CHESHIRE DIGITAL
ROADMAP
2016
A local digital roadmap developed by Eastern Cheshire, South
Cheshire, Vale Royal and West Cheshire Clinical Commissioning
Groups in conjunction with their partner organisations.
link to page 3 link to page 9 link to page 25 link to page 28 link to page 37 link to page 53 link to page 55 link to page 66 link to page 68
Contents
1.0 Introduction ............................................................................................. 2
2.0 Local Digital Roadmap 5 Year Vision ...................................................... 7
3.0 Readiness Assessment .........................................................................23
4.0 Capability Deployment Schedule and Trajectory ...................................26
5.0 Universal Capability Delivery Plans .......................................................34
6.0 Information Sharing Framework .............................................................50
7.0 Infrastructure Approach .........................................................................52
8.0 Appendix A – Local Digital Roadmaps – ................................................63
9.0 Appendix B List of Initial Pioneer Panel Partner Organisations .............65
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1.0 Introduction
This document describes the ambition of our regions health and social care
services and how we intend to improve services for patients, citizens and staff
involved in health and caring services across Cheshire.
In this document, there are many references to government programmes,
upcoming legislation and targets to fulfil, but ultimately it is about how we all
work together, patients public and staff and how we interact with other regions
to experience and provide the best service possible within the limited
resources available to us.
The area that we represent is rural, with an elderly population, relatively
affluent in places but with significant areas of deprivation. This presents
challenges in delivering and coordinating care, as well as developing services
that acknowledge the richness of services available within the major
conurbations surrounding our region. The issue is one of connectivity, how do
we coordinate the logistics of health and care between different providers of
care, staff, locations and services and maintain an approach that must put the
individual at the heart of all that we do. We aim, through this local digital
roadmap, to bring the currently diverse infrastructure up to a new baseline
level of connectivity, providing seamless and simple access to digital
resources across all public services in Cheshire, for workers and citizens.
Our longer term ambitions are to develop services that give control of data
and therefore care, back to the citizen, making them the centre of our local
care system. To achieve this we aim to procure and develop standards based
services that will seamlessly interconnect with public facing digital applications
that empower our citizens and allow them to control and manage their data.
This in turn will remove barriers to access data crucial to supporting the best
levels of care.
Our strategy to achieve this is:
Make the most of what we already have and connect to everything.
For example we are now linking existing networks across East, Central
and West Cheshire which should allow data to flow seamlessly and
provide a platform upon which new local services can develop at pace.
Develop a standards based care economy: by agreeing technical and
information governance standards across Cheshire we can improve
connectivity and make significant economies in resources expenditure and
improve the security and level of service provided.
Actively seek out willing partners to develop services at scale ( LDR,
STP Regional and National) including the development of an EPR across
a wide footprint would bring benefits in standardisation, interconnectivity,
economies of scale and efficiency of investment. For example, the
Cheshire Care Record was developed at an accelerated pace with a much
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richer data set and a much reduced investment compared to programmes
pursued by individual CCGs.
Investing in digital technology is a key enabler to integrating care, improving
the experience our citizens have of the services available to them, and
ensuring the care system operates at the greatest level of productivity and
efficiency. Investments must however be managed within an increasingly
challenged economic environment and therefore investments will be made
responsibly, maximising economies of scale and through ensuring we access
support through Nationally supported digital funding streams.
Technology enabled transformation will be a key part of our future and I hope
through our Local Digital Roadmap we can collectively start that journey.
1.1
Digital Roadmap Drivers
1The Five Year Forward View recognised the need for the NHS and social
care to exploit the information revolution to meet the fundamental challenges
facing us – the health and wellbeing gap, the care and quality gap, and the
funding and efficiency gap. Recognising the need for sector-wide leadership
to deliver this agenda the National Information Board (NIB) has brought
together organisations from across the NHS, public health, clinical science,
social care, local government and representatives of the public. In November
2014, the NIB produced ‘2Personalised Health and Care 2020, Using Data
and Technology to Transform Outcomes for Patients and Citizens - A
framework for action’. This document committed that local health and care
economies would, by June 2016:
produce detailed roadmaps highlighting how, amongst a range of digital
service capabilities, they will ensure clinicians in all care settings will be
operating without the need to find or complete paper records by 2018; and
that by 2020 all patient and care records will be digital, real-time and
interoperable.
An important element of this strategy is the production of local digital road
maps, led by local commissioners in conjunction with local authorities, local
providers, local citizens and other stakeholders. The citizen will release
benefits in every aspect of care evolving over the years of deployment of the
digital roadmap. These will be a blend of clinical outcome benefits and
efficiency gains. As and when the digital roadmap becomes fully deployed
every aspect of care as viewed by the citizen will have been transformed from
1
Paper PB 150326/09 BOARD PAPER - NHS ENGLAND Title: Digital Health Services by 2020:
Delivering Interoperability at Point of Care to Support Safe, Effective, Efficient and High Quality Care
2Personalised Health and Care 2020... - A Framework for Action Pub. Nov 2014
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our current baseline. The end goal of this is the introduction of fully
interoperable digital records, including primary, secondary, social, mental
health, community and specialised care.
In addition the local health systems are required to develop Sustainability and
Transformation Plans (STP) which will incorporate the Local Digital
Roadmaps. NHS England is asking every health and care system to come
together, to create its own ambitious local blueprint for accelerating its
implementation of the Forward View. STPs will cover the period between
October 2016 and March 2021.
The Spending Review provided additional dedicated funding streams for
transformational change, building up over the next five years. This protected
funding is for initiatives such as the spread of new care models through and
beyond the Vanguards, primary care access and infrastructure, technology
roll-out, and to drive clinical priorities such as diabetes prevention, learning
disability, cancer and mental health. Many of these streams of transformation
funding form part of the new wider national Sustainability and Transformation
Fund (STF). The most compelling and credible STPs will secure the earliest
additional funding from April 2017 onwards.
This document encompasses the first iteration of the Cheshire Local Digital
Roadmap and represents a first significant step to delivering joined up
solutions to the current challenges faced by the NHS and recognition and
structure around the excellent cooperative work that is already taking place
within Health and Social Care across Cheshire. We recognise fully the need
to scale up the Local Digital ambitions to integrate with those contained in the
STP and to this end we expect to join with other areas in developing
cooperative programmes of work, deployed at scale, to overcome our most
significant challenges.
1.2
Digital Roadmap Development and Footprint
The Cheshire Digital Roadmap (LDR) footprint covers the Central, Eastern
and Western areas of Cheshire represented by four CCGs and two local
authorities. The area which is largely rural, borders Merseyside and Greater
Manchester, Derbyshire, Staffordshire and Shropshire and Wales. Cheshire's
county town is Chester and major towns include Congleton, Crewe,
Macclesfield, Northwich, Wilmslow, and Winsford. (Note: this excludes
Stockport, Warrington and the Wirral)
The population covers some of the richest and poorest parts of the county
across a varied geography that impacts on how health and care services are
accessed, delivered and financed. This brings its own challenges for workers
in the community and patients in terms of connectivity to digital resources,
and whilst we benefit from the close proximity of major conurbations, with
access to additional acute and specialist services, this has a penalty in terms
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of distances travelled and a disaggregation of management and technical
standards across the region.
A further challenge is the local financial position within the digital footprint as
each of the CCG’s are planning a deficit and all 4 of the providers are in
deficit. This picture translates to the wider Sustainability and Transformation
Plan footprint of Cheshire and Merseyside, with 6 out of the 12 CCG’s
planning a deficit and 12 out of the 19 providers in deficit. Significant external
investment is required to deliver our ambitions in meeting the challenge and
successfully delivering the Five Year Forward View and the Lord Carter of
Coles review, without this the levels of success will be diminished.
Figure 1 Distribution of health centres
Whilst there are a range of potential directions in terms of cooperative
development, the Local CCGs involved in the development of the Roadmap
have a history of working together, including most recently the Cheshire Care
Record and Cheshire Shared IT network programmes. These programmes of
work were sponsored by the following transformation programmes:
Caring Together – Eastern Cheshire
Connecting Care – South and Vale Royal
West Cheshire Way – West Cheshire
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The three transformation programmes have a collective vision to deliver the
highest quality of life and wellbeing for our population, through partnership
working, service integration, patient empowerment and local consultation.
These collective transformation programmes are being delivered successfully
as part of the Cheshire Integrated Care Programme which is governed by the
Cheshire Pioneer Panel and are the foundation of the LDR, which feeds into
the Sustainability and Transformation Plans.
The diagrams below provide an indication of how the various Transformation
Programmes, Responsible Bodies and the STP interlink.
Figure 2 Visual summary of integrated care programmes
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Cheshire &
Merseyside
Sustainability &
Transformation Plan
Cheshire
Pioneer
Cheshire East
Caring
Together
West
Cheshire
Connecting
Way
Care
CWAC
Cheshire East Health and Wellbeing Board
West Cheshire
Vale Royal
South
Eastern Cheshire
CCG
CCG
Cheshire CCG
CCG
Countess of Chester
Mid Cheshire FT
East Cheshire Trust
FT
Cheshire & Wirral Partnership FT
North West Ambulance Service NHS Trust
Cheshire Pioneer Panel
Cheshire & Warrington Sub-Regional Leaders Board
Figure 3 STP footprint connections
The Cheshire Integrated Care programme was formed as part of the Pioneer
programme of which Cheshire Pioneer was one of the first 14 areas across
England (now 25), that are leading in delivering better joined up health and
social care.
The Cheshire Pioneer Panel is responsible to the Health and Wellbeing
Boards in Cheshire East and Cheshire West and is supported by the local
authorities of Cheshire West and Chester and Cheshire East, along with the
constituent Clinical Commissioning Groups of Eastern Cheshire, South
Cheshire, Vale Royal, and West Cheshire, who combined, have 90 GP
practices serving a population of 750,000.
A number of significant provider organisations operate within the Cheshire
Pioneer including Countess of Chester Hospital NHS FT (CoCH), East
Cheshire NHS Trust (ECT), Mid Cheshire NHS FT (MCHfT), Cheshire and
Wirral Partnership NHS FT (CWP) and the North West Ambulance Service
(NWAS), who together provide a comprehensive range of acute, community
and mental health services. A full list of the initial partners can be found in
Appendix B:
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The Cheshire Care Record and the Cheshire IT Shared Network programmes
are endorsed by the Cheshire Pioneer Panel who oversees the provision of
the funding for the project. The programme boards themselves have full
representation and involvement from local CCIO (Chief Clinical Information
Officer) / Clinical leads as well as Information Governance and Technical
Leads for the organisations involved in delivery.
The digital road map is endorsed by the four clinical commissioning groups,
the two councils and the four principal providers based within the locality
(CWP, CoCH, ECT and MCHfT)
2.0 Local Digital Roadmap 5 Year Vision
The Five-Year vision is a mandated element of the Local Digital Roadmap
describing how by March 2021 the LDR will support a digitally-enabled
transformation to help address the three national challenges (i) closing the
health and wellbeing gap, (ii) closing the care and quality gap and (iii) closing
the finance and efficiency gap. In addition it is recognised that the five year
vision needs to encompass the potential within the STPs for developing and
funding interoperable digital solutions at scale with an expectation that some
of these will not be feasible without developing programmes and funding at a
regional/national level.
2.1
Closing the health and wellbeing gap:
Delivering appropriate tools to patients to support self-care and wellbeing and
make the most of the ensuing data to monitor and improve their health
management.
The four LDR CCGs have encouraged the use of a single clinical system
provider, in order to harvest the advantages that a common technology
platform delivers, such as service delivery improvements and efficiencies in
change management, security and training support as well as the delivery of
initiatives in common such as access to personal care records. As systems
become standards based and interoperable, we would expect this to change,
but through this approach, the vast majority of patients across the Cheshire’s
now have the potential to access their personal health record held on GP
clinical systems and make and manage their GP appointments. Note: The use
of the single system has now extended to the vast majority of GP Clinical
Systems, East Cheshire Community and CWP.
This is a significant achievement in itself, but to realise any long term benefit
we need to expand our ambition, going from a parent child model (Care
provider to patient) to an interactive model where the informed and engaged
patient has full control of their own care, including a the ability to interact with
their own record and maintain a care diary which contains details of all
appointments, primary, secondary, nursing and social care. All of this
information would be available to people involved in the patient’s care, with
the ability for patients to manage their diary, provide direct consent for
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information sharing and allow for a more integrated, efficient and secure
approach to care delivery.
Step changes in technology and change management are required to realise
this ambition by 2021.
Increase the numbers of patients accessing their full GP personal health
record, through a progressive communications and engagement change
programme.
Development of technical solutions to the Information Governance consent
model – a single data solution holding details of data sharing agreements
across an agreed footprint for health and social care and the ability for
citizens to directly manage and store individual consent across broad
categories. (See LPRES and NWSIS Lancashire and Cumbria Information
Sharing Gateway)
Development of technical solutions that can interact with existing data
repositories to provide a comprehensive patient view of their personal care
information, personal care budgets and future care provision, including
appointments with all health care providers and care givers. This includes
the ability to manage their appointments and directly communicate
securely and efficiently with the organisations and people involved in their
care.
Development of services that can receive and monitor health metrics
remotely and provide advice and support as well as health alerts and
interventions where appropriate, including the development of risk
stratification (population health management) services using health and
social care data.
We consider that all of these developments are best approached at scale,
where efficiencies and maintenance of high standards are better achieved
through a dedicated centralised function with a collective management
approach. To this end willing partner organisations in Cheshire and
connected areas have formed a Digital Leads sub–group of the Cheshire
Pioneer Panel, which will provide the engagement, ideas, guidance and
governance for producing solutions to support the Roadmap and
engagement with other LDRs across the STP footprint.
2.2
Closing the care and quality gap:
Supporting new models of care, including 7 day working and effective triage
by delivering real time and comprehensive patient information.
The Cheshire Care Record supported by Roadmap partners delivers one of
the most comprehensive care records available in the UK and is an excellent
demonstration of the high level of commitment to collaborative working across
health and care organisations in Cheshire.
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This provides clinicians and social care workers with access to near real time,
comprehensive health and care information on a 24 hour 7 day basis,
available through universal internet devices. Currently the project is in its first
phase of deployment to all health and social care professionals, with further
data sources being added on a continuous basis. An active programme board
with cross Cheshire representation manages the delivery of the programme
and this is supported by a Governance Committee with clinical, patient and
executive representation at its heart. A full engagement and communication
programme is underway to maximise the take up of this service.
Christie Cancer Care
Clatterbridge Cancer Care
Vale Royal CCG
CWP (Mental Health) Trust
CWP (Community) NHS Trust
East Cheshire Community Trust
West Cheshire CCG
East Cheshire Trust
West Cheshire Council
East Cheshire Council
Countess of Chester Hospital
Eastern Cheshire CCG
South Cheshire CCG
Fully Live
Mid Cheshire Hospital FT
Partially Live
Not Live
Figure 4 CCR Data sources and status June 2016
The vision for the Cheshire Care Record is one of ubiquitous use across the
“Cheshire’s” and further, with a longer term expectation that this will provide
the basis for the development of more targeted and refined future services.
Developments in phase 2 include:
Expanding access to organisations and services such as North West
Ambulance Service (NWAS), Hospices, Continuing Care and others.
Patient Portal Pilot
Generating alerts
Add GP letters
Enhancement of existing datasets, including social care, mental health.
Addition of a child health dataset
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Enhanced end of life data from community care
A much later phase of the programme would see the evolution from third party
middle ware to procurement of platforms that are interoperable. This will allow
records to be read and updated in real time, as well as reducing the
substantial cost of maintaining a middle ware solution. Eventually we would
expect all data will comply with agreed industry standards across all major
systems, allowing it to be moved to a single repository or virtual single
repository with a government standard level of security and access applied to
it all. This provides opportunities for a granular level of citizen control over
their data to comply with upcoming EU information governance initiatives and
equally empowers the citizen to provide clear permissions to access their data
for a much wider range of uses than are currently supported by legislation.
In terms of supporting 7 day working or flexible working, the development of
the Cheshire Shared IT Network, encompassing health and social networks,
provides the foundation to enable the economic development of new services
to support extended working hours. By moving the majority of IT infrastructure
out of health and social care premises and adopting a centralised support
model, it becomes economical to provide extended hours support services.
The ability to share and interconnect resources across health and social care,
will allow the development of new services that are not tied to any specific
location or team
2.3
Closing the finance and efficiency gap:
Deployment of mobile working solutions, access to real time comprehensive
patient information to avoid unnecessary tests and better asset and resource
management.
Different ways of working and harnessing innovation and technology will
ensure the NHS works more efficiently and cost-effectively. We recognise that
the existing limited infrastructure is a barrier to change and the adoption of
new technologies, for example the plethora of new digital services such as
“uber” have only been enabled by the universal availability of smart phones
working on standardised platforms with a reliable and accessible universal
communications network.
In response to this the Roadmap CCGs are in the process of deploying the
Cheshire Shared IT Network programme which is the first step in bringing all
of the practices in the area together on one network, which in turn will connect
to existing service providers. This is an enabling piece of work, which
supports mobile working, integrated teams and patient access to Wi-Fi at local
health and council premises. (Currently being piloted between CWP and
Cheshire East Council) Longer term the intention is to create physical links
between networks that conform to the Public Services Network standards
(PSN), thus allowing data and resource sharing across all public services and
providers, with ubiquitous Wi-Fi access.
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This foundation work also supports a greater level of security, with investment
in new firewalls and security appliances, plus the opportunity to work with
partners on a wider basis. For example The North West Shared Infrastructure
Service (NWSIS), where there are more chances to work, specify and
purchase at scale. For example in Eastern Cheshire the new network will
allow local practice servers to be moved to a virtual environment where they
will benefit from industry standard data security with closer to real time data
recovery as well as removing the need to back up services in practice
premises..
Longer term there are plans for unified communications across Cheshire (and
beyond), covering voice, video, data and text, with the chance of free internal
calls for health and social care, ubiquitous video and web conferencing,
including consultations and opportunities to develop new methods of working
and interaction with staff and citizens, including federated working.
In terms of efficiency we see considerable advantages in developing these
services at scale and preferably at an STP or regional/national level. By the
adoption of common standards and choices agreed at a high level there are
opportunities for us to deploy new services much more quickly and efficiently
with a reduced support requirement. For example: services such as data
storage and support can be centralised, with the potential for significant
monetary savings as well as providing much better security and resilience,
which in turn helps deliver extended or out of hour’s services.
2.4
The Forward View:
“At times we have tried highly centralised national procurements and
implementations. When they have failed due to lack of local engagement and
lack of sensitivity to local circumstances, we have veered to the opposite
extreme of ‘letting a thousand flowers bloom’. The result has been systems
that don’t talk to each other, and a failure to harness the shared benefits that
come from interoperable systems.”
The Digital Roadmap and associated local initiatives provide an opportunity to
develop technical solutions that are sensitive to local needs but at a scale that
allows efficient use of resources and an accelerated programme of
development towards a “digital first” future.
A significant enabler for this collective vision is the intelligent use of
technology to support the transformation of services and realise the vision of
integrated services and a connected population fully involved in the
management of their health and wellbeing. This includes the development of
multi care providers (MCP) where any technical infrastructure has to be
flexible enough to support integrated teams operating from multiple locations.
We hope that the detail of our developing programmes of work will support
this and the current NHS drivers.
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Key NHS Drivers3,4,5:6,7
Engagement with patients through digital technology including telehealth
and telemedicine technologies.
Integrated local care records
Structured electronic messaging for transfers of care
Health and Social Care technical integration
Meaningful use of technology to drive transformation
Support for new models of care
Paper free at the point of care
Federated working
Efficiency through the better use of technology
Support for better communications and collaboration
Video consultations
Patient self-care and diagnostics.
3
Five year Forward View
4
Personalised Health and care 2020
5
General Practice Forward View
6
Examining new options and opportunities for providers of NHS care The Dalton Review
7
Operational productivity and performance in English NHS acute hospitals: Lord Carter of Coles
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Timeline
Cheshire Shared IT Network
Cheshire Care Record
6
1
0
Unified Communications
2
SMART Applications
Electronic Patient
Record
ePrescribing
7
IG
1
0
Development
2
8
1
0
2
9
1
0
2
0
2
0
2
1
2
0
2
Figure 5 Timeline for major programmes of work, including phases.
2.5
The Baseline Position
NHS Providers
Cheshire & Wirral Partnership NHS Foundation Trust
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Countess of Chester Hospital NHS Foundation trust
East Cheshire NHS Trust
Mid Cheshire Hospitals NHS Foundation trust
Social Services Providers
Cheshire East Council
Cheshire West and Chester Council
Historically the Eastern and Central areas of Cheshire have worked together
closely having strong links through their Acute trusts, local councils and at one
time were managed as one Primary Care Trust. More recently these regions
have joined with the West Cheshire initiative of an integrated care record,
which is now known as the “Cheshire Care Record” involving organisations
across the region. This initiative has increased the potential level of digital
maturity, providing the opportunity for those supporting a patients care, to be
able to view a comprehensive digital health record at the point of care. We
intend that this record will eventually be available in all care settings and
through most clinical and social care systems as well as ubiquitous internet
browsers. This single programme has moved us from a position of diverse
clinical systems that have not been connected to a comprehensive view of
patient care, but there are still significant variations amongst providers in
terms of digital maturity.
2.6
Cheshire & Wirral Partnership NHS Foundation Trust (CWP)
CWP mental health services have used an electronic patient record since
2004, in the first instance the record was used to capture individuals care
plans, over time this record has evolved to be a near complete record of an
individual’s medical care, with the exception of Medicines management which
remains on paper. In addition approximately 99% of community staff now
uses an electronic patient record.
The West Cheshire Out Of Hours (OOH) service uses a robust decision
support tool as part of their assessment process. This tool is part of the
clinical system.
Transfer of Care
CWP currently has a defined discharge summary, which is sent to GPs
electronically using the current Cheshire distribution solution in a PDF format.
CWP is working to review the feasibility of using this technology to send all
letters to GPs electrically. The challenge is affordability of the current
solution due to discharge numbers being relatively small, in comparison to a
large acute trust. With the review we will look to identify other potential
delivery and costing options. The plan is to identify solutions during 16/17
and implement the chosen option during 17/18.
ePMA
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An ePMA (Electronic Prescribing and Administration) system is aligned with
CWP’s route to the achievement of the paper lite/paperless goal by 2020,
where the use of information and technology, such as electronic prescribing
and electronic patient records, can improve care, allow health professionals to
spend more time with patients and make savings in Service budgets.
Migrating our prescribing services from paper to electronic means that secure,
digital information will be fully available (barring any individual opt outs),
across NHS and Social Care Services. The system would be the enabler for
the Services to redesign. This implementation would also ensure CWP are
compliant with NHS England’s clear expectation that hospitals should plan to
make information digitally and securely available by 2014/15. This means
that different professionals involved in one person’s care can start to safely
share information on their treatment, as set out in the NHS England’s recent
publication ‘Everyone Counts: planning for patients in 2013/14.8
For these reasons, CWP Broad of Directors recognise that ePMA is the next
major information system the Trust should implement. This is one of the
projects identified in the IT Enabled Service Transformation Programme
(established in January 2014), to provide enablers for the Trust to achieve its
Clinical Strategies for all localities. The programme portfolio was approved by
the Trust Operational Board in March 2014 and is fully supported clinically
and corporately, whilst this is still an aspiration for the trust, the financial
challenges across the health economy have resulted in the need to put a hold
on projects until funding can be secured.
Orders & Results
Comparing responses to the Digital Maturity Assessment (DMA) survey from
the Orders & Results Management and Medicines Administration sections of
the DMA insight report, it confirms that the contact points between patient
identity and provider workflows remain predominantly manual; both the
process of identifying patients in the context of collecting lab samples as well
as identifying patients in a medicines administration context have yet to
benefit, receipt of test results electronically and will in the future benefit
from barcoding technology. Again CWP have the ambition to work with our
partners to transfer orders and results to and from patient records, as is the
norm within GP surgeries.
Again funding would be required to enable orders and results communications
to flow between the 3 acute trusts and CWP.
2.7
East Cheshire NHS Trust – Baseline position
8
https://www.england.nhs.uk/everyonecounts/
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East Cheshire Trust is typical of many organisations, in that, historically
systems and solutions have been purchased to suit a specific clinical and or
service need, to the point where there is in excess of 100 in use across the
organisation. The Trust Board approved Informatics Technology Strategy in
2012 had the clear objective for the implementation and provision of flexible,
versatile digital solutions which share information, with other care providers,
and provide the user with the ability to record patients care in the ‘right place,
right here, right now’ irrespective of their location organisationally or
geographically. This objective stands true today but the necessity to widen
the use of solutions is more pronounced. Progression in delivering the
strategy has been slow and hampered by the challenging financial position of
the Trust. This is evident from the recent digital maturity assessment which
highlighted the areas of weakness.
The most recent investments based on digitalisation, transformation and
benefit return. Two examples of this are the Vital Observations solution and
the Clinically Mobile solution; target users for both are nurses, both schemes
were possible from the allocation of external funding from the Nurse Tech
Fund. Practice and processes have been transformed and outcomes and
benefits have improved. The use of the mobile device for these staff is now
commonplace. But this is not organisation wide.
The digital disparity of collection, access, recording and sharing of care
information is illustrated against some of key capabilities below:
Records, assessments and plans
Depending on how a patient enters secondary care influences the modality of
records used.
a) A patient seen in GP Out of Hours has their record captured digitally
b) A patient that self presents to A&E, has their record is captured on a
blend of paper based and digital media
c) A patient brought in by ambulance, might have a digital electronic
patient record or paper depending on which ambulance services brings
the patient in.
As the patient moves through the hospital, the records assessments and
plans are skewed towards paper based formats with some digital components
e.g. recording of vital observations, radiology using PACS and bloodletting to
transfusion provision using RFID functionality. The bulk of the care record is
in paper form, including care plans.
Correspondence and discharge notifications are digitally recorded, transmitted
and shared and are part of the Cheshire Care Record (CCR) which will
provide clinicians access to a near real time comprehensive shared clinical
record.
The community staff does have a fully digital solution in use and extensively
use mobile devices, care information with primary care is active.
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Transfers of Care
The transfer of care from primary to secondary care is currently only digital for
some of elective care. There is no digital transfer of care at the point of
referral from primary to secondary care; with the exception of one of the
ambulance services who have recently started providing us an EPR for that
hand over and transfer of care.
Transfer of care within the acute hospital is progressing with nurse handover
being digital but not yet medical hand over.
The transfer for of care from acute to intermediate care is partially digital.
The transfer of care from hospital to primary care at discharge is via an
electronic notification form, typically within 24 hours.
Orders and Results management
Radiology orders are digital only when requested within secondary care;
primary care processes for radiology orders are inconsistent and disparate.
Laboratory orders will come on stream this financial year. Results
management will also come on stream this financial year, but will not have the
capability of a closed loop component to the results management, which is a
clinical governance weakness of the solution.
Medicines Management and optimisation
The Cheshire Care Record provides robust up-to-date list of medications.
Medicines reconciliation is then a paper based process. The Trust does not
have an e-prescribing solution. This capability is scheduled for financial year
2018/19.
The electronic discharge notification form includes secondary care prescribed
medicines for the primary care physician to then continue as required.
Decision Support
There is some digital clinical digital support in the application for the
community staff.
Within hospital based secondary care there is ad-hoc sparse digital decision
support
Remote Care
Telemedicine for clinician to patient consultations is embryonic. There is some
clinician to clinician “remote care” within clinical networks using MDT
meetings
The full breakdown of the initiatives required by the Trust to meet digital
maturity is laid out in the capability deployment schedule. To achieve this
vision external funding will be required.
2.8
Mid Cheshire Hospitals NHS Foundation Trust - Baseline Position
18Cheshire Digital Roadmap Vision Published Final June 2016 - Revision 0.1 (Autosaved)
In February 2016, the Trust Board approved a new ‘Clinical IT Strategy’ which
acknowledged the gaps in digital maturity the Trust currently faces. It also
recommended a programme of work to meet this shortfall and address the
clinical IT gaps they present.
These digital gaps identified in the Strategy were confirmed in the results of
the digital maturity survey, whilst acknowledging that we had strong strategic
alignment, leadership and governance.
Business cases have been developed and approved for systems which will
dramatically increase quality and safety of care, collaboration across the
health and social care economy and improve patient experience.
However, whilst the plans and appetite for transformation exist in the
organisation, funding does not.
Records, assessments and plans
Any patient that presents at the Trust has their record is captured on our
Patient Administration system, however clinical notes and guidance is paper
based. Exceptions are those who present through the GP Out of Hours
Service or those brought in by West Midland Ambulance Service who give us
access to their EPR.
At the Trust, the records assessments and plans are primarily paper based
formats with some small digital components e.g. Endoscopy, Ophthalmology,
Rheumatology and Maternity.
The background history of a patient is typically being provided by a blend of
paper based notes and electronic (outpatient) letters. However the rollout of
the Cheshire Care Record (CCR) and Stronger Together portal provide
clinicians access to a near real time comprehensive shared clinical record.
The Trust currently has no system to record clinical observations, and only a
small percentage of care plans and clinical notes are available digitally (see
digital components above).
A business case has been approved for a Trust-Wide EDMS system, although
local funding is not available to progress this.
Transfers of Care
The Trust is working with the local CCG to increase referrals into the Trust via
the national e-Referral system to 80% by the end of 16/17. Currently, referrals
into the Trust using e-Referral are at 30%, however, a large number are
received via nhs.net e-mail (46%).
There is no digital transfer of care at the point of referral from primary to
secondary care; with the exception of West Midlands Ambulance Service (not
North West Ambulance Service) providing us an EPR for that hand over and
transfer of care.
Currently, a handover solution is partly deployed at the Trust for medical
handover. This is being extended across the Trust and due to be completed
19Cheshire Digital Roadmap Vision Published Final June 2016 - Revision 0.1 (Autosaved)
by the end of the current financial year. We have no nursing handover
solution.
All hospital discharges are sent digitally to primary care on discharge.
Orders and Results management
Currently, Pathology orders at the Trust are digitally requested by primary and
secondary care and the results are also sent back digitally.
Radiology orders are currently paper based but a project is underway to make
these digital for primary and secondary care and this will be completed by the
end of financial year 16/17.
For other diagnostic areas, Endoscopy orders are 95% digital and cardiac
tests 30%.
The Trust’s Order Communications system has the potential to expand to
provide ordering for other services including ECG and Therapy Services.
Medicines Management and optimisation
The Cheshire Care Record provides robust up-to-date list of medications for
patients within Cheshire. Patients outside the area have medications available
in the Summary Care Record, but this is only partially used.
Medicines reconciliation is then a paper based process.
Mid Cheshire Hospitals NHS Foundation Trust have electronic prescribing
solely for Chemotherapy medication which accounts for less than 1% of
prescribed medication at the Trust. A business case has been approved for a
Trust-Wide e-prescribing system, although local funding is not available to
progress this.
Prescribing is recorded digitally at discharge using the Trusts discharge
system rather than a prescribing system. This system has no decision support
or drug templates available.
Reference sources are available for staff at the Trust, but these are stand-
alone and so not seamless.
Decision support
Clinicians currently receive no decision support from our IT Systems:
We have no systems to alert clinicians to patients whose clinical
observations or EWS are deteriorating.
We have no system that alerts healthcare professionals outside our
organisation to relevant operational information about their patients.
We have no systems that provide evidence based reference material
as part of a clinical workflow or care pathway.
We have no system which prompts clinicians for next actions required.
20Cheshire Digital Roadmap Vision Published Final June 2016 - Revision 0.1 (Autosaved)
The Trust are currently developing a business case for an EPR and have
been in discussions with other secondary care organisations who are in a
similar situation around a collaborative EPR solution.
Remote Care
Video-conferencing is available across the health community for clinician to
clinician MDT meetings. The Trust currently has no other Telemedicine
solutions.
A business case for a new VoIP telephony system is currently progressing,
which, if successful, will have an element of video capabilities.
2.9
Summary of Recent Achievements
2.9.1 Cheshire Shared It Network
The Cheshire Shared IT Network (MPLS) is a programme of work supported
by the following CCGs:
Eastern Cheshire
South Cheshire
West Cheshire
Vale Royal
The Cheshire Shared IT Network takes the existing N3 network infrastructure
and using new technology (MPLS) allows technically isolated organisations,
such as practices, to connect to each other. In the first phase all of the
partnership practices will be brought together in one network and instead of
working in isolation will be able to share information and ICT resources
between practices and secondary care sites. This does not provide immediate
connectivity, but puts in place the foundations to allow systems to connect
and data to be shared. Further phases of the programme will encompass
community sites, social care and other locations such as Nursing Homes,
where additional access would improve services to patients and citizens.
The network provides a platform which will support the work streams and
initiatives that will bring us much closer to the 2020 goals: This includes:
Developing efficient paper free services and connectivity between
organisations
Improved access through universal access via Wi-Fi
Improved security for patient and citizen data through investment in
technology and centralised management systems.
Enabling access to data flows across organisations
Enabling the purchase of ICT solutions at scale, with improved efficiencies
in terms of cost, licencing, management and deployment.
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Enabling the sharing of existing resources, which have been confined to
single organisation domains.
Allowing the management of bandwidth on demand leading to a much
more resilient service
The contract with the principal supplier (BT) was signed by the four CCGs in
January 2016 and the programme is expected to continue into the fourth
quarter of 2016 at which point all of the practices and resources identified in
the first phase, will be connected to one single Cheshire IT health and social
care network. This will then provide an opportunity to deploy other federated
services such as Wi-Fi, Centralised Server Management and Backup and
Unified Communications.
2.9.2 Cheshire Care Record
The Cheshire Care Record (CCR) is a summary care record project involving
all GP, hospital, community, mental health and social care services provided
in the county of Cheshire. The CCR is considered to be one of the most
comprehensive care records available in the UK and is an excellent
demonstration of the high level of commitment to collaborative working across
health and care organisations in Cheshire.
22Cheshire Digital Roadmap Vision Published Final June 2016 - Revision 0.1 (Autosaved)
Cheshire East Council successfully secured NHS England Tech II funding to
extend the West Cheshire Care Record to become the Cheshire Care Record
in March 2015 and initially indicated that the project would complete within six
months by October 2015. This was always recognised as an ambitious target
and it became apparent quite quickly that the project required a more
considered implementation rate and mid-year the Project Board agreed a
revised timeline of July 2016.
The Project committed to NHS England that it would deliver £5.3m benefits
over four years (circa £1.55m of benefits per annum). This equates to circa
£222k per partner per annum.
Current Position and Achievement to Date
Delivery of the Cheshire Care Record comprises two components for each
partner:
1) The delivery of nightly data feeds into the Cheshire Care Record to
populate the summary record
2) Operational use by staff within each partner organisation to pilot access
to the Cheshire Care Record and quantify benefits
To date the Cheshire Care Record holds a summary longitudinal GP record
for West and Eastern Cheshire patients from 70 practices, plus acute data
from the Countess and East Cheshire, all mental health data across Cheshire,
social care data for clients in Cheshire West & Chester and cancer data from
Clatterbridge.
2.9.3 CATCH Health App and Smart Health Apps
CATCH (Common Approach to Children’s health) is a Smartphone Application
– that provides parents and carers of children aged 0-5 in Cheshire East with
NHS-approved information to help you know when your child needs medical
attention and when self-care would be more appropriate.
This app was launched in February 2016 and its development was supported
by Cheshire East Council, Eastern Cheshire and South Cheshire Clinical
Commissioning Groups and NHS Choices.
2.10 Rate Limiting Factors
The East, West and Central Cheshire organisations have been successful in
delivering significant levels of change and progress towards digital maturity
23Cheshire Digital Roadmap Vision Published Final June 2016 - Revision 0.1 (Autosaved)
over a short period of time and the success of these programmes is a
testament to the level of cooperation between individuals and organisations.
The rate limiting factors to our collective ambition are resources, both financial
and human. All of the organisations are facing significant financial challenges
without any additional funds to support change management and resources
available are stretched in fulfilling existing business as usual change
management programmes. In order to achieve the level of change required to
meet our and national ambitions, funding is required to support fully resourced
change programmes including the capturing of benefits in the long term. For
some programmes of work, such as a new EPR, our expectation is that this
funding would be at an STP or regional level, in order to reach a scale of
deployment that makes this type of ambitious programme affordable and
workable.
In addition we hope to tackle the process blockers around sharing information,
through the use of cooperative, centralised and efficient data sharing
processes supported by technology.
3.0 Readiness Assessment
The CCGs and provider organisations involved in the Roadmap have
benefited from working in partnership on other projects, such as the Cheshire
Care Record and Cheshire Shared IT Network programmes. These
programmes are being delivered successfully as part of the Cheshire
Integrated Care Programme which is governed by the Cheshire Pioneer
Panel.
The Cheshire Integrated Care Programme was formed as part of the NHS
England Pioneer programme and is one of 25 areas across England, that
are leading in delivering better joined up health and social care.
Clinical leadership in the development and management of digital services
has strength in depth across the programme boards and the Cheshire Pioneer
Group. This includes a strong presence in the Information Governance groups
established to support the deployment of services such as the Cheshire Care
Record. We intend to make use of this extensive clinical involvement when
establishing the new programme boards to realise our digital vision.
Governance will be managed through the Cheshire Pioneer Group, which has
high level representation (i.e. Chief Officer and Chief Finance Officer) from the
organisations involved and a remit to manage our delivery of the LDR.
Within the Cheshire Pioneer Group we have the Clinical Design Group, which
is a clinically led design group working in conjunction with technical leads to
develop, review and recommend digital solutions. The Technical Architecture
Group has a responsibility for making the most of our infrastructure, agreeing
common standards for the procurement and deployment of software and
hardware to realise the vision of a connected Cheshire where all public sector
24Cheshire Digital Roadmap Vision Published Final June 2016 - Revision 0.1 (Autosaved)
employees, patients and provider partners have simple and consistent access
to digital resources at all public sector premises.
Cheshire & Merseyside Sustainability & Transformation Plan
Pioneer Panel
Digital Roadmap
Digital Leads
Task and Finish
Group
Technical
Information
Clinical
Comms and
Architecture
Governance
Design Group
Engagement
Group
Group
Connecting Care
Caring Together
West Cheshire Way
The Information Governance group is involved in the deployment of the
Cheshire Care Record and the expectation is that it will encompass our
ambitions around the development of a patient facing service that will allow
direct control over data sharing and meet future legislative requirements.
3.1
Finance
Currently there are joint bids in place for GP IT Capital funding for expansion
of the Cheshire Shared IT Network and Wi-Fi programme, as well as
connectivity to the Council PSN networks. Further bids are being developed
through the Estates and Technology Transformation Fund (Primary Care) to
develop patient facing digital services and innovative digital solutions for
remote health monitoring, consultation and access to specialist services.
Major programmes of work such as the development of an EPR and Unified
Communications will require funding at an STP, regional or national level, in
order to realise any benefits.
3.2
Change Management:
In order to achieve effective change it is essential to have processes in place
that ensure engagement with all parties involved and effective leadership to
successfully deliver the desired outcomes. The Cheshire Care Record (CCR)
represents a successful model of change management that has delivered
25Cheshire Digital Roadmap Vision Published Final June 2016 - Revision 0.1 (Autosaved)
change across a wide footprint with a supporting programme of benefits
management to ensure delivery of the programme objectives.
As part of the Cheshire Care record bid, a significant amount of work is
required to accurately quantify the benefits, in order to fulfil the requirements
of the Tech II fund and this is a model that has proved successful and we
would continue to follow. In summary:
Each partner organisation appointed a Benefits Manager to lead on
benefits identification.
Operational use of the CCR record was contingent on the delivery of
stated quantified benefits by each partner organisation before they
were given access to the shared records. To achieve this, the
following more specific work stream were identified and acted upon:
o Objective 1: Identify the quantifiable financial benefits that the
Programme will deliver.
o Objective 2: Identify the clinical benefits that the Programme will
deliver.
o Objective 3: Determine the expected profiling of when benefits
will accrue.
o Objective 4: Establish baseline calculations and measurement
mechanisms for benefits.
The outputs to support these objectives included a benefits framework,
planned statement of benefits and templates to support the process.
We intend to continue to follow this model which is now embedded within the
local PMOs involved in the CCR project. In future programmes, Programme
Management Office arrangements will be developed and budgeted for each
programme of work and we will utilise existing capacity where available.
Governance and reporting will be through the Programme Boards to the
Cheshire Pioneer Panel and the PMO functions within the individual
transformation programmes allied to individual CCGs.
3.3
Plans for 2016 – 2017
Programme Delivery 2016 -2017
Q1
Q2
Q3
Q4
Cheshire Shared IT Network Phase 1
Cheshire Care Record Phase 1
CATCH App
26Cheshire Digital Roadmap Vision Published Final June 2016 - Revision 0.1 (Autosaved)
Summary Care Record (Pharmacies)
Orders and Results (ECT )
Orders and results (MCHT - radiology)
EPaCCS Acute and GP OOH
Unified Communications Phase 1
eReferrals – increase uptake
eReferrals – increase provider slots
Clinical Correspondence Options
Paper
Update Discharge Summaries against
Academy of Medical Royal Colleges
Headings
4.0 Capability Deployment Schedule and Trajectory
The Local Digital Roadmap Guidance and commentary identified 7 key
capabilities to support the delivery of Paper Free at the Point of Care, listed
below:
Records, assessments and plans
Transfers of Care
Orders and results management
Medicines management and optimisation
Asset and resource optimisation
Transfers of Care
Remote Care
4.1
Digital Maturity
The Digital Maturity Self-Assessment has been completed by four local NHS
providers and collated into a digital maturity index. As a first step this index is
being used as the basis of a conversation to identify areas of strength and
27Cheshire Digital Roadmap Vision Published Final June 2016 - Revision 0.1 (Autosaved)
presents opportunities for shared learning and coordinated improvement
plans. It has the potential to assist organisations across Cheshire, setting out
on common journeys to explore whether common technical solutions or a
consistent approach will pay dividends.
Organisations can understand and learn from those who have optimised and
exploited what is often the same core technology to deliver a higher level of
benefit
It is worth noting that the results recorded in the Digital Maturity Index will also
inform key lines of enquiry and the determination of overall ratings within the
revised CQC inspection regime.
4.2
Current Capability Scores
The following table provides the capability scores determined through completion of
the Digital Maturity Index Return in February 2016
Capability
Countess
East
Mid
Cheshire
NWAS Average
of Chester
Cheshire Cheshire
and Wirral
Foundation NHS
NHS
Partnership
Hospital
Trust
Foundation Trust
Trust
Trust
Records,
64
28
27
88
16
44.6
assessments
and plans
Transfers of
47
38
55
42
2
36.8
Care
Order and
84
31
60
18
n/a
48.3
results
management
Medicines
50
22
31
21
n/a
31
management
and
optimisation
Decision
44
23
25
58
13
32.6
support
Remote Care
50
8
25
50
n/a
33.3
Asset and
25
40
25
50
n/a
35
resource
optimisation
4.3
Deployment schedule
The following table highlights the key deliverables to 20/21 for Provider
organisations. It should be noted that whilst this shows the current plans
against the key capabilities funding has not yet been secured against a large
28Cheshire Digital Roadmap Vision Published Final June 2016 - Revision 0.1 (Autosaved)
number of ambitions. Further work is required to identify where and how
organisations can work collaboratively to implement shared single or best of
breed systems to provide common functionality and to close the finance and
efficiencies gaps that currently exist within the health economy.
Improvements within the capability deployment trajectories will be affected by
the availability of funding to support ambitions.
Capability
Plans
Funding
Aspiration
secured
funding
required
Records, assessments
All Mental Health clinicians
Y
and plans
able to access Cheshire
Care Record (CWP) 16/17
A&E and Urgent Care
Clinicians able to access
Y
Cheshire Care record (all
acute Trusts) 16/17
Community nursing and
clinical staff able to access
Y
Cheshire Care Record (CWP
and ECNT) 16/17 – 17/18
GPs able to view agreed
acute, mental health,
community health and social
Y
care data sets 16/17
Implementation of Electronic
Document Management
System (MCHfT). Business
Y
case approved, funding
being sought – 16/17
Implementation of clinical
Y
portal for secondary and
primary care clinicians
(MCHfT) 17/18
Y
Extend use of SCR for
Mental Health Clinicians
(CWP) 16/17
Extend use of SCR to acute
clinicians for out of area
Y
patients (All acute trust)
17/18
Commence implementation
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of EPR to support structured
clinical notes and ability to
capture information at the
Y
point of care (MCHfT).
Currently at business case
development stage 18/19
Commence implementation
of EPR with integration to
EMIS Web to support real
time updating and availability
Y
of clinical records (ECNT)
18/19
Provide access for patients
to view their digital record
(ECNT) 19/20
Y
Increase utilisation of e-
template and electronic
medical records by
Y
Community staff (ECNT)
16/17
Transfers of Care
Enable Carenotes system to
Y
support e-referral. Including
purchase of hosted solution
and develop solution/training
of staff for deployment
(CWP) 17/18
Implementation of E-
handover (MCHfT) 16/17
Y
Enable digital handover of
patients between wards with
Y
Extramed (ECNT) 16/17
Increase uptake of directly
bookable appointments in
EMIS Web and sending and
Y
storage of eReferrals against
patient record (ECNT) 16/17
Order and results
Deployment of Patient
Y
management
Centre to support orders and
results management (ECNT)
16/17
Deployment of Radiology
Orders and results for
Y
secondary and primary care
clinicians 16/17(MCHfT)
Deployment of digital orders
and diagnostic tests for
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secondary and primary care
Y
clinicians (MCHfT) 17/18
Extender orders and results
functionality through
implementation of EPR.
Y
(MCHfT) Business case in
development for EPR
implementation from 18/19
Commence implementation
of EPR (ECNT) 18/19
Y
Medicines management
Implementation of e-
Y
and optimisation
prescribing solution (MCHfT)
17/18
Implementation of e-
prescribing solution (ECNT)
Y
18/19
Cheshire Care Record for
complete view of patients
Y
existing medication and
prescriptions (all Acute
Trusts) 16/17
Implement EPMA solution
Y
(CWP) 16/17 - 18/19
Decision support
Access to end of life EPaaCs
templates –
All Trusts 16/17
Provision of access to Child
Protection Data through CP-
IS 17/18
Implementation of EPR to
support digital alerts and
patient observations and
support warning scores
(MCHfT) Business case in
development for 18/19
Y
implementation
Implementation of EPR to
support digital alerts and
patient observations and
support warning scores
(ECNT) 18/19
Increased utilisation of digital
Y
patient information through
greater deployment of
VitalPac, Extramed, Adastra,
CCR, SCR and CP-IS
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(ECNT) 16/17 & 17/18
Y
Remote Care
Continued deployment of
Y
digital devices to support
delivery of care at point of
contact utilising existing
Clinically Mobile solution
(ECNT) 16/17 – 17/18
Telecare deployment to
support care at home
(ECNT) 16/17
Unified communications
including additional
functionality through
NHSmail2 (ECNT) 17/18 &
18/19
Rollout of hand held devices
to support access to and
Y
Y
input of clinical data at the
point of care (MCHfT) 16/17-
18/19
Implementation of virtual
clinical consultations,
Y
contribution to MDTs and
provision of remote clinical
advice through Skype, video,
etc. (MCHfT). Business case
approved 17/18
Remote Care Home
Monitoring System (MCHfT)
Y
18/19
Asset and resource
Extend use of digital asset
Y
optimisation
tracking for key clinical
assets (ECNT ) 17/18Extend
digital staff rostering
functionality through all Trust
clinicians (ECNT) 17/18
Y
EPR and medical device
Y
integration (ECNT) 18/19
Track patient flow through
EPR functionality. Business
Y
case in development of EPR
(MCHfT) 18/19
Track assets through RFID
Y
(MCHfT)18/19
Implementation of e-rostering
Y
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system (MCHfT) 18/19
Infrastructure
Public Wi-Fi (MCHfT) 16/17
Y
Public Wi-Fi (ECNT) 17/18
Y
Single Sign On functionality
implementation (ECNT)
Y
17/18
Multi-site redundancy (ECNT
& MCHfT) 18/19
Y
4.4
Deployment trajectory
The following provides the projected improvement in Digital Maturity Indexes if
funding is secured for all planned projects and the deployment schedule in 5.3
is implementation
Capability
Countess
East
Mid
Cheshire
NWAS Average
2016/17
of Chester
Cheshire Cheshire
and Wirral
Foundation NHS
NHS
Partnership
Hospital
Trust
Foundation Trust
Trust
Trust
Records,
75
40
40
93
65
62.6
assessments
and plans
Transfers of
47
50
55
42
10
40.8
Care
Order and
18
50
80
84
n/a
58
results
management
Medicines
50
25
31
21
n/a
31.8
management
and
optimisation
Decision
50
30
25
58
25
37.6
support
Remote Care
50
20
60
50
n/a
45
Asset and
50
40
25
25
n/a
35.
resource
optimisation
33Cheshire Digital Roadmap Vision Published Final June 2016 - Revision 0.1 (Autosaved)
Capability
Countess
East
Mid
Cheshire
NWAS Average
2017/18
of Chester
Cheshire Cheshire
and Wirral
Foundation NHS
NHS
Partnership
Hospital
Trust
Foundation Trust
Trust
Trust
Records,
75
50
60
95
75
71
assessments
and plans
Transfers of
65
60
55
60
80
64
Care
Order and
18
50
90
84
n/a
60.5
results
management
Medicines
50
25
65
70
n/a
52.5
management
and
optimisation
Decision
60
40
25
65
50
48
support
Remote Care
60
40
70
50
n/a
55
Asset and
50
60
40
25
n/a
43.8
resource
optimisation
Capability
Countess
East
Mid
Cheshire
NWAS Average
2018/19
of Chester
Cheshire Cheshire
and Wirral
Foundation NHS
NHS
Partnership
Hospital
Trust
Foundation Trust
Trust
Trust
Records,
85
80
95
95
90
89
assessments
and plans
Transfers of
65
85
95
60
95
80
Care
Order and
18
90
95
84
n/a
71.8
results
management
Medicines
50
90
95
90
n/a
81.3
management
and
optimisation
Decision
70
80
85
65
90
78
support
Remote Care
75
60
70
50
n/a
61.3
Asset and
50
80
60
25
n/a
53.8
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resource
optimisation
4.5
Electronic Patient Record
The Electronic Patient Record programme – In Primary Care there is a higher
and more consistent level of digital maturity and presence of a cohesive EPR.
However there is considerable disparity and variance in the digital maturity of
secondary care providers, such that interoperability within secondary care and
with Primary Care is challenging and therefore an enterprise wide EPR would
bring considerable benefits on a Cheshire wide digital footprint for the provider
organisations.
By tackling the EPR at scale there is an opportunity to procure an agreed
standards based EPR system, that is interoperable with existing GP clinical
and other compatible systems and will provide an efficient and cost effective
path to a real time, editable, comprehensive, reliable and safe single view of a
patients record across all care settings. This would provide a significant boost
to achieving the goal of patient centred care supported by integrated and
flexible teams and accelerate the deployment of electronic messaging to
support patient discharge and transfer.
All of the acute provider organisations are either at the point where they need
to replace or will shortly need to replace their existing Patient Administration
Systems (PAS) and will not be able to fund these programmes without joining
a development programme operated and externally funded at scale i.e. STP
or regional/national footprint. Note this is an opportunity to go beyond an
acute centred service, other organisations and smaller concerns e.g. AHPs
would benefit from access to and contribution to a single EPR. By taking a
wider approach, this would also ensure that data held by smaller or private
care organisations would no longer be lost, but accessible to all those
involved in a patients care and data locked in large hospital systems
inaccessible to outside organisations, would now be a valuable accessible
resource, resulting in much safer and better joined up patient centred care.
As part of fulfilling this aim we will actively seek out willing partners within the
LDR area as well as other LDRs within the STP footprint and beyond, where
objectives and potential benefits align. Without funding at this level, it is
unlikely that a local deployment of an EPR would be sufficiently robust to fulfil
the ambitions around our digital future and compromise on the “going
paperless” target.
4.6
CDP Complex Dependency Programme
The CDP programme vision is to establish a new multi-agency approach to
tackling issues of complex dependency for children, families and vulnerable
adults across Warrington, Cheshire West and Chester, Halton and Cheshire
East.
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This new development is supported by an award of £5m in December 2014
from the Department of Communities of Local government and involves local
council, health and care organisations across the public sector.
The programme is looking to support in excess of 10,000 people - cohort
drawn from:
adults and children involved in crime or anti-social behaviour
children who have problems at school
children who need help
adults out of work or at risk of financial exclusion
individuals and families affected by domestic violence and abuse
individuals with a range of (non-age related) health problems - young
people affected by homelessness/rough sleeping
5.0 Universal Capability Delivery Plans
Local Health economies are expected to make progress against 10 universal
capabilities which are defined as:
A - Professionals across care settings can access GP-held information on
GP-prescribed medications, patient allergies and adverse reactions
B - Clinicians in urgent and emergency care settings can access key GP-
held information for those patients previously identified by GPs as most
likely to present (in U&EC)
C - Patients can access their GP record
D - GPs can refer electronically to secondary care
E - GPs receive timely electronic discharge summaries from secondary
care
F - Social care receive timely electronic Assessment, Discharge and
Withdrawal Notices from acute care
G - Clinicians in unscheduled care settings can access child protection
information with social care professionals notified accordingly
H - Professionals across care settings made aware of end-of-life
preference information
I - GPs and community pharmacists can utilise electronic prescriptions
J - Patients can book appointments and order repeat prescriptions from
their GP Practice.
5.1
Grouping the Universal Capabilities
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In terms of delivery within the Cheshire area the Universal Capabilities can be
grouped as follows:
Group
Universal Capability
Shared Electronic
A - Professionals across care settings can access
Patient Record(s)
GP-held information on GP-prescribed
medications, patient allergies and adverse
reactions
B - Clinicians in urgent and emergency care
settings can access key GP-held information for
those patients previously identified by GPs as
most likely to present (in U&EC)
F - Social care receive timely electronic
Assessment, Discharge and Withdrawal Notices
from acute care
G - Clinicians in unscheduled care settings can
access child protection information with social
care professionals notified accordingly
H - Professionals across care settings made
aware of end-of-life preference information
Clinical
D - GPs can refer electronically to secondary care
Correspondence
E - GPs receive timely electronic discharge
summaries from secondary care
I - GPs and community pharmacists can utilise
electronic prescriptions
Digital Enabled
C - Patients can access their GP record
Self Care
J - Patients can book appointments and order
repeat prescriptions from their GP Practice.
5.2
Shared Electronic Patient Record(s) – Cheshire Care Record
Cheshire has invested through receipt of Tech II Funding from NHSE in the
development and implementation of a shared electronic patient record ‘The
Cheshire Care Record’ which is supported by all of the partners included
within the digital roadmap and also receives additional data from Clatterbridge
Cancer Hospital with a feed from Christies Cancer Hospital to be delivered
during 16/17. It will deliver a rich health and social care record for people
living in Cheshire which is currently being made available to health and social
care staff within Cheshire named in the digital roadmap footprint.
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Data feeds are taken into the record nightly from GP Practices and Acute and
Mental Health Trusts within the Cheshire area.
The Cheshire Care Record includes or within 2016/17 is planned to include a
Primary Care summary record; information on medications; diagnostic results
and reports; procedure details for the acute Trusts; allergies/alerts; clinical
correspondence, summaries and assessments; appointment/event details
(IP/OP/A&E); cancer summary; mental health summary; key contacts;
summary social care records and details of care plans and service providers;
community appointments and details of care plans and services provided.
The Cheshire Care Record meets a number of the Universal Capabilities A, B,
F, G and H but provides a much richer data set to assist health and social
care professions with access to data to support the delivery of care, without
the need for duplication of effort or inefficiencies of needing to chase up
information about a person in their care.
The Cheshire Care Record is already delivering against the early progress on
a number of the universal capabilities as outlined below:
Professionals across care settings can access GP-held information on GP-
prescribed medications, patient allergies and adverse reactions ✔
Data
present for 70 GP Practices, with the remaining 20 scheduled for June and
accessible by all social and health care professionals treating the patient from
across 12 Cheshire partners.
Clinicians in urgent and emergency care settings can access key GP-held
information for those patients previously identified by GPs as most likely to
present(in U&EC) ✔
In use at Countess and Macclesfield Emergency
Departments and will be accessible at Mid Cheshire; Leighton Emergency
Department by July
Social care receive timely electronic Assessment, Discharge and Withdrawal
Notices from acute care ✔
Discharge letters available in the Cheshire Care
Record.
Clinicians in unscheduled care settings can access child protection
information with social care professionals notified accordingly ✔
Child
protection data is part of the Cheshire Care Record social care dataset and
can be accessed by clinicians now for West Cheshire. East Cheshire social
care data will be added over the summer. The alerting option that is planned
as part of phase 3 will enable notification to social care professionals.
Professionals across care settings made aware of end-of-life preference
information ✔
The full EPACCs end of life preferences dataset is being added
to the Cheshire Care record in July and key data such as DNRs will be
displayed in the summary hub and will be one of the areas that alerting will
notify professionals of. This will be invaluable to the Ambulance Services, Out
of Hours and Hospices.
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The following table shows the current baseline of use of the Cheshire Care
Record based upon the period January to March 2016:
Organisation
Total access
No of individuals’ Number of
attempts
records viewed
active users
GP Practices – West
370
131
35
Cheshire
GP Practices East
63
11
16
Cheshire
Countess of Chester
2093
811
142
Hospital
Cheshire & Wirral
489
182
101
Partnership Trust
Social Care Teams
121
21
8
Total
3,136
1,156
302
During 2016/17 it is planned that the following data will also be included within
the patient record
GP primary care data from Vale Royal and South Cheshire GP
Practices (30 GP practices),
acute data from Mid Cheshire NHS Foundation Trust
Cancer data from Christie’s Hospital.
Community data for all of Cheshire,
social care data from Cheshire East Council
5.3
Cheshire Health Record Ambitions
During 2016/17 planning and development will be undertaken for future
phases of the Cheshire shared record to include
Extending the record into Hospices, North West Ambulance Service and
NHS 111
Incorporating the End of Life Care template (EPPACs)
Determining the requirements for sharing of care plans
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Provision of data to support timely electronic Assessment, Discharge and
Withdrawal Notices from acute care to Social Care
enhancement to datasets:
o Adding further information to the CWP mental health dataset such
as discharge letters or prescription summaries
o Adding EPACCs from community care
o Adding assessment summaries for social care
o Adding a child health dataset.
It is anticipated that these Phase 2 requirements will be completed during
2016/17 – Q1 17/18.
Future phases will look to extend the Cheshire Care Record to
support read and write capabilities for clinical staff.
provide capabilities for citizen access to a comprehensive care record
Linking with neighbouring localities with local shared records such as
Wirral, North Staffordshire and Stockport...
5.4
Shared Electronic Patient Record(s) - National Summary Care Record
Whilst the Cheshire Care Record will provide a rich health and social care
data set for use in all health and social care settings it is recognised that
access to clinical data for patients visiting Cheshire from out of the area will
still be required and to this end we propose to make better use of the National
Summary Care Record (SCR).
Whilst the SCR is in use in areas of all acute trusts within Cheshire the extent
to which this has been rolled out or is utilised varies. Acute Trusts within
Cheshire have plans to review functionality and undertake engagement with
clinicians to demonstrate benefits and increase take up of SCR this will need
to be linked with rollout of smartcards to clinical users.
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The Mental Health Trust also plan to undertake a review of the functionality
and use of the SCR in OOH services with a view to increasing take up as well
as reviewing how access can be provided directly through EMIS Community
for community staff and the Care Notes clinical system used by Mental Health
Clinicians.
NHSE are also funding a project being delivered across Cheshire and
Merseyside to extend the use of SCR to Pharmacies.
Provider Trusts recognise the need to ensure review of future EPR solutions
or best of breed systems to replace current PAS should consider SPINE
compliancy within system requirements.
Ambitions for SCR in Cheshire include:
Review functionality and usage in acute trust and delivery of engagement
plans during 2016/17 to increase use.
Review and increased take up in OOH during 16/17;
Extending use to Community and Mental Health clinicians during 17/18.
SCR to be made available to 80% of pharmacies in Cheshire by the end of
2016/17 and 85% of pharmacies in Cheshire by 2017/18.
5.5
Child Protection Information
Currently information is provided by the two local authorities through secure
means to provider organisations to ensure that they have an awareness of
children who are on child protection plans. Alerts are made available to
clinicians in unscheduled care settings but there is no common approach and
clinicians in some areas have to rely on manual checks and in all cases do
not have access to Child Protection plans.
Some progress has been made in West Cheshire with Child protection data
being part of the Cheshire Care Record social care dataset and can be
accessed by clinicians now for West Cheshire. East Cheshire social care data
will be added over the summer. The alerting option that is planned as part of
phase 3 will enable notification to social care professionals.
Current acute PAS/EPR solution versions do not support the national CP-IS
solution in all organisations. Community services across Cheshire utilise
EMIS Web which is spine compliant and capable of receiving CP-IS alerts and
there are plans for the Child Health Service to also move to EMIS Web during
16/17.
In addition Cheshire East Council are in the process of raising a change
notification to support implementation of the CP-IS module into their current
Liquid Logic Social Care System during 2017/18 and timescales for
implementation in Cheshire West and Chester local authority will also need to
41Cheshire Digital Roadmap Vision Published Final June 2016 - Revision 0.1 (Autosaved)
be agreed. As they also use Liquid Logic then addition of the CP-IS module
would be the preferred approach.
The Health Economy recognises that a single project across Cheshire to
implement CP-IS and ensure availability of alerting into healthcare settings
would provide an efficient and consistent approach, making the most of
available resources to drive delivery.
Project scoping will need to take place in 16/17 with comparison against
functionality within the Cheshire Care Record. Implementation of national
solutions would take place through 17/18.
To support improved access to Child Protection Information the health
economy will
Include Cheshire East social care data including Child Protection data set
into the Cheshire Care Record 16/17
Cheshire Care Record alerting for children with a Child Protection Plan in
Phase 3
Project scoping/ comparison of data in Cheshire Care Record and CP-IS
will need to take place in 16/17
CP-IS Module to be implemented into Social Care systems in 17/18
CP-IS implementation in Community Services 16/17-17/18
CP-IS implementation in acute trusts through 17/18.
CP-IS integration in primary care settings 18/19
5.6
EPaCCS and End of life Care Templates
The 4 Cheshire CCGs are all using the EMIS EPaCCS template, and will
continue to use this and the national ICDO10 codes. The template will be
added to the Cheshire Care Record during 16/17 with the ambition for
information to be pulled from all EPaCCS records, rather than just the GP
record.
The need is to increase the use of EPaCCS across all 4 CCGs and this has
been included in the Eastern Cheshire CCG GP contract for 2016/17.
Current baseline figures for 15/16 quarter four are:
CCG
Percentage of
Number of Patients
Practices Actively
with EPaCCS Record
Using the Template
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NHS Eastern Cheshire
95%
450
CCG
NHS South Cheshire
100%
686
CCG
NHS Vale Royal CCG
100%
348
NHS Western Cheshire
86%
468
CCG
EPaCCS Ambitions include
Inclusion of data / sharing of EPaCCS templates from and with local
Hospices across Cheshire 16/17
provision of read only access to NWAS and 111 service through the
Cheshire Care Record in 16/17
Ensuring availability of EPaCCS in acute trusts and GP OOH services
either through EMIS Viewer or Cheshire Care Record 16/17
Future ambitions include
The ability for provider organisations to have read and write access to
the EPaCCS 17/18
For patients to access the EPaCCS information and to be able to
update their own records, adding care plans as required. 18/19
To achieve 80% (of the expected 1% of the population) having an
EPaCCS template.
5.7
Clinical Correspondence
Across Cheshire significant investment has been made over a number of
years to improve the delivery of clinical correspondence by electronic means.
This includes not just discharge summaries but outpatient letters and support
of electronic referrals through the e-referral system (formerly Choose and
Book) or by e-mail to reduce the reliance on paper.
Work is taking place across the health community to increase the uptake of e-
Referral and to identify other digital solutions to reduce the amount of referrals
coming from ‘other sources’.
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5.7.1 Discharge Summaries and Out Patient Letters
Whilst provider organisations may use different solutions to create their
electronic correspondence a single method of delivery from acute providers is
in place to GP Practices in Cheshire. The Health economy has two electronic
distribution hubs in place using the same technology to ensure delivery of
clinical correspondence from acute Trusts to GP Practices who then use
"docman" document management solution to attach documents to the patient
record.
Discharge summaries are already shared as structured electronic documents
and plans are in place to ensure all summaries meet the Academy of Medical
Royal Colleges standards.
Proof of concept has previously taken place to support the delivery and
receipt off clinical correspondence from out of area.
The Mental Health Trust currently has a defined discharge summary, which is
sent to GPs electronically using the current Cheshire distribution solution in a
PDF format. Other letters are sent through emailing via NHS Mail. CWP is
working to review the feasibility of using this technology to extend to sending
all letters to GPs electronically. The plan is to identify solutions during 16/17
and implement chosen option during 17/18.
Currently of discharge summaries and outpatient letters are distributed
electronically
through
the
distribution
hubs
including
electronic
correspondence from North Staffordshire.
In addition The Cheshire Care Record displays clinical letters in near real time
so that as soon as they are authorised by the hospital they can be viewed and
in some cases GPs have found that the letters are accessible more quickly via
the Cheshire Care Record.
5.7.2 E-Referral
Current use of E-referral across Cheshire is at 60% across all CCG localities.
There are a number of contributing factors to this not just take up within GP
Practices but availability of appointment slots across specialities within
provider organisations. Whilst recognising the e-referral system is unable to
support referrals to Urgent and emergency care referrals, our ambition is to
increase the use of electronic referrals so that 80% of referrals are made
electronically.
Investigation into the capabilities of the Cheshire Care Record and utilisation
of the “write” functionality to develop an electronic referral with a common
shared initial section which can be reused and have tailored specialty
components will be undertaken in 17/18...
Other solutions that can support electronic referrals to urgent and emergency
care should also be undertaken; including reviewing the capabilities of the
Cheshire Care Record. We will do this by
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Supporting GP Practices to increase use of the e-referral solution to
ensure that at least 80% of patients are able to select their first
appointment for a date and time of their choosing 16/17
Increase the number of provider slots available for e-referral to over 80%
in line with national targets 16/17
Investigate ‘write’ functionality of Cheshire Care Record to support
electronical referrals
making better use of existing tools such as NHS mail, in a new patient
centric way, to support referrals into urgent care, while also exploring
other possible options
Reduce the reliance on fax machines within organisations
5.7.3 Electronic Prescribing between GPs and Community Pharmacies
89% of GP practices have been setup to use EPSR2 across Cheshire and it is
planned that the remaining practices will go live with EPSR2 during the
second quarter of 2016/17
Projects have been agreed for delivery during 16/17 for extended EPS
training sessions to include use of EPS and repeat dispensing and working
alongside pharmacies and GP practices to facilitate breaking down barriers
and encouraging closer working relations to increase usage of repeat
prescribing.
The baseline in this is:
CCG
% Practices
Average use of
Average Use of
Enabled for
EPS in Enabled
Repeat
EPSR2
Practices
Prescriptions
NHS Eastern
87%
65%
1%
Cheshire CCG
NHS South
89%
54%
2%
Cheshire CCG
NHS Vale Royal
100%
68%
8%
CCG
NHS West
89%
53%
4%
Cheshire CCG
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Our ambitions are
All GP Practices enabled for EPSR2 by end of 16/17
10% increase in use of repeat prescribing in16/17
15% increase in use of repeat prescribing in 17/18.
5.8
Clinical Correspondence Ambitions
The health economy would like to review current methods of distribution of
clinical correspondence including the current distribution hub and the
Cheshire Care Record to identify where efficiencies and cost savings can be
made through implementation of a single solution or as a minimum by
adoption of the MESH standards and joining the two current distribution hubs
to support delivery of clinical correspondence from out of area.
The Mental Health Trust will be reviewing options available to provide
solutions for their current clinical systems to support electronic transfer of
correspondence, recognising the cost may be prohibitive in the short term
without investment from the health economy.
Plans to improve delivery of discharge summaries and outpatient letters
include:
Update acute discharge summaries to reflect Academy of Medical Royal
Colleges Headings 16/17
Mental health Trust to
o Undertake review of available options to support extending sending
of all letters electronically from current systems. 16/17
o implement chosen solution 17/18 (subject to availability of funding)
Review current clinical correspondence distribution system and make
recommendations on future options 16/17
Implementation of any changes to clinical correspondence distribution
system across whole health economy 17/18.
Plans to support increased uptake of electronic referrals includes:
Supporting GP Practices to increase use of the e-referral system to
ensure that at least 80% of patients are able to select their first
appointment for a date and time of their choosing 16/17
Increase the number of provider slots available for e-referral to over
80% in line with national targets 16/17
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Some provider organisations to enable digital requesting of radiology
examinations from primary care systems 17/18
Some provider organisations to provide speciality email addresses to
enable referral into urgent Care (A&E, acute medicine, and acute
surgery)
Electronic Prescribing:
All GP Practices enabled for EPSR2 by end of 16/17
10% increase in use of repeat prescribing in16/17
15% increase in use of repeat prescribing in 17/18.
5.9
Digital Enabled Self Care
Our ambition is to put the person at the centre of their care provision to
promote choice and control over wellbeing, care and health.
Future patient story
I know what’s going on, I can see my medical and care records, I can
see when my appointments are no matter who with – GP, nurse,
pharmacist, social worker, physiotherapist or homecare – and I can
choose how and where I have those appointments. I may want to talk to
my GP online, I can order repeat prescriptions whenever I need to and I
can arrange for those to be delivered to me. And I can do this at 2:00am
in the morning if I want to.
I have my own care diary. It’s mine and I can block out times when I
can’t or don’t want to see my GP. I can also see if and when I need to
go into hospital or a specialist centre for a scan or other procedure. I
can see when my physio appointments are and when my carers are due
to arrive. I can see when my prescriptions are due and when the next lot
will be delivered. Everyone who works with me will be able to see my
care diary to as I’m happy to give them access to work around and with
me as my life is about more than being a patient.
Our aspirations include provision of online consultations, creation of a care
calendar that incorporates all health and social care appointments, regardless
of where they will be delivered, and smart applications to enable patients to
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access local service directories or condition specific support as well as
providing access to their GP record, booking online appointments and
ordering repeat prescriptions from their GP.
5.9.1 Online Appointments and Repeat Prescribing
Our current baseline in this area is:
CCG
% GP
% Patients
% of GP
% of Patients
Practices Can Enabled to
Practices
enabled to
Support
Electronically enabled for
Request Repeat
Electronic
Book and
Requesting
Prescriptions
booking and
Cancel
Repeat
Online
Cancelling of
Appointments Prescriptions
Appointments
Online
NHS Eastern
100%
17.6%
100%
16.5%
Cheshire
NHS South
100%
16.5%
100%
17%
Cheshire
NHS Vale
100%
28.2%
100%
28.2%
Royal
NHS West
100%
16.8%
100%
16.7%
Cheshire
Our ambitions in this area include:
By 16/17 to demonstrate a 10% increase in patient activation and by 17/18
to demonstrate a further 10% increase
By 17/18 to facilitate access through our Care Passport
5.10 Patients Accessing Their GP Record Online
We aim to ensure that access to detailed coded GP records is actively offered
to patients who would benefit the most and where it supports their active
management of a long term or complex condition as well as providing access
to those patients who request access.
We recognise that further work will be required to support GP Practices to
understand the benefit of sharing GP records with patients and to understand
the cohort of patients who would benefit from access to enable self-care of
their medical condition.
In addition in
16/17 a patient portal will be piloted in the Cheshire Care Record
for patients with gestational diabetes to enable access to the summary view of
all of their records across social care, mental health, primary, acute and
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community and provide access for updating information to support self-care
and reduce hospital visits during pregnancy.
CCG
% of GP Practices
% of patients enabled to
enabled to give access
access their GP Record
to online records
NHS Eastern Cheshire
95%
0.19%
CCG
NHS South Cheshire
100%
0.61%
CCG
NHS Vale Royal CCG
100%
2%
NHS West Cheshire CCG
95%
0.27%
Our ambitions in relation to this are:
By 16/17 to increase patient activation by 10% and by 17/18 to
demonstrate a further 10% increase
16/17 pilot access to summary view for patients with gestational diabetes
to all of their records across social care, mental health, primary, acute and
community through Cheshire Care Record and provide access for
updating information to support self-care and reduce hospital visits during
pregnancy.
By 17/18 to facilitate access through the Digital Passport
5.10.1 SMART Apps
Recognising the success of CATCH and similar apps, local CCGs have
applied for capital funding around the development of more general health
directory applications for smart phones. It is recognised that there is
considerable development in this area which is expanding rapidly, but this
particular category of app appears to be digitally mature, stable and provides
a useful platform upon which to deliver many of the patient and citizen
ambitions outlined in the Governments 9Five Year Forward View and 102020
Vision
9
.https://www.england.nhs.uk/wp-content/uploads/2014/10/5yfv-web.pdf
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The app will give users rapid and easy access to more up-to-date local health
and social care information including a directory of pharmacies, GPs,
hospitals, clinics, care homes and other services. At a touch of a button users
will be able to find the services that are nearest to them at any time. For
example, if you’re trying to find a late night chemist, the app will automatically
sort out which are the closest to you and then give you the opening hours,
address and contact details.
It will also signpost patients and citizens to other resources, such as access to
their own health record or the ability to book appointments on line. These
apps are also used to deliver information about waiting times at local A&E
centres and health campaigns.
If the bid is successful the intention is to run this as a procurement exercise
across a wide footprint. Information is provided on a geo location basis, so
there are considerable advantages to operating this at a Cheshire wide as
opposed to a local level. Information can be maintained centrally with any
changes deployed across the whole footprint, leading to a well maintained,
useful and consistent service.
5.10.2 Patient Centred Access and Care Calendar
This scheme articulates an ambition for using technology and information so
that people who want to manage their own care can do so via access to
joined up information and systems, whilst clinicians and care professionals
are freed to focus on their practice rather than administration.
We are also proposing reclaiming time and attention of our public – patients
and other local people who use care and support services. An example is test
results. Rather than calling during a two hour window, we propose that people
have secure access to their own care information and are alerted if new
information becomes available.
We want to reshape that relationship, using the gifts and opportunities of
ubiquitous technologies and tools already used by millions, to unlock true and
authentic choice and control. The building blocks are both technical and
cultural – as although technology opens the door – we need a reason to walk
through it. The building blocks of our scheme are:
To articulate, champion and support a positive, pragmatic risk approach to
information governance that prioritises supporting and meeting the needs
of local people throughout commissioner and provider organisations in
Cheshire including agreed consent and privacy models.
Working in partnership with adult social care, we will support the care
home market to progress into the digital realm. Through Wi-Fi connectivity
10
.https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/384650/NIB_
Report.pdf
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in care homes, accreditation of provider organisations via the IIG toolkit
(for those who meet the necessary criteria) and seamless continuous
access for visiting GPs, nurses and social workers, the practice or support
base will travel with the professional including the ability to conduct remote
consultations.
To develop a system to provide patients with direct control over their data
and enable local people to unlock their information and advice. We will do
this by establishing a trusted and accredited identity registration service in
Cheshire which will enable the sharing of confidential information not just
between professionals but also between the patient and clinician or
practitioner enabled by a transparent trust relationship.
To set up digitally based systems that will provide patients with direct
access to information such as test results, assessments, alerts and letters,
available in one place.
With our patient representatives, voluntary, community and faith sector
organisations as well as others who receive care and support, their
families and carers, we will design a rollout model and a pipeline for the
secure, robust and prioritised take on of additional digital services. This is
to enable the benefits of other digital services – be that online social care
assessments, healthy weight advice, mobile health solutions such as
diabetes monitoring or video consultations – to be realised at pace and
scale.
The financial benefits are likely to be derived from whole system efficiencies.
However key lines of enquiry for the financial benefits modelling work stream
include:
Efficiency savings due to reducing missed appointments for both health
and social care
Reduced travel time due to video calling and other remote consultation /
monitoring options
Reduced hospital stays and visits
Reduction in social isolation and associated costs
Benefits for patients of the direct access to care information include:
Reduced complexities of accessing their care and health information via a
single, trusted authentication process
Reduced anxieties waiting to find out information about themselves
Reduced likelihood of losing or misplacing care information
Improved quality of care as no longer need to tell their story more than
once
Increased signposting and smart directing to support in their area
51Cheshire Digital Roadmap Vision Published Final June 2016 - Revision 0.1 (Autosaved)
Benefits for clinicians include:
Reduction in missed appointments
Reduction in administrative tasks
Fewer G.P. appointments due to social isolation
Increased visibility of relevant information
Being able to focus on having conversations with those patients who really
need support
Improved quality of data as patients point out inaccuracies
Forward compliance with 2018 EU data protection directive
6.0 Information Sharing Framework
The Cheshire Care Record programme established an information sharing
framework and governance body to manage the information sharing issues
and agreements between the different parties involved in supporting the care
record and invested a considerable amount in finance and resources
establishing a legal process.
The demand for information sharing and data agreements continues unabated
outside of the CCR. Specialist services that require access have limited
choices in terms of gaining access to data that would improve the quality of
treatment and patient safety. Currently they can make a data sharing
agreement with each practice, which may run into hundreds, or send out a
general request for their service to be added. This is not a tenable process
going forward, as it creates an unsustainable administrative burden on both
the practice and the organisation requiring access, this in turn will lead to
either no access to records or a lack of effective governance.
Other health areas have taken a more organised approach, for example
11iLinks Information Sharing Framework based around North Mersey, which
used the collaborative approach pioneered in the CCR to establish a
methodology and process for managing the sharing of information across the
region’s health and social care organisations.
Using models of best practice such as iLinks there is an opportunity to
develop technical solutions to the Information Governance consent model – a
single data solution holding details of data sharing agreements across an
agreed footprint for health and social care and the ability for citizens to directly
manage and store individual consent across broad categories. (See LPRES
and NWSIS Lancashire and Cumbria Information Sharing Gateway)
11
http://www.ilinksinnovationsmersey.nhs.uk/media/1128/ilinks_informatics_transformation_stra
tegy_2014_2017.pdf
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This solution would encompass the new requirements for the General Data
Protection regulations, due to come into force in mid-2018.
6.1
NHS Number
Use of the NHS number: 12To date, the performance of providers of publically-
funded care in this context has fallen short of expectations in many instances.
Whilst a recent national survey has indicated that the NHS Number is now
being used as a consistent unique identifier in the vast majority of settings, it
is still not being adopted universally... To help respond to this challenge, the
2015/16 Planning Guidance referenced that the NHS number will be used as
the primary identifier in all settings when sharing information. Commissioners
have additional powers proposed through the NHS Standard Contract for
2015/16, to withhold funding from providers unless these conditions are met.
99% of services within CWP use an electronic patient record to review and
capture information pertaining to an individual’s treatment. As a trust CWP
run regular NHS batch number tracing exercises to ensure our records are
accurate. Our current compliance with NHS number capture is around 90%.
To further improve our NHS number compliance, we are extending the use of
the summary care record in 16/17.
This is typical of our provider organisations across Cheshire, East Cheshire
Trust reporting a compliance rate in excess of 95% and Mid Cheshire in
excess of 97% for “Verified” NHS Number and Cheshire East Council have
adopted the NHS Number as their primary identifier. On-going issues are
around patients who are either non-residents or who present at the
Emergency Department and cannot provide accurate registration information.
We are aware that there are a small minority of legacy systems that do not
have NHS Number as a primary identifier, but providers are addressing this
directly with system suppliers.
In terms of the SUS data quality dashboard at the Countess of Chester , NHS
Number compliance is as follows:
•
99.8% IP
•
99.8% OP
•
98.5% A&E
Reasons for the absence of NHS Number include:
12
BOARD PAPER - NHS ENGLAND Title: Digital Health Services by 2020: Delivering
Interoperability at Point of Care to Support Safe, Effective, Efficient and High Quality Care
53Cheshire Digital Roadmap Vision Published Final June 2016 - Revision 0.1 (Autosaved)
•
Overseas visitor
•
Patient not registered with a GP
•
Scottish patient
•
No fixed abode
•
Military Personnel
NHS Number, where available, is present in all CoCH clinical systems and
documentation as the primary identifier and is used in conjunction with the
Countess number along with other partner organisation identifiers, when
provided to us. In response to the recent Digital Maturity Index question ‘For
what proportion of patients is a verified NHS number included on all
information shared with any other care provider or organisation directly
involved in a patients care and treatment?’ the CoCH recorded the highest
level of compliance (96-100%). As a result of our current levels of compliance
we do not perceive there to be any further steps to take at this time that would
further increase our compliance rates.
7.0 Infrastructure Approach
The network infrastructure across the health services in Cheshire has been
diverse in its connectivity and maturity. Some areas such as South and Vale
Royal have an established Community of Interest Network with the ability to
manage resources centrally and share information. Elsewhere in Eastern
Cheshire, the majority of practices work in isolation. Each practice manages
their own domain, but is unable to access resources at other practices and
most of the provider organisations work within their own infrastructure with
limitations to their connectivity to the wider world.
By contrast the councils CEC and CWaC have a well-established PSN
compliant network, actively seeking linkages to other public sector networks.
In order to redress the imbalance the four CCGs developing this roadmap
instigated the Cheshire Shared IT Network programme.
The Cheshire Shared IT network encompasses our vision of an agnostic
network, delivered as a managed utility. The ultimate aim of secure access to
all resources on the network by anybody who is involved in patient care and
has a legitimate need to access and share relevant information and digital
resources.
It will be managed centrally to ensure efficient management, procurement
efficiencies and significant and consistent investment in security. This will free
up individual organisations (e.g. practices, providers) from the everyday
administrative burden of managing and backing up servers and will ensure a
consistent approach to security across the piece.
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Layered over this are programmes of work to provide a universal mobile
infrastructure using Wi-Fi and federated Wi-Fi access to allow health and
social care workers access to their own digital resources wherever they are
located. This is to be achieved through the deployment of universal SSIDs
across Cheshire.
Relevant initiatives include:
Federated Wi-Fi programme which is expanding simple connectivity to
professional ICT services across health and social care premises.
Active Directory restructures, to provide connectivity and improve system
management and service deployment.
Public Sector Network connectivity between the Health and Social Care
networks, providing new opportunities for resource and data sharing.
EPR Electronic Patient Record
Out of Hours and End of Life EPR programmes
CDP Complex Dependency Programme
NHS Number normalisation –
NHS number will be used as the primary identifier in all settings when sharing
information
with other social and healthcare providers.
A programme of work to roll out the use of NHS Number as the unique
identifier when sharing information across health and social care.
Common adoption of secure government approved email systems such as
NHS mail and GSXI across all public service organisations involved in
patient care.
7.1
Federated Wi-Fi
The development of an efficient communications network is fundamental to
the delivery of care in a paperless system. Currently Wi-Fi is seen as the
technology of choice for providing efficient and simple to use access to digital
resources and this underpins many of the current plans supporting whole
system change.
Wi-Fi is a preferred solution for supporting integrated working in the short to
medium term as it provides a method whereby teams from health and social
care can be physically located together and access their own technical
resources, without having to engage in a costly network re-engineering
programme. The 13Stockport Together programme sees WI-FI as the
13
http://www.stockport-together.co.uk/
55Cheshire Digital Roadmap Vision Published Final June 2016 - Revision 0.1 (Autosaved)
foundation for bringing services together and improving on the current reality
of paper, faxing, telephones and disconnected IT, resulting in lack of
continuity, repeating tests and information.
In Cheshire Wi-Fi system availability is patchy across the region and the
Cheshire Federated Wi-Fi project is an informal collection of existing work
streams, which by cooperation amongst commissioners, councils and
providers is seeking to achieve the following mutually beneficial goals:
Adoption of a common SSID (Unique identifier broadcast by the network
for users to connect to) for health and council workers. This means that
any council or health worker will be able to connect automatically to their
resources at any location that is transmitting the common SSIDs.
Connection of Wi-Fi networks to allow reciprocal connectivity between
council and health. Currently CWP and Eastern Cheshire are trialling a
connection between their Wi-Fi systems which allow each to connect
securely to the other where common technical standards are already in
place.
Expansion and standardisation of Wi-Fi connectivity. This is currently
being rolled out in Eastern Cheshire to all practices, but at an LDR level
we are seeking funds to expand and upgrade / standardise the
infrastructure, in order that Wi-Fi is universally available and deployed and
managed as efficiently as possible i.e. centrally.
The ultimate aim is for a Cheshire Public Service employee to be able to work
from any public building in the region and automatically log on to their own
digital resources, such as shared files. This requires a single cross
organisation programme to:
Agree common standards for ubiquitous SSIDs and then deploy this
across the estate
Identify the gaps in Wi-Fi access and develop finance and roll out plans to
fill those gaps.
Agree future common standards for the purchasing of networking and IT
equipment to leverage better and more efficient access across Cheshire.
Develop a programme to provide Public Wi-Fi (plus Guest Wi-Fi) to
support patients and citizen access to their 14care records and accredited
health and social care applications and digital information services.
Create a permanent group to manage and develop the network to achieve
common goals and to horizon scan for new communication methods, as
14
Personalised Health and Care 2020 Using Data and Technology to Transform Outcomes
for Patients and Citizens – National Information Board - November 2014
56Cheshire Digital Roadmap Vision Published Final June 2016 - Revision 0.1 (Autosaved)
technologies such as 4G evolve and replace the need for existing fixed
infrastructures.
Engage with new partners such as Midlands and Lancashire CSU with a
view to using their existing expertise in this area and seek out other
provider organisations to adopt these common Wi-Fi standards (e.g.
Hospices, Nursing Homes, Private Hospitals and other providers operating
adjacent to the current footprint)
Funding
The realisation of the goals of the Cheshire Wi-Fi project is dependent on a
number of resource streams, some are business as usual, changing internal
processes to align to a common model and others require external financing.
To date we have applied for Capital GP IT funding to support patient / guest
access to Wi-Fi services in practices and elsewhere and an expansion of the
network and Wi-Fi access to nursing homes and community premises. The
progress of this latter aspect of the programme is entirely dependent on the
funding available.
7.2
Mobile Working and Virtual Desktop Infrastructure (VDI)
The Virtual Desktop Infrastructure (VDI) solution is key in developing further
federated working across organisations and will also enable the workforce to
become more agile and mobile.
Implementation of a fully managed VDI service requires a stable centralised
technical infrastructure to be deployed on which fits with intentions around the
following initiatives:
•
Single COIN network Infrastructure (Cheshire Shared IT network)
•
Centralised domain and document storage
•
Managed N3 Wi-Fi provision
It will provide the ability to standardise on software that is used to support
both clinical and non-clinical functions, centralising functionality and software,
change the way that support services are currently provided and also the
provision of IT hardware replacement and software purchases. ‘Dumb
terminals’ would replace PCs increasing its lifespan over the recommended 5
years.
VDI enables users to have a true mobile solution using either wireless or
3G/4G connectivity. It provides access to all desktop applications from any
device (iPad, laptop, Android, smartphone) including full access to clinical
solutions, including diagnostic requesting, referrals and the patients full
medical history. Within some GP clusters there are plans for combining back
office functionalities and this infrastructure would facilitate the achievement of
this goal.
Once established the VDI infrastructure will support and expand a number of
local initiatives e.g. Home Visiting Services, Nursing Home visits, enabling full
57Cheshire Digital Roadmap Vision Published Final June 2016 - Revision 0.1 (Autosaved)
access to the patients’ hospital, community and social care records. It will
also enable new technologies to be implemented e.g. Softphones –enabling
connectivity to the user’s device via a single number, mobile Skype
consultations, ability to work from any location to provide full health care
services.
West Cheshire CCG have accessed funding and are piloting VDI with a
cluster of GP practices, with the intention of rolling this across their boundary.
Elsewhere, community service providers have invested in the use of
technology to support access to patient information at the point of care. One
provider utilises mobile devices and EMIS Web mobile the other provider has
invested in Virtual Desktop Infrastructure (VDI) technology to support the use
of mobile devices and provide remote access to the full EMIS Web client and
other applications. Both solutions support mobility of workers and access to
the patient record at the point of care.
Extending the use of VDI across the health economy is a future ambition to
support the delivery of new care models and improve information flows and
access to IT systems to improve staff productivity
7.3
Active Directory Restructure
The Active Directory service is a distributed database that stores and
manages information about network resources and other application related
data. This allows administrators to organise users, computers and devices
into a hierarchical collection of containers. The top level container is the
“forest”. Within a forest are domain containers and within domains
organisational units. The relationship between these determines what can or
cannot be done in a network such as delegation of authority to access or
restriction to access certain resources.
The structure affects how services can be deployed – moving to a centralised
hierarchy makes it easier to cascade changes throughout the network and roll
out new services. Security can be improved as it is centralised and will benefit
from more efficient investment and consistency. Resources can also be
shared and it benefits mobile working across the network.
Currently within Health Care and with some notable exceptions, we have
traditionally developed on an individual organisation basis, with domains that
are not connected to an external hierarchy.
The deployment of the Cheshire Shared IT Infrastructure will require the
redesign of the existing Active Directory structure, leading to opportunities for
centralising data storage, moving servers out of practices to reduce the
practice workload and improving security, data integrity and resilience. It is
also an opportunity for other organisations that are part of the Roadmap to
review their structures and consider the advantages of being part of a larger
structure.
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This also a propitious time to consider a restructure as there is considerable
expertise available within some partner organisations, having completed
similar exercises elsewhere.
The opportunity here is to take the existing work stream within the Cheshire
Shared IT Network programme and expand it out to the rest of the partner
organisations that are willing or able to engage.
7.4
PSN Connectivity
One of the benefits of the Cheshire Shared IT Network programme is that it
will support the Public Service Network (PSN) standard. This in theory will
allow the Cheshire Shared IT Network to connect to other PSN accredited
networks such as the local councils Cheshire East and Cheshire West and
Chester.
The principal advantages are:
Ability to connect the network to allow cross organisation working and
access to resources
More efficient use of resources – the Councils and the NHS often duplicate
the network connections into buildings and provide duplicate resources
such as printers and computers in the same location.
Ability to share and link data resources.
Eastern Cheshire CCG has bid for capital monies to support a linkage of the
two networks and this will require a programme of work and organising body
to ensure compliance to the PSN standards, so that other parts of the
Roadmap group can be linked across Cheshire and accelerate growth and
participation.
7.5
Unified Communications
The Eastern Cheshire Unified Communication programme is the next phase
in the Cheshire Shared IT Network which brings Eastern, South and West
Cheshire and Vale Royal CCGs on to a common network. The Unified
Communications programme is designed to exploit the potential of the new
network by leveraging its ability to share resources, realise efficiencies and
connect with other services that were previously out of reach. The deployment
of the Unified Communications structure is dependent on the successful
implementation of the programmes outlined earlier, including active directory
restructure, move to single domain, PSN connectivity and federated Wi-Fi and
expansion of the MPLS network.
The principle elements are:
Create a unified communications infrastructure across the whole Cheshire
footprint and beyond, encompassing all care organisations, including links to
provider organisations and other public services.
Run an options appraisal , specification and procurement exercise to
purchase and deploy a unified or single technology platform to deliver:
59Cheshire Digital Roadmap Vision Published Final June 2016 - Revision 0.1 (Autosaved)
o Voice services including VOIP and IVR
o Web and tele conferencing
o Shared data, including calendars
o Text
o email management
o Instant messaging
o Video conferencing and consultation
This unified infrastructure would have potential benefits in the development of
integrated teams, mobile working, free inter service voice calls and access to
simple web and tele conferencing systems optimised for use on our network.
Systems resilience would be much improved by the ability to shift resources
around the network and better security through a consistent and measured
approach to management and investment.
These programmes of work will be planned in conjunction with our partner
organisations with a view to deployment at scale across Cheshire with the
possibility of joining other existing infrastructures. Funding would be at an
LDR / STP level with some specific areas financed through ETTF.
7.6
Minimising Risk Arising from Technology
The organisations across the Cheshire Footprint have robust plans, policies
and procedures in place to minimise risks to patient safety and organisational
reputation associated with the use of technology.
For example the Cheshire CCGs have cooperated and invested in the
Cheshire Shared IT Network, which provides connectivity across Cheshire
and a higher level of data security, protection and privacy by adopting PSN
standards and investing in new firewall technology. This service also provides
a greater level of resilience by offering consistent access to services
regardless of location and multiple points of failure. To develop consistent
standards across all NHS organisations in Cheshire the CCGs are in the
process of committing to joining NWSIS (North West Infrastructure Service)
which covers a much larger footprint and access to additional resources which
will improve business resilience. Cheshire East and Cheshire West and
Chester Councils have invested in a PSN network across Cheshire and both
the CCGs and the councils have been involved in enabling talks to look at
PSN connectivity (this will now be replaced by the HSC Network)
The Midlands and Lancashire CSU which supports the majority of
organisations in the area have been investing in improved network
infrastructure development such as network connected uninterruptable power
supplies, ensuring that any potential faults are resolved at an early stage.
The Cheshire Pioneer Panel are expanding the role of the Cheshire Care
Record Clinical Design Authority to bring together Clinical and Digital leaders
who will collectively own the clinical and technical design of the Local Digital
60Cheshire Digital Roadmap Vision Published Final June 2016 - Revision 0.1 (Autosaved)
Roadmap and supporting technology initiatives. This will be known as the
Cheshire Clinical Design Authority and its purpose is defined as follows:
To support and own the clinical and technical design of the LDR so that
personal information can be shared safely, securely, appropriately and
confidentially to enable the delivery of health and care services wherever and
whenever they are provided.
The CDDA (until full STP arrangements are in place) will report directly to the
Cheshire Pioneer Panel and be responsible for developing and maintaining
collective agreement on:
· The design for deploying digital technology
· Common clinical processes underpinned by technology
· Common or compatible technical architecture
· Expert clinical and technical advice given to organisation
· Assurance related to patient safety and technical security
· Liaison with national and local external agencies
· Common interoperability standards
Terms of reference for the CCR Clinical design Authority are available on
request
7.7
GS1 (AIDC) Standards Compliance
The Department of Health has mandated that every service and product
procured by an NHS Acute Trust in England must be compliant with GS1
Automatic Identification Systems (AIDC) standards. The current deadline for
compliance is 2019/20.
AIDC systems (barcode or RFID) have very wide applications, including point-
of-care scanning to match product data to patient data, verification of patient
identity via a wristband, enabling the introduction of robotic dispensing
systems, recording implant serial numbers in patient records and central
registries,
tracking
and
tracing
of
individual
instruments
through
decontamination, stock control and supplies management, tracking assets
throughout a network of facilities, …15
The GS1 compliance table below indicates the current state of adoption of this
new technology standard across our principal providers:
15
http://www.gs1.org/healthcare/standards
61Cheshire Digital Roadmap Vision Published Final June 2016 - Revision 0.1 (Autosaved)
Provider
Commentary
East Cheshire NHS Trust
We are beginning the process to look at
the implications, and the next step for the
Trust is to appoint a lead. We aim to do
this by the end of September 2016.
Mid Cheshire Hospitals NHS FT
At Mid Cheshire Hospitals NHS
Foundation Trust, the Director of Finance
presented a strategic options paper to the
Trust Board in October 2015 around GS1
and the Pan-European Public
Procurement Online (PEPPOL) standards.
The Trust’s GS1 vision is “To improve
patient outcomes, drive efficiency and
reduce risk by providing visibility of the full
patient pathway through GS1
standardisation”
The Trust’s preferred approach is to
coordinate activities relating to the
adoption of GS1 and PEPPOL standards
through a single programme operating
across all relevant departments. The trust
nominated GS1 lead would head up the
programme reporting progress to the
board. Individual elements of activity
would be subject to specific business
cases / justifications.
Parts of this programme have been
discussed, particularly the RFID element,
which is due to be presented to the IT
Strategy Group in October 2016.
Countess of Chester NHS FT
At the Countess we are in the process of
reviewing GS1 roll out and currently utilise
barcodes to support the following
processes:
Blood Transfusion Tracking
Pathology Sample
Tracking/Management
Drug Dispensing
Case note Tracking
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Patient Identification
The next key area of usage would be in
terms of medicines management but this
won’t progress until we replace our EPR
due to current system constraints of the
Electronic Prescribing/Administration
module.
Cheshire and Wirral Partnership
The procurement department have been
NHS FT
aware of the likelihood of GS 1 being
introduced. The preparation work to
enable GS 1 introduces and improves
good procurement practice which should
be in place anyway. It is also an area
where significant efficiencies can be
achieved. This therefore forms a
significant part of the procurement
department work plan and is undertaken
in a series of logical stages.
Authors:
Mike Purdie: Eastern Cheshire CCG
Julie Murdy: Midlands and Lancashire CSU
Contributing Authors:
Angharad Jackson: Cheshire East Council
Guy Kilminster: Cheshire East Council
Ian Bradbury: Midlands and Lancashire CSU
John Glover: Countess of Chester
Kevin Carbery: West Cheshire CCG
Kevin Highfield: South Cheshire and Vale Royal CCGs
Mandy Skelding-Jones: Cheshire and Wirral Partnership
Matt Palmer: Mid Cheshire FT
Torin Glazer: East Cheshire Trust
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We recognise the contribution and collaboration between all members of the
health and social care economy in developing the Cheshire Local Digital
Roadmap
64Cheshire Digital Roadmap Vision Published Final June 2016 - Revision 0.1 (Autosaved)
8.0 Appendix A – Local Digital Roadmaps –
Copy of Footprint and Governance Template A - for Lead CCG
Information Requested Guidance
Response
State the name of the CCG who will
act as the ‘lead’ for communicating
with NHS England on behalf of the
organisations in the footprint.
Lead CCG
NHS Eastern Cheshire CCG
(Note - this does not imply that they
take the leading role above other
CCGs in the roadmap development
process)
Identify any other CCGs who will be
partners in the local digital roadmap
NHS South Cheshire CCG
footprint.
Partner CCGs
NHS Vale Royal CCG
(Note - this may be a null response if
the CCG identified above has chosen NHS West Cheshire CCG
not to work within a cluster)
East Cheshire NHS Trust
Mid Cheshire Hospitals NHS
Identify the providers who have agreed Foundation Trust
to play an active role in the
development of the local digital
Countess of Chester NHS Foundation
roadmap. It is anticipated that all
Trust
providers with a lead commissioning
relationship with any CCG identified
Cheshire & Wirral Partnership NHS
above would be listed here.
Foundation Trust
Providers
Please also identify any Providers that Cheshire West & Chester Council
you anticipate would have been
(social care provider)
involved at this stage but were not,
Cheshire East Council (social care
and provide any explanation as to why
this is the case.(Note - we are not
provider)
asking for a list of all providers who
Primary Care Cheshire
are contracted by the CCGs above)
East Cheshire Hospice
St Luke’s (Cheshire) Hospice
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Identify any local authorities who have
agreed to play an active role in the
development of the local digital
Cheshire West & Chester Council
Local authorities
roadmap.
Cheshire East Council
(Note - this may be a null response if
the overlapping local authority is a
member of another footprint)
Please provide a statement of why
The partners form part of the Cheshire
the footprint and partners set out
Pioneer Programme which
above are appropriate.
encompasses the integrated care
programmes: Caring Together;
Footprint rationale
Connecting Care and the West
For CCGs working in clusters, please Cheshire Way. They are also
reference (as appropriate) common
collectively engaged in the
key providers, common Health and
Wellbeing Boards, track record of
development of the Cheshire Care
working together, joint informatics
Record.
roles.
This might be
F
a or a CCG
Commissi not
oning
working in a cluster,
Support Unit, an Academic Health
please explain why
Organisations providing
Science Networ c
k lus
, a teri
cad ng i
emi s
c de
i
em
nstit ed
uti
support in the
on Midlands and Lancashire
or independent not app
organis ro
ati pria
on. te.
development of the
Commissioning Support Unit
roadmap
A null response indicates that
support arrangements have not yet
been identified.
Please outline the proposed
governance and sign-off
It is intended to use the existing
arrangements for the local digital
Governance
Cheshire Pioneer Programme
roadmap. Indicate to what degree
these governance arrangements are
governance arrangements.
already established
Contact details for the
Please provide name, job title,
Jerry Hawker, Chief Officer – ECCCG,
individual who will be
organisation, e-mail address and
xxxxx.xxxxxx@xxx.xxx, Tel: 01625
leading the roadmap
phone number.
663477
development
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9.0 Appendix B List of Initial Pioneer Panel Partner Organisations
North West Ambulance Service NHS Trust (NWAS)
Cheshire West & Chester Council (CWaC)
Cheshire East Borough Council (CEC)
Eastern Cheshire CCG (ECCCG)
South Cheshire CCG (SCCCG)
West Cheshire CCG (WCCCG)
Vale Royal CCG (VRCCG)
Cheshire & Wirral Partnership NHS FT (CWP)
Midlands and Lancashire Commissioning Support Unit
Mid Cheshire Hospitals NHS FT (MCHfT)
East Cheshire NHS Trust (ECT)
Countess of Chester NHS FT (CoCH)
Bridgewater Community Healthcare NHS Trust
Health Education England
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