Operating Framework

1
Operating Framework

• Local IMT Plans

2
Contents

• PART ONE OVERVIEW
• Introduction
• Greater Manchester Governance Structure
• Greater Manchester Overview
• Local Health Community Overview (1)
• Local Health Community Overview (2) Sector
  Governance
• Local Health Community Overview (3)IMT
  Arrangements
• Local Health Community Overview (4)Sector
  Funding Overview
• Local Health Community Overview (5)Planned NPfIT
  Sector Revenue Investment
• Sector 3-Phase Strategy (1)Overview
• Sector 3-Phase Strategy (2)Options for iCM
  Deployment
• Sector 3-Phase Strategy (3)Key Barriers to
  Achieving Strategy
• Data Quality
• Expected Growth in iPM Users
• GPSoC Status
• Current DIP
• Risk Issues Management

• PART TWO ORGANISATION DETAILS
• Bury PCT System Architecture Roadmap,
  Commentary and Budget
• HMR PCT System Architecture Roadmap,
  Commentary and Budget
• Oldham PCT System Architecture Roadmap,
  Commentary and Budget
• Pennine AcuteSystem Architecture Roadmap,
  Commentary and Budget
• Pennine Care System Architecture Roadmap,
  Commentary and Budget
• Key Contacts

3
Introduction

• This document sets out the context and strategy
  for the delivery of NPfIT in the NE Sector of
  Greater Manchester. The document has two main
  parts
• Sector-wide,
• Organisation specific
• plus a number of attachments that provide
  backing detail
• In the first part the document begins by
  describing the Greater Manchester context and the
  governance arrangements at that level
• It then provides an overview of the sector as an
  LHC, sets out the sector governance structure,
  summarises the IMT arrangements and the funding
  in place to support the deployment of the NPfIT
• The sector is working with a three phase
  strategy
• Common PAS using iPM,
• Deployment of local NPfIT components,
• LHC wide integration
• Phase 1 is complete apart from Pennine Acute
  where there are significant scalability issues
• Phase 2 centres on the use of iCM to begin the
  deployment of clinical functionality in a
  step-by-step process, based on co-operation with
  the service redefinition priorities of the PCTs
  and Pennine Care
• The barriers to the delivery of the strategy are
  summarised
• The approach to data quality is outlined
• A trajectory for user take up is provided as a
  guide to the requirements of the sector for
  system capacity
• The current status of GPSoC is tabulated, showing
  the progress already being made with GP2GP, EPS
  and GP Summary.

• The proposed DIP for 2007-08 sets out the short
  term deployment plans for iCM, Child Health and
  MoM. The DIP is subject to confirmation of the
  functionality and timing of releases of the
  software
• The sector operates a comprehensive risks and
  issues process, which is summarised
• The second part of the document provides road
  maps and timelines for each organisation on the
  LHC together with individual commentaries on
  current readiness and deployment plans
• All organisations, apart from Pennine Acute, have
  already deployed iPM and are actively preparing
  for iCM as a step along the path towards LE3.5
• All PCTs are planning to implement further
  components of GPSoC and other GP related systems
• Choose and Book is deployed in all PCTs and at
  Pennine Acute, which is a major DBS site.
  Pennine Care is preparing to deploy Choose and
  Book
• The road map for Pennine Acute is still under
  discussion and the options being considered are
  outlined
• Key contact names are listed.

4
Greater Manchester Governance Structure
Department of Health
CfH
NWSHA
CSC-A and other vendors
PCTs
Acutes
MHTs
GM IT Board
NE Board
NW Board
SE Board
SW Board
FSG
Greater Manchester Instance Board
Sector Programme Directors
Instance Manager
NE Projects
NW Projects
SE Projects
SW Projects
Data Quality Team
Common Projects
5
Greater Manchester Overview

• INTRODUCTION
• The Greater Manchester community remains totally
  committed to the National Programme for IT and
  sees it as a major enabler in the modernisation
  of service provision across the conurbation. This
  commitment is self-evident given the way it has
  coherently planned and embraced the deployment of
  systems and associated initiatives.
• LORENZO PATIENT ADMINISTRATION SYSTEM
• The Lorenzo Patient Administration System (iPM)
  has been deployed across all 10 (14 prior to PCT
  re-configuration) PCTs, one acute (University
  Hospital Of South Manchester NHS Foundation
  Trust) and one mental health Trust (Pennine Care
  NHS Trust) with over 1,100 concurrent users
  accessing the system. These deployments have been
  to one single instance enabling the sharing of
  over 2.3 million individual patient records
  across the Great Manchester community.
• The creation of a single instance has required
  the establishing of robust management and
  governance arrangements and this has been
  undertaken through the Sector structure and the
  creation of a Greater Manchester Instance Board
  which manages upgrades and seeks to balance the
  needs of those organisations wishing to join the
  instance and those already on it.
• A key benefit of the single instance is the
  opportunity it provides to establish a
  consistent, patientcentred approach to activity
  analysis and reporting. This is being

• achieved through the GM-wide implementation of a
  set of standard data definitions (initially
  focusing on a non-acute setting) which are
  facilitating meaningful analysis and reporting
• The roll out programme for Lorenzo continues
  across Greater Manchester through increasing the
  size of the user base, the range of functionality
  deployed and the addition of further Trusts to
  the instance.
• PACS/RIS
• The PACS Programme within Greater Manchester
  continues to progress well. All Trusts are on
  schedule to deploy by the end of December 2007 in
  line with the national target.
• Most Trusts within Greater Manchester are also
  choosing to implement the LSP RIS. The RIS will
  operate on a single instance for Greater
  Manchester and again providing the opportunity
  for information sharing. Governance and
  management arrangements are being established to
  ensure that the benefits provided by this
  approach are maximised.
• EPS
• The introduction of the Electronic Prescribing
  Service has seen over a third of all GP Practices
  across Greater Manchester achieve a technical go
  live for Release 1 with a quarter of all
  pharmacies attaining the same status.

6
Local Health Community Overview (1)

• Sector Structure
• Greater Manchester NE Sector is a well
  established LHC with a track record of cross
  organisational cooperation. It continues to work
  towards improvements in patient care through
  service re-organisation and joint activity to
  achieve NHS targets.
• It comprises
• Bury PCT
• Heywood, Middleton Rochdale PCT
• Oldham PCT
• plus its main providers
• Pennine Acute Hospitals Trust (coordinating
  commissioner is Oldham PCT). The Trust operates
  across four major hospital sites.
• Pennine Care MH Trust (coordinating commissioner
  is Tameside Glossop PCT)
• The LHC has, or is negotiating, contracts with a
  number of independent sector providers,
  including
• ATOS Origin, providing diagnostic services
• NetCare - ICATS
• CareUK - ICATS
• Greater Manchester Surgical Centre
• The LHC has completed public consultations on the
  restructuring of secondary and maternity
  services
• Commitment to NPfIT Deployment is included in
  current contract discussions between the PCTs and
  Pennine Acute

• PCTs within the sector are actively undertaking
  market testing of its PCT provided services.
  They are also undertaking a major LIFT centre
  programme aimed at providing modern coordinated
  community health care facilities.
• Funding Planning
• In common with the rest of Greater Manchester,
  the PCTs pool the monies ring fenced for NPfIT.
  The pooled monies are then distributed to the
  four sectors. In the NE sector the monies are
  then further allocated to specific deployment
  projects through approved business cases and
  against defined protocols. Actual distribution
  of monies is against actual spend and any surplus
  is returned to the sector pool.
• HMR PCT acts as host for the NE Sector NPfIT
  programme.
• The sector programme office maintains a detailed
  sector programme plan and cost model. It
  supports deployments through the sector-wide
  provision of project management, training,
  application support and communications services.
• The programme office works closely with sector
  and Trust managers charged with the delivery of
  the NHS reform programme.
• The Sector governance structures are illustrated
  on page 7.

7
Local Health Community Overview (2) Sector
Governance
Scheduled Care Board
Boards Projects (pre-LE3.5)
Unscheduled Care Board
Trust Boards
NE Sector Programme Board
NE Sector User Group
NIG
FSG
GP Systems and PbC Project Board
Pennine Acute Project Board
Community Project Board
Pennine Care Project Board
GPSoC
iPM
iPM
iPM
GP2GP
Community PACS
iPM (MHA)
Acute PACS
Reporting
GP Summary
CB (MH)
Theatres
Child Health
ETP
iCM (Clinical docs)
iCM (OR internal)
iCM (Clinical docs)
Map of Medicine
iCM (Service Orders)
iCM (Service Orders)
PACS Access
Non-Acute Standards
PbC
8
Local Health Community Overview (3)IMT
Arrangements

• Overview
• The following organisations within the sector
  each have their own IMT function
• Bury PCT
• HMR PCT
• Pennine Acute
• Pennine Care
• Oldham PCT has a joint arrangement with Tameside
  Glossop PCT through OTHIS
• All PCTs have well established networks. However
  the detailed technologies used by the PCTs differ
  from one another.
• Pennine Acute has a well established IMT
  function supporting a single Clinicom PAS over
  its four main hospital sites. Departmental
  systems are integrated with the PAS.
• Pennine Care was formerly supported by Pennine
  Acute. Tameside Acute and Stockport Foundation
  Trust. It has now implemented its own PAS using
  iPM and has built its own IMT function.

• Support Arrangements
• All users refer issues to their local help desk.
  For NPfIT issues the local help desk refers the
  problem to the sector NPfIT help desk provided by
  Pennine Care who, in turn, refer to the Fujitsu
  help desk when necessary. Application support is
  provided by the sector training and support team
  operated by the Sector Programme Office.
• Pennine Care is seeking accreditation under the
  national help desk scheme.
• A formal User Management group is being
  established to ensure that organisations within
  the NE Sector that use the Greater Manchester
  Instance are consulted regarding upgrades to the
  instance, including its expansion to new user
  organisations.
• A user group is being established to provide a
  forum for all NPfIT users to discuss and
  prioritise issues and ideas for improvement

9
Local Health Community Overview (4)Sector
Funding Overview
10
Local Health Community Overview (5)Planned NPfIT
Sector Revenue Investment
Summaries of business as usual revenue and
capital budgets for individual organisations
appear within the organisations entries in the
second half of this document
11
Sector 3-Phase Strategy (1)Overview

• The sector has a three phase deployment strategy
• Deploy a common PAS solution across all
  organisations, using the reference solution iPM
• All organisations apart from Pennine Acute, have
  now deployed the iPM PAS.
• Deploy components of the NPfIT locally in each
  organisation, driven by the imperatives of local
  service reform and supported by the available
  components of the NPfIT
• During the two years 2007-2008, the sector plans
  to deploy
• PACS RIS within Pennine Acute
• iCM Clinical Documents within each of the PCTs
  and within Pennine Care
• iCM Service Orders within each of the PCTs and
  Pennine Care
• HSW Child Health
• EPS 2
• Elements of GPSoC including GP2GP, GP Summary
• Map of Medicine
• Combine the local deployments into a sector wide
  information sharing environment as more
  comprehensive applications become available from
  the NPfIT.
• From 2009, with the planned availability of
  LE3.5, the sector will deploy sector wide
  solutions based upon the local solutions and
  processes deployed during Phase Two
• In the same timeframe GPSoC will evolve towards a
  fully hosted solution

12
Sector 3-Phase Strategy (2)Options for iCM
Deployment
For PCTs Mental Health iCM Assessments and iCM
OR
Business Case
Process Design
LE2.2 Clinical Documentation and Service Orders
Phase 1
Review Business Case
LE2.2 Clinical Documentation and Service Orders
Phase 2
Upgrade to LE3.5
L3 Planning
Assumes processes created for LE2.2 can be
readily transferred to LE 3.5
For Pennine Acute OR (if adopted)
Business Case
Process Design
LE2.2 OR (Internal)
Review Business Case
LE2.2 or LE3.5 OR LHC
Upgrade to LE3.5
PAT Plan
13
Sector 3-Phase Strategy (3)Key Barriers to
Achieving Strategy

• iPM (PAS) performance, especially as perceived by
  front line users, has been poor and although
  some progress has been made, there is significant
  room for improvement. This is affecting user
  acceptance and usage volumes
• The scalability of the Greater Manchester iPM
  instance to cope with increased user numbers in
  the community and additional organisations has
  yet to be proven. The continued existence of a
  single Greater Manchester iPM instance in the
  short to medium term cannot be assured
• The delay in the deployment of iPM by Pennine
  Acute will reduce the benefits of using iCM to
  track patients across multiple providers in
  revised patient pathways
• The lack of timely provision of integrated PACS
  outside of Pennine Acute, eg ICATS, IS Diagnostic
  providers and primary LIFT centres, will require
  interim measures for the sharing of images and
  reports, to support the achievement of the 18
  week target
• In general the specification of NPfIT has not
  evolved in line with the NHS Reform Programme and
  is often seen as peripheral to the priorities of
  senior management
• There is a lack of real clinical engagement at
  local level
• Uncertainties in the provision of integrated GP
  systems from EMIS will delay the roll-out of EPS
• Lack of details about the functionality and
  registration requirements for EPS 2 threaten
  achievement of EPS deadlines

• GP system suppliers may not have the capacity to
  support EPS, GP2GP and GP Summary simultaneously
• Lack of effective liaison at sector, Greater
  Manchester and SHA levels with suppliers other
  than CSC-A, makes timely issue resolution
  difficult
• Reluctance of GPs to make full use of Choose and
  Book due to consultation time constraints and
  system performance issues is hampering the
  achievement of the 90 referral target
• Adoption of hosted interim Child Health solution
  depends on assurances that all current
  functionality will be replicated
• Lack of an effective reporting solution for PCTs
• Lack of an effective document scanning solution
  within NPfIT
• Need to develop Lorenzo to support mobile
  working, especially pen based data entry, to
  support roll-out to community staff
• Repeated delays in software releases both
  threaten commitment and require trusts to adopt
  expensive work arounds.

14
Data Quality

• Data Cleansing
• The approach taken in the NE Sector is to ensure
  that data cleansing is built in as appropriate to
  the cost model, business case and project plan
  for each component of the Programme Plan. The
  sector considers this is a more effective way of
  ensuring that the potential benefits from
  deploying NPfIT systems are realised
• Initial data quality benchmarking and analysis
  has been performed (including local code
  utilisation and recode scripting, missing data,
  erroneous data and duplicated data) in
  preparation for Child Health System migration.
• A specialist data quality lead is being recruited
  to at sector level to coordinate this work
• Adoption of NHS Number
• The implementation of iPM (PAS) by the three PCTs
  and Pennine Care included a data cleansing
  process that improved the coverage of NHS
  numbers
• FURTHER DETAILS FOR EACH ORGANISATION APPEAR IN
  PART 2

15
Expected Growth in iPM Users
Table shows expected growth in user numbers.
Excludes effect of increased usage per user
Table shows expected growth in concurrent user
numbers. Excludes effect of increased usage per
user
16
GPSoC Status
17
Current DIP
18
Risk Issues Management

• General risks issues
• Risks and issues are managed at multiple levels
• Reviewed at project boards, with escalation to
  Trust executive management teams if necessary
• Risks and issues escalated as required
• Major issues reported to the Sector Programme
  Board
• Major and pan-Greater Manchester issues reported
  to Greater Manchester IT Board
• Close liaison with CSC-A is maintained at all
  levels, with regular risk and issue review at
  project, sector and cross-sector levels.
• Deployment and Release Management
• A specific process is in place for the management
  of risks and issues connected with deployments
  to, or upgrades to, the GM iPM instance
• All software releases are rigorously tested by
  Greater Manchester
• Risk logs are maintained through to resolution
• Release implementation is managed by a deployment
  board comprising the sector PDs, CSC and the SHA
• The NE Sector is establishing a formal user board
  to ensure user organisations have a clear input
  into release management decisions.

CSC-A
19
Bury PCT System Architecture Roadmap
20
Bury PCT (1) Commentary

• GP Infrastructure
• All GP Practices in Bury use the InPS Vision
  clinical system.
• Practices are linked to the PCT COIN, but
  currently all practices work on a stand-alone
  basis, with servers in each practice. A remote
  management system allows the PCT to provide
  on-line support to GPs.
• The PC inventory is well maintained on a three
  year replacement cycle.
• There is no central business continuity
  provision.
• N3 is implemented across the PCT but there are
  bandwidth problems at larger practices.
• The PCT has not yet decided to adopt nhs.net
  email.
• GPSoC
• The PCT is a pilot site for GP2GP. Almost all
  practices are now transferring patients
  electronically.
• The PCT is also a pilot for GP Summary with the
  first records to be loaded in June/July 2007
  after a full public engagement programme
• The PCT would expect to migrate to a hosted GP
  system in 2008/09.
• The PCT would expect to evolve towards a hosted
  InPS system depending upon the outcome of the
  GPSoC contract.
• Choose and Book
• All practices use integrated Choose and Book

• EPS
• All practices are EPS 1 enabled and pharmacies
  are being implemented as they become technically
  enabled.
• The PCT has expressed an interest in being an
  Early Adopter for EPS 2.
• PAS and OR
• The iPM PAS has been rolled out to all clinical
  services.
• An initial implementation of iCM (Clinical
  Documents) is planned to commence in Autumn 2007.
  Implementation will be on a limited
  service-by-service or a pathway-by-pathway basis.
• Implementation of iCM (Service Orders) is planned
  to take place in parallel with Clinical
  Documents.
• The initial iCM implementations will be extended
  to further services or pathways and will evolve
  into LE3.5.
• Child Health
• The PCT currently uses HSW Child Health with a
  contract until Dec 2008.
• Will consider moving to the CSC hosted version
  starting in June 2008 provided concerns regarding
  functionality are resolved.
• Future Requirements from CfH
• Document management system (within Lorenzo and
  Corporate requirement).
• Dental systems.

21
Bury PCT (2)Commentary

• IT Support Arrangements
• The local IMT service supports all PCT services
  and the GP practices.
• IMT DES
• 32 out of the 33 GP practices signed up to the
  DES by February 2007. The remaining GP practice
  is expected to sign up shortly.
• The PCT has one fully trained PRIMIS facilitator
  and three staff who are undertaking training. A
  0.5 WTE additional support is being provided by
  CfH at present, linked to the GP Summary project.
• Work on the DES is progressing well. A baselines
  e-audit has been completed by the 32 GP
  practices. The majority of practices have good
  quality data. 2 practices require significant
  work and will be a focus for the data quality
  team.
• Information Governance (IG)
• IG is integral to the IMT department.
• The PCT has mandated IG training for all staff
  and has commenced an IG training programme.
• Commissioning Data Sets
• The PCT has migrated from receiving CDS extract
  from McKesson to using SUS.
• IMT Strategy
• In July 2006, the PCT Board approved a new IMT
  Strategy that is now being implemented.
• The Bury PCT IMT Strategy, including a work
  programme, appears as Attachment D.

• The key strategic themes of the Strategy are
• Creating an Informed Organisation
• Demands for information are increasing
  significantly
• Need to integrate information across the care
  pathway
• Need to support decisions from a more robust
  information platform.
• Being Assertive and Collaborative
• The PCT does not have the critical mass to cover
  all IMT elements to the level needed in future
• The PCT needs to be clear about its own needs for
  IMT services as it works with other NHS and
  private sector partners.
• Developing the IMT Services
• Customer-focus
• Strengthening Capacity and Skills
• Responding to changing demands.
• The PCTs vision for IMT is shown below

22
Bury PCT IMT Budget
23
HMR PCT System Architecture Roadmap
24
HMR PCT (1)Commentary

• GP Infrastructure
• GP Practices in HMR are split between EMIS (60),
  InPS Vision (37) and iSoft (3)
• Practices are linked to the PCT COIN,. Most
  practises work on a stand-alone basis, with
  servers in each practice. 23 of practises take
  compliant hosted services from the PCT IT
  Department . A remote management system allows
  the PCT to provide on-line service support and
  service delivery to GPs for infrastructure,
  desktop systems and applications, e-mail and
  first line response and referral for GP clinical
  systems.
• The PC Configuration (Inventory) is well managed
  on a replacement cycle matrix and will now be
  adjusted to comply with guidance in GPSoC.
  Positioning against GPSoC is in benchmarking
• A robust business continuity provision exists for
  those GP systems that are hosted centrally
  including offsite backup/retention UPS and
  standby generator power supplies.
• Those GP systems which stand alone present most
  risk in that few actually comply fully with IG
  level 0. Work is in progress to make suitable
  adjustments to local GP sites to being in
  conformity but a balance will also be sought
  between the need to comply with IG Level 0
  locally and the benefits obtained by adoption of
  a hosted stance at Level 3 or 4.
• N3 is implemented across the PCT.
• The PCT has not yet decided to adopt nhs.net
  email. A study will be committed in June 2007.
• GPSoC
• The PCT is currently consolidating adoption of
  CB whilst progressing with EPS.

• The PCT will implement GP2GP when version 2 is
  available
• The PCT will implement GP Summary when it becomes
  generally available
• The PCT would expect to evolve towards a hosted
  system depending upon the outcome of the GPSoC
  contract
• Choose and Book
• 77 of practices use integrated Choose and Book.
  The remaining 23 are subject to negotiations
  with the prime supplier (EMIS).
• EPS
• All InPS practices are EPS 1 enabled and the
  remaining practices and the pharmacies are being
  implemented as they become technically enabled
• An outcome over EMIS Practises is anticipated
  soon
• EPS 2 will be rolled out when available
• PAS and OR
• The iPM PAS has been rolled out to all clinical
  services.
• An initial implementation of iCM (Clinical
  Documents) is planned to commence in Autumn 2007.
  Implementation will be on a limited
  service-by-service or a pathway-by-pathway basis.
  Implementation will support service
  reorganisation.
• Implementation of iCM (Service Orders) is planned
  to take place in parallel with Clinical
  Documents.
• The initial iCM implementations will be extended
  to further services or pathways and will evolve
  into LE3.5.

25
HMR PCT (2)Commentary

• Support Arrangements
• IT services are provided from a centralised team
  housed in a purpose built IT centre
  geographically situated in the centre of the PCT
  Area of Responsibility.
• A small specialised call centre, with protected
  powered supplies provides Service Level,
  incident, configuration and problem management
  functions between 8-18hrs using HP Openview
  ITIL compliant management software.
• Data Cleansing
• HMR PCT has plans to enhance the Information
  Departmental functions to include the requirement
  for a continuous programme of DQ work are in
  development.
• A study to introduce a data quality improvement
  programme for primary care with an examination of
  the viability of re-introducing PRIMIS will be
  commissioned during June 2007. Following a
  benchmarking exercise This study will inform
  future data quality work in the PCT.
• Information Governance
• P1 Link agreement to interconnect the PCT network
  with the Local Government/Social Services and
  Education networks has passed technical trials
  and is now in the legal stages of adoption. This
  agreement will provide a compliant means for NHS
  employees on Non NHS premises and Local Gov/SS
  employees in NHS premises to access their
  respective clinical systems.
• The legacy Information sharing agreement with
  local Trusts is still extent but will be reviewed
  in the light of current direction of travel and
  commissioning pathways by October 2007.

• GPSoC is in the implementation stages and
  particular emphasis will be directed towards the
  compliance with IG at Levels 1 and 2.
• A study of GP systems under GPSoC and local
  strategy will determine the need to replace
  existing GP Servers or accelerate the migration
  towards hosted solutions. It is expected that
  80 of GPs will have Hosted Clinical Systems
  within the timescales detailed in GPSoC.
• Newly appointed Information Assurance/IT Security
  Officer is working on heightening IG ratings in
  GP practises as part of a detailed and extended
  work plan.
• Measures to protect clinical systems users from
  Malware, Spyware and enhanced anti Virus are
  scheduled for implementation by June 2007.
• NHS Number
• Following the recruitment of a Database Analyst /
  Programmer, the PCT will examine a diversity of
  legacy clinical databases in order to plan their
  future use. Expected outcomes will be a phased
  migration to iPM/iCM for those databases where
  function is compatible. A considerable number of
  databases will be phased out of service. The
  remainder will be assessed on value and utility
  to establish interim or legacy status. These
  systems will need modification and upgrades to
  become compliant with NHS Numbers. When the new
  product from the PDS is introduced the PCT will
  plan to migrate as part of the GPSoC programme of
  work.
• Commissioning Data Sets
• HMR PCT expect receipt of Cds V6 from October
  2007, generated by Providers. This trajectory is
  planned to meet the live date of April 2008.

26
HMR PCT IMT Budget
27
Oldham PCT System Architecture Roadmap
28
Oldham PCT Commentary (1)

• GP Infrastructure
• GP Practices in Oldham are split between EMIS
  (74), InPS Vision (13) and iSoft (13)
• All practices work on a stand-alone basis, with
  servers in each practice.
• The PC inventory is well maintained on a three
  year replacement cycle. All PCs are GPSoC 2006
  standard.
• The main patient care computer system used by the
  PCT (Community PAS) is hosted by suppliers at a
  secure remote data centre. For local systems,
  standard Information Security operating
  procedures apply. For GP systems disaster
  prevention and recovery training has been
  delivered to practice staff. Template disaster
  recovery plans have been issued.
• N3 is implemented across the PCT
• The PCT has adopted nhs.net email as standard and
  is rolling this out across the GP community
• GPSoC
• The PCT will implement GP2GP when version 2 is
  available
• The PCT will implement GP Summary when it becomes
  generally available
• The PCT would expect to evolve towards a hosted
  system depending upon the outcome of the GPSoC
  contract

• Choose and Book
• All practices use integrated Choose and Book
• EPS
• All InPS practices are EPS I enabled and the
  remaining practices and the pharmacies are being
  implemented as they become technically enabled.
• EPS 2 will be rolled out when available
• PAS and OR
• The iPM PAS has been rolled out to all clinical
  services.
• An initial implementation of iCM (Clinical
  Documents) is planned to commence in Autumn 2007.
  Implementation will be on a limited
  service-by-service or a pathway-by-pathway basis.
• Implementation of iCM (Service Orders) is planned
  to take place in parallel with Clinical
  Documents.
• The initial iCM implementations will be extended
  to further services or pathways and will evolve
  into LE3.5.
• Commissioning Data Sets
• Oldham PCT is capable of handling CDS V5 (XML)
  submissions.
• There are no plans to adopt V6 as CfH announced
  on 29/12/06 that V6 had been withdrawn (DSCN
  20/2006).

29
Oldham PCT Commentary (2)

• ICATS
• Oldham PCTs has identified there are several key
  issues with regards to the information
  infrastructure and systems supporting ICATS. The
  PCT will require each ICATS to support their
  service with an information system that meets the
  national data quality requirements in respect of
  Information submissions to national datasets such
  as HES / CDS / SUS can provide appropriate level
  data for the PCTs SLAM system is in line with
  CfH and NPfIT requirements and suitably future
  proofed to meet the ongoing needs of the PCT and
  patients in respect of delivering and
  demonstrating the 18 week RTT target. The current
  expectation is that any ICATS that can not
  provide this level of Information infrastructure
  will be supplied a system by the PCT but will be
  paid for by the individual service.
• In relation to the Mobile Diagnostics Project,
  the PCT is committed to ensuring that appropriate
  IT infrastructure is implemented to enable the
  anticipated benefits to be realised to help meet
  the 18 week RTT target, for which OPCT is a
  national pilot
• Development of Business Intelligence
• The PCT is currently developing, or replacing,
  legacy systems where appropriate, as part of its
  business intelligence strategy to meet interim
  information requirements subject to Connecting
  for Health strategic solutions coming on line, or
  where it is anticipated that such strategic
  solutions will not meet business requirements.
  These are being developed to support our
  strategic objectives and the NHS modernisation
  agenda and are intended to complement those
  provided nationally

• Information Governance
• The PCT has a suite of Information Governance
  Polices, Procedures and guideline documents.
  Included are
• Access to Health Records Policy and Procedures
• Information Security and Confidentiality Policy
  and Procedures, and supplementary guidelines on
  the handling of confidential information
• Subject Access Request Policy
• For most electronic systems used by the PCT it is
  currently not possible to provide information on
  who has accessed a patients data, as the
  provision of legitimate relationships is
  required to permit this (data changes are
  audited, but data viewing is not). For GP
  systems, audit trails identify who has accessed
  the patient records.
• PCT and General Practice staff contracts contain
  a specific clause regarding information security
  and confidentiality, and note that disciplinary
  action will be taken for non-compliance An
  awareness session on NHS CRS is under development
  for GP staff, and that will cover the Care Record
  Guarantee. Those sessions should be available
  from June 2008.
• Data Quality
• The PCT is developing plans for General Practices
  to achieve Data Accreditation (IMT DES) by April
  2008. All practices will have conducted
  baseline audits and produce action plans for
  improvement. Read code/data quality training is
  in place for GP staff.
• All major electronic care record systems utilise
  the NHS number.

30
Oldham PCT IMT Budget
31
Pennine Acute System Architecture Roadmap
See Page 27 for iPM and iCM options
32
Pennine Acute Commentary (1)

• General
• Pennine Acute has, over the past few years,
  successfully integrated its systems across its
  four constituent sites. As part of that
  integration it has implemented a common PAS,
  Clinicom. It has implemented common systems for
  AE, Maternity and Theatres. It is on the point
  of completing the roll-out of a common Pathology
  system It has not therefore implemented CSC
  emergency bundles in these areas
• Pennine Acute does not currently have a fully
  automated order communication system. However
  GPs can access results for tests they have
  ordered
• It has developed its own data warehousing and
  reporting system
• Disaster recovery and service continuity plans
  are in place, with the DR contract placed with a
  third party provider
• It does not have plans to move to nhs.mail.
• Data Quality
• Data cleansing work streams embedded in recent
  PAS replacement and planned for RIS / PACS
  deployment. Adequate capacity and capability has
  and will be made available
• Major programme of work in place to reduce /
  eliminate duplicate records on PAS
• Each critical system has a data quality
  improvement plan
• IQA Board,strategy and plan in place.

• Programme of work to ensure maximisation of NHS
  number on patient master index on existing
  Clinicom PAS
• HL7 interfaces developed for all major systems to
  share a demographic data from PAS including NHS
  number
• NHS number to be used for all patient
  communications outside of the organisation
• IMT Strategy
• The Pennine Acute IMT Strategy appears as
  Attachment A.
• PACS
• Pennine Acute Hospitals Trust is scheduled for a
  PACS and RIS deployment between March and
  December 2007. The GE PACS at Fairfield Hospital
  has been upgraded to the LSP solution in advance
  of this deployment
• February 2007 22 (Fairfield advance
  deployment)
• December 2007 100 (subject tobig bang
  deployment)
• Please note this assessment does not include
  digital imaging provision from non LSP source
  i.e. at Rochdale provided by Fuji. Approximately
  21

33
Pennine Acute Commentary (2)

• PAS
• The planned migration to iPM has been put on hold
  due to a number of significant risks that could
  not be mitigated in the timeframe necessary to
  complete deployment before the main PACS project.
  
• The key risk was the need to prove that the
  Greater Manchester instance was scaleable to the
  degree necessary to accommodate Pennine Acute.
  The Trust remains committed to the deployment of
  the NPfIT APS but timing remains uncertain.
• OR
• The Trust is keen to implement a full
  communications system. To this end it is
  considering the options for implementing iCM and
  iPM. The options are summarised on the next page
  and include implementing iCM on top of its
  Clinicom PAS.
• Theatres and HSDU
• The Trust would also like to consider
  implementing a new Theatres system capable of
  handling multiple HSDUs. Discussions are due to
  start with CSC-A.
• CB
• The trusts PAS has been upgraded to full Choose
  and Book compatibility and the Trust offers
  direct booking for most of its services. It is
  in discussion with the LHC to move to completely
  paperless referrals this year.
• Risks Issues Process
• PAHT has a formal Assurance Framework that
  includes a risk and issues register that is
  reported to the Board
• See Attachment B for full details

• Information Governance
• Patient Information Leaflet given to all
  patients which outlines how we use your
  information. Contact details of Health Records
  and Information Security staff are included.
• Information Security Manager in post to
  implement arrangements with Caldicott Guardian.
• Compliance with IG Toolkit standards indicate
  an achievement of Green status for Clinical
  Information Assurance, Confidentiality Data
  Protection Assurance, Corporate Information
  Assurance, Information Governance Management,
  Information Security Assurance and Amber
  status for Secondary Use Assurance.
• The Information Governance policy which
  encompasses data sharing is under constant review
  and will be significantly revised in 2007 to
  ensure compliance with current Legal and DH
  regulation.
• The Information Governance staff code of
  conduct has been updated and will be promoted to
  all staff to further raise awareness of data
  sharing responsibilities.
• Information Sharing Protocols are in place and
  being further developed and updated to reflect
  organisational and procedural changes.
• Whilst the Trust does not share data with the
  national spine at this time policy guidelines are
  being prepared for staff to respond to requests
  from patients who do not wish their dated to be
  shared
• Policy guidelines are also being prepared to
  respond to patients who do not wish their data to
  be held on Trust systems

34
Pennine Acute IMT Budget

• 2007/8 Capital 7.775m
• 2007/8 Revenue 5.33m

35
Pennine AcuteOptions for Deployment of iPM and
iCM
PAS
Clinicom PAS
iPM PAS
Lorenzo LE3.5
PAS
Clinicals
iCM Clinicals
Local OR
LHC OR
PAS
Clinicom PAS
Lorenzo LE3.5
PAS
Clinicals
iCM Clinicals
Local OR
LHC OR
PAS
Clinicom PAS
Lorenzo LE3.5
PAS
Clinicals
36
Pennine Care System Architecture Roadmap
37
Pennine Care Commentary

• General
• Network and PC infrastructure was upgraded to
  cope with iPM
• The Trust has a Disaster Recovery Contract in
  place with a third party supplier covering all
  critical systems.
• Pennine Care is an existing user of Health Data
  Manager for reporting purposes
• The Trust plans to migrate to NHS mail during
  2007
• Information Governance
• A copy of Information Governance Toolkit plus
  policies that clearly document the Trusts
  approach to sharing and managing sensitive data,
  is attached as attachment C
• Confidentiality Policy
• Access to Health Records Policy
• Records Management Policy
• PAS
• iPM PAS has now been implemented within Pennine
  Care and is being rolled-out further to community
  based staff
• Specific release and extensions, to provide
  additional specialist MH functionality, will be
  deployed this year.

• Choose and Book
• Pennine Care will implement Choose and Book with
  DBS in 2008 when the national process and
  requirements for MH are agreed.
• iCM Clinical Documentation
• A business case will be produced in Spring 2007
  for a limited initial implementation of iCM,
  following studies of MH patient pathways
• The limited implementation will be reviewed late
  in 2007 and further deployments planned.
• iCM - OR
• Consideration will be given to the benefits of
  implementing OR alongside clinical
  documentation.
• NHS Number
• The Trust ensures that the NHS number is used in
  all template patient communication documents
  produced from NCRS. The Trust will update its
  Records Management Policy to reflect the need to
  ensure all patient communications should include
  the NHS number. As an early implementer of the
  NCRS the Trust has deployed the PDS

38
Pennine Care IMT Budget
39
Key Contacts
40
Attachments
41
Document Controls

• This is a controlled document belonging to the
  Greater Manchester NPfIT NORTH EAST SECTOR. The
  master version is filed within the programme
  library. Only the currently filed master version
  is approved. All printed versions are to be
  considered out of date as soon as they are
  printed.

42
For further information or to comment on the
contents of this presentation please contact
Steve Ranger by email using steve.ranger_at_hmrpct
.nhs.uk or by phone on 0161 655 1735.