verifies the data entered during the consultation, and checks that the handwriting recognition software has correctly interpreted his writing. Satisfied he completes the summary information that will be available to GPs via the portal, and sends a copy of the summary to Mrs Agrawal. His notes are immediately available within the system. As Mrs Agrawal leaves she notes that a cleaner has arrived to clean the women's toilets as a result of her complaint and an email arrives later that day to confirm this.]

Sally Smith brings her father Mike into the local Polyclinic at 9am on Sunday. The clinic houses GPs (including specialist GPs), ambulatory, and coordination services (district nurses, therapy, ambulances). Many more patients are treated at home in 2013, and traditional A&E patients, other than “blue light” patients, go to the polyclinic for care.

Following on from registering with Mike's token, Sally and Mike are seen for the initial consultation with Dr Ubbi and update her as to what's happened.

Dr Ubbi: So, you fell yesterday and now you're having difficulty walking. I see from your record that you're due have a minor knee operation at UCLH in a couple of weeks - we need to establish if your current difficulties are related to this, or need different care. We have a few options for your treatment from here: We could admit you while we arrange for further tests and arrange further home care directly, or do an urgent CT scan and x-ray with a view to admitting you and brining your operation forward to this week. I'd like to do the latter and arrange for you to have the scan / x-ray now with a view to admission today. Is that OK?

Mike: Yes, although I'm not prepared for admission today.

Sally: Don't worry, Dad, if the tests show you need to go in to hospital today, I'll sort out whatever you need.

Dr Ubbi: OK. I'm requesting the tests, and doing a preliminary request for a bed. Looking at the planned discharges for today we should be able to admit you in a couple of hours if necessary. I see you've already been to your pre-assessment clinic for the operation and had your DNA scan done - that's good. It will enable us to prescribe specific drugs linked to your DNA profile if necessary. It's really helping us target the most effective treatment and limit side effects in many cases. If you wait here, one of the team will take you for your scan and x-ray shortly.

Following the tests Dr Ubbi establishes that the walking difficulties are linked to the existing knee problems and makes a decision to admit.

Mike Smith has been in T9 since noon yesterday (Sunday) waiting for his minor knee operation. He has seen nurses and doctors but is a bit confused. His daughter Sally visits today, Monday morning, and asks for help from Mike's assigned nurse, Grace.

Grace: Shall I help you look at your patient summary through your bedside screen? Do you have your access token?

Sally: Yes, I've got it here.

Grace: Ok, if we go to this section here, patient summary, we can see that you're currently due to be in anaesthetics at 8 on Tuesday morning, in surgery at 10, and back in bed on T9 by 2pm. Looking at this we're expecting you to take 24 hours to recover in the Ward, and be discharged at 10.30am on Wednesday. Shall I take you through what we've done so far to make sure you're both up to date with everything?

Sally: Yes, that would be helpful.

Grace: Right, as Mr Smith was already booked in for his operation his basic nursing assessment was completed at pre-assessment clinic - you can see what was entered here on this screen. At the polyclinic some of these were updated, here. When you were admitted, Mr Smith, I did baseline observations of your vital signs (pulse rate, breathing rate etc) and recorded and entered them into the clinical system. The system can tell me if your readings fall outside the parameters set by latest guidance (NICE), which they didn't, and from now until the operation it will take automatic readings, letting me know if anything it outside of the readings we'd be expecting so I can intervene if necessary. This information is available to all the nursing and clinical staff - so when I go off shift, or when the doctor does her ward round, everyone has access to the same information about you and your treatment. Does that make sense so far?

Sally: Yes, thank you.

Mike: Did you go through the list of drugs I'm taking too? The doctor yesterday said something about a DNA sample?

Grace: Yes. The system lists the drugs you're taking, and any we might expect you to take after your operation. If we go through the list again now your daughter's here and then we can re-confirm your prescriptions. Doing this ensures that there are no contra-indications from your DNA profile, your allergies, or the mix of drugs you're taking, and that our ward stock of drugs is kept up to date with your requirements. If you're currently taking a drug that I'm not able to prescribe then the system will forward the request for that drug to the doctor to authorise after the ward round (or sooner if necessary).

[They confirm the list of known allergies and prescribed drugs and no problems are identified].

Sally: There seems to be an option to take different R&D-sponsored drugs when Dad gets home. Is that correct?

Grace: Yes, I can print you some leaflets to read with likely outcomes and possible side effects so you can have a look at them before deciding to request the R&D drug. I will flag your record so the doctor will discuss it at the next opportunity.

Sally: Thanks. That's good, isn't it Dad?

Mike: Yes, if it works.

Grace: The allergies we have listed for you will also be alerted to theatre and any other relevant departments. The other thing we did when you first arrived was double check all your demographic information, and assign your ID number and details to the patient tracking wristband you're wearing. This enables you to be identified/located via the unique ID number/ ID card bar code throughout your stay (essential for drug administration, procedures & interventions, information access). This is a lot to take on board, so the final thing I want to show you is how to review your care plan.

The nurses looking after you will review and update this and evaluate your pre-operative preparation.

It shows us various alerts in line with the pre-op care plan, drug chart and theatre schedule as reminders for you and us, for example when fasting should commence, when we need to give you your pre-med, anti-coagulants and prophylactic antibiotics etc. These times will be adjusted remotely from the operating department to take account of real time delays/rescheduling. The bedside system will prompt you when you need to start fasting. Which reminds me, would you like to order your lunch now?

Mike: Yes. I'm not very hungry though. Could I have a salad of some sort?

Grace: This is how you order. The system will tell us if there are any dietary constraints on your order. That seems to have gone through OK. So, you can see that you can access and update everything about your care from here. Even the planning for your discharge arrangements was initiated at pre-assessment. The discharge plan is evaluated and updated regularly - post-discharge services are ordered electronically via the GP and Community Nursing services' links. Any Physiotherapist and Occupational Therapist who assess you will enter their respective data into the multi-disciplinary evaluation of post-op progress, and if your discharge date changes everyone will be informed automatically - even you Sally! We've got your mobile phone number and we can automatically send you a text, if you want?

Sally: That would be great. Thanks - you've been really helpful and I think we both understand a lot more about what's happening and where to find out what's going to happen next. Looking forward to Dad coming home on Wednesday!

Prof. Dennis updated the post graduate audience as part of their ongoing education on some of the latest examples of care for chronically sick patients “Ms Brown is one of the 4% of people in London who use 30% of the capital's annual healthcare budget. She has chronic kidney disease, and has had an intelligent device from UCLH for a year.

The device holds Mrs Brown's care plan, monitors her condition, alerts her to take her medication, and alerts her GP or UCLH of problems in real time as necessary.

She is also piloting a device funded jointly by a consortium of Health and social care providers, including UCLH and Camden, who are piloting a community-based (Personal Health Information Service)”.

Mr Black is feeling unwell and thinks it may be to do with his current prescription. He uses NHS Choices (www.nhs.uk) to find out where he could get rapid treatment and identifies his local polyclinic. He uses his token to record his arrival and is called into see the doctor.

Dr White: Good morning, Mr Black, how are you this morning?

Mr Black: I'm doing OK, but not sure my current pills to thin my blood suit me. I seem to be getting some side effects and I saw an article on my health space about a trial of a new drug that does the same thing so wondered if I could try that one instead?

Dr White: Ah, yes, that might be possible, however I can't prescribe it for you because I'm not a trained stroke specialist. What I can do is call up my colleagues at NHNN via the webcam and ask them to take a look at you, at your recent test results and your clinical history. They will be able to approve the prescription if it's appropriate for you. Would you like me to do that?

Mr Black: Yes, please, go ahead.

Dr White: We have a 24 hour on call arrangement with UCLH so bear with me a moment and I'll get connected……[he logs on to the UCLH clinical portal and starts a webcam session with the NHNN specialist team] Ah, good morning Dr Brown. I am here with Mr Black, as you can see, and we'd like to discuss a prescription for the thrombolysis trial drug with you. I've called up his details on the screen for us all to view, if you'd like to go ahead and click the icon.

Dr Brown: Good morning. I've got the clinical history and brain scans on the screen now. I need the answers to a couple of questions, do a quick examination and then we can see about the prescription. [Mr Black and Dr White answer Dr Brown's questions verbally, and enter the results via the portal.]

Dr Brown: That all seems fine. I'll approve the prescription request and it will transfer to the polyclinic pharmacy in a few moments.

You're now added to the clinical trail with ID number CD357 which will appear on any letters or emails we send to you and helps us keep track of your progress. We need to do a follow up in three months, so would Wednesday, 10^th at 10.30 am suit you, Mr Black? I can see both Dr White and I are in clinic and available at that time.

Mr Black: Thank you, yes Wednesday 10^th at 10.30 is fine with me. Thanks, again.

Dr Brown: Good luck, see you in 3 months.

Dr Brown signs off. Mr Black and Dr White complete the appointment and Mr Black leaves to collect his prescription via the polyclinic pharmacy, using his token as identification.

Mark Hrynczak is a new nurse starter. He receives the following letter on appointment:

Dear Mark

Below is your username to access the Induction and Training section of the Trust website (www.uclh.nhs.uk). Your password will follow by separate letter.

There are a number of things you need to do before starting with us.

Firstly please log onto your personal information space and ensure that your personal information (name, address, phone number, date of birth etc) is correct.

Next, please complete your bank details so we can ensure your pay is received correctly at the end of your first month with us.

If you have any annual leave commitments already booked, please give details in the appropriate section. This request will be forwarded to your manager, Louise Singh, for her approval and you will receive confirmation when it is granted.

As a nurse you require access to various Trust systems. Please follow the links to the Training section. Here you will find video and graphical simulations of relevant UCLH processes, with links to relevant procedures and supporting documentation, and to training versions of the ICT systems to support these. There are a number of at home exercises for you to complete, involving the principal information you will be responsible for entering as part of your new role. The system tracks how far you've got through the training, and will lead you to an assessment at the end. You will not be granted access to live systems without completing this assessment. On your first day your system access will reflect your ability to perform the functions you have practised at home. Please note that sharing your username and password, or access to the training system, with anyone else constitutes gross misconduct.

Completing the above information and training prior to your first day at work will significantly improve your first few weeks at UCLH, and the care you're able to deliver to patients. If you have any problems please contact us on the number at the top of this letter.

Your induction has been booked for Monday 14^th December, in Room A, Training Centre, 250 Euston Road.

As part of your induction your fingerprint will be recorded and you will be given an ID card. Your fingerprint will enable the display of your personalised screens on any device through the Trust within 5 seconds.

We look forward to welcoming you to UCLH.

Yours sincerely

Emma Goldstein

Recruitment services

Doctor Miller is moving from General Surgery to Women's Health. This rotation means a change of role, involvement in different processes, the need to use different systems and to access different patient and specialty information. She's discussing her move with a friend (Dr Fernando) who works for another Trust:

Dr Miller: 10 days to go until rotation, how's your prep going?

Dr Fernando: (laughs) What prep? I guess it'll all get sorted on the day. Would be nice to get some things done in advance though, wouldn't it?

Dr Miller: Well, things here seem pretty organised, to be honest.

Dr Fernando: Oh, yeah? Like what?

Dr Miller: Like, when I logged on to the system a couple of days ago it prompted me about my rotation, got me to confirm I'd read the prompt and then offered me a whole load of training stuff to do. I can do it online, and it takes me through the processes and protocols in Gynae so I know what's coming. It also now gives me access to see the elective patients we're expecting and what they're coming in for, test results etc

Dr Fernando: Blimey! That's good - we don't get anything like that.

Dr Miller: Apparently it will also let me have access to my existing patients during the transfer, so I've got 4 weeks to sort out letters and results along with the guys who're taking over. Hopefully it should make life a lot easier all round.

Dr Fernando: Sounds like it will…

[Their conversation moves on to other topics]

A group of managers from the Academic Health Science System (UCH, UCL, Royal Free), Whittington and Camden PCT are meeting to look at the costs of and options for various processes. They meet monthly to review costs and care pathway options to see whether other drug or home care regimes could be introduced which would be more cost-effective. Jas (UCH): It's pretty clear from the figures that we're in danger of missing the wait time targets for inpatient MRI scans at UCH. It looks there might be capacity at the Royal Free, is that the case Nick?

Nick (RF): Yes, I think so. We do have some capacity now that we're doing full weekend service. We need to be aware of the additional cost of transport to us though. It's probably not something you'd want to do routinely.

Paul (CPCT): How about bringing it in only when there's more than a day's wait for a scan at UCH? We'd support that.

Jas (UCH): That sounds possible. I'll use the BPM (Business Process Mapping) system to simulate the new workflow and check it will work out - it will be able to tell me if there is sufficient capacity at the predicted times for the Free to take on this work. If it's OK then I'll update the BAM (Business Activity Monitoring) engine so that it diverts patients automatically based on the new rules. I wonder if we can do the same with minor cardiac ops? What do you think, Sonia?

Sonia (UCL): Well, it's possible we could run this service for you at the Whittington instead of the Heart, but I'm not sure it would be acceptable to patients. The data I've circulated on patient satisfaction seems to indicate that they're very resistant to travelling to the Whittington for these kinds of minor ops. Given the cost differences are minimal, is it worth the upheaval and the potential complaints?

Paul (CPCT): Probably not, but it's always worth asking the question.

Jas (UCH): Ok, we'll stick with the Heart for now then, and perhaps review in 6 months. Thanks everyone.

The chief executive returns from a few days international travel. His desktop hologram display, which visitors and commissioners find very impressive, is a real time 3D visualisation of the Trust: hospitals, wards, admin, clinical and support services. Most of the representative icons are coloured green, but there are two amber and one red icon. The infection alert status is green.

The red icon is from a Ward in the National Hospital. The CEO taps the ward icon on the desktop, and his computer screen gives him the information that generated the alert. This includes

The CEO calls the DM at the National, and is reassured.

The first amber icon is from administration at the Heart. The CEO taps the icon and is presented with financial trend information for the last 12 months which has generated this alert.

He asks for more information: procedure outcomes, components of cost, surgeons involved, and arranges a videoconference with the DCD and DM that afternoon

The second amber icon is from the AAU, where there is an alert against potential shortage of ward stock .

This alert was generated by the process monitoring system which has identified an order which is awaiting authorisation. The order would normally be approved by the Divisional Manager, who is on leave. His deputy has been seconded to help a recently acquired non Foundation hospital, and his MD is also on leave. The CEO does an exceptional order approval, sends a cautionary email, and turns his attention to longer term issues …….

There are six underpinning elements to enable the vision, ranging from business continuity to information governance. Together these form the foundation for delivering the vision and are explained fully below.

This section of the Strategy describes the approach that the ICT directorate will take to ensure that the Trust's mission statements can be delivered. Many of these services are and will be provided through our relationships with our strategic business partners.

Key features of the service are:

The Trust has recognised that the evolution of our ICT Strategy requires corresponding changes in policies and governance. In the coming years, as we move towards the delivery and exploitation of collaborative systems, ICT will continue to take up and adapt best management practice guidelines. Guidelines such as PRINCE, Managing Successful programmes (MSP), IT Infrastructure Library (ITIL), and Management of Risk (MoR) will be instrumental in delivering the Trust's vision for ICT.

The Trust has increasingly recognised that change management is a service to be offered and delivered and that benefits realisation for IT-enabled initiatives should be tracked and published. We must continue to acknowledge that successful change will only be possible if we deliver transformation for all three areas of People, Process & Technology.

The information and knowledge assets of the Trust represent valuable resources that require careful management to protect and exploit their value. A layered information architectural model will provide the framework for improved presentation, processing and storage of the Trust's data.

A three layer model is used to reflect the different standards required for each of the elements that make up an information architecture.

The top layer of the model - the presentation layer - defines how incoming data will be captured and outgoing information presented to end-users. This ensures consistency in the “look and feel” of information systems, maximising the return on investments in training and reducing variation and the risk of poor data quality.

The middle layer of the model - the process layer - is concerned with defining the key processes which create and use data. These processes cover the clinical activities associated with the provision of direct patient care, the “back-office” business activities which maintain the operation of the Trust and the processes supporting education and research functions of the Trust and its partners.

The foundation layer of the model - the data layer - is concerned with the storage of data, setting technical standards for the storage and protection of the raw data, taking account of the local, national and international standards which need to be applied.

The model also allows for any of the three layers to be upgraded or replaced independently as requirements or technology change. This means that the Trust will be able to keep up with the latest technologies in presentation, processing and data storage, without the expensive decommissioning costs associated with other approaches.

.

The Trust's ability to continue activity under situations of reduced resources is ever more important. The dependency of the Trust on ICT can be illustrated by the fact that A&E would shut to blue lights within 45mins if electronic pathology results were unavailable. The resilience of the Trust's ICT needs to be significantly increased as the dependency on electronic information becomes ever greater.

The Trust's data storage and processing networks need sufficient resilience to withstand the loss of the main data centre and still fully support the organisation's operational requirements. This resilience MUST be achieved in the next five years.

A secure VPN (Virtual Private Network) which gives access to all Trust applications is an essential enabler to be able to relocate large numbers of administrative and clinical staff and still be able to continue services if a Major Incident occurs.

Key to the Trust using information as a strategic resource is for all employees to be given the opportunity to become confident and competent using ICT.

Training will adopt a multi-layered approach to learning, utilising both traditional classroom and e-learning. Fundamentally, technology will be seen as an enabler, allowing knowledge generation and sharing. CBT (computer based training) will be developed to provide flexibility of access from anywhere, anytime. Learning Management Systems will provide the ability to log and track all learning activities.

In this way staff can access “just in time” training and self service and self accreditation will be supported by a mature and encompassing security and access control policy. Training will cover the essential processes and procedures tailored to each individual's role within the organisation, alongside the system training required to carry out that role.

New approaches will also be exploited such as online discussions, web seminars, virtual classrooms, podcasts and blogs. Although generic material will sometimes be appropriate, in- house customised materials will need to be created and learners will be supported by on- line tutors and mentors. Specialist learning communities (clinical and non clinical) can be established and supported across the Trust.

The IT Training Centre will operate as a learning resource centre providing facilitation to staff requiring help to access e-learning. This could operate extended hours to provide staff with an appropriate learning environment. This would help demonstrate the Trust's commitment to learning.

Our ICT Vision and Implementation Strategy recognise that changes are required in order to deliver best practice information governance. As our delivery of the strategy moves from an emphasis on point solutions towards the delivery and exploitation of collaborative systems, we also need to continue to evolve our mechanisms to exploit and manage existing solutions. In the coming years we need to develop and bring forward proposals for:

A single Trust wide records service will be formed, with controlled gateways for release of accurate and quality patient information (e.g. DPA, FOIA). This central record service will also aid the control of information flows. The inclusion of records management responsibilities in key personnel JD's and KSF's will need to be established.

Training in records management, Caldicott Guardian principles, NHS code of confidentiality and the basic requirements of the Data Protection Act needs to be routinely delivered to NHS employees and users of this records service, before they process personal data. This will emphasise the key importance of information to the Trust and aid the Trust in achieving a full record lifecycle, womb to tomb, driving forward the data quality management needs.

The driver for a single Trust wide records service is the need to know where all records are and that they are being appropriately managed within the law. This requires organisational measures and procedures to be in place ensuring for appropriate security and availability. The Trust has to be able to identify accountability, ownership and responsibility for all records. This service will need be a proactive service, leading from the front whilst still listening to the needs of its users.

By 2013 we will have implemented the ICT Records Strategy Roadmap and have achieved

An assessment of all Trust ICT systems will be made to establish if they are strategic or tactical (ie filling a short term need). Part of this assessment will include understanding the suppliers' roadmap for the future development of their systems.

All strategic ICT systems in the Trust must have a relevant programme of development and upgrade by the supplier.

This will start to inform the work programme of upgrades for future functionality and facilitate benefits assessments on how to best gain from the supplier's development plans.

Consolidation of suppliers will also be considered; this will bring reduced support and maintenance costs. This could also increase the influence UCLH has over the direction of products and development. The main suppliers will be encouraged to become a strategic partner of UCLH.

The Trust has already taken the strategic decision to utilise managed service contracts for non core business service provision. These are seen as highly productive mechanisms for delivering;

For the purpose of this document the vision can be translated into systems (technology and process) aspirations as shown in the diagram below. These have been plotted based on their likely need and timetable of delivery over the next five years. The diagram shows the four key enterprise flows of the trust,

with the time horizons being represented as the bands moving across from left to right. The bottom left is Today and the top right is 2013.

The delivery of this vision will require several concurrent work programmes. These will need to address issues from data quality and applications selection, through to infrastructure replacement and enhancement. The development of a detailed work programme is the scope of the next phase of work following acceptance of this ICT vision. The outline of the work programmes is explained below.

The BPM programme will document the standard processes of the Trust in all areas. These processes, with the information needed to support them, will form the backbone of the Trust's ICT Process repository.

These will also be the platform for BAM (Business Activity Monitoring), which will automate the monitoring of workflows based on the business processes.

A substantial education programme will be required to implement the cultural changes implicit in a strategy of process standardisation across the Trust. Visualisation of business processes will support both this implementation and the management of process changes needed for continuous performance improvement in both clinical and non-clinical areas.

The EPR programme will implement the single patient record and the single portal for access by all appropriate parties. It will also include PAS replacement, and the development of process based care systems and care performance reporting.

The EPR programme in combination with the INFR programme will include the development of a role based access management mechanism.

The TRP programme will support the efficient management of trust resources: Finance, Personnel and Purchasing. This programme will pull together all the elements required to control the Trust resource base and enable detailed, timely and self-management of resources. This will significantly drive forward the Self Service agenda and support the Patient Level costing initiative.

As one of the five delivery programmes in place to implement the Vision, SHIP will lay the foundations for an integrated and standardised approach to information sharing and collaborative working across the Trust

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Elements of the programme include:

Adopting a systematic and structured approach through this programme reduces the risk of duplication of data, and the maintenance of the integrity of the Trust's information systems, as well as ensuring consistency in the approach adopted to new initiatives through the use of common standards.

The Infrastructure programme will deliver the ICT technology and processes needed to support the programmes above and documented in “Enabling the Vision”.

Delivery of the “hard” infrastructure (Presentation, Processing & Storage) according to best practice is largely the responsibility of our business partners (Logica, Azzuri, future TRP partner). This includes delivery of tools to support efficient data entry and information access where and when it is needed.

The Infrastructure programme will also be a main tool for delivering on the business continuity requirements for the trust. This will include the replacement of the main data centre and the delivery of a robust secondary data centre.

Patients will benefit from standardised processes, better access to staff / clinical information and improved communication via portal.

A Healthcare Professional will benefit from single sign on, reducing the time taken to log on to a pc / device and accessing the relevant systems. They will also be able to place test orders electronically and prescribe outpatient drugs via the EPR and to use advanced mobile devices to access and update patient information. They will routinely input and update information and clinical data in real time and will also rely on the use of that real time information in making clinical decisions.

A Manager will benefit from improved data quality and real time business intelligence reporting.

An administrative staff member will benefit from rapid access to up to date person information, improving the speed and accuracy of communication with colleagues.

R&D will benefit from clinical datasets integrated within the EPR, enabling full treatment data to be analysed alongside specific clinical trial information.

Patients will benefit from improved access to their own health and treatment information, including the ability to schedule their own appointments, receive electronic copies of letters and store them in their own health space on line.

A Healthcare Professional will benefit from care pathways and integrated decision support, including access to real time information held on systems in partner organisations.

A Manager will benefit from cost based accounting and supporting information.

R&D will benefit from the ability to share information across research communities via the R&D Portal.

The National Programme for IT (NPfIT) is the obvious vehicle for sharing patient information nationally; however it is not expected to provide the level of clinical system functionality needed to support UCLH as a world leader over the next 5 years

We will need to develop and police overarching constraints, notably adherence to development and presentation standards, but extending to statements such as `Patient information should be stored wherever possible in searchable form' i.e. we should restrict the use of scanned images and pdfs, which are not easily searchable media.

NPfIT is a central pillar of the NHS IM&T strategy. The National Programme is running behind schedule in delivering EPR solutions to acute hospitals in London. We are the only user of the Carecast Patient Administration System supplied under the National Programme and implemented in the Trust in 2005. Support arrangements with GE give us flexibility over when Carecast will need to be replaced. During 2008 Monitor will be releasing guidance on the framework for assessing a trust's take up or not of the CfH NCRS offerings. This will give a strong external methodology for assessing the next steps for provision of the Trust's core Patient Administration System. The work programmes to be developed will need to address the timing and scope for the adoption of any deliverables expected from the National Programme.

There are multiple bodies which can issue compliance notices which reduce the degree of freedom that the Trust has in which to operate, and which impose specific responses and requirements upon the Trust. The Trust will establish a Trust-wide group to monitor the organisations that can issue compliance notices, which will have a significant impact on the Trust ICT requirements. This group will liaise with those organisations and endeavour to become pro-active members, helping to shape and lead the changes. We will consider becoming pilot sites for monitoring and assessing the impact of proposed changes where appropriate.

External to NHS

European Union Directives

Freedom of Information

Data Protection Act

Heath and Safety Executive

Corporate Governance

Business Continuity / National Resilience

R&D Related

Medicines and Healthcare Products Regulatory Agency

European Medicines Agency

Food and Drugs Agency

NHS Specific

Data Set Change Notice

NHS Litigation Agency

National Patient Safety Agency

Healthcare Commission

Information Governance Toolkit

National Institute for Clinical Excellence Department of Health

Records Management NHS Code of Practice I &II

Health Care Records Act

This then needs to be assessed against ongoing development plans to understand the potential impact.

Assumptions: Accept the vision

Board Support required for the following enablers

Trust-wide

Service Delivery

Programme Specific