STRATEGY 2018-2021 - WHATDOTHEYKNOW
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NHS Lothian eHealth Strategy 2018-2021
Strategy 2018-2021
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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.
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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
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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.
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Fig 1 – Example of key eHealth achievements since 2015
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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.
6NHS 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.
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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.
8NHS 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.
9NHS 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.
10NHS 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
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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.
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Deprecated items refer to software or applications that are considered to be end of life by the manufacturer
11NHS 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
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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.
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For the purposes of the diagram in Fig 3, the different projects and aspirations have been placed in the most appropriate strategic aim
12NHS Lothian eHealth Strategy 2018-2021
Fig 3 – Overview of Projects that require additional resources
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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
14NHS 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
15NHS 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).
16NHS 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.
17NHS 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.
18NHS 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
19NHS 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
20NHS 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
21NHS 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
22NHS 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
23NHS 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
24NHS 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
25NHS 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
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