Informatics Strategy 5 Year Forward View 2016 2021 - Bolton ...
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Informatics Strategy
5 Year Forward View
2016 - 2021
Informatics Strategy Forward View - 2016 – 2021 Bolton NHS Foundation Trust
Versions:
Version Date Amendment
V0.1 17/03/15 Internal first draft QA
V0.2 10/04/15 Changes to layout and tables
V0.3 16/04/15 Comments back – changes made
V0.4 20/04/15 Further detail added
V0.5 04/05/15 CCIO changes
V1.0 18/05/15 Final Document
V1.4 16.05.2016 Update- EPR Business case refresh 5 Year View
Approvals:
Name Lead Date of Review Date of Version
sign-off
Phillipa Winter and CIO 16.05.2016
Ken Bradshaw
David Haider, Simon CCIOs 19.05.2016
Irving and Brendan
Lane
Brett Walmsley CTO 16.05.2016
Trust Board Chairman 26.05.2016 26.05.2016 V1.4
1|PageInformatics Strategy Forward View - 2016 – 2021 Bolton NHS Foundation Trust
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1 EXECUTIVE SUMMARY.....................................................................................................4
2 STRATEGIC CONTEXT .......................................................................................................6
2.1 NATIONAL CONTEXT ...................................................................................................................... 6
2.2 LOCAL CONTEXT............................................................................................................................ 9
2.3 NATIONAL TARGETS FOR INFORMATICS ........................................................................................... 12
3 STATUS OF INFORMATICS .............................................................................................. 13
4 STRATEGIC DIRECTION................................................................................................... 14
4.1 VISION ...................................................................................................................................... 14
4.2 STRATEGIC OBJECTIVES ................................................................................................................ 14
4.3 ELECTRONIC PATIENT RECORD (EPR) AND OTHER SUPPORTING CLINICAL SYSTEM DEVELOPMENT ............. 15
4.4 INFRASTRUCTURE ........................................................................................................................ 20
4.5 SHARED SERVICES ....................................................................................................................... 22
4.6 TELEMEDICINE ............................................................................................................................ 24
4.7 COMMUNITY INTEGRATION .......................................................................................................... 24
4.8 UNIFIED COMMUNICATIONS ......................................................................................................... 26
4.9 SKILL DEVELOPMENT ................................................................................................................... 27
4.10 MOBILE WORKING ...................................................................................................................... 27
4.11 HEALTH INNOVATIONS ................................................................................................................. 28
4.12 BUSINESS INTELLIGENCE ............................................................................................................... 29
4.13 DELIVERING THE STRATEGY ........................................................................................................... 29
5 SUPPORTING AREAS ...................................................................................................... 31
5.1 APPROACHES AND METHODOLOGY ................................................................................................ 31
5.2 CONNECTION TO THE BUSINESS ..................................................................................................... 32
5.3 CHANGE DELIVERY ...................................................................................................................... 33
6 HIGH LEVEL PLAN .......................................................................................................... 34
7 CONCLUSION................................................................................................................. 35
APPENDIX A – TEAM SIZE AND SPENDING ANALYSIS ................................................................
APPENDIX B – DELOITTE BUSINESS CASE CATEGORIES ..............................................................
2|PageInformatics Strategy Forward View - 2016 – 2021 Bolton NHS Foundation Trust APPENDIX C – DIGITAL MATURITY INDEX ................................................................................. APPENDIX D – BUSINESS INTELLIGENCE STRATEGY 2015-2018 .................................................. 3|Page
Informatics Strategy Forward View - 2016 – 2021 - Bolton NHS Foundation Trust
2
Strategic Context
The world outside the NHS is changing rapidly and the NHS has acknowledged it is struggling to keep
up. In the outside world access to information and services is easier, social interactions no longer
require face to face environments, consumers are no longer passive and transparency is increasing.
While the NHS productivity and efficiency challenge remains, there is increasing consensus that
Bolton NHS Foundation Trust needs to transform in line with the outside world to improve quality,
experience, outcomes and efficiency.
Over the last 18 months the Trust has made considerable progress in Informatics achievements
including the analysis of community IT needs, securing funding for the community IT initiative and
delivery of phase one of this programme. The Trust also engaged with an independent 3rd party to
carry out an assessment of the Trust’s Informatics ‘burning platform’ to aid in the definition of scope
for replacement and the production of a business case to address this issue
The Trust is now entering a period of unprecedented change. Nationally, focus on efficiency,
productivity and quality is increasing whilst locally, the ‘Healthier Together’ reconfiguration and the
Greater Manchester Devolution Agreement echo the national aims. While the challenges are vast
and the transformational change needed is bigger than any before, the Trust is dedicated to moving
forward and providing high quality healthcare for its local community.
Strategic Challenge
There are a number of key areas that will enable this transformation but nationally and locally it is
recognised that creating a digital future through information and technology will be critical. As a
result, this document sets out the key Information management and technology focus for the Trust
over the next five years.
To create this strategy we reviewed key documentation and spoke to the CCIOs and other key
stakeholders. We gathered information on the national context, local context, current Informatics
capability and vision for informatics. This gave us a clear view of the challenge ahead and the ability
to meet the vision for informatics. The gap between the vision and the ability of the Trust identified
the key objectives for informatics that will move us forward.
Strategic Vision
"To facilitate exceptional patient care through informatics that is innovative, reliable, resilient, agile
and for informatics to become a valued corporate asset”.
The high level aims of this strategy are
1. Digital enablement: Providing clinical staff with the tools to use technology to support the
deliveryof patient care through the use of systems as the iBleep replacement and eOBS.
Supporting the use of technology at the point of care.
2. EPR for hospital and community services: A key deliverable based on a revised approach to
procurement and implementation of an electronic patient record and developing a supportive
culture that enables clinicians to use and exchange information to improve the quality and
safety pf patient care
3. Infrastructure: Upgrade our hardware to deliver leading edge technology enabling lower cost
of ownership and better performance
4. Mobilising our workforce and empowering patients: Supporting patients to help in the their
own care through the use of telehealth and telecare
4|PageInformatics Strategy Forward View - 2016 – 2021 - Bolton NHS Foundation Trust
In order to address the strategic challenges highlighted above, this strategy identifies priorities for
development which are set out below.
1. Electronic Patient Record (EPR) – To move to a world where all information is captured and
available electronically allowing care to be truly patient centric.
2. Supporting Administrative Systems
- Patient Administration System (PAS) convergence – The operation of a single
administration system across acute and community services.
- Enterprise Master Patient Index (EMPI) – Establishing a patient index across the North
West Sector.
3. Electronic Document Management System (EDMS) - Enable the trust to move to a paper-
light operation.
4. Supporting Clinical Systems –
- iBleep replacement
- E-obs
- Theatre system replacement
- OpenEyes
- PACS and VNA
5. Infrastructure – To create a stable, modern infrastructure that provides a robust foundation
for future Informatics requirements.
6. Shared Services – To provide the best possible IT service for staff and patients potentially as
part of a regional shared service.
7. Community Integration – To integrate health and social care to support economy wide
accessibility and integration.
8. Unified Communications – To deliver a modern communications solution that enables
flexible and more agile working.
9. Skill Development - Ensure all staff are informatics literate and confident.
10. Business Intelligence – Implement the business intelligence strategy.
11. Mobile Working – Delivery of the technology and process change to enable the ability to
provide care at the right time and at the right location.
12. Telehealth/ Telecare – To provide telehealth and telecare solutions to our patients to
support patient empowered care and greater efficiencies in care provision.
13. Shared Data – To enable data access and data sharing for patients to enable the Trust to
reach national and local initiatives. (Datawell)
14. Health Innovations – Delivery of truly innovative technologies that support the delivery of
patient centric and patient empowered care. These strategic objectives and the required
supporting themes are discussed below.
Delivering the Strategy
The key for the strategy is to create an approach that can be flexed to adapt to the changing
landscape in Greater Manchester and the financial status of the organisation.
This strategy clearly sets out the focus for the next 5 years and will be supported by a robust
operational plan, related business cases and informatics enabled transformational change.
5|PageInformatics Strategy Forward View - 2016 – 2021 - Bolton NHS Foundation Trust
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3.1 National Context
The national context for NHS organisations across the country is increasingly challenging. In October
2014, NHS England produced The NHS Five Year Forward View that aims to articulate why change is
needed, what change might look like and how to achieve it.
The Five Year Forward View (FYFV) states that the biggest challenges the NHS faces remain:
- Changes in patient health needs and personal preferences.
- Changes in treatments, technology and care delivery and the need to provide care that is
genuinely co-ordinated around what people need and want.
- Changes to funding/continued decline in funding growth.
The Five Year Forward View sets out a number of key themes that need to be addressed to
overcome these challenges. Subsequent National Information Board and HSCIC strategies have
echoed the FYFV. Overall there are eight key themes that Trusts need to focus on and Informatics
needs to enable:
Quality - raising the bar for all NHS organisations;
Prevention - enabling healthier futures;
Patient & Communities - joined up care pathways with patient access to their own
information;
New Models of Care - the introduction of new models of joined up multi-specialty care
providers;
Leadership & Workforce - development of skill sets and upskilling programmes for staff;
Efficiency & Productivity - delivery of high quality care whilst responding identified financial
pressures;
Information & Technology - the joining and sharing and management of information across
healthcare providers;
Health Innovation - delivering clinical care through technologies such as apps and
telemedicine.
An analysis of the key themes and there implications can be found in the next table:
6|PageInformatics Strategy Forward View - 2016 – 2021 - Bolton NHS Foundation Trust
Meeting the Challenge of the five year forward view - Informatics Implications
No. Key Themes Detail Implications for Trust Strategic
INFORMATICS Aims
Quality NHS organisations - Access to robust data, - Implement
1
must narrow the gap information and business
between the best knowledge. intelligence
and the worst whilst - Systems and processes to strategy
raising the bar for all. easily capture - Create stable
information. and modern
- Increased transparency of infrastructure
information.
Prevention Enabling healthier - Technology and access to - Implement EPR
2
futures. Focus on information that supports - Deliver modern
targeted prevention, citizen owned care. communication
healthier workforce - Data to track trends and solutions.
and integrated support prevention. - Enable data
working. - Access to data for access and
research processes. sharing
Patient & Patients must have - Online systems that fully - Provide
3
Communities access to their support patient Telehealth and
healthcare interaction and telecare
information and must ownership. solutions to
have increased - Ability to have meaningful support patient
control over their 2 way contact and empowered
care. Needs inclusion communication between care
of wider community, healthcare providers and - Deliver modern
including carers, third patients and carers. communication
sector and general - Ability to connect solutions that
citizens. communities and enables flexible
appropriate share and agile
information. working
- To fully
integrate the
community and
acute
informatics
service
New Models Introduction of new - Infrastructure provision
4 - Implement EPR
of Care organisational types/ that can be flexed to the
care models needs of any future care - Support mobile
including; model. working to
Multi-specialty - Ability to integrate enable right
Community Providers systems as and when care, right time
(MCPs); required. in the right
Primary & Acute Care - Provide one patient
location.
Systems (PACS) review regardless of care
provider.
Leadership & Help mobilise leaders - Better connection - Ensure all staff
5
Workforce and workforces to between INFORMATICS are informatics
7|PageInformatics Strategy Forward View - 2016 – 2021 - Bolton NHS Foundation Trust
work differently, and the business. literate and
develop the newly - Ability to support the confident.
needed skills, values, workforce to develop the - Undertake IT
behaviours and knowledge and skills training needs
numbers to deliver needed. analysis
the improvements - Ensure staffing, skill mix - Improve
needed. and resilience is adequate investment in
to fulfil the informatics informatics
agenda/strategy. resources
Efficiency & Doing more, - Infrastructure, systems - Review
6
Productivity including increasing and processes that enable potential
quality, with static or different ways for opportunities
reduced funding. working and delivering for Shared
£20 billion savings
care. Services and
due in 2015 with an
- Comprehensive Assets.
additional £30 billion
required by 2021. transparency of - Develop
performance data. Business
- Systems that support Intelligence (BI)
robust activity tracking. systems and
services
Information Information and - Expanding set of NHS - Implement EPR
7
& technology being the accredited health apps to - Deliver modern
Technology key enabler to the support digital inclusion; communication
changes the NHS has - Fully interoperable solutions.
to make. National electronic health records - Ability to
focus on key systems
continuing the move support
that will provide the
‘electronic glue’ to towards paperless; integrated
work better together. - Family Doctor services
appointments and through
prescriptions online, interoperable
everywhere; systems and
- Better audit data; adhere to
- Increased focus on interoperable
technology including standards.
smart phones; - Ability for
- Support to help build pathways to run
capacity and help those seamlessly
unwilling or unable to use across the
technology. entire local
health economy
and local
partners.
- Ensure all staff
are informatics
literate and
confident.
8|PageInformatics Strategy Forward View - 2016 – 2021 - Bolton NHS Foundation Trust
Health In relation to - Better connection to the - Deliver
8
Innovation research, research agenda. innovative
personalised care, - Understand implications technologies
accelerated of future applications and that support
innovation in ways of wearable devices patient centric
delivering clinical - Develop infrastructure, and patient
care and the systems and processes to empowered
unexploited support telemedicine. care.
opportunity to - Flexible, robust
combine different infrastructure
technology such as ready for any
apps and future changes
telemedicine. - To enable data
access and data
sharing in
relation to ill-
health,
prevention and
research
(DATAWELL)
Note: Some of the Informatics implications were taken from the National Information Board Report,
2014.
3.2 Local Context
Our Trust is made up of 5370 (including Bank = 8544) brilliant staff and has an annual turnover of
£292 million. Our vision is:
“To be an excellent integrated care provider within the Bolton and beyond, delivering patient-
centred, efficient and safe services.”
Our Organisations primary objectives are to:
• Integration of hospital and community services
• Services for Women and Children
• Major A and E provider.
• Continuously improve the quality of our services.
Our Part in Greater Manchester;
In February 2015 the 37 NHS Organisations and Local Authorities in Greater Manchester signed a
landmark agreement with the government to take charge of health and social care spending and
decisions in our city region.
We will not achieve this in isolation, We will work both across sector in collaboration with our
partners to deliver the best care for our most sick patients and commissioners and providers within
Bolton to deliver place based care at pace tailored to meet the needs of our residents. Informatics
will be the enabler to support integration and collaboration across Greater Manchester.
9|PageInformatics Strategy Forward View - 2016 – 2021 - Bolton NHS Foundation Trust
Bolton NHS Foundation Trust 2016/2017 Operational Plan
No. Strategic Goals Detail Implications for Informatics
1 Quality and Safety The trust signed up to “Sign Ability to capture information
and patient up to safety” campaign in electronically to be able to
experience 2014. And linked this work to accurately report and inform
the Quality improvement quality and safety agenda.
strategy and integrated
patient family and carer Supporting electronic
experience strategy. systems to record
information, from falls,
escalation and rota’s.
2 To be a valued The trust works closely with Replace out of date desktops
provider the CCG Bolton council and and roll out virtual desk top
NHS England to develop environment.
realistic and aligned activity
plans. Improve accessibility to WIFI
for staff and public
To improve system resilience
to enable timely and Move to single PAS
appropriate flow through the
hospital having clear plans in Need to integrate and
place to ensure our IT systems provide parity of service so
are fit for the future. Acute and Community feels
like one organisation.
Ability for pathways to run
seamlessly across the entire
local healthcare economy.
3 To be a great place to The team should feel fully Need to address the
work engaged in their work, well management of skill sets and
recognised and fairly resources required across all
rewarded. Trust IT programmes that are
Informatics currently has planned to run concurrently.
limited resource capability to
support the Trust, the
capacity to deliver Informatics
programmes proves
challenging.
4 To be well governed As part of the Trust Need to proactively work
Turnaround process more closely with
information was moved from information to ensure IT
Informatics and placed with enables accurate and timely
finance.
information.
IT needs to understand the
information strategy in order
10 | P a g eInformatics Strategy Forward View - 2016 – 2021 - Bolton NHS Foundation Trust
to better support
programmes or work.
Adhere to governance
process and risk
management.
Look to gain ISDN Foundation
Accreditation.
5 To be Financially The trust is forecasting a Creation of robust businesses
viable and surplus of £1.8 million for cases with strong case for
sustainable 2015/2016 however there is a change and clear return on
significant non recurrent value.
element to this. The
underlying position is a deficit Review of current finance
of £5.9 million. models to provide the ability
to cost change initiatives to
ensure successful
deployment and full benefits
realisation.
Systems and data to support
efficient financial
management.
Ability to mobilise Informatics
team to deliver the required
infrastructure programme
and EPR as required.
The right skills and business
relationships to deliver the
programmes of work.
The ability to maintain
business as usual with a
failing platform.
6 To be fit for the In February 2015 the 37 NHS Flexible, robust infrastructure
future Organisations and Local ready for any future changes.
Authorities in Greater
Manchester signed a Ability to support integrated
landmark agreement with the services through
government to take charge of interoperable systems and
health and social care adhere to interoperable
spending and decisions in our standards.
city region
Table 1: Local Context and Informatics Implications.
11 | P a g eInformatics Strategy Forward View - 2016 – 2021 - Bolton NHS Foundation Trust
3.3 National Targets for Informatics
NHS Digital, formally NHS England’s “Five Year Forward View” (October, 2014) the National
Information Board’s “Personalised Health and Care 2020 – Using Data and Technology to Transform
Outcomes for Patients and Citizens” (November, 2014) and the HSCIC’s strategy “Information and
Technology for Better Care” (February, 2015) all emphasise the importance Informatics in enabling
the NHS of the future. There are four major targets that NHS organisations are moving towards.
These are captured in the table below.
Date Target
2016 Implementation of new Data Standards.
2017 Significant progress to be made towards £3m people with Long Term Conditions
being able to benefit from telehealth and telecare.
2018 Digital information to be fully available across NHS and Social Care
2020 All patient and care records will be digital, real time and interoperable.
Table 2: National Targets.
National and Local Implications
Both the national and local contexts have numerous implications for Informatics. There
are also a number of national targets that must be met that require large investment.
Due to the financial situation of the Trust consideration is needed as to what level of
Informatics delivery is possible over the next 5 years.
12 | P a g eInformatics Strategy Forward View - 2016 – 2021 - Bolton NHS Foundation Trust
4
The turnaround situation of the Trust had a disruptive impact on the Informatics department.
National guidance states that NHS Trusts should be spending 4% of their overall budget on
Informatics. Historically the Trust has been spending less than 1% on Informatics and, with the
additional 20% cuts due to turnaround, the spend has been reduced even more.
The Trust has re-focused on Informatics and created four Chief Clinical Information Officer (CCIO)
roles. This newly created Multi-Disciplinary Team (MDT) is already having a positive impact by
building better connections between Informatics and the business and by giving Informatics a
stronger voice at board level. The MDT team works closely with the CIO role and together they
continue to raise the profile and importance of Informatics across the Trust. There will be an
increased need for enhanced clinical leadership, including further development of the CCIO roles,
Associate CCIO’s and Clinical Champions to support the delivery of this strategy.
In addition to the general need for improved levels of IT, the Trust is also facing the following
challenges:
• end of the national programme.
• limited service delivery skills with no ITIL upskilling development programme;
• an Informatics team with limited resources or programme managers to deliver future projects;
• smallest team with the lowest level of funding in the sector (see Table 4 in appendix A of this
document).
In July 2014, Deloitte worked with the Trust to produce “The Digital Trust – Informatics Essential
Services Options Analysis”. This paper set out the funding needed to deal with the ‘burning
platforms’ and key areas of focus. This business case was submitted to the Department of Health
and Monitor as a case for additional funding. The Trust was successful in its application and is in the
process of completing phase one of the programme, which will see the replacement of obsolete
infrastructure.
The Clinical Digital Maturity Index (CDMI) is a benchmarking tool which aims to provide NHS Trusts
with a better understanding of how investing in and using information technology can provide
benefits. The Index is based on a nine-level electronic patient record rating. Recommended by NHS
England, the Trust aims to us this model to support its future journey.
In Appendix C, Bolton NHS Foundation Trust scores above average for leadership, governance,
information governance and transfers of care, but below average for resourcing, records,
assessment and plans, decision support and standards. All of which will be improved significantly by
the implementation of an electronic patient record and investments from the burning platform
programme. However the Informatics service is still significantly benchmarked below its peers in
relation to resources.
Key Consideration – Current Status of Informatics
The Trust’s strategy, vision for Informatics and national targets cannot be achieved with the
current levels of resource and investment in Informatics. A longer term, strategic view of
Informatics is needed to deliver these areas and the required efficiencies and savings across the
Trust.
13 | P a g eInformatics Strategy Forward View - 2016 – 2021 - Bolton NHS Foundation Trust
5
The following section sets out the vision and strategic objectives for Informatics. The vision depicts
what the delivered strategy looks like and the strategic objectives set out the key areas the Trust
needs to deliver, over the next five years, to achieve the vision.
5.1 Vision
The Vision for Informatics is to;
"To facilitate exceptional patient care through informatics that is innovative, reliable, resilient,
agile and for informatics to become a valued corporate asset”.
This will create a ‘digitally mature’ Trust which will support care in the right location at the right
time.
5.2 Strategic Objectives
Through the context review, stakeholder interviews and current status analysis, ten strategic
objectives have been identified. These objectives set out the areas of focus needed to close the gap
between the current status of Informatics and the vision for Informatics and achievement of the
national targets.
The objectives for the next 5 years are:
1. Electronic Patient Record (EPR) – To move to a world where all information is captured and
available electronically allowing care to be truly patient centric.
2. Supporting Administrative Systems
3. Patient Administration System (PAS) convergence – The operation of a single
administration system across acute and community services.
4. Enterprise Master Patient Index (EMPI) – Establishing a patient index across the North West
Sector.
5. Electronic Document Management System (EDMS) - Enable the trust to move to a paper-
light operation.
6. Supporting Clinical Systems –
7. iBleep replacement
8. E-obs
9. Theatre system replacement
10. OpenEyes
11. PACS and VNA
12. Infrastructure – To create a stable, modern infrastructure that provides a robust foundation
for future Informatics requirements.
13. Shared Services – To provide the best possible IT service for staff and patients potentially as
part of a regional shared service.
14. Community Integration – To integrate health and social care to support economy wide
accessibility and integration.
15. Unified Communications – To deliver a modern communications solution that enables
flexible and more agile working.
16. Skill Development - Ensure all staff are informatics literate and confident.
17. Business Intelligence – Implement the business intelligence strategy.
14 | P a g eInformatics Strategy Forward View - 2016 – 2021 - Bolton NHS Foundation Trust
18. Mobile Working – Delivery of the technology and process change to enable the ability to
provide care at the right time and at the right location.
19. Telehealth/ Telecare – To provide telehealth and telecare solutions to our patients to
support patient empowered care and greater efficiencies in care provision.
20. Shared Data – To enable data access and data sharing for patients to enable the Trust to
reach national and local initiatives. (Datawell)
21. Health Innovations – Delivery of truly innovative technologies that support the delivery of
patient centric and patient empowered care. These strategic objectives and the required
supporting themes are discussed below.
The Strategic development for Information technology will be supported and complimented by the
development of the business intelligence services and robust Information Governance practices.
5.3 Electronic Patient Record (EPR) and other supporting clinical system
development
Modern Electronic Patient Records (EPR) offer the potential to embed computerised decision
support into day-to-day care delivery and record-keeping to provide full patient information,
promote best practice, minimise errors and hence improve safety, quality, efficiency and
effectiveness.
An Electronic Patient Records provides;
a single integrated patient record with a common look and feel that supports a more
seamless provision of clinical and operational information across the health economy.
improved data quality and reporting that enables better care planning, operational
planning, clinical coding and day to day decision making.
better safety and quality of care through more holistic patient and clinical information and
access for the right people at the right time.
support for new models of care delivery including integrated care by providing more
accurate information, data and interoperability options.
more efficient use of clinical information which will support more patient facing time, less
duplication and a reduction in possible areas for clinical incidents.
more efficient working practices through streamlines processes, more timely access to
information and the ability to see a holistic view of patient and service information.
a rationalisation of the current suite of Trust clinical IT systems and reduce the risks
associated with multiple, disparate systems creating far greater efficiencies and freeing up
Informatics time to concentrate on providing exceptional INFORMATICS and future strategic
requirements.
replacement of aged, often slow and clunky IT systems with a modern, integrated and
flexible approach that does not constrict or constrain how care should be delivered;
the ability to customise IT solutions to best suit the needs of the Trust, its staff and
patients rather than being stuck with a range of off the shelf solutions that cannot be
enhanced or integrated.
a reduction in the reliance on paper to capture and share information making it easier,
quicker and safer to share information.
15 | P a g eInformatics Strategy Forward View - 2016 – 2021 - Bolton NHS Foundation Trust
What does the future look like?
The adoption of the Allscripts EPR across the Northwest Sector, to provide a shared digital care
record is the goal for achieving integrated care across the sector. At the present time, the Salford
and WWL instances of Allscripts are independently hosted and managed by their respective
organisations. The creation of a Bolton instance of the Allscripts EPR presents a number of hosting
options and opportunities for the sharing of resources, skills and knowledge. A key decision will be
on how and where the application should be hosted, these options are listed below:
• Internally hosted by Bolton NHS Foundation Trust
• Hosted by Salford Royal NHS Foundation Trust
• Hosted By Wrightington, Wigan and Leigh NHS Foundation Trust
• Hosted externally by a commercial partner
Given that the preferred solution is to adopt the Allscripts application across the Northwest sector.
The issue then is to determine the preferred delivery solution. The high level pros and cons of the
hosting options are set out below:
16 | P a g eInformatics Strategy Forward View - 2016 – 2021 - Bolton NHS Foundation Trust
• PRO Ease of delivery
• PRO Local control over pace of delivery
Bolton Hosted • PRO simplifies business case development
• PRO local control over configuration which is key to clinical engement
• CON Potentially higer costs
• PRO Expereience of succesful implementation
• CON May delay business case development
Salford Hosted • CON Potentail procurement issues
• CON Potential limit to adopt BNFT policy and proactice
• CON Timescale for delivery due to Salford contract renegotiation
• PRO Similar scope to Bolton
• PRO Recent experience of delivery
WWL Hosted • CON May delay business case development
• CONPotential delay until WWL implementation completes
•PRO Scalability
Externally Hosted •CON Cost of delivery
•CON May not be supported by Allscripts
The approach to implementation clearly needs to reflect the aspirations and capabilities of the
organisations involved. Regardless of the chosen delivery route, it is imperative that
implementation should not prevent the realisation of the potential ultimate goal of a centrally
hosted EPR across the sector running on a single platform which delivers a fully integrated digital
care record.
It is proposed that for the first cut of the business case that a locally hosted standalone version
of the Allscripts Application is costed. This is a pragmatic solution, as it is one that least impacts
each organisation from an implementation perspective and also does not require immediate
consideration of the system architecture and design, factors which would need to be completed
to determine potential costs. This proposal does not prevent ongoing discussions with other
partners about other hosting options.
The proposed option does not prevent a future linking of the Allscripts applications across the
sector to provide a shared digital care record. The locally hosted option can still embrace the
notion of shared resources through the transfer of knowledge and skills and some high level
sharing of resources. The following diagram highlights the opportunity to progression to a
shared digital care record for the North West Sector of Manchester, based on an
implementation of the Allscripts EPR solution.
There are a number of supportive technologies that are required to support the delivery of the
vision of EPR delivery in Bolton and which will prepare the way for a digitally enabled Trust.
These include:
Single PAS
The Trust is committed to the merger of its two patient administration systems to provide an
integrated PAS for hospital and community services. This is also an essential step into ensuring
we have an integrated approach to the delivery of an EPR.
Patient Flow
It is proposed that the existing Extramed system is retained and integrated with the Allscripts
applications. Allscripts are currently reviewing their commercial offering for patient flow and it
would be prudent to at this stage continue the use of Extramed and to integrate that with the
Allscripts. This allows the Trust to continue to develop Extramed to meet the challenges of
managing patient flow.
17 | P a g eInformatics Strategy Forward View - 2016 – 2021 - Bolton NHS Foundation Trust
eOBS
The Trust is in the process of procurement and implementation of a replacement hospital at
night solution to support escalation of deteriorating patients out of hours. The solution can be
extended to enable the transition from the manual recording of patient observations and
calculation of MEWS to a fully digital solution that enable the electronic recording of
observations including device integration. The e-Obs system would be capable of integration
with Allscripts and would be a first step towards a digitally enabled workforce, improving
timeliness and accuracy of the recording of patient observations and providing more time to
care through the reduction in time taken to carry out this critical clinical activity. It would also
provide the opportunity to transition from an organisation dependant on paper to a digitally
enabled organisation.
OpenEyes
To address compliance with national audits, high productivity virtual working and the drive to
paper light operation, the Trust is implementing OpenEyes in the Eye Unit. OpenEyes is an open
source EPR for ophthalmology that is championed by NHS England and designed by clinicians.
OpenEyes has the functionality needed to tackle the specific challenges ophthalmic care
provides. The software is capable in integrating with our planned Trust-wide EPR. Funding for
this project has been provided by an award from the Technology Fund.
EDM
Another key area in relation to the move to EPR is Electronic Document Management (EDM).
EDM supports both the reduction of paper and storage as well as providing electronic access to
historical/archived records. The implications of this need to be understood fully and the review
of EPR options should further consider the role EDM needs to play in the Trust’s move to a full
Electronic Patient Record.
In order to reduce the reliance on paper and the consequential impact of processing, storing and
retrieving it, the implementation of an electronic document management system (EDMS) is a
desirable component a digital care record strategy. It is proposed that the business case for is
revisited in parallel to the development of the EPR business case to enable the trust to move to a
paper light operation. The emphasis should be on the limiting the need to store newly created
paper records in a physical form rather than the elimination of the existing archive. This will
reduce the need to back scan records, that in all probability will never be needed. Instead
records should be scanned on demand and reviewed in a digital form.
Community Services EPR Delivery
The establishment of an EPR to support community services using the Allscripts application is
complicated by the requirement of the application for an “always on” connection to the
Allscripts database. This is difficult, if not impossible to achieve using current mobile telephony
services. The Trust will review solutions form leading community system suppliers and integrate
the preferred solution into the EPR to provide a comprehensive EPR covering both hospital and
community care.
Procurement Route
Since the original Digital Trust Business Case was compiled the SBS Framework for procuring EPR
solutions has been developed. The Trust played a pivotal role in its development and it has
recently been used by a number of Trusts to successfully procure the Allscripts application in
relatively short timescales this included South Manchester University NHS Foundation Trust. The
SBS framework provides for mini tender and direct to award. The benefit of using the SBS
framework to procure is that it provides a quick and relatively low cost route to procurement.
This also reduces the risk legal challenge which complicated the use of the existing Salford or
18 | P a g eInformatics Strategy Forward View - 2016 – 2021 - Bolton NHS Foundation Trust
Wigan contracts. It is therefore proposed that the SBS framework is used to procure the
Allscripts application and that a direct award is made.
The diagram below sets out the proposed path to the selection, procurement and
implementation of an EPR for Bolton NHS Foundation Trust and progression towards a Shared
Care Record for the North West Sector of Manchester.
Integrate with WWL
and Salford EPR to
Implement provide a Digital
Bolton NHS Shared Care Record
SBS Foundation
Procurement Trust EPR
Framework
Allscripts -
Locally
Hosted EPR
This strategy provides the quickest route to the implementation of an EPR for the Trust which
supports shared care across organisation in the North West Sector using a common clinical care
record and the provides the Trust with the capability to exploit the use of technology to provide
innovative solutions to the delivery of care.
Build the
Merge Acute Implement workforce to
Maximise use Implement Establish and
Implement and Business support EPR
of existing Bolton Hosted Information
eOBS Community Intelligence and IT
iCM EPR Culture
PAS Strategy Strategy
Delivery
Key Consideration – Electronic Patient Record
An integrated Electronic Patient Record that supports the delivery of safe, efficient clinical care
that positively impacts patient outcome and experience is integral to enabling the Trust to
participate in both national and local initiatives.
High quality and reliable data will enable better patient outcomes and more effective
management of resources.
19 | P a g eInformatics Strategy Forward View - 2016 – 2021 - Bolton NHS Foundation Trust
5.4 Infrastructure
Due to historical under-investment in Informatics the Trust infrastructure was totally inadequate for
‘business as usual’ let alone any future Informatics plans. As previously mentioned, in July 2014, the
Trust commissioned Deloitte to create a business case for Monitor and the Department of Health to
facilitate funding the infrastructure ‘burning platforms’ that had been identified. Burning platform
areas were defined as areas of Informatics that needed upgrading and that are essential for running
the hospital.
The report categorised the areas that needed focus into three categories:
Category A - Burning platform and like for like replacement needed;
Category B - Burning platform with options for replacement;
Category C - Investment required but not considered a burning platform.
The Trust took the full replacement option, category A, to Monitor and the DoH, the funding for this
was granted.
The following Infrastructure areas to be considered:
Datacentres
• Currently the organisation has scalable, resilient and secure data centres through continued
development and review and this needs to be continued
• Using our current true vendor agnostic software defined datacentre (SDS) two or more
datacentres should be off site and fully replicated.
• Needs to be scalable resilient and secure
• Review options for shared datacentre services across the GM or local trust controlled WAN
attached datacentres.
Networking
• There was a large investment in 2011 and this needs to be reviewed to ensure a warrantied
environment ensuring security and to support other projects such as unified communications.
• In 2016 the network needs to be reviewed to ensure it is suitable for EPR, EDMS and Unified
Communications.
Wireless
• Wireless should be expanded into the community and we should federate to neighbouring
organisations to allow seamless connectivity to the trust infrastructure. Mobile workers can
connect to desktops regardless of location.
• Wireless should be scalable to incorporate wireless Unified Communications, medical devices
and public access without affecting core services.
Infrastructure
• Telemedicine and mobile working should be expanded to homes to provide the same level of
experience as working within the trust environment. Including secure diagnostic quality
imaging.
• Core infrastructure: development / Migration to a new active directory forest design to include
a new local domain optimised for federated and shared services.
Desktop
• Moving to the latest version of the desktop operating system (as of this document windows 10)
to support the latest technologies. We are also looking at open source desktops, general office
applications including cloud based offerings such as Office 365.
• A continued development of secure and resilient desktops.
20 | P a g eInformatics Strategy Forward View - 2016 – 2021 - Bolton NHS Foundation Trust
• Expand the already established virtual desktop infrastructure
• An upgrade to the on premise Exchange to support unified communications.
• Expand the desktop infrastructure to offer federated integrated desktops to external NHS
organisations.
• Providing a Shared workspace and document sharing environment for collaborative working.
Security
• A continued overarching security programme that covers all aspects of the infrastructure.
Given the fast paced development this needs to be left generic and everything will be appraised
and brought to attention as required.
• A continued programme of external auditing and reviews (penetration testing) to ensure
compliance and integrity.
• A regular review of backup hardware and software infrastructure (including disaster recovery
planning) to ensure the infrastructure meeting organisation /departmental recovery time
objectives (RTO) and recovery point objectives (RPO)
• Expansion of backup practices to meet new IG backup and recovery policy guidelines.
• Regular reviews of Email, Firewall and Desktop Security due to constant threats.
• Evaluation and investment in implementation of active Data Loss Protection (DLP) including
email and external gateways.
Servers and Storage
• Continue to refresh and develop to deliver a resilient and secure infrastructure to support the 5
year strategy as detailed in this document.
• We will look at the feasibility of hybrid cloud computing for resources for ad-hoc projects.
• A proactive monitoring system linked to a digital service desk to pre-empt issues and provide
detailed reporting to the board on service delivery.
Environmental
• Constantly reviewing the most cost effective solutions taking into account environmental
considerations.
• Continue looking for efficiencies on power, cooling and emissions from servers, storage,
network, desktops and datacentres.
Digital Dictation
• A digital dictation and voice recognition system that integrates into the trusts EPR and unified
communications to allow increased efficiencies in reporting and remote working.
IT Unified Communications
• Instant messaging, multi user video conferencing and patient liaison teleconferencing.
• An accredited ISO 27001 email system.
Support Services
• To support EDMS, EPR and general infrastructure we need to provide adequate resourcing to
support 24 hour service delivery within IT services.
Key Consideration – Infrastructure
The vision and strategic objectives for informatics can only be obtained through a robust,
resilient and future proofed infrastructure. Without funding to replace the burning platform all
other Informatics investments are unlikely to be successfully implemented. The inability to fully
21 |implement
P a g e solutions will also impact any benefits and transformation programmes associated
with solution implementations.Informatics Strategy Forward View - 2016 – 2021 - Bolton NHS Foundation Trust
5.5 Shared Services
In response to national digital objectives, NHS Trusts are required to obtain higher levels of digital
maturity whilst often responding to cuts in funding within Informatics departments. Informatics
delivers an essential service to the Trust but this service, above most others, must not only be value
for money, but responsive, flexible, robust and adaptable whilst delivering solid business as usual
services.
Three methods of service delivery are available to the Trust;
• In House – continue to deliver the Trust’s Informatics using an In-House team.
• Outsourced – commission the delivery of the Trust’s Informatics services from an industry IT
specialist.
Shared Service – working with other local healthcare providers create a single team across the local
organisations that can deliver Informatics services across the local economy.
Each of these approaches has its own merits and draw backs as described in the table below:
Approach Quality of Service Flexibility Cost
In - House With a historically An In-House service This option is likely to
underfunded team it will can provide a great cost the least of the
prove increasingly difficult to deal of flexibility in three in the long run.
respond to nation digital responding to the However due to
objectives in an agile way. Trust’s requirements. historical under
With the current funding the Trust will
The skill sets currently
staffing and be required to
present within the team will
investment levels it substantially invest in
need to be expanded and
may prove difficult to the current service
improved to allow for
be truly responsive delivery team in order
continued digital
and flexible to change. to improve current
development.
BAU practices and
An In-House service will give the service the
provide closer links to the ability to respond
business, with an effectively to large
understanding of the Trust’s scale implementations
objectives. in line with national
objectives.
Out Sourced Outsourcing the Trust’s This approach is likely This option is likely to
informatics delivery service to give the least be the most expensive
would provide the highest amount of flexibility to of the three.
quality with industrial the Trust through the
standards of service delivery likelihood of lengthy
being utilised to retrieve, contracts and little
host and process data and ability to change or
systems. adapt services in a
responsive agile way.
Shared Service A Shared Service model A Shared Service This option is likely to
would utilise the Trusts’ model would prove sit in the middle of the
current health care partners more flexible than an other two in terms of
and peers to create a good out sourced model. costs, however it
22 | P a g eInformatics Strategy Forward View - 2016 – 2021 - Bolton NHS Foundation Trust
quality service through an This approach also would prove the most
NHS sensitive culture. provides the Trust cost effective in terms
with the ability to of the value for
It would create a team
develop services in money, service
which covers all key skills
line with each other, provided and
and rids the service of single
raising the bar for all. flexibility offered
points of failure through the
through this economy
sharing and accessibility of
of scales approach.
knowledge and expertise.
This approach also enables
career structure
development and effective
up skilling programmes.
In order to make a Shared Services Agreement successful it is important that the Trust engages fully
and is active in the definition of the Service Level Agreements. It is also imperative that the service is
governed by clear and transparent policies on accountability, escalation procedures, prioritisation,
investment and costs.
The GM Devolution agreement and subsequent strategic plan, “Taking Charge of our Health and
Social Care” sets out the ambition for Health and Social Care provision over the next five years in
Greater Manchester. The wider ambition of Greater Manchester is to become a financially self-
sustaining city region and the reform of Health and Social Care will provide a significant contribution
towards this.
The GM strategic plan is focused on five key areas one of which is the standardisation of clinical
support and back office services. At a strategic level the consideration of shared back office services
is considered an accepted part of business strategy and a necessary part of driving efficiencies across
the health and social care economy in GM. The devolution agenda does however provide us with the
opportunity to go further than simply pooling and sharing resources, it allows and enables us to
think differently, considering new organisational forms and potential collaborations across new parts
of the public sector we hadn’t previously considered.
There is currently significant opportunity to assess Services reduce duplication across IM&T and
drive efficiencies through collaboration and consolidation. It is inevitable that as individual
organisations look for increasingly efficient mechanisms for providing services within a decreasing
financial envelope some will look to external providers. Taking this approach on and organisations by
organisation basis misses the opportunity to take advantage of scale and drive reduced costs.
Collaboration will enable participating organisations to drive efficiencies, share costs and ensure
consistency in levels of current provision. Standardisation of infrastructure and joint models of
working could enable participating organisations to potentially reduce reliance on external providers
and outsourcing, which would potentially have higher associated overall cost. In addition a
collaborative approach would enable future proofing through scale and the retention of specialist
skills and experiences across the collective workforce.
Moving to a joint IM&T service could be undertaken in a phased approach whereby specific services
and assets are on boarded individually. This would allow for testing and management of risk but will
inevitably reach a critical point at which transformation to a new organisation could be significantly
scaled.
A detailed understanding of the right services to be part of a new organisation would need to be
considered and planned in a systematic way. As part of this clear deliverables would need to be
23 | P a g eInformatics Strategy Forward View - 2016 – 2021 - Bolton NHS Foundation Trust
established to ensure standards under the new organisation are at least as good if not better than
current provision. Accepting that each individual organisation currently performs differently across
the range of IM&T services this will mean a minimum of lifting performance in each service area to
the current best performing of the participating organisation.
Key Consideration – Shared Services
A Shared Service model is a cost effective way forward for the Trust to continue developing its
digital maturity with an improved, flexible service delivery approach which meets both local and
national objectives. The Trust will need to ensure that any Shared Service agreement is subject
to the appropriate governance procedures and SLAs
5.6 Telemedicine
Telemedicine is the use of communication and information technologies to deliver clinical care
where the individuals involved are not at the same location. They can either be two healthcare
professionals or a healthcare professional and a patient. Telehealth includes this definition, and also
covers telecommunication to deliver non-clinical services such as research and health education
promotion.
Telemedicine can be split into three main categories: store-and-forward, remote monitoring, and
interactive telemedicine. ‘Store-and-forward’ telemedicine involves transmitting medical data from
a patient to a doctor for assessment at a later time; ‘remote monitoring’ uses devices to monitor
patients in a non-medical setting; and ‘interactive telemedicine’ uses technology such as
videoconferencing and telephones for real-time remote communication.
Telehealth technology is now also widely available and has been successfully implemented in
numerous care settings including a number of North West organisations. Connecting patients in
their home to clinicians through video technology has been proven to drastically reduce hospital
admissions, cut on travel expenses, provided care quicker and more efficiently for patients who are
not able to travel easily, and has greatly improved the end of life care of patients who have trialled
this approach at NHS Trusts. During the lifetime of this strategy, the Trust will review opportunities
to utilise to facilitate telehealth.
The first stage is to complete a Telemedicine review that engages clinicians and stakeholders to
understand the needs and benefits that Telemedicine can bring. This review will include the
exploration and trialling of appropriate telehealth technologies before a full implementation plan is
created.
Key Consideration – Telemedicine
Telehealth solutions enable care to be provided in locations that best suit the patient and
reduces unnecessary travel. These solutions enable self-management and enhanced health
ownership for patients and their families. These developments rely on a strong infrastructure
but can produce cost savings and work efficiency gains across the clinical departments.
5.7 Community Integration
Acute and Community
As a result of the community integration in 2011, the Trust Informatics team has had to flex its
approach from a customer base that is mainly fixed at the hospital site to one that is far more
mobile. In addition, the Informatics team is now a combination of two existing teams. While work
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