LIS Programme PCT

1
Worcestershire Health Informatics
Programme Priorities Planning Framework 2003 -
2006 IMT Delivery Requirements Chris
Greening Local Implementation Strategy (LIS)
Programme Manager Secretary to WHIP Steering
Group 01905 760105 (Internal 31251) chris.greening
_at_sworcs-pct.nhs.uk
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Today's Presentation-

• What health community need to deliver under IMT
  modernisation agenda
• What priorities exist - and how they can be
  grouped
• Implications of non delivery
• What funding streams exist
• How we can apply those funding streams to the
  prioritised list - i.e. stretch the existing
  baseline budget by.
• Shifting the capital load from revenue baseline
  fund
• Tapping into national funding - requires strong
  business cases to StHA indicating commitment to
  IMT modernisation

3
Statements of Vision

• NHS Plan
• Para. 1.8. Achieving this vision and improving
  the overall experience of patients -means that
  the NHS and its partners must focus on
• better prevention and health promotion,
  treatment...
• making better use of IT and staff.
• Nigel Crisp

• Building the Information Core (BIC) -
  Implementing the NHS Plan
• For too long the NHS has thought of IT projects
  in isolation. Something to be left to the IT
  specialists. Something that is not a priority
  for patient care and health services. Let us set
  this right.
• The better capture, management and use of
  information analysed, communicated and shared
  through modern systems and networks is central
  to managing change and modernising the front-line
  delivery of care, treatment and services to
  patients.
• Alan Milburn

4
Information for Health (IfH) Core Themes-

• To ensure that patients can be confident that the
  NHS professionals caring for them have reliable
  and rapid access, 24 hours a day, to the relevant
  personal information necessary to support their
  care.
• To eliminate unnecessary travel and delay for
  patients by providing remote on-line access to
  services, specialists and care, wherever
  practicable.
• To provide access for NHS patients to accredited,
  independent, multimedia background information
  and advice about their condition.
• To provide every NHS professional with on-line
  access to the latest local guidance and national
  evidence on treatment, and the information they
  need to evaluate the effectiveness of their work
  and to support their professional development.
  And.
• To ensure the availability of accurate
  information for managers and planners to support
  local Health Improvement Programmes and the
  national Performance Assessment Framework.

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Delivering 21st Century IT Support for the NHS
(DC21IT) - Themes Remain-

• support the the delivery of services designed
  around the patient, quickly, conveniently and
  seamlessly
• support staff through effective electronic
  communications, better learning and knowledge
  management, cut the time to find essential
  information (notes, test results) and make
  specialised expertise more accessible
• improve management and delivery of services by
  providing good quality data to support NSFs,
  clinical audit governance and management
  information.
• IMT key enabler of NHS Plan
• IMT a key priority for StHA

6
Delivering 21st Century IT Support for the NHS
(DC21IT) - New Mechanisms-

• Greater central control of specification,
  procurement, resource management, performance
  management and delivery-
• Re-connect IT delivery to NHS Plan
• Ruthless standardisation
• Reduction in procurement time-scales through
  Development Partnership Consortia, strategic
  outsourcing and Preferred Supplier Lists.
• Financial input to be raised 2003/4 but held
  centrally to secure funding previously diverted
  away therefore still needs to be supported by
  revenue within PCT baselines earmarked for IMT.

7
General PrinciplesNational IMT Greek Temple
Architecture
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Delivering 21st Century IT Support for the NHS
(DC21IT) - Priorities-

• No new targets, BUT..
• Re-emphasis on..
• connectivity - large organisations (min 2Mbps),
  Others (gt128Kbps) to patient level information,
  knowledge facilities e-learning.
• Transmission of encrypted pathology radiology
  results
• EPR procurement under new mechanisms (ICRS)
• National booking
• And new specifications (to be provided in 2003)
  on...
• Access authentication (e.g. Smartcards for
  staff)
• Full National Health Record Unified Health
  Record with Social Care
• Picture Archiving Communication System (PACS)
• Telemedicine Telecare

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Delivery Priorities 2003 to 2006

• Priorities Planning Framework Big 4
• Infrastructure
• Electronic Booking
• Electronic Prescribing
• Integrated Care Records Service
• PLUS PPF Pg 24 - LDPs will need to implement the
  national strategy, described in-
• Delivering 21st Century IT Strategy Targets
• NSF Information Strategies
• Other Associated Strategies (Ways of Working etc)

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Priorities Planning Framework - Big 4

• Infrastructure (Apr 04)
• information where and when required via...
• NHS wide Broadband
• Worcestershire Wide Area Network (WAN)
• Worcestershire organisational Local Area Networks
  (LAN)
• Desktop replacement programme
• Electronic Booking (Dec 05)
• care arranged at patients convenience
• Electronic Prescribing (Dec 05 - Dec 07)
• prescriptions managed more effectively and
  efficiently

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Priorities Planning Framework - Big 4

• Integrated Care Records Service (Dec 05)
• Core of Govs view on modernising NHS
• NHS professionals having reliable and rapid
  access, 24 hours a day, to the relevant personal
  information necessary to support their care.
• Clinical messaging, results orders
• radiology (Apr 04)
• discharge summaries (Apr 05)
• Integrated patient index (Apr 05) (May 04 for
  Acute PAS)
• Validated NHS Number on all transactions (Apr 05)
• Picture Archiving Communications Systems (PACS)
  (Apr 06)
• Health records infrastructure (Apr 04)

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PPF Big 4 - No. 1 - Infrastructure (Pg 24)

• Also a Delivering 21st Century I.T. prime
  target
• NHS wide broadband by Apr 2004 PLUS locally-
• Make arrangements for local networks
• Maintain connectivity for all trust-based staff -
  requiring...
• Worcestershire Wide Area Network (WAN)
• Phases 1,2,3 - Core data voice network large
  sites (03/04)
• Phase 4 - Migrate health centres (04/05)
• Phase 5 - Migrate small sites (05/06)
• Internal Local Area Networks (LAN)
• Rolling Replacement of Desktop PCs / Printers /
  Servers
• Data quality, accreditation (ISO-9001) and
  security (ISO-17799) compliance including access
  authentication as well as domain to domain
  encryption
• National Directory Service (Apr 04)
• Messages over NHS net move from X.400 to eSMTP
  (Nov 03)

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PPF Big 4 - No. 1 - Infrastructure (Pg 24)

• Implications of Non Delivery?
• Loss of clinical effectiveness efficiency-
• Clinical and support staff unable to access
  relevant patient information where and when
  (bottlenecks) they are required
• New technologies (esp. PACS) unable to function
• Access to knowledge management sources reduced
• Reduction in professional development through
  reduced online Education, Training Development
  programmes
• Increase in electronic messages and online
  requests for information places large demand on
  existing network which may fail

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PPF Big 4 - No. 2 - Prescribing (Pg 24)

• National Prescriptions Service by Dec 2005 (50)
  - rest by Dec 2007
• What is Required Locally ? - Details awaited but
  will need in place-
• Robust, secure infrastructure
• Connectivity for all staff involved in
  prescribing
• ETD capacity
• Implications of Non Delivery?
• Reduced throughput and efficiency of
  prescriptions
• Loss of perceived cost savings of utilising a
  standardised system

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PPF Big 4 - No. 3 - Booking (Pg 24)

• Implement Electronic Booking by Dec 2005
• What is Required Locally?
• Specification in place
• Local pilots being undertaken to determine
  favoured system - REVIVE appears to be favoured
  option
• Robust, secure infrastructure
• Connectivity for all staff involved in booking
• ETD capacity
• Implications of Non Delivery?
• Reduced patient choice of desired location, time
  and type of care
• Loss of integrated approach to booking between
  professionals
• Increased administrative overheads

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PPF Big 4 - No. 4 (Pg 24) Integrated Care
Records Service (ICRS)

• Integrated components by Dec 2005
• Seismic shift from current organisation based
  systems to standardised and open components
  capable of sharing information between local
  clinical interfaces.
• Foundation services include and require local-
• Clinical messaging, results orders
• radiology (Apr 04)
• discharge summaries (Apr 05)
• Integrated patient index (Apr 05) (May 04 for
  Acute PAS)
• Validated NHS Number on all transactions (Apr 05)
• Picture Archiving Communications Systems (PACS)
  (Apr 06)
• Health records infrastructure (Apr 04)

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PPF Big 4 - No. 4 (Pg 24) Integrated Care
Records Service (ICRS)

• Implications of Non Delivery?
• ICRS is core to the Governments view of a modern
  NHS with
• NHS professionals having reliable and rapid
  access, 24 hours a day, to the relevant personal
  information necessary to support their care.
• NSF requirements will be unachievable
• Pressure on existing local systems (esp. Acute
  PAS) may cause collapse of system

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Delivering 21st Century IT Targets

• Application Services (on-going)
• Knowledge Management
• Populating national regional sites (NHS.UK,
  NHSDirect Online, NELH, EQUIP etc..)
• Supporting enhanced, common, local library
  services
• Education, Training Development
• Specialist IMT development needs
• On-site clinical IMT support via peripatetic
  trainers
• Clinical informatics incl. PRIMIS facilitation
• Common Web Infrastructure (Intra-Extra-Internet)
• Devolved authorship toolkits (10,000 staff)
• Specialist web based software developments
  (e-cancer referrals)

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Delivering 21st Century IT Targets

• Application Services - Implications of Non
  Delivery?
• Infrastructure clinical system developments
  will remain as islands of development used
  inefficiently
• Application services gel the large developments
  (esp. the NSFs) together ensuring all staff-
• have the generic IMT skills to undertake their
  work
• remain up to date within their fields of
  expertise therefore increasing their professional
  capabilities
• are able to share protocols and information
  between themselves in an effective and efficient
  manner

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Delivering 21st Century IT Targets

• Capacity Planning (On-going)
• Stable Programme Project Management Base
• DoH StHA mandated standard approach - PRINCE2
• Modernisation needs to be undertaken in a
  co-ordinated manner - job share with operational
  work does not work
• Existing project leads are experts in their own
  fields and have been invested in heavily
• Fixed term contracts may require rolling
  extension
• Expanded, Enhanced Stable IMT Services
• IMT technicians no longer generic - many skilled
  in complex clinical and infrastructural systems
• Modernisation places further pressure on their
  skill base which needs continued updating

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Delivering 21st Century IT Targets

• Capacity Planning - Implications of Non Delivery
• Programme Project Management Base
• scope and planning ambiguity as to deliverables
• loss of control - implications to time, cost and
  quality
• loss of previous investment
• Expanded, Enhanced Stable IMT Support Services
• Loss of support and skill base to complex
  critical systems as well as generic communication
  and knowledge management systems - e-mail and
  internet access are no longer a nicety
• Loss of support now occurring - undermanned
  departments through increased need for IMT
  modernisation programme
• Continued high turnover accounting for high
  replacement and induction costs - difficult to
  get skilled replacements on mandated salaries

22
NSF Information Strategies

• Current Ones (Variety of Dates)-
• Cancer Plan
• Coronary Heart Disease
• Older People
• Mental Health
• Diabetes
• Others awaited
• ?

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NSF Information StrategiesCancer Plan (Pg 14)

• Modernise clinical systems and communications for
  referral (particularly e-referral pilot),
  diagnosis and reporting of results between
  professionals
• Access to open data sources for national and
  local audit
• Extend clinical registers and standardisation of
  clinical coding and data entry templates
• Enhance provision of information to national
  awareness programmes of local services (NHSDirect
  Online NHS.UK)

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NSF Information StrategiesCoronary Heart Disease
(Pg 15)

• Install Rapid Access Chest Pain Clinic systems
  for 2 week wait standard
• Ensure pre-hospital thrombolysis systems
  connected to hit 60 minute target
• Extend clinical registers and standardisation of
  clinical coding and data entry templates
• Enhance access to national and local guidance and
  protocols for clinicians and public

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NSF Information StrategiesMental Health (Pg 16)

• Comparative clinical audit and information from
  the Mental Health Minimum Data Set
• Out of Hours access to clinical records available
  - (crisis resolution to all eligible patients by
  2005) - including prisons
• Access to latest protocols guidance at national
  and local level esp. for management of older
  people with mental health problems (Apr 2004).

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NSF Information StrategiesOlder People (Pg 17)

• Support target to enhance quality of life and
  independence of older people so they can live at
  home (30 by Mar 2006) - telemedicine telecare
• Enhance remote access to patient notes to
  increase assessment process for community based
  professionals and subsequent tracking of care
  between professionals.
• Extend clinical registers and standardisation of
  clinical coding and data entry templates,
  particularly for diabetic retinopathy - (80 by
  2006)

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NSF Information StrategiesDiabetes

• Information Strategy only just arrived therefore
  not in PPF but...
• Access to data across clinical professions - ICRS
  / General Practice registers
• Access to clinical records made available to
  people with diabetes - issues of confidentiality,
  format, standard
• Access to latest protocols guidance at national
  and local level for professional and public use
• Consolidation of service information to NHSDirect
  NHS.UK
• Develop capacity to analyse information incl.
  national audits

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NSF Information StrategiesCommon Themes

• Professional access to standardised patient notes
• Open Systems to import / export relevant data
• Robust infrastructure to access data
• Secure High Quality Data
• Professional access to protocols / guidance etc..
• Libraries Access to Evidence Programme
• Intranet / Extranet / Internet
• IMT Education, Training Development
• Public access to notes guidance
• Open Systems to import / export relevant data
• Confidentiality Data Accreditation

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NSF Information StrategiesSpecialist Areas

• Telemedicine Telecare
• Open Systems to import / export relevant data
• Robust infrastructure to access data
• Prison Based Health
• Robust infrastructure required
• Enhanced clinical systems
• IMT Education, Training Development
• NSF Specific Systems
• Rapid Access Chest Pain Clinic

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Funding - Mixture

• New National Funding (?!?)-
• Earmarked -
• Electronic Booking (local component)
• Electronic Prescribing (local component)
• Some for ICRS
• Some for infrastructure (local integration -
  possibly WAN)
• Predominantly capital
• Held by DoH StHA
• Only released upon agreed plans incl. full PCT
  baseline spend...
• PCT Baseline Funds ( 2.7million)
• Discretionary Funds ( 255K 2002/3 last year)
• Other ( 20K for ETD,200K Booking 2003/4 last
  year)

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Expenditure Streams 2003 to 2006

• Local
• Area 1 - Consequences of previous modernisation
• 1a (revenue) (via PCT baseline)
• 1b (capital) (via block capital?)
• Area 2 - Existing Programme Project Management
  (via PCT baseline)
• Area 3 - Underpinning countywide services incl.
  project management
• 3a (revenue) (via PCT baseline)
• National
• Area 3b - Underpinning countywide services incl.
  project management (capital)
• Area 4 - Multi-organisational system developments
  
• Area 5 - Organisation specific system developments

32
Confirmed PCT Baseline Funds Available

• 2002/3 funds committed 1.7million
• Need to consider how mixture of PCT and National
  Funds can meet the shortfall

33
Confirmed PCT Baseline Funds Available

• 2002/3 funds committed 1.7million
• Need to consider how mixture of PCT and National
  Funds can meet the shortfall

34
Recommendations (1)

• PCT Baseline Revenue
• Up to 1.7m (2002/3 sum)
• (Area 1 rev) licences, capital charges etc
  (1.26m)
• (Area 2) Programme Project Management (0.5m)
• Get existing service co-ordination
• Up to 2.7m (hypothecated sum)
• (Area 3 rev) infrastructure licences, app.
  Services (1.26m)
• Get developments in ETD, KM, Web, DQSA
• Block Capital
• Up to 0.8m
• used for Area 2 - capital consequences of
  previous years
• Desktop connectivity
• use this to bolster business case to StHA for
  release of nat. funds because 1.7m 0.8m
  almost original 2.7m but doesnt require all
  the hypothecated revenue)then.

35
Recommendations (2)

• National Capital via StHA
• 0.77m - (Area 3b cap)
• for WAN
• will be more acceptable by StHA as revenue
  covered
• Up to 5.1m
• 4.3m (Area 5) - Organisation specific
  developments
• 3.8m - ICRS
• 0.4m - LANS
• 0.8m (Area 4) - Countywide system developments
• Difficult gt mainly revenue required
• Difficult gt largely NSFs (implications for those
  programmes)
• Booking
• Need to go back to NSF clinical leads for
  assistance and timing
• For completeness - Ex modernisation work now in
  operations
• PCT WSSA SLA General Practice Rolling Replacement
• 0.74m

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Expenditure Principles 2003 to 2006

• Area 1a - Consequences of previous modernisation
  (revenue)
• Infrastructure - Local Area Networks (LANs)
• Communication licences
• Electronic Booking - licences
• Results reporting
• Clinical system licences
• Picture Archive Communication System (PACS)
• Community Mental Health Systems
• Telemedicine
• Pre-hospital Thrombolysis
• ETD Specialist IT Training e-learning material
  licences
• Intranet Licences
• Library Services Licences

37
Expenditure Principles 2003 to 2006

• Area 1b - Consequences of previous modernisation
  (capital replacement)
• Desktop PC
• Printer
• Server
• Non Primary Care - dealt with via separate
  agreement made in September 2002.

38
Expenditure Principles 2003 to 2006

• Area 2 - Programme Project Management
  (Existing)
• Programme Management
• WHIP Project Management
• Technical Infrastructure
• Data Security, Quality Accreditation
• Education, Training Development support
  trainers
• Intra-Extra-Internet Developments NHS.UK
  population
• Libraries Access to Evidence co-ordination
• Project Management (WHIP contribution)
• Programme Management Administration
• Education, Training Development Administration
• Acute EPR (ICRS) Co-ordination
• Web Based Developments

39
Expenditure Principles 2003 to 2006

• Area 2 - Programme Project Management
  (Existing)
• Does not include-
• NSF Co-ordination (via Discretionary Funds likely
  to end 31 March 2003)
• NSF Co-ordination
• Cancer
• CHD
• Older People
• Mental Health
• Primary Care project management technical
  support
• Extension of fixed term WHIP contracts to 31
  March 2006
• stability for planning co-ordination
• reduced re-appointment costs
• Conversion of library Access to Evidence
  project officers to substantive posts (currently
  substantive posts on fixed term secondments)

40
Expenditure Principles 2003 to 2006

• Area 3 - Underpinning countywide technologies /
  services including project management (revenue)
• Countywide Wide Area Network (PPF Big 4 No. 1
  Infrastructure)
• 2003/4
• Core Data Network (368K)
• Core Voice System (500K)
• Migration of Large Sites (105K)
• 2004/5 (Migration of health centres) (564K)
• 2005/6 (Migration of small sites) (80K)
• Education, Training Development (290K)
• Specialist IMT training
• Clinical informatics training incl. PRIMIS
  facilitation
• External training provision for generic IMT
  skills

41
Expenditure Principles 2003 to 2006

• Area 3 - Underpinning countywide technologies /
  services including project management (capital)
• Countywide Wide Area Network (PPF Big 4 No. 1
  Infrastructure)
• 2003/4
• Core Data Network (368K)
• Core Voice System (500K)
• Migration of Large Sites (105K)
• 2004/5 (Migration of health centres) (564K)
• 2005/6 (Migration of small sites) (80K)
• Education, Training Development (290K)
• Specialist IMT training
• Clinical informatics training incl. PRIMIS
  facilitation
• External training provision for generic IMT
  skills

42
Expenditure Principles 2003 to 2006

• Area 3 - Underpinning countywide technologies /
  services including project management
• Data Quality, Security Accreditation (495K)
• National data quality accreditation stages
• Acute (stage 3)
• Community Mental Health (stages 2 3)
• General Practice Quality Review (incl. Practice
  Based Registers)
• National data security programme (incl. domain to
  domain encryption)
• Acute (incl. disaster recovery)
• Community Mental Health
• PCT Primary Care
• Ambulance Trust
• Freedom of Information Act co-ordination
• Online DQSA Induction Training Product

43
Expenditure Principles 2003 to 2006

• Area 3 - Underpinning countywide technologies /
  services including project management
• Web Based Developments (35K)
• Intranet discussion group module
• Clinical expert system (Pathfinder)
• Library Services Access to Evidence (238K)
• Countywide library facilitators
• Union catalogue extension
• e-journal subscriptions
• Information kiosks
• Library web Portal Digital Library
• NSF Information Strategy Co-ordination (20K)

44
Expenditure Principles 2003 to 2006

• Area 4 - Multi-organisational system developments
• PPF Big 4 No. 2 - Electronic Booking (249K)
• Acute Trust
• Ambulance Trust
• Primary Care
• PPF Big 4 No. 3 - National Prescriptions
  Service (0)
• Details currently unknown - assumed finance will
  follow national programme
• PPF Big 4 No. 4 - Integrated Care Records
  Service (55K)
• e-clinical letters repository

45
Expenditure Principles 2003 to 2006

• Area 4 - Multi-organisational system developments
• PPF Appendix B incl. NSF Information Strategies
  (482K)
• Access Emergency Planned Admissions (incl.
  Telemedicine) (100K)
• NSF Cancer (66K)
• NSF CHD (136K)
• NSF Mental Health (110K)
• NSF Older people (20K)
• Improving patient experience (50K)

46
Expenditure Principles 2003 to 2006

• Area 5 - Organisation specific system
  developments
• Infrastructure (374K)
• Local Area Networks (LANS)
• Connectivity, incl. migration to e-smtp
• ICRS - local clinical interfaces (3,788K)
• Acute (2,735K)
• Integrated Mental Health Electronic Record
  (135K)
• Integrated Primary Community Care (300K)
• Primary Care Clinical Systems (incl. Torrex
  issue) (450K)
• Community Care Systems (87K)
• Clinical messaging (81K)

47
Expenditure Principles 2003 to 2006

• Area 5 - Organisation specific system
  developments
• Enhancing VFM (112K)
• WSSA Helpdesk (10K)
• Data Warehouse / Management EIS (52K)
• Acute Document Management (50K)

48
Expenditure Principles 2003 to 2006

• Ex Modernisation - Operations-
• Transfer of modernisation work to operational
  baselines
• GP Rolling Replacement within WSSA base (736K)

49
Expenditure Summary (1) (000K)
50
Expenditure Summary (2) (000K)
51
Expenditure Summary (3) (000K)
52
Expenditure Summary (4) (000K)
53
Summary

• Long list of priorities from variety of
  strategies
• Significant levels of capital required - local /
  National mix
• Supported by recurrent sums hypothecated into PCT
  baselines - national capital may not available
  without this!!but...
• We have some options to mix the funding streams
  to best effect - it requires close collaboration
  between WHIP, PCT Finance Teams and StHA
• A prioritised list of developments exist based on
  above
• The time to act is now - fixed term project lead
  posts (who have been invested in heavily) are
  already over-running their period of notice..so-
• commit the recurrent baseline spend already
  available
• Nominally agree targeted capital sums to allow
  planning to be finalised