STRATEGY 2018-2021 - WHATDOTHEYKNOW
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NHS Lothian eHealth Strategy 2018-2021 EXECUTIVE SUMMARY NHS Lothian’s eHealth Strategy provides a vision outlining where time and resources will be directed over the period 2018-21. The document outlines NHS Lothian’s strategic aims regarding eHealth and where efforts should be focused. At the forefront of these efforts will be the constant requirement to ensure that patient safety and quality of care is maintained or improved. This strategy recognises the need to introduce transformational change that will permeate throughout the whole organisation, positively impacting the way care is provided and outcomes for patients. Against a weak economic position, this strategy is bold and ambitious and will aim to help the whole organisation deliver financial stability as well as sustainable services for patients. The strategy outlines seven strategic aims; 1. Enhance the availability of appropriate information 2. Assist patients to manage their own health and wellbeing 3. Support people with Long Term Conditions (LTC) 4. Improve medicines safety 5. Improve access to management information 6. Help deliver efficient working practices 7. Contribute to innovation. In order to fully implement the proposed delivery plan for these strategic aims, additional resources will be required. Although only high-level estimates at this point, initial figures suggest the organisation will require additional capital funding of £12m to cover 2018-2021, and that by 2021 there will be additional recurring annual revenue costs of £4.8m. NHS Lothian is facing a reality where aging software and hardware across the entire organisation requires immediate action to either replace this or to begin the replacement process. Failing to address this will compromise system availability, increase service disruptions and impact performance across a number of major eHealth systems which will ultimately lead to a negative impact on patient care. In order to maintain current service provision there are aspects of this strategy which reflect this imperative need. The proposed plan to deliver this strategy is therefore a balance between meeting the challenges posed by aging infrastructure and the aspirations to improve services and functionality. An element of flexibility will be needed as new national and regional policies and strategies are released over the coming years. NHS Lothian will be required to respond to and implement elements of strategies currently under development and unreleased. NHS Lothian’s eHealth Strategy plans to deliver some transformational changes over the coming years. These changes will deliver new functionality and opportunities but will also open up new possibilities to build upon the initial changes. For example, the implementation of Hospital Electronic Prescribing and Medicines Administration (HEPMA) will deliver a significant change to working practices and patient safety; however, this would then facilitate additional changes in decision support and clinical working practices that would be truly transformational. A glossary of terms is provided in Appendix B. 2
NHS Lothian eHealth Strategy 2018-2021 CONTENTS EXECUTIVE SUMMARY ............................................................................................................................................ 2 1. NHS LOTHIAN – ICT PROGRESS TO DATE ....................................................................................................... 4 1.1 OVERVIEW OF NHS LOTHIAN eHEALTH DEPARTMENT ......................................................................... 4 1.2 FINANCES, FUNDING AND RESOURCES ................................................................................................. 4 2. STRATEGIC VISION ......................................................................................................................................... 7 2.1 STRATEGIC AIMS ................................................................................................................................... 7 2.1.1 STRATEGIC AIM 1 – ENHANCE THE AVAILABILITY OF INFORMATION .......................................... 7 2.1.2 STRATEGIC AIM 2 - ASSISTING PATIENTS TO MANAGE THEIR OWN HEALTH & WELLBEING ....... 7 2.1.3 STRATEGIC AIM 3 – SUPPORT PEOPLE WITH LONG TERM CONDITIONS ..................................... 8 2.1.4 STRATEGIC AIM 4 – IMPROVE MEDICINES SAFETY ....................................................................... 8 2.1.5 STRATEGIC AIM 5 – IMPROVE ACCESS TO MANAGEMENT INFORMATION ................................. 8 2.1.6 STRATEGIC AIM 6 – HELP TO DELIVER EFFICIENT WORKING PRACTICES ..................................... 8 2.1.7 STRATEGIC AIM 7 – CONTRIBUTE TO INNOVATION ..................................................................... 8 3. INFLUENCES ................................................................................................................................................. 10 3.1 NATIONAL INFLUENCES ....................................................................................................................... 10 3.2 REGIONAL INFLUENCES ....................................................................................................................... 10 3.3 LOCAL INFLUENCES ............................................................................................................................. 10 3.3.1 LOCAL ESSENTIAL ITEMS............................................................................................................. 10 3.3.2 LOCAL DESIRABLE ITEMS ..................................................................................................................... 11 3.4 MANAGING EXPECTATIONS ................................................................................................................ 11 4. PROPOSED DELIVERY PLAN .......................................................................................................................... 12 4.1 PROJECTS AND ASPIRATIONS WITH RESOURCES ALLOCATED ............................................................ 12 4.2 PROJECTS AND ASPIRATIONS THAT REQUIRE INVESTMENT ............................................................... 12 4.3 KEY ELEMENTS OF THE PROPOSED DELIVERY PLAN ............................................................................ 12 4.3.1 TRAKCare .................................................................................................................................... 12 4.3.2 HEPMA........................................................................................................................................ 16 4.3.3 MOBILE COMPUTING ................................................................................................................. 16 4.3.4 USE OF FUTURE TECHNOLOGIES ................................................................................................ 16 5. GOVERNANCE AND DELIVERY ...................................................................................................................... 17 5.1 LEADERSHIP ......................................................................................................................................... 17 5.2 SUPPLIER RELATIONSHIPS AND PROCUREMENT ................................................................................ 18 APPENDIX A – PROPOSED DELIVERY PLAN AND RESOURCE REQUIREMENTS ...................................................... 19 APPENDIX B – GLOSSARY ...................................................................................................................................... 26 3
NHS Lothian eHealth Strategy 2018-2021 1. NHS LOTHIAN – ICT PROGRESS TO DATE NHS Lothian has an extensive digital footprint and has delivered much to be proud of over the past few years. Almost every aspect of what NHS Lothian does as an organisation relies on the hardware and software that is already in place, such as the clinician at an Outpatient Clinic, a patient having their appointment booked, an enquiry from a colleague to Human Resources, Finance reviewing transactions, a patient having their records read electronically by multiple clinicians across multiple sites simultaneously, clinics being run Paperlite and so much more. All of this is possible through the strides NHS Lothian has already made regarding eHealth. Moving forward, NHS Lothian will strive to maintain and build upon this excellent existing eHealth framework. As society moves into a new digital age the importance of eHealth will increase as more and more is demanded from the services NHS Lothian provides. Moving forward it is expected that our eHealth footprint will become even more important to the day-to-day activities undertaken across the organisation. 1.1 OVERVIEW OF NHS LOTHIAN eHEALTH DEPARTMENT The eHealth Department of NHS Lothian is made up of a diverse group of teams, providing a wide range of services across Lothian. There are over 700 members of staff within the eHealth Department who make up over 40 separate teams covering eHealth Director / Heads of Service (approx 10 staff), Operations, Infrastructure, and Telecoms (approx 200 staff), Programmes, Development and Training (approx 80 staff) and Health Records (approx 420 Staff). The eHealth Department supports the day-to- day work carried out by more than 27,000 NHS Lothian staff. The eHealth Department has delivered some major achievements over the past few years and the efforts which have gone before provide an excellent example of what the Department, working with colleagues across the entire organisation, can deliver. The impact that some projects have had over the last few years, including the upgrade to TRAKCARE 2016, the launch of Paperlite working, patient digital letters (eCommunications), the beginning of the GP server centralisation project and development of electronic document transfer to GP Practices across the country, have delivered new capabilities, helped speed up processes, assisted Services in managing increased demand, improved efficiencies and become so ingrained with how we all work that it would be difficult, if not impossible, to return to how things were before these were introduced. Fig 1 offers a snapshot of some of the excellent achievements that have been delivered since 2015. 1.2 FINANCES, FUNDING AND RESOURCES Like all public bodies, NHS Lothian is under intense pressure to deliver a balanced budget. However, achieving the strategic aims set out in this strategy will be impossible without increased funding to deliver the proposed eHealth delivery plan. NHS Lothian’s eHealth Department will play a key role in the implementation of the proposed delivery plan and it will be expected to lead on technical projects. Where projects will deliver new functionality or changes to clinical processes, it is more appropriate that clinical colleagues take a leading role in the delivery of those projects, with eHealth taking a service provider role to implement. 4
NHS Lothian eHealth Strategy 2018-2021 Fig 1 – Example of key eHealth achievements since 2015 5
NHS Lothian eHealth Strategy 2018-2021 NHS Lothian’s eHealth Department currently spends approximately 90% of its annual budget simply maintaining the current environment. This means that almost all the budget NHS Lothian allocates to eHealth is spent ensuring applications and software work as users expect them to, day in and day out. This leaves little resource to deliver new projects. Therefore additional resources will be required to deliver the proposed plan and achieve our strategic aims. It is estimated that £12m of additional capital funding will be required from 2018-2021, with an increase in recurring annual revenue of £4.8m by 2021. 6
NHS Lothian eHealth Strategy 2018-2021 2. STRATEGIC VISION NHS Lothian’s strategic vision is to ensure that patient care, safety and outcomes are maintained and where possible improved. The eHealth Strategy therefore aims to support services and colleagues across the organisation to provide this care by making the necessary tools available to ensure patients are treated effectively and efficiently resulting in the attainment of positive outcomes for all concerned. At a time of increased service demand and tight fiscal control, a significant aim will be to help deliver sustainable services and facilitate increases in productivity and efficiency gains through the introduction of new digital approaches. Going forward, the organisation has an aspiration to embrace some of the newly emerging technologies, such as artificial intelligence to support decision making or new functionality within existing systems which offers additional opportunities to improve care provision. 2.1 STRATEGIC AIMS The seven strategic aims identified in the new National Digital Health and Care Strategy are incorporated in NHS Lothian’s strategic ambitions; 1 Enhance the availability of appropriate information 2 Assist patients to manage their own health and wellbeing 3 Support people with Long Term Conditions (LTC) 4 Improve medicines safety 5 Improve access to management information 6 Help deliver efficient working practices 7 Contribute to innovation. These seven aims are not mutually exclusive, so implementation of certain proposed projects will help to deliver several of the aims. For example, the implementation of HEPMA will help to not only deliver an improvement in medicines safety but will also positively impact the availability of appropriate information for healthcare workers, improve access to timely management information, help to deliver efficient working practices and also offer the opportunity to develop innovative working practices. Fig 2 offers an overview of the strategic aims and some of the high-level plans proposed to help NHS Lothian meet these aims. 2.1.1 STRATEGIC AIM 1 – ENHANCE THE AVAILABILITY OF INFORMATION An aim of this strategy is to improve and enhance the availability of all relevant information for healthcare workers to enable them to make the right choice for the patient first time. This will mean shared IT systems and records which are accessible to different professionals across the care system ensuring clinicians and other staff at all stages have the necessary information about the patient, with care better tailored to the patient’s needs. For example, mobile computing in the community, Federated TRAKCare, as well as the ability to communicate information effectively increasing productivity and efficiency through more flexible working practices. 2.1.2 STRATEGIC AIM 2 - ASSISTING PATIENTS TO MANAGE THEIR OWN HEALTH & WELLBEING Over the next few years NHS Lothian has a strategic aim to provide the opportunity for more patients to take an active role in the management of their own health and wellbeing. By providing patients and carers with access to technologies and their own personal information, it is hoped that they will be able to become increasingly more involved in care planning and self manage their own health and wellbeing. 7
NHS Lothian eHealth Strategy 2018-2021 2.1.3 STRATEGIC AIM 3 – SUPPORT PEOPLE WITH LONG TERM CONDITIONS With an aging population, more and more of the patients treated within NHS Lothian have long term conditions with many also having multiple co-morbidities that add a level of complexity to the care provided. If, as an organisation, NHS Lothian were to give additional support to patients living with a long term condition which would enable them to remain in their own homes and out of a care setting, it would be of benefit to both the patient and the organisation. This would be supported through the provision of improved access to services via video consultations in both primary and secondary care settings. Using data, the stratification of the patient population could ensure care is targeted at the appropriate level with supporting anticipatory care plans in place. 2.1.4 STRATEGIC AIM 4 – IMPROVE MEDICINES SAFETY Statistically hospitals are not a safe place to be and there are times when mistakes made can cause harm. There can be serious consequences if patients receive the wrong medicine or an incorrect dosage and a strategic aim of NHS Lothian is to reduce the risks of harm to patients through medication errors. Improving medicine safety through systems such as Hospital Electronic Prescriptions and Medication Administration (HEPMA) and Medications Reconciliation will reduce errors and ensure that patients get the right medication, in the right dose, at the right time. 2.1.5 STRATEGIC AIM 5 – IMPROVE ACCESS TO MANAGEMENT INFORMATION Having up to date, relevant information on what is happening within services throughout the organisation is vital to the management of those services. NHS Lothian has an extensive data set already in place for use by Service Managers and Heads of Departments to help manage resource to meet demand, by providing information systems which enable the organisation to gather the information needed to monitor whether changes are working, including disaggregated data on activity and outcomes for equality groups. Moving forward, it is a strategic aim of the organisation to improve access to relevant management information to assist senior managers and clinicians in their attempts to improve the sustainability of services. 2.1.6 STRATEGIC AIM 6 – HELP TO DELIVER EFFICIENT WORKING PRACTICES Demand across services is increasing, resulting in the need to identify ways in which to utilise the same, or even fewer, resources to manage that increase. Improving productivity and efficiency across services to allow colleagues to work smarter as well as streamline some of the less efficient processes is a strategic aim of this strategy. An ambition will be to facilitate the development of jointly agreed care plans with input from GPs, community teams, specialist nurses and consultants with jointly agreed protocols and care pathways, supported by IT tools. 2.1.7 STRATEGIC AIM 7 – CONTRIBUTE TO INNOVATION Given the pressure the organisation is currently under with increased demand and tighter controls on resources available to meet those demands, innovation will be a necessity to help manage those pressures. An aim of this strategy is to allow eHealth developments to inspire new ways of thinking and to open up opportunities to do things in new and exciting ways. 8
NHS Lothian eHealth Strategy 2018-2021 Fig 2 – Overview of the strategic aims and key elements of proposed plan to meet those aims The proposed delivery plan outlined in section 4 is a mixture of projects with resources attached to them already, and some which will require additional resources. Fig 2 does not show all the individual projects but it does provide an overview of the total funding required to deliver each strategic aim. 9
NHS Lothian eHealth Strategy 2018-2021 3. INFLUENCES When developing NHS Lothian’s eHealth Strategy a number of different influences were taken into account and used to help mould the strategy. 3.1 NATIONAL INFLUENCES As part of a wider organisation, NHS Lothian’s eHealth Strategy is shaped by the policies and direction set at a national level. The new National Digital Health and Social Care Strategy is expected to be delivered in 2018 and although it has yet to be released, the emerging themes and expected areas of focus have already been outlined. The seven strategic aims set out in this strategy have been aligned closely to what is expected to be delivered in the upcoming national strategy. One area of focus has been the convergence of systems to reduce the overheads of managing and operating multiple versions of applications from multiple suppliers, where a preferred system exists and procurement options allow. This convergence work was successfully undertaken as part of the creation of NHS Lothian whereby the number of systems in operation within the previous autonomous Trusts was reduced creating single instances. Where possible a ‘Once for Scotland’ or ‘Once for Regional Working’ approach will be followed as opportunities arise, such as at the end of supplier contracts, end of system life or during new procurements. 3.2 REGIONAL INFLUENCES Across NHS Scotland significant focus is currently being placed upon increasing regional working and collaboration. NHS Lothian sits within the East of Scotland Region along with NHS Borders and NHS Fife. NHS Lothian’s eHealth Strategy therefore also takes into account the regional aspirations that are being outlined in the East of Scotland’s Regional Delivery Plan which will be published in March 2018. Not only will the three eHealth Departments within the East of Scotland area work more closely together towards the delivery of a shared service model, there is also a requirement for eHealth across the region to work closely with other services and departments to help deliver their regional goals. 3.3 LOCAL INFLUENCES There are a number of aspirations that this strategy and proposed delivery plan will aim to achieve which are focused primarily on NHS Lothian specific issues. It is accepted that plans focusing on local aspirations will not compromise national or regional deliverables without justifiable reasons. A prerequisite of this strategy is that NHS Lothian’s eHealth Department will ensure that the services and applications used by NHS Lothian staff will be available and every effort made to minimise unscheduled downtime. Therefore maintaining business as usual will continue to absorb the vast majority of eHealth Department resources. The local aspirations which contribute to the overall eHealth Strategy can be categorised from a different perspective into things which ‘must’ be done and things that we would ‘like’ to do. 3.3.1 LOCAL ESSENTIAL ITEMS Certain items that focus on local requirements are in this strategy and proposed delivery plan because NHS Lothian simply ‘must do’ something to tackle a localised issue, as to do nothing would incur too high a risk to business continuity, patient safety and quality. For example, NHS Lothian must replace its telephony infrastructure, as to not do so would leave NHS Lothian with a major risk of a catastrophic failure to our telephony system which is now technologically obsolete and unsupported, placing patients at immediate risk. 10
NHS Lothian eHealth Strategy 2018-2021 A list of high priority items is as follows: Remove and replace devices operating on Windows XP to reduce the vulnerability this poses to NHS Lothian’s infrastructure as Windows XP will not be updated against new threats Replace Microsoft Office 2007 – this requires investment to maintain a supported environment for desktop users and compatibility with applications needing to utilise Microsoft Office functionality (e.g. letter production) Replace NHS Lothian’s telephony infrastructure – requires investment as the existing equipment is past end of life and the availability of a telecoms service is at risk 1 Replace deprecated items/software within TRAKCare – requires investment as these are no longer supported but are needed to maintain functionality (such as TRAKCare letter production and Order Entry facilities). 3.3.2 LOCAL DESIRABLE ITEMS There are aspects of the strategy, focusing on local issues the organisation would ‘like’ to deliver, that are less imperative from a risk perspective. Whilst they may have the potential to deliver benefits, not doing them would simply be a missed opportunity rather than open NHS Lothian up to significant risk. For example, adding more resource into the TRAKCare team to increase their capacity to deliver change requests would have wide reaching benefits for staff using TRAKCare across NHS Lothian, however TRAKCare is still usable in its current form and therefore arguably not a ‘must do’. 3.4 MANAGING EXPECTATIONS This strategy and proposed delivery plan has attempted to be both ambitious whilst at the same time setting realistic expectations around what can be delivered. As staff and patients immerse themselves into a digital world outside of work, they are becoming increasingly frustrated that NHS Lothian is not able to deliver services in a manner they find commonplace in other industries. NHS Lothian has made great strides to become more digital - the Paperlite Project is good example of this - but the reality is that the wider world is moving forward more quickly than NHS Lothian can keep up and managing expectations now may help remove some unavoidable frustration. 1 Deprecated items refer to software or applications that are considered to be end of life by the manufacturer 11
NHS Lothian eHealth Strategy 2018-2021 4. PROPOSED DELIVERY PLAN A high level proposed delivery plan has been drafted to indicate how NHS Lothian can meet the strategic aims of this eHealth Strategy. The delivery plan looks at the different projects and aspirations that would enable the organisation to meet its strategic aims. An overview of this proposed delivery plan can be viewed in Appendix A. The delivery plan focuses on the period 2018-2021 and is split into two categories; those with resources already allocated to them and those which require investment. 4.1 PROJECTS AND ASPIRATIONS WITH RESOURCES ALLOCATED There are a number of projects and aspirations that have already been approved and resources put in place to deliver over the next three years. It is therefore highly likely that these resourced projects and aspirations will be delivered. 4.2 PROJECTS AND ASPIRATIONS THAT REQUIRE INVESTMENT A large portion of the proposed delivery plan will require additional investment in both capital and recurring revenue resources in order to be delivered. At this point, such investment has not been made available and in the current economic climate there is a significant element of risk that funding may not be forthcoming which would impact on the organisation’s ability to delivery its strategic aims. In order to deliver the proposed plans, high level estimates indicate that additional capital funds of £12m over the period 2018-21 would be required, as well as an increase in recurring revenue funds of £4.8m by 2021. Based on agreed priorities, a business case would be required for each scheme taken forward. Fig 3 outlines a high level representation of the additional capital and revenue costs required to 2 implement the proposed delivery plan. Fig 4 outlines the funding schedule, the progress expected to be achieved in delivering each of the strategic aims and the expected benefits the funding would deliver each year. 4.3 KEY ELEMENTS OF THE PROPOSED DELIVERY PLAN 4.3.1 TRAKCare TRAKCare is the primary clinical system for the vast majority of services across NHS Lothian. Throughout the life of this strategy we will seek to build upon the strong foundations already in place with a view to expand the footprint of the system (adding Theatres, HEPMA and Laboratories). In addition, the organisation will look to invest in additional resource with the sole aim of making a series of small changes, at the request of system users, to deliver refined processes and improve efficiency with the ultimate goal of minimising the amount of paper notes in use. 4.3.1.1 TRAKCare – CENTRES OF EXCELLENCE By the end of 2018 it is hoped that NHS Lothian will have centres of excellence in the use of TRAKCare within each of the acute hospitals which can be used to highlight the functionality available and show how TRAKCare can make a greater difference to the way we treat patients. These centres of excellence can then be used as examples to demonstrate how working processes can be improved in care areas across NHS Lothian when TRAKCare is used to its full potential. 2 For the purposes of the diagram in Fig 3, the different projects and aspirations have been placed in the most appropriate strategic aim 12
NHS Lothian eHealth Strategy 2018-2021 Fig 3 – Overview of Projects that require additional resources 13
NHS Lothian eHealth Strategy 2018-2021 Fig 4 – A funding schedule, progress and benefits for projects that require additional resources £9M CAPITAL £2M CAPITAL £1M CAPITAL 2019 2020 2021 2018 £3.1M REC. REVENUE £4.4M REC. REVENUE £4.8M REC. REVENUE 14
NHS Lothian eHealth Strategy 2018-2021 4.3.1.2 TRAKCare – DEPRECATED ITEMS In September 2016, NHS Lothian upgraded to TRAKCare 2016. At that time, InterSystems (supplier of TRAKCare) indicated that some of the software which supports TRAKCare was end of life and that moving forward future versions of TRAKCare would no longer work if the software was not upgraded. The end of life software is referred to as ‘deprecated items’. As TRAKCare is the main Electronic Patient Record (EPR) for patients, not upgrading these components would impact the service levels eHealth and the supplier could offer, compromising patient safety as much of the information held and accessed in TRAKCare supports critical clinical decision making on a day-to-day basis. The deprecated items impact the way TRAKCare prints, the order entry screen and the appointment booking screen. The amount of time and resource it will take to resolve these issues should not be underestimated, and once the deprecated items have been replaced the outcomes will look very similar to the current functionality within TRAKCare. This means that a large amount of time and resource will be spent maintaining the status quo, however to do nothing would result in NHS Lothian being unable to upgrade to new versions of TRAKCare. Requires investment. 4.3.1.3 TRAKCare – THEATRES It is an aspiration to introduce the TRAKCare Theatres module to Lothian over the coming years. This will see the replacement of the current ‘ORSOS’ system and provide improved continuity for clinicians using TRAKCare, together with improved theatre utilisation. An additional aspiration is to use the Theatres module a regional level to help bring about sustainable services for the entire region. Requires investment. 4.3.1.4 TRAKCare – FEDERATED TRAKCare Delivering the functionality proposed by Federated TRAKCare will allow clinical information from other Board’s instances of TRAKCare to appear seamlessly into NHS Lothian’s version. For example, if a patient lives in another Health Board using TRAKCare or is treated while visiting another region, the information housed in that Health Board’s version of TRAKCare will become visible within the patient’s record within NHS Lothian’s version of TRAKCare. Requires investment. 4.3.1.5 TRAKCare – CHANGE REQUESTS Since 2010 the TRAKCare team have received over 480 Change Requests. As of October 2017, 204 of these (43.5%) had been completed. A further 7 (1.5%) are currently being worked on, leaving 256 (55%) not currently being progressed. These requests have been submitted from across services and departments in NHS Lothian and the reality is that the resources available to the team mean that the change request process is not working since current resources are often focussed on business as usual instead of delivering change requests. In a time of finite resources, it is not feasible to provide sufficient resource to clear the entire backlog; however an aim of the eHealth Strategy is to provide more resources to the TRAKCare team to allow them to focus on delivering more change requests over the coming years. Options have previously been proposed to resource this work with additional monies throughout the 3 year period of this strategy, funded at a low, medium and high level. Progressing these options will not completely clear the current RFC backlog but will increase eHealth’s ability to deliver significant change 15
NHS Lothian eHealth Strategy 2018-2021 Requires investment. 4.3.2 HEPMA The implementation of HEPMA is expected to deliver significant benefits to patient care in NHS Lothian. Changing the way in which clinicians prescribe medications from paper cardex to an electronic method will significantly reduce the risks of medication errors. The introduction of HEPMA will also help manage stocks of medication thereby reducing waste. Once implemented, HEPMA will not only deliver positive changes but will also open up new possibilities to change processes in ways unavailable with the current method of prescribing and administering medication. Requires investment. 4.3.3 MOBILE COMPUTING One of the problems NHS Lothian staff face working out in the community is the lack of access to relevant information. As more of our processes become electronic, the more difficult it becomes to work in a non-electronic environment. Working in the community can be difficult as colleagues are away from their desk and their PCs. It often means that staff have to go to their base to prepare for appointments, carry everything they need when visiting patients and handwrite notes off site before returning to their base to type those notes into the electronic system. The proposed plan is to introduce large scale mobile computing for a significant proportion of our community based staff. This will give them with the tools they need to access patient information electronically and, crucially, allow them to type up notes off site rather than having to head back to base to do so. Requires investment. 4.3.4 USE OF FUTURE TECHNOLOGIES The use of Artificial Intelligence (AI) is increasing across industries and healthcare is beginning to see how AI can positively help manage the levels of service demand, and also aid clinicians in ensuring that a level of standardisation in patient care is achieved. There are many ways AI could assist in the treatment of patients; by helping triage referrals or providing support to help clinicians make relevant decisions. We will continue to evaluate new technologies, e.g. to deliver clinical “apps”, integrate the output of wearable devices into patient records, further enhance patient information, security and privacy, and derive greater insights from clinical notes through Natural Language Processing (NLP). 16
NHS Lothian eHealth Strategy 2018-2021 5. GOVERNANCE AND DELIVERY The diagram below in Fig 5 outlines the overall governance structure for the delivery of this strategy. It is expected that progress reports, issue resolution and quality assurance would be provided by the reformed Digital Transformation Group, TRAKCARE Board, LCIG, CMT, F&R and the Board. There is an established process of submitting and evaluating New Work Requests (NWR), for both TRAKCare and non-TRAKCare eHealth Systems, as outlined in Appendix A. These are triaged within eHealth and resource estimates/specifications defined and costed as required. Key prioritisation decisions for TrakCare related changes is the responsibility of the TRAKCARE Board. Non-TRAKCare projects are reviewed with the appropriate CMT who sponsored the change, the eHealth Executive Team for eHealth infrastructure changes and NHS system-wide changes are reviewed/managed/ priorities by the Digital Transformation Group. eHealth has Account Managers assigned to each key operational unit within NHS Lothian to develop and maintain effective working relationships across a range of services, and to lead the development/coordination of eHealth priorities for these operational units. The Diamond Group reviews strategic changes and brings together an eHealth, Finance, Medical and Nursing Directors’ perspective. It is expected that the Scottish Government will also require and seek assurances from NHS Lothian that aspects of their agenda are being met. It is expected that the different projects which will deliver outcomes to meet the aims of this strategy will use governance structures valid for that particular project depending on the projects size and level of resources required. These potential governance structures are also outlined in the diagram in Fig 5. Fig 5 – Governance Structure 5.1 LEADERSHIP Delivering this strategy will require strong leadership across the entire organisation. The strategy is aiming to deliver transformational change in the way we all work and how services are delivered. For this to be effective each of the building blocks of this strategy will require to be clinically or service led, as appropriate, with the eHealth Department playing a delivery role. 17
NHS Lothian eHealth Strategy 2018-2021 5.2 SUPPLIER RELATIONSHIPS AND PROCUREMENT NHS Lothian will continue to build upon the excellent working relationships with suppliers and partner organisations in an attempt to ensure consistency in securing the best possible value deal for patients and staff. At all times, eHealth Department will work to the guidelines set out both locally and nationally to ensure fair and equitable practices are adopted throughout any procurement exercise, again ensuring the best possible outcome for patients and staff. 18
NHS Lothian eHealth Strategy 2018-2021 APPENDIX A – PROPOSED DELIVERY PLAN AND RESOURCE REQUIREMENTS REF STRATEGIC AIM PLAN CURRENT POSITION FUTURE POSITION Resourced Requires 2018/19 2018/19 2019/20 2019/20 2020/21 2020/21 Project Investment Capital Rec Rev Capital Rec Rev Capital Rec Rev £,000 £,000 £,000 £,000 £,000 £,000 1 Enhance Perform a periodic Currently no formal digital NHS Lothian will understand its availability of assessment of digital maturity assessment has been own digital maturity when information maturity - HIMSS and undertaken focused primarily on compared to other organisations Yes 40 40 40 TRAKCare Essentials a healthcare setting and also identify areas to focus evaluation of usage investment priorities 2 Enhance Deliver desktop via VDI NHS Lothian already utilises VDI Virtual Desktops provide many availability of (WYSE machines) widely with over 40% of our benefits, for standardisation, information devices currently VDI speed of machines and the support required to maintain the Yes machines. The more that are deployed enhances those benefits. Target penetration 80% 3 Enhance Replace telephony NHS Lothian’s telephony system Replacing the system will availability of infrastructure is antiquated and needs to be provide enhanced functionality 2000 information replaced. Currently going to our users and additional Yes (early 350 350 350 through a Business Case process flexible working patterns in est) to seek approval addition to improved resilience 4 Enhance Professional to There is limited functionality Enhancing the speed and ease of availability of professional beyond telephones and email how colleagues can information communication communicate via applications Yes like SKYPE for Business improves communication and efficiency 5 Enhance Complete CTG There is currently no electronic A dedicated CTG solution will availability of Implementation storage of CTG tracings provide electronic storage and Yes information AI algorithms to assist in Clinical Decision Support 6 Enhance Complete Neonatal The existing Neonatal solution is A new solution will improve availability of System replacement obsolete and unsupported information availability and Yes information enhance the integration with other associated systems 7 Enhance TRAKCare - expand to Currently NHS Lothian has a Using TRAKCare to provide Labs availability of deliver TRAKCare Labs separate Labs system that is able functions will reduce risks information to send information into associated with two systems TRAKCare. This system is at the which need integration to end of its contract term and communicate. It will open up requires to be replaced additional functionality to aid Yes decision support and how results are viewed in TRAKCare. Will also benefit regional working if all boards move onto TRAKCare 19
NHS Lothian eHealth Strategy 2018-2021 REF STRATEGIC AIM PLAN CURRENT POSITION FUTURE POSITION Resourced Requires 2018/19 2018/19 2019/20 2019/20 2020/21 2020/21 Project Investment Capital Rec Rev Capital Rec Rev Capital Rec Rev £,000 £,000 £,000 £,000 £,000 £,000 8 Enhance TRAKCare - replace NHS Lothian currently replaces Implementing the proposed availability of hardware to ensure it is hardware as and when funding infrastructure set up for information future proof with is made available irrespective of TRAKCARE will provide a more scalability system performance robust and resilient application. Yes It will also make scaling up the use of TRAKCARE simpler as adding server/storage space will be easy and affordable 9 Enhance ICU System There is currently no dedicated A dedicated ICU system for adult availability of ICU system in place within adult ICU areas in NHS Lothian will No information units enhance patient care and improve patient safety 10 Enhance EPR - next steps Paperlite is well established Over the coming years the next availability of throughout NHS Lothian phase of Paperlite will include information the automatic uploading of data from medical devices directly into the patient record. This will result in more relevant data Yes 250 30 30 30 being available to clinicians to assist them in their decision making. It will remove the need to input data manually thereby saving time 11 Enhance Basic computer NHS Lothian currently has a Replacing older software will availability of operating systems are large number of machines that remove security risks and information often old and pose a use windows XP. Also elements provide additional functionality Yes security risk of infrastructure are starting to that can be used over time become aged and require replacing i.e. our 2008 Servers 12 Enhance Internet access – social NHS Lothian currently bans all A number of educational links availability of media forms of social media on its will be viewable moving information networks forward, allowing clinicians and support staff to access this to aid them in their work. In addition, Yes these services will open up new informal means of communication, together with information sharing 13 Enhance National CHI / Child The current national solutions A national initiative will see the availability of Health are obsolete and not easily procurement of new National information upgradeable CHI and SCPHWS Child Health Yes solutions and their implementation 20
NHS Lothian eHealth Strategy 2018-2021 REF STRATEGIC AIM PLAN CURRENT POSITION FUTURE POSITION Resourced Requires 2018/19 2018/19 2019/20 2019/20 2020/21 2020/21 Project Investment Capital Rec Rev Capital Rec Rev Capital Rec Rev £,000 £,000 £,000 £,000 £,000 £,000 14 Enhance Enhance training We currently focus our efforts We will take an active part in availability of opportunities to cover on systems training. A large gap determining national training information all elements of our is increasingly becoming initiatives but until the work force so they apparent in some areas where requirements are outlined it is Yes receive appropriate staff are poorly equipped to difficult to identify a programme training relevant to operate a PC even at a very and the funding required to their duties rudimental level deliver it 15 Enhance Improve IT security NHS Lothian currently spends Ensure that NHS Lothian is able availability of time and money protecting the to manage the risks of cyber information perimeter of our network. threats will help to keep systems Moving forward our aim will be up and running allowing patient Yes 100 100 100 to improve the protection of our care to be uninterrupted network if something is able to get through our perimeter 16 Assisting GP Online booking and Universally, patients are unable All patients will be able to take patients to repeat prescriptions to book online appointments control of their bookings and manage their and repeat prescriptions via the repeat prescriptions and avoid Yes own health GP patient management system unnecessary telephone calls 17 Assisting Every citizen should Work is currently underway on a Providing patients with access to patients to have a personalised West of Scotland Patient Portal more information, on a platform manage their view of their Personal pilot. The work planned for NHS that can expand over the years own health Health Record (PHR) Lothian in this area will be to deliver new levels of information by 2020, informed by this pilot functionality, will allow them to lab results, outpatient understand more of their own Yes 300 75 75 appointments, link to information and help them vetted mobile apps, manage their conditions allow to input data from their digital devices 18 Assisting Deliver patient WiFi to NHS Lothian has WiFi set up at Offering patient WiFi at all of patients to all NHS Lothian the four main sites and some our main sites, and some other manage their locations that already other smaller clinical areas but locations, will offer a new level Yes 93 93 93 own health have WiFi set up for does not offer patient WiFi of patient experience which will clinical and business anywhere aid in their recovery purposes 19 Support Modernisation of Currently NHS Lothian utilises Provide the opportunity for people with outpatient video / video consultations with our patients to access healthcare LTC telecommunications Midwives to Mother service, from the comfort of their own Yes 175 75 100 75 75 providing breast feeding advice. home avoiding unnecessary trips Expanding use of this proven to healthcare centres technology to support LTCs 21
NHS Lothian eHealth Strategy 2018-2021 REF STRATEGIC AIM PLAN CURRENT POSITION FUTURE POSITION Resourced Requires 2018/19 2018/19 2019/20 2019/20 2020/21 2020/21 Project Investment Capital Rec Rev Capital Rec Rev Capital Rec Rev £,000 £,000 £,000 £,000 £,000 £,000 20 Support Modernisation of GP Currently the number of video Provide the opportunity for people with video / consultations is limited across patients to access healthcare LTC telecommunications GP practices from the comfort of their own Yes 400 60 60 60 home avoiding unnecessary trips to healthcare centres 21 Improve Medicine This is an important Provide clinicians an easy way to medicine Reconciliation development and work needs to reconcile the medications safety be undertaken in advance of the patients are prescribed from implementation of HEPMA to different healthcare settings to Yes 100 100 100 deliver early safety benefits ensure safe working practices. To be automated as far as possible to remove lengthy manual processes 22 Improve HEPMA - Implement NHS Lothian currently does not HEPMA in place in hospitals medicine have HEPMA but it is a priority across NHS Lothian with safety HEPMA – support the aspiration to introduce electronic prescribing and change to workflows medicines administration being and implement new the norm Yes 2000 125 1300 125 900 525 solutions to streamline process and improve safety (e.g. barcode scanners) 23 Improve Public Records Act – a The organisation needs a NHS Lothian meets all of the access to document document records management requirements placed on it by the management management system is system to store policies, Public Records Act Yes 250 50 50 information required procedures etc with adequate timelines for destruction 24 Improve Replace the Microsoft NHS Lothian currently uses the A new version of MS Office will access to Office 2007 product MS Office 2007 product suite be used across the organisation, management suite with a modern however licensing for the use of with everyone provided with the information equivalent this is coming to an end and relevant levels of access to Yes 50 1140 1140 there is a need to move to an applications that their role alternative solution requires, offering enhanced ways of working, collaborating and communicating 25 Improve TRAKCare – Offer a TRAKCare does have some audit Services will be able to use the access to suite of generic audit tools but these are set up for generic audit tools to better management tools that services can each service individually; having understand their patients, Yes 32 32 32 information use to gain additional a generic set would allow more identify trends and make data and insight into audit to occur relevant changes to help deliver their patients sustainable services 22
NHS Lothian eHealth Strategy 2018-2021 REF STRATEGIC AIM PLAN CURRENT POSITION FUTURE POSITION Resourced Requires 2018/19 2018/19 2019/20 2019/20 2020/21 2020/21 Project Investment Capital Rec Rev Capital Rec Rev Capital Rec Rev £,000 £,000 £,000 £,000 £,000 £,000 26 Help to TRAKCare – Implement Limited amount of resource New levels of standardisation deliver and maintain decision available to introduce decision will ensure an equitable and safe efficient support and local support and effect change service for patients. Having working changes and requests in TRAKCare currently TRAKCare identify the next step Yes 500 500 500 practices customisations for for a patient or offer advice clinicians within based on pathway, will aid TRAKCare clinicians and enhance patient care 27 Help to Technology enabled NHS Lothian currently supports a This would see specific steps of deliver care - implement system called Florence which the patient pathway completely efficient something to actually facilitates blood pressure removed due to the introduction Yes working remove/replace tasks readings at home of technology/digital solutions practices not just enhance 28 Help to Increase the prevalence NHS Lothian currently has small Community based staff will be deliver of mobile computing in numbers of staff using mobile able to access information away efficient the community computing, having access to from the office and also input working documents and files wherever information off site allowing Yes 3500 950 950 950 practices there is adequate 4G mobile them to avoid unnecessary trips connectivity back to their base to complete paperwork 29 Help to Reduce the complexity Single Sign On (SSO) has been NHS Lothian is undertaking a deliver and inefficiency of enjoyed for a numbers of years process of centralising GP efficient logging on to multiple within the acute sector and servers which will provide working applications corporate functions. Hitherto, additional options to roll out Yes practices this functionality has not been SSO, removing the need to available within General Practice remember so many different passwords for the different applications used by GPs 30 Help to Improve the speed of The speed of connection across Increasing the speed that data is deliver GP practice networks NHS Lothian varies; the aim will retrieved by devices in GP efficient be to ensure all practices have practices, and the speed at Yes working adequate connection speeds and which those devices work, will practices capacity increase efficiency and reduce frustration 31 Help to Improve the experience Due to limited network capacity, Ensure software updates and deliver of applying security patching processes often impact patches are implemented via efficient updates within GP system performance and create central infrastructure to reduce Yes working practices inefficiency the risks of cyber threat with practices minimal user disruption 23
NHS Lothian eHealth Strategy 2018-2021 REF STRATEGIC AIM PLAN CURRENT POSITION FUTURE POSITION Resourced Requires 2018/19 2018/19 2019/20 2019/20 2020/21 2020/21 Project Investment Capital Rec Rev Capital Rec Rev Capital Rec Rev £,000 £,000 £,000 £,000 £,000 £,000 32 Help to Introduce outpatient Inpatient results are already The ability to safely check deliver result sign off signed off electronically within outpatient results, and be efficient TRAKCare but the functionality confident that all of the results working for outpatient areas is only now are sent electronically to the Yes practices becoming available correct clinician, will reduce risks as well as increase patient safety and efficiency 33 Help to TRAKCare centres of In the early stages of planning to NHS Lothian will be able to show deliver excellence – create set up wards on each of the the true potential of using efficient internal demonstrator main sites which have access to TRAKCare, and all of its current working areas an enhanced level of resources functionality, showing how practices to help use TRAKCare to its full more productive and efficient potential to demonstrate what the organisation could be and Yes can be done with current how patient care can be functionality. Use these wards enhanced as exemplars for rest of organisation 34 Help to TRAKCare Deprecated Some of TRAKCare is built upon By replacing the deprecated deliver items - project to coding that is now considered items, NHS Lothian can efficient remove obsolete obsolete. The system continues implement future upgrades of working software (e.g. reporting to operate but we have been TRAKCare allowing new practices mechanism) informed by the supplier that functionality to be utilised Yes unless we remove this obsolete coding the application cannot be upgraded in the future 35 Help to TRAKCare - expand to Currently NHS Lothian has a We will implement a new deliver deliver TRAKCare separate Theatres application Theatre solution which is more efficient Theatres that is reaching end of life and tightly integrated to TRAKCare Yes 600 75 75 75 working needs to be replaced Waiting List functionality practices 36 Help to Radiology reporting Each Health Board in Scotland New functionality will be deliver solution aims to do its own Radiology implemented to allow radiology efficient reporting. Staffing difficulties in examinations to be reported on working some areas of Scotland have securely from any Health Board Yes practices significant recruitment and in Scotland retention issues 24
NHS Lothian eHealth Strategy 2018-2021 REF STRATEGIC AIM PLAN CURRENT POSITION FUTURE POSITION Resourced Requires 2018/19 2018/19 2019/20 2019/20 2020/21 2020/21 Project Investment Capital Rec Rev Capital Rec Rev Capital Rec Rev £,000 £,000 £,000 £,000 £,000 £,000 37 Contribute to Develop a suite of There is currently no Offer clinicians the use of innovation clinical apps / certify functionality of this nature applications that have been apps already available reviewed, or even developed, by for use in NHS Lothian NHS Lothian developers to assist Yes 100 100 100 in the improvement of patient care and outcomes 38 Contribute to Artificial Intelligence There is currently no Begin to identify how NHS innovation (AI) – automation of functionality of this nature Lothian can utilise the data held the upload of data from by wearable fitness and wearable devices monitoring devices, and how Yes 75 100 100 directly into the patient this could be automatically record in TRAKCare/GP uploaded directly into the patient’s EPR 39 Contribute to Automated workflows There is currently no Work with external suppliers to innovation using AI, including functionality of this nature explore the triaging of referrals, referral management and other repetitive processes, via AI in a safe way thereby Yes 500 500 500 freeing up resources to focus on other tasks TOTAL 9000 3180 2050 4395 1000 4795 25
NHS Lothian eHealth Strategy 2018-2021 APPENDIX B – GLOSSARY AI Artificial Intelligence CHI Community Health Index CMT Corporate Management Team CTG Cardiotocography Diamond Group Subset of CMT tasked with oversight of eHealth Strategy creation (Director of Finance, Executive Nurse Director, Executive Medical Director, Director of eHealth) EPR Electronic Patient Record F&R Finance and Resource Committee HEPMA Hospital Electronic Prescribing and Medicines Administration HIMSS Healthcare Information and Management Systems Society ICU Intensive Care Unit LCIG Lothian Capital Investment Group LTC Long Term Conditions PACS Picture Archiving and Communication System PHR Personal Health Record PC Primary Care RFC Request For Change SC Secondary Care SCPHWS Scottish Child and Public Health Wellbeing System SSO Single Sign On VDI Virtual Desktop Infrastructure 26
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