Microsoft Word - IMT Strategy 2009 v1 1.doc

DERBYSHIRE COMMUNITY
HEALTH SERVICES

INFORMATION MANAGEMENT AND
TECHNOLOGY STRATEGY /
INFORMATICS PLAN 2009 - 2011
Version 1.1

Document History
Document name  DERBYSHIRE COMMUNITY HEALTH SERVICES INFORMATICS
PLAN 2009

Author:
Alvaro Pancisi

Owner:
Ali Shields

Revision History
Version
Revision date  Summary of Changes
V0.1
March 2009
First draft
V0.2
April 2009
Minor content changes following review by A.S
V0.3
June 2009
Inclusion of strategic overview following IMT Strategy Group review
V0.4
July 2009
Further comments from ali shields including costings and timeline
V0.5
August 2009
Minor iteration following further IMT Strategy Group review
V0.6
August 2009
Rework of benefits
V1.1
August 2009
District Nursing removed

Distribution and Approval
Name
Version
Date
Comments
DCHS IMT Strategy Group
0.6
July 2009
DCHS Executive Committee

DCHS Board

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1.  Strategic Overview
High quality information is essential to the delivery of transformational change in the
NHS.  In delivering such change Derbyshire Community Health Services (DCHS)
requires information to improve patient care, support clinicians and to understand and
evidence the performance of its services.  The move towards quality driven care
closer to local communities most recently encapsulated within the Darzi review; the
progression towards patient pathways; the increasing importance of activity based
contracts and payment by results for community based services and Transforming
Community Services are but a few of the national and local drivers for high quality
information.

It is critical that information and information systems meet some specific challenges.
We must:
•  Ensure that our services collect and provide information on an individual
patient basis to fully understand our business.
•  Ensure that we are able to measure the quality and outcomes of the care we
deliver.
•  Have the capacity to critically analyse the information that we collect and
through that analysis, add value and knowledge to the information.
•  Ensure the speed at which we are able to conduct that analysis results in timely
and relevant information.
•  Have a holistic approach to the information by harnessing the information held
in finance, human resource and estates systems and combining this with
information on clinical activity.
•  Ensure that information is available to support new analyses such as patient
pathways and service line reporting.
•  Ensure that our staff have the appropriate skills and technology to collect and
understand information relevant to their services.

In essence, to meet all requirements our aim must be to deliver high quality, patient
level information which is reflective of the patient journey and experience and is
relevant to and readily accessible by those that have a justified requirement to access
it.

There has been significant progress on developing information within DCHS.
Clinically focussed information systems, which support the capture of individual
patient information, have now been deployed to large volumes of staff supporting
them in their day to day work.  This work has also given us the opportunity to better
understand what we do and begin to examine patient pathways.  The harmonisation of
information processes has been achieved across many services. The development of
information means that we are now able to contract for over 60% of our service on
activity basis.  The increased provision of computing equipment and improvements in
infrastructure have enabled more staff to have better and more reliable access to
information. The improvements in our information governance help to assure both
staff and patients that their information is held securely and treated in confidence.

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The current situation still leaves room for significant development and in particular
we will need to:
•  Deliver patient level information across the remaining services
•  Increase the sophistication of what we record to include outcome measures
•  Link health records to deliver information that supports and portrays the
patient journey
•  Provide clinical staff with more clinically focussed information systems
•  Harness the disparate information collected across and outside of the
organisation
•  Increase our analytical capacity to improve the timeliness and ease of access to
information to inform our business decisions

The specific developments to meet these requirements are set out in the Priorities
section within the Informatics Plan.

The programme of work set out within this plan is extensive but in order to meet our
aspirations in a timely manner it needs to be delivered within relatively short
timescales. Not withstanding the subsequent iterations and developments that will be
deployed over time, DCHS will aim to:
•  Ensure all major services are utilising patient based information systems
within 2 years
•  Ensure we begin to routinely capture outcomes electronically within 1 year
•  Demonstrate marked improvements in the timeliness of information from
collection to value added analysis within 1 year
•  Draw together a plan to introduce a co-ordinated approach to the use of
information from across the organisation within 6 months

The DCHS Informatics Plan set out below outlines a path for progressing this strategy
over the next year and beyond.  Whilst the plan sets out some specific developments it is
inherently wedded to the strategic approach which seeks to support our services and
underpin our business development and organisational change plans.  These
developments are framed within a set of principles that can be categorised against the
DCHS change plan:

Working Smarter- understanding what we do:
•  We will continue the move towards patient level data and individual patient
datasets across all of our services
•  Ensure that IM&T developments are driven by information requirements
rather than systems
•  Ensure we have ownership and control of our information assets
Working Smarter- eliminating waste:
•  We will reduce the duplication of recording.
•  We will ensure that new systems are fit for purpose, enable efficient working
and are not a retrograde in terms of functionality.
•  We will provide staff with the necessary training to take advantage of
information technology developments.
Thinking Derbyshire, acting locally
•  We will unify information and systems across the geography of DCHS.

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Getting the basics right
•  We will seek to exploit modern information systems to benefit both patients
and clinicians involved in the delivery of care.
•  We will seek to make access to IT a simpler, more efficient process for our
staff.
Putting patients at the centre of what we do
•  We will ensure that all information is treated with the appropriate
confidentiality and that security will be paramount.
Communication – staff know what we do and how to influence it
•  We will seek to broaden access to information systems and provide
appropriate training to all staff in order to aid communication and knowledge
sharing.

In broader terms the DCHS strategy also needs to be aligned to the NHS, East
Midlands and Local Health Community IM&T strategies.
•  We will take account of and participate in the strategy of other partners in the
local health and social care community.
•  To facilitate working with partners, we will seek to exploit systems in line
with the National Programme for Information Technology (NPfIT) wherever
appropriate.

These principles will be used to guide future developments contained within the
Informatics Plan.  Each development listed below will be referenced against the
DCHS Change Plan.

2.  Introduction to the Informatics Plan
The DCHS Informatics Plan is designed to progress the DCHS IM&T strategy in
underpinning the development of high quality information. The principle purpose of
this document is to set out the specific developments within Information Management
and Technology (IM&T) which will support the continued improvement of our
services and underpin our business development and change plans.

In addition to the above, the DCHS Informatics Plan must support service
development and broader business development, meet the national expectations set
out in the NHS Operating Framework and contribute to the Local Health Community
plan. A great number of the developments included within this plan will span these
requirements.

The Informatics Plan sets out current progress to date and charts the way ahead for the
coming year and beyond.  It identifies specific development requirements and the
resources required to achieve them.

3.  Background
The formation of Derbyshire County PCT brought together six PCTs.  Inevitably, this
amalgamation brought with it a plethora of information systems which reflected the
historical needs of the original PCTs.  The IM&T Plan of 2007/8 was developed at the
outset of DCHS to begin the process of harmonising and modernising information
systems across the new organisation.

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3.1.
Developments to Date
The development of information systems within DCHS has been designed to meet the
local and national requirements for information. The requirement for information to
support activity based contracting, to enable more effective service management and
to provide a solid platform to determine the costs of our services have been major
drivers.

To that end a number of significant changes have been put in place:
•  The enhancement of the Information Development Team to increase capacity
in understanding and meeting information requirements
•  The replacement of paper systems in Minor Injuries Units to improve data
capture and support more efficient reporting
•  Harmonisation of information collection across community nursing to allow
more informed service management
•  The migration of therapy and disability services onto national systems to
support joint care records
•  The enablement of choose and book to provide patients with ease of access to
our services

In addition to the developments aimed at delivering improved information, a number
of governance initiatives have also been pursued to facilitate and progress the
information development agenda.  These include:
•  The establishment of an IM&T governance structure, including an IM&T
Strategy Group and Information Delivery Group to guide and progress IM&T
work programme an strategy
•  The inception of a wide ranging information governance programme to ensure
the quality of data as well as its secure, confidential storage and processing.
•  The increase in provision of IT equipment to support all staff in gaining access
to IT including the initiation of a programme to improve networks across
Derbyshire.

3.2.
Existing Information Systems
While significant progress has been made over the last two years in developing and
harmonising systems, DCHS still utilises a wide range of national and local
applications. Its information systems encompass modern, NPfIT specified systems,
older electronic information systems as well as paper systems.  A full list of systems
which support our services are included in Appendix 1.

National Applications
•  iPM Patient Administration System – Following the recent successful
extension of iPM into the north of the county, iPM Patient
Administration System is now used in all 12 community hospitals. It
supports inpatient, outpatient and minor injuries services.
•  The Phoenix Partnership(TPP), SystmOne – Community module has
been deployed across an increasing number of clinical services across
DCHS.  Most recently it has been deployed to approximately 300

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therapy and podiatry staff across the organisation. The Child Health
module is also deployed.
•  NHS mail – NHS mail is in use across large parts of the community
nursing service although its usage is not comprehensive or uniform.
•  Choose and Book – The integrated choose and book function within
the PAS systems enables direct booking to outpatient services. Indirect
booking also allows booking to those services using TPP SystmOne.
•  Care Record Service – Batch and on line tracing are used across the
PCTs community hospitals and within other services.
Local Systems
•  McKesson TotalCare Patient Administration System – used in 7 of the
12 community hospitals and hosted by the Chesterfield Acute Trust.
The A and E module within Mckesson PAS is used within the minor
injuries units at Buxton and Whitworth Hospitals. This is soon to be
replaced by the iPM PAS.
•  STAR – In house database system for Speech and Language Therapists
across the south of the county.
•  Paper based systems – there remains a considerable amount of paper
based systems operating within DCHS.  The majority of community
nursing services across DCHS report activity via paper based systems.
•  Email – the majority of the PCT uses Microsoft Exchange email
although NHS mail is reasonably prevalent with community based
staff.

4.  Moving Forward
Notwithstanding the developments across information and information systems there
remains much to be done. Information gaps still exist for some services, there are
improvements in data quality to be made and further harmonisation of systems is
required.

The NHS Operating Framework for 2009/10 outlines the need for local informatics
plans, with board level ownership and support, to focus on three areas.

•  Making available routine and high quality patient focussed information
•  Underpinning service transformation
•  Improving the quality and safety of patient care through better data quality and
information governance

Included within these broad categories are explicit requirements within the operating
framework to:
•  Pursue specific clinical developments outlined in the Informatics Review of
2008, the ‘Clinical Five’
•  Align with the Strategic Health Authority  for the implementation of National
Programme for Information Technology (NPfIT) solutions
•  Support patient pathways both within health and across health and social care.

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Locally, there are a number of broad objectives which contribute to determining the
IM&T agenda. Activity based contracting, Transforming Community Services, the
need for improved service and business reporting processes, facilitating joint working
across the local health community and meeting the Darzi challenge’s to IM&T all
require developments in IM&T.

The three areas used within the Operating Framework provide a useful structure
against which both local and national requirements can be set.

4.1.
Making available routine and high quality patient
focussed information
The availability of high quality patient information is essential to the effective
treatment of patients.  The appropriate and effective sharing of such information is
central to developing the summary care record and supporting patient pathways both
inside and outside of the immediate health organisation. DCHS will continue to
support and enhance the availability of patient information on a number of fronts.

DCHS will continue to exploit NPfIT applications where appropriate, which support
the development of information exchange. The extension of TPP SystmOne and the
progression to unified patient administration systems through to clinically rich care
systems such as Lorenzo will form a key part of that development.  In addition, where
such systems are not appropriate we will seek to deploy modern systems which
support clinicians and capture individual patient level information. The deployment of
PACS into our community services will be a significant development for clinical
staff.

The ‘Clinical Five’ identified in the Health Informatics Review of 2008 along with
the Darzi Challenges to IM&T developed within the East Midlands Strategic Health
Authority (See Appendix 2), represent challenges for information technology to
directly support the work of clinicians within the NHS. These include electronic
discharge letters, access to results reporting, advanced patient administration systems
and access to shared electronic records.  DCHS will continue to pursue this agenda
and build upon the work it has already undertaken in these areas.

DCHS recognises the importance of working with other agencies to deliver care and
the importance of sharing and integrating information and information systems.  We
will work with partners to increase the appropriate sharing of information in such
areas as results reporting, children’s services, the common assessment framework and
single assessment processes.

The harmonisation of systems brings significant benefits to patients and staff. The
creation of shared records, the ability to share caseloads and work remotely, the
reduction in duplication of recording and the ability to link with external agencies will
all be products of unified systems. In achieving these benefits DCHS will remain
mindful of the impact on others in the health community of potential system
migrations. We will work with colleagues from outside DCHS to ameliorate any loss
of direct data input by ensuring that appropriate measures are put in place to exchange
relevant information and maintain the integrity of patient records.

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4.2.
Underpinning service transformation
Governance
It is recognised that effective governance structures are essential to assuring the
progress of information management and technology and to ensuring organisational
commitment to the development agenda.  With the advent of autonomous provider
status it is imperative that DCHS further strengthens its governance structures. DCHS
will:
•  Enhance membership of the DCHS Information Strategy Group to strengthen
both executive and clinical representation to the group.
•  Establish its own Information Governance Committee to address information
governance issues exclusive to DCHS.
•  Develop its own Information Governance Toolkit against which Information
Governance compliance will be measured.

Business requirements
High quality information is essential for the day to day management and development
of services and a prerequisite for business development and service transformation.
Information is required to support individual services and the business as a whole in
managing itself and proving its efficiency and efficacy to others.  The move to
activity based contracting; the increased usage of Payment by Results in community
settings; the requirements of new patient based community care data sets all increase
the pressure on producing high quality, individual patient focussed data.  To facilitate
this DCHS will:
•  Continue the move towards information which supports activity based
contracting.
•  Increase the availability of individual patient based recording to support more
accurate contracting
•  Develop the use and recording of outcome measures for clinical services.
•  Explore the potential for business intelligence systems to improve on the
efficient processing and dissemination of information.
•  Strengthen the analytical and broader information management function
within DCHS following the reorganisation of Derbyshire Health Informatics
Service (DHIS).

In addition to the information required to support the ongoing business activity of
DCHS, development work is also needed to consolidate the establishment of
Autonomous Provider Organisation status. To that end DCHS will:
•  Further enhance the separation of all DCHS data from Derbyshire County
PCT commissioning function.
•  Maintain processes to identify all DCHS staff in relation to information
services to aid information security and improve the accuracy and specificity
of informatics service level agreements.
•  Continue to pursue its own information strategy while taking account of the
strategies of the national, regional and local health community.

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Infrastructure
The demand for the increasing use of information and information systems places an
increasing burden on the technical infrastructure which currently exists within DCHS.
In conjunction with other partners within the local health community, DCHS is
committed to ensuring that its information technology infrastructure, in terms of
networks and access to computers, continue to be improved.  Furthermore, we will
look to exploit technologies to support new ways of working and increase the
efficiency of our services. To that end we will:
•  Continue to work with partners across the local health community to complete
the Community of Interest Network (COIN) and develop the infrastructure to
improve the storage, security and business continuity of our systems.
•  Continue to increase the provision of computers to enable all staff to have easy
access to IT and information.
•  Through the individual staff appraisal process, we will seek to identify and
meet the need for general IT training giving staff the skills to take advantage
of the increased opportunities to use computers.
•  We will continue to seek the establishment of network connectivity between
DCHS and colleagues in local government to improve information flows
relating to patient and client care.
•  We will extend the coverage of mobile working for peripatetic clinical staff
subject to the successful completion of early trials of relevant technology.
•  Finalise the transfer of the health informatics IT support services to DCHS in
order to ensure continuity of service and ongoing IT support to our services.

4.3.
Improving the quality and safety of patient care
through better data quality and information governance
Information Governance
DCHS is committed to the production of high quality data and its secure and
confidential processing, storage and handling.  DCHS has a strong information
governance structure which drives the information governance agenda to ensure high
data quality, the confidentiality of information, the security of information and the
systems on which they sit and the relevant governance procedures.  We have detailed
and stringent policies on both information security and data quality.

In progressing the information governance agenda, DCHS will:

Governance
•  Develop its own dedicated DCHS Information Governance structures,
including the appointment of its own Caldicott Guardian, to oversee the entire
information governance programme.
•  Produce and meet the requirements of a DCHS specific information
governance toolkit.

Confidentiality and Security
•  Fully comply with all relevant legislation such the Data Protection Act.

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•  We will meet all NHS standards such as the Care Record Guarantee, keeping
the public informed of what happens to their data, protecting the
confidentiality of records at all times and responding to patient requests for
access to records and to responding to requests to restrict sharing.
•  Ensure that all information exchange is conducted in adherence with
information sharing protocols and in line with the Care Record Guarantee.
•  Ensure that we utilise appropriate technology such as the encryption of mobile
devices and password protection on key systems to prevent breaches of
security.
•  Promote the extended use of NHS mail to communicate confidential
information.
•  Ensure that all staff are aware of their responsibilities in relation to security
and confidentiality through the delivery of appropriate training.
•  Fully exploit the information governance functionality within the national
programme applications such as the Registration Authority, Roll Based Access
Control and Legitimate Relationships.
Data Quality
•  Ensure that all relevant staff are aware of their responsibilities in relation to
data quality through the delivery of appropriate training.
•  Continue a programme of data quality improvement through established data
quality working groups.
•  Continue to monitor and report on data quality in all key systems.
•  Develop a programme to ensure the accurate use of the NHS number across all
services including the continued tracing and monitoring of NHS numbers.

5.  Benefits
Any information development or implementation of information systems should
deliver benefits to DCHS. These may include patient benefits, financial benefits,
efficiency savings, and many others. DCHS will identify and measure benefits for all
significant projects.  A benefits statement for each project will be included at in every
project initiation document with a plan to measure those benefits before and after
project completion.

6.  Priorities for 2009/10
The developments for 2009/10 and beyond are designed to meet local requirements
within the framework and guiding principles set out above.  They include a number of
significant projects already in progress and a significant amount of new work. The
new projects represent the output of a dedicated consultation exercise conducted with
heads of service and the senior team within DCHS to prioritise IM&T developments.
They also reflect priorities identified through ongoing consultation within DCHS.

6.1.
Projects in progress
iPM Patient Administration System consolidation
(Working Smarter- understanding what we do, Working Smarter- eliminating waste,
Thinking Derbyshire, acting locally,  Putting patients at the centre of what we do)

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The iPM Patient Administration System (PAS), previously used in the south of
Derbyshire, has been rolled out across all relevant sites in the north of the county.
The unification of the PAS across the county will deliver short term benefits of
harmonising business processes and consolidating reporting as well as laying the
groundwork for long term benefits of clinical recording, system integration and the
subsequent move to Lorenzo.  The service review analysis resulting from this work is
in progress and the potential for further benefits will be identified as part of this
process.

Picture Archiving and Communication System (PACS)
(Working Smarter- understanding what we do, Working Smarter- eliminating waste,
Putting patients at the centre of what we do)
DCHS has initiated a project to roll out the Derby Hospitals Foundation Trust PACS
into relevant sites in the south of the county.  The advent of PACS within these
facilities will enable digital image capture at its community hospitals and health
centres currently using traditional x-ray and ultrasound technology and facilitate the
viewing of PACS images in all appropriate locations.

Infrastructure consolidation
(Working Smarter- eliminating waste, Thinking Derbyshire, acting locally, Getting
the basics right, Communication – staff know what we do and how to influence it)
DCHS, with its partners in the local health community, is currently in the process of
upgrading its network connections and improving its storage facilities.  This process
is designed to improve system performance and facilitate more co-ordinated working
across the county as well as improve information security. The programme is already
delivering significant benefits and will increasingly do so as it progresses towards
completion.

TPP SystmOne
(Working Smarter- understanding what we do, Working Smarter- eliminating waste,
Thinking Derbyshire, acting locally, Putting patients at the centre of what we do,)
TPP SystmOne is the primary community system supplied by the NPfIT to support
community clinical services.  Its usage provides shared care records across clinical
services enhancing patient safety and service efficiency.  There is already a
considerable user base of TPP SystmOne users within the Allied Health Professionals
and community nursing groups in DCHS and a number of other projects are in train to
bring further services onto the system. Projects to move respiratory nursing staff and
community matrons will continue to completion.

Results reporting
(Working Smarter- eliminating waste,  Putting patients at the centre of what we do)
DCHS is currently working with colleagues at Derby Hospitals Foundation Trust to
increase the availability of results reporting to appropriate staff within DCHS. This
work will continue to extend access to a wide range of relevant staff, subject to
appropriate access controls, for the benefit of patient care.

Contraception and Sexual Health Services (CaSH)
(Working Smarter- understanding what we do, Working Smarter- eliminating waste,
Thinking Derbyshire, acting locally, Putting patients at the centre of what we do,)

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The implementation of an information system to support Contraception and Sexual
Health Services (CaSH) has suffered significant delays due to the lack of availability
of an appropriate system.  The original intention to place this service on TPP
SystmOne has not yet come to fruition due to deficiencies in functionality of the
system.  Options for this service are currently being reviewed and national
developments are being closely monitored to identify which solution will provide the
best fit.

Patient Transport Services
(Working Smarter- understanding what we do, Working Smarter- eliminating waste,
Thinking Derbyshire, acting locally, Putting patients at the centre of what we do,)
The deployment of the Cleric system will support the DCHS patient transport service.
This work is scheduled for imminent completion pending the procurement of further
functionality to support the service.

6.2.
New developments
New developments will build on much of the foundation work that has already been
completed.  The focus moving forward will be on those developments that can make a
tangible difference to the way we deliver our services; increasing efficiency and
developing an IM&T culture across DCHS.  Set out below is a list of new
developments which will be embarked upon in the coming months.  Each project, at
its initiation will set out the benefits, costs and risks of implementation.

Community Services Activity Collection(CSAC)
(Working Smarter- understanding what we do, Thinking Derbyshire, acting locally)
A system of activity collection for community services has been developed to collect
basic activity data for a number of services.  This has contributed significantly to
DCHS’s ability to move towards activity based contracts.  Although this is seen as
predominantly a temporary measure pending the implementation of clinically
focussed systems a project will be initiated to move from the predominantly paper
based reporting from frontline staff to one where they input directly into the system
itself (eCSAC). This will make the collection process more efficient and result in
more timely reporting.

Electronic discharge letters
(Working Smarter- eliminating waste, Putting patients at the centre of what we do)
In line with the ‘Darzi Challenges to IM&T’ and Informatics Review ‘Clinical Five’,
DCHS recognises the considerable benefit to be gained from the production and
distribution of electronic discharge letters to general practice.  Following an initial
scoping exerciser, DCHS will undertake a project to deliver discharge letters to
general practice for patients in our care.

Electronic clinical noting
(Working Smarter- understanding what we do, Working Smarter- eliminating waste,
Putting patients at the centre of what we do)
As information systems become more sophisticated, the possibility of exploiting
information systems increases. One of the key opportunities is the use of electronic
systems to record full clinical noting – a critical step in achieving true electronic

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health records.  In order to test the feasibility of this approach we will embark on a
project to pilot the use of full clinical recording via electronic systems.

TPP SystmOne
(Working Smarter- understanding what we do, Working Smarter- eliminating waste,
Thinking Derbyshire, acting locally, Putting patients at the centre of what we do)
The ability of TPP to enhance patient safety and promote efficient working through
the delivery of shared care records is a benefit which is enhanced as more services are
brought onto the system.  Projects will be developed to add to the already
considerable user base of local clinical services using TPP SystmOne.  Among these
projects will be a proposed roll out of TPP SystmOne to the Health Visiting service
and Learning Disabilities.  Work to extend the use of SystmOne mobile working
capability will also be undertaken.

Mobile data collection
(Working Smarter- understanding what we do, Working Smarter- eliminating waste)
In addition to deployments of TPP SystmOne, DCHS will investigate the potential for
mobile activity capture and workload management for community nurses.

Lorenzo
(Working Smarter- understanding what we do, Working Smarter- eliminating waste,
Thinking Derbyshire, acting locally, Putting patients at the centre of what we do)
The Lorenzo Regional Care system is viewed as the backbone of shared care records
by the NPfIT. Its implementation will provide the ability to access clinically focussed
functionality such as clinical noting and electronic prescribing and will allow
seamless exchange of patient information with local acute trusts as they migrate onto
the system. In 2009/10, DCHS will begin planning work for the proposed deployment
of Lorenzo in 2011.

Business intelligence
(Working Smarter- understanding what we do, Working Smarter- eliminating waste)
Information to support service and business management, meet commissioner
demands and the requirements of the Department of Health is critical to DCHS. While
a major information development programme has improved quantity and quality of
available information, the processing and application of that information remains
relatively cumbersome. As part of a process to improve the use of information we will
explore the opportunities offered by business intelligence systems to increase the
speed and ease with which information is processed.

Outcome measures
(Working Smarter- understanding what we do, Putting patients at the centre of what
we do)
Transforming Community Services encapsulates the increasing importance of the
outcome of health interventions. We will work with services to begin to capture
outcome information through our information systems.

Service specific systems
(Working Smarter- understanding what we do, Thinking Derbyshire, acting locally,
Putting patients at the centre of what we do)

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In addition to the strategic direction set out above there will continue to be
requirements for services that require discreet systems.  The rationale for these
systems may be service delivery support or business information driven or a
combination of both.  Following consultation a number of services have identified
specific needs for development.  The IM&T team will work with the relevant services
to deliver:
•  Functionality for Support Services to assist asset management, asset utilisation
and staff rostering.
•  Improvements in information capture and production for Dental Services to
support activity based contracting.
•  Functionality to support the Endoscopy Service in meeting national
requirements for reporting
•  Improvements in the Child Health systems to provide greater accessibility of
reliable data.

Delivering efficiency through IM&T
(Working Smarter- understanding what we do, Working Smarter- eliminating waste,
Getting the basics right, Putting patients at the centre of what we do, Communication
– staff know what we do and how to influence it)
The deployment of IM&T solutions brings with it the potential to deliver efficiencies
in the way we work.  DCHS is already piloting mobile working for community
nursing staff and using telephone conferencing to reduce the need for travel.  In
addition to expanding these areas we will also investigate the deployment of other
technologies that can deliver further efficiencies.  In particular we will look to exploit
the potential efficiencies in Single Sign On technology, which will allow all staff to
access appropriate systems through he use of a single password. We will also examine
the potential to route our telephone calls over our computing network (VOIP).

7.  Funding and resource
The funding and resource required to meet the priorities identified for 2009/10 are set
out below:

Community Services Activity Collection
No associated additional cost. This development will be funded from within current
budgets.

Electronic discharge letters
No associated additional cost. This development will be funded from within current
budgets.

Electronic clinical noting
No associated cost

TPP SystmOne
The average roll out period for a new community unit is approximately 20 weeks. Set
out below are indicative costs for the proposed projects. All of these costs would be
confirmed as part of the project initiation.


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The roll out of TPP SystmOne to Health Visiting and District Nursing services
represent large projects.

Health Visitors
Based on a staffing complement of 250 staff:
•  Business change 0.5 WTE x 20 weeks

= £6500
•  Project Management 0.5 WTE x 20 weeks
= £5400
•  Training 1 WTE x 6 weeks

= £2800
•  Configuration and testing 0.4 WTE x 5 weeks
= £900
•  Hardware 100 x PCs @ £300

= £30000
•  Hardware 50 printers @ £400

= £20000
•  Total

= £65600

The costs outlined above will be met from within the existing service level
agreements with DHIS.

Learning Disabilities
Based on a staffing complement of 100 staff:
•  Business change 0.5 WTE x 20 weeks

= £6500
•  Project Management 0.5 WTE x 20 weeks
= £5400
•  Training 1 WTE x 6 weeks

= £2800
•  Configuration and testing 0.4 WTE x 5 weeks
= £900
•  Hardware 50 x PCs @ £300

= £15000
•  Hardware 25 printers @ £400

= £10000
•  Total

= £40600

The costs outlined above will be met from within the existing service level
agreements with DHIS. It is expected that the bulk of these costs will be in financial
year 2010/2011.

Ongoing support
The increase in general usage of computer systems carries with it a requirement for
additional support, for example the need to increase capacity on the customer service
desk and the need for extra support technicians. The estimated annual costs for
ongoing support of the above TPP roll outs are:
Total

= £35000

Lorenzo
The Lorenzo Regional Care system will be fundamental to the future of health
informatics and health care delivery in Derbyshire and across the entire north,
midlands and east of England.  As such its deployment locally will be significant not
only in terms of its importance to the future healthcare landscape but also in terms of
the project size.

The Project Brief , outlining the broad aim of the project will be produced in autumn
2009. A full breakdown of costs will be included in the project initiation document
and brought to DCHS Board for consideration. The costs below only represent the
necessary spend up to project initiation.

16

•  Business change .5 WTE x 16 weeks

= £6000
•  Project Management .5 WTE x 16 weeks

= £58000
Total

= £11000

The costs outlined above will be met from within the existing service level
agreements with DHIS.

Business intelligence
Initial scoping work has already taken place.  The early estimates from this work have
produced an initial cost of £45000.

Outcome measures
No associated additional cost. This development will be funded from within current
budgets.

Service specific systems
Service specific systems will be costed according to the specific requirements of each
service. Each of these will be presented to the DCHS Information Strategy Group
with costs and identified funding streams in advance of initiating the project.

8.  Conclusion
The DCHS Informatics Plan 2009 sets out a strategic direction which builds upon the
progress already made in developing the capacity to produce and utilise high quality
information for the benefit of patient care and service and business management.  The
Plan recommends a considerable challenge but offers the opportunity to move further
towards the information enabled service transformation that will ensure the delivery
of high quality services to the patients and clients of DCHS.

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Appendix 1
Existing Systems
Service Line
Sub Category
Current System Description
Current Developments
CSAC monthly paper forms for basic contract, ref costs and
Review and develop use of TPP
Health Visiting

service data.
SystmOne
TPP SystmOne in Southern Derbyshire with limited use.
CSAC monthly paper forms for basic contract, ref costs and
Review and develop use of TPP
School Nursing

service data.
SystmOne
TPP SystmOne with limited use.
Inpatients
PAS system used for all Inpatient activity

Learning Disabilities
Community
Manual data collections in place

Community Nursing
CSAC monthly paper forms across County

Community Nursing
Long Term Conditions template used across County on TPP
Community Matrons

SystmOne or GP Practice system
Inpatients
PAS system used for all Inpatient activity

Older People's Mental
Review underway of systems for
Health
Day Services
Range of systems – PAS and manual data collections
day services
eCSAC electronic monthly forms in use for all Specialist
Specialist Services

Nursing Services
Daycases

PAS system used for all activity

RadWeb at Ilkeston, RIS at Buxton & Whitworth, Database at
Direct Access
Investigate requirements for

Ripley Hospital. Endoscopy, hysteroscopy and cystoscopy
Diagnostic Services
Endoscopy system
activity is paper based.
Hospital based Outpatients
PAS system used for all activity

Outpatients
Physiotherapy and
TPP SystmOne used for all activity

Occupational Therapy OPs
Patient Transport

Cleric being implemented

Services
Community Podiatry
TPP SystmOne used for all activity

Podiatry
Surgical Podiatry
PAS system used for all activity – Daycase and Outpatient

Community
CSAC Monthly paper collection form in place from 1st April

Intermediate Care
2009
CSAC Monthly paper collection form in place from 1st April
Community Therapy

2009

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Service Line
Sub Category
Current System Description
Current Developments
Day Services

Range of systems – PAS and manual data collections

Specialist Rehabilitation
Monthly collection form being

Units
developed
Contraception & Sexual

Database in use

Health
R4 Kodak System used in North Derbyshire, Software of
Dental Services

Excellence used in South Derbyshire
Psychology Services

Manual data collection forms in place

ELMS (Northern Derbyshire) and BEST (Southern
Wheelchair Services

Disability Equipment
Derbyshire) systems in use
Services
Disability Resource Team
TPP SystmOne used for all activity

and Traumatic Brain Injury
Speech & Language

STAR system used for all activity

Therapy
Inpatients

PAS used for all Inpatient activity

Minor Injuries Unit

PAS used in all four MIUs

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Appendix 2

Darzi Challenges to IM&T
Informatics Review ‘Clinical 5’
1.The provision of modern & compatible electronic administrative systems that supply accurate
A Patient Administration System with integration with other systems
data for flexible reporting and auditing purposes including clinical process and outcome
and sophisticated reporting
measurement (ADVANCED PAS)
2. The ability to electronically request & to electronically receive the results of pathology &
Order Communications and Diagnostics Reporting (including all
radiology tests (relates to both secondary & primary care and includes “rules based” ordering)
pathology and radiology tests and tests ordered in primary care)
with results available irrespective of ordering location or clinical system (ORDER COMMS)
3. The ability to prescribe, dispense and control stock of medications electronically (with “rules
e-Prescribing (including ‘To Take Out’ medicines).
based” decision support) in both secondary and primary care, with the update of medication
details in the GP record (ePrescribing)
4. The inclusion of “to take out” medications on electronic initial discharge summary documents

(TTO's)
5. The electronic production and transmission of clinical letters (e.g. referrals, discharges, out
Letters with coding (discharge summaries, clinic and Accident and
patient letters & out of hours care) sent & stored directly in the GP electronic patient record
Emergency letters)
(LETTERS)
6. The systematic use of clinical codes in every NHS IM&T application (CODING)

7. The ability to make time-related dependencies' between the ordering of multiple activities (e.g.
Scheduling (for beds, tests, theatres, etc)
the system “knows” that in order to perform procedure A the results of tests B & C must be
available, and offers appointments for the patient accordingly) (SCHEDULING)
8. Access to shared electronic patient records across a local health community in order to share

patient information and deliver pathways of care (DETAILED CRS)
9. Diagnostic images relating to a patient should be visible to every clinician involved in their care

regardless of location, including within primary care systems (PACS EVERYWHERE)
10. The implementation of a secure electronic method of communication between consultants and

GPs (Email)
11.The ability to securely access clinical systems regardless of physical location and to view and

enter patient clinical details when connected ( MOBILE ACCESS)
12. Single smartcard sign on to all systems (SINGLE SIGN-ON)

13. To bring forward the National Summary Care Record, Electronic Prescriptions Service and GP
to GP transfer in order to provide immediate patient benefits (SCR/EPS/GP2GP)

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Appendix 3
Development Timeline

Q1
Q2
Q3
Q4
Q1
Q2
Q3
Q4
2009/10
2009/10
2009/10
2009/10
2010/11
2010/11
2010/11
2010/11
iPM PAS Consolidation

PACS

Infrastructure

TPP AHPs

TPP Respiratory Nurses

TPP Community Matrons

Results Reporting

CaSH
TBC

Cleric PTS

eCSAC

Electronic discharge letters

Electronic clinical noting

TPP health visiting

TPP district nursing

Lorenzo

Business Intelligence

Outcome measure

VOIP
TBC

Single Sign On
TBC

Asset management systems
TBC

Dental systems
TBC

Endoscopy system
TBC

Child Health
TBC

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