Date: / 28 May 2008
Agenda item: / 7.1, Part 1
Title: / Pathology IT System Business Case
Prepared by: / Liz Boylan, IT Systems Project Manager
Presented by: / Mike Stevens, Director of Finance & Business Development
Action required: / Board to consider the business case and give approval to proceed to procurement
Monitoring Information / Please specify HC standard numbers and
tick üother boxes as appropriate
Healthcare Standards – CORE / Standard numbers
Healthcare Standards – DEVELOPMENTAL / Standard numbers
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Service Development Strategy / Performance Management
Local Delivery Plan / Business Planning
Assurance Framework / Complaints
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Pathology IT System Business Case
Board Report 28 May 2008 / Page 1 of 2
1. / PURPOSE
1.1 / This paper sets out the proposals to replace the existing Pathology IT system (EDS Systems) with a new system (Clinisys)
2. / BACKGROUND
2.1 / The Trust has for many years operated a range of systems supported by EDS Systems. These systems originated from the former South West Regional Computer Centre which was subsequently sold to EDS Systems.
2.2 / As a result of the contract award for the National Programme for IT, many of these systems are no longer being developed to meet current and future user requirements and are on a ‘care and maintenance’ basis only. EDS has given formal notice they will no longer support the Pathology system beyond December 2008 and although this date may be extended to a limited extent, the cost of support will escalate as the cost falls on an ever smaller user base.
3. / KEY ISSUES
3.1
3.2 / The identification of a replacement system has been undertaken by the Acute Trusts within the Peninsular (with the exception of Plymouth) acting together under the auspices of the Peninsular Pathology Network and have selected a single system for use across the Peninsular.
After much consideration the system selected is marketed by Clinisys. This system is already sold as a ‘non core’ application through the National programme for IT by BT and has therefore already been subjected to a competitive tendering process. The added advantage of this system is that it will be readily interfaced to the Cerner Millennium clinical system being installed as part of the national programme.
4. / PROPOSALS
4.1 / It is proposed that the Trust proceed to procure and install the Clinisys Pathology IT System.
5. / FINANCIAL/OTHER IMPLICATIONS
5.1 / The costs of the system over the next 7 years will be £2.1m comprising £1.3m initial capital cost and £0.8m in revenue costs. Offset against this will be revenue savings of some £1.5m such that over that period the net revenue benefit will be £0.7m equivalent to £100k per annum.
A capital provision for the procurement has already been included within the capital programme approved by the Board.
6. / RECOMMENDATIONS
6.1 / The Board is requested to consider the business case and give approval to proceed to procurement and implementation.
Pathology IT Systems Business Case
Board Report 28 May 2008 Page 2 of 2
LIMS Business Case / NPFIT-PATH-ORG-IPL-0001 V0.912th May 2008 Draft
Page 7 of 48
LIMS Business Case / NPFIT-PATH-ORG-IPL-0001 V0.9
12th May 2008 Draft
Laboratory Information Management System (LIMS)
Business Case
Draft v. 0.9
Amendment History:
Readership for this document is intended as:
· Key stakeholders involved in the management and delivery of the project;
· Individuals involved in the scrutiny of the business case; and
· Individuals involved in the approval for this investment
Reviewers:
This document must be reviewed by the following.
Name / Signature / Title / Date of Issue / VersionLIMS Project Board / 7th December 2007 / 0.6
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On receipt of a new version, please destroy all previous versions (unless a specified earlier version is in use throughout the project).
Related Documents
These documents will provide additional information.
Ref no / Doc Reference Number / Title / Version1 / NPFIT-NPO-GEN-IP-0067 / Glossary of Terms Consolidated.doc / Latest
Glossary of Terms
List any new terms created in this document. Mail the librarian to have these included in the master glossary above [1].
Contents
1. Executive Summary 1
1.1 Introduction and Purpose 1
1.2 Strategic Case Overview 1
1.3 Economic Case Overview 1
1.3.1 Option Appraisal – Solution Choice 1
1.3.2 Clinical Evaluation of Options 1
1.3.3 Risk Evaluation of Options 1
1.3.4 Identifying the preferred option 1
1.3.5 Selection of LIMS Supplier 1
1.3.6 Pre –Contract Cost Estimates 1
1.4 Commercial Case Overview 1
1.5 Financial Case Overview 1
1.6 Management Case Overview 1
1.6.9 Conclusion 1
2 Strategic Case 1
2.1 National Context 1
2.2 Local Strategic Context 1
2.3 The Case for Change 1
2.4 Local Investment Objectives 1
2.5 Existing Workload 1
2.6 Future Business Needs and Service Gap 1
2.7 Potential Scope 1
2.8 Benefits 1
2.9 Main Risks 1
2.10 Constraints & Dependencies 1
3 Economic Case 1
3.1 Introduction 1
3.2 Options 1
3.3 Economic Appraisal Assumptions 1
3.3.1 Costs 1
3.3.2 Risks 1
3.3.3 Benefits 1
4 Commercial Case 1
4.1 Introduction 1
4.2 Specification of Requirements 1
4.3 Acquisition Timetable 1
4.4 LIMS Supplier & Solution 1
4.5 Payment Mechanism 1
4.6 Commercial Risk 1
4.7 Performance Options 1
4.8 Dispute Resolution 1
4.9 Proposed Contract Lengths 1
4.10 Key Contractual Clauses 1
4.11 TUPE 1
4.12 Implementation Time-scales 1
4.13 FRS5 Accountancy Treatment 1
5 Financial Case 1
5.1 Introduction 1
5.2 Assumptions 1
5.3 Current Trust Funding 1
5.4 Impact on Trust Income & Expenditure Account 1
5.5 Impact on the Trust Balance Sheet 1
5.6 Overall Affordability 1
6 Management Case 1
6.1 Introduction 1
6.2 Project Management Structure, Methodology and Governance 1
6.2.1 Governance 1
6.2.2 Project Management Methodology 1
6.2.3 NHS Gateways 1
6.3 Project Plan 1
6.4 Milestones 1
6.5 Implementation Plan 1
6.6 Project Reviews 1
6.6.1 Post Implementation Reviews 1
6.6.2 Project Evaluation Reviews (PERs) 1
6.7 Risk Management Strategy and Framework 1
6.8 Benefits Management 1
6.8.1 Arrangements for Benefits Realisation Plan 1
6.9 Modernisation Agenda 1
6.10 Training 1
6.11 Contract Management Strategy 1
6.12 Communications Management Strategy 1
6.13 Security and Confidentiality 1
6.14 Advisors 1
Appendix 1 Estimated Costs for Business Case 1
Appendix 2 Benefits by Business Process 1
Appendix 3 Benefits Realisation Plan 1
Appendix 4 Project Risk Register 1
Appendix 5 Existing Laboratory Interfaces 1
Appendix 6 Detailed Project Plan 1
Page 7 of 48LIMS Business Case / NPFIT-PATH-ORG-IPL-0001 V0.9
12th May 2008 Draft
1. Executive Summary
1.1 Introduction and Purpose
This document is the Business Case to support the local investment in a Laboratory Information Management System (LIMS) and seeks to gain approval and commitment from the Royal Devon & Exeter NHS Foundation Trust Board and support from the Exeter Health Informatics Board.
Pathology services are an integral part of a modern healthcare organisation and play a key role in primary and secondary care involved in the cycle of diagnosis and management of illness across the whole spectrum from coronary artery disease prevention to cancer and infectious disease. `
Speedier diagnosis leads to quicker treatment and therefore achievement of access targets such as 18-week referral to treatment and 4-hour wait in ED and MIUs.
Although the national procurement, for an LIMS solution, has agreed the system suppliers costs with the Local Service Providers (LSP), local resources and funding in the form of cash savings and other funding sources will be required to implement it and to achieve the efficiency gains, across the health community, that LIMS can bring for the benefit of patients.
Approval is therefore required for a capital investment of £1,267k over the contract period until October 2015. Costs include VAT where applicable and exclude the future impact of inflation. Service charges have been applied from January 2009. Initial effects of costs and benefits are shown in the following table.
Table 1A Net Revenue Cost of Scheme (with RDE Implementation Staff capitalised)
Net Revenue Cost of LIMS Implementation / 2008/9 / 2009/10 / 2010/11 / 2011/12 / 2012/13 / 2013/14 / 2014/15 / Apr/Oct 2015/16 / Total£000 / £000 / £000 / £000 / £000 / £000 / £000 / £000
Capital Charges / 0.0 / 12.4 / 10.5 / 8.6 / 6.7 / 4.8 / 2.9 / 1.0 / 46.9
Service Charges / 30.5 / 122.0 / 122.0 / 122.0 / 122.0 / 122.0 / 122.0 / 71.2 / 833.7
Cash Benefits / -0.0 / -230.7 / -230.7 / -230.7 / -230.7 / -230.7 / -230.7 / -134.8 / -1519.0
Total Net Revenue Cost / 30.5 / -96.3 / -98.2 / -100.1 / -102.0 / -103.9 / -105.8 / -62.6 / -638.4
Note: 1. (- figure) denotes income expected to be realised from cash-releasing benefit
2. Capital charges calculated on 30% of Contract Price as advised by KPMG for NPfIT services (para 4.13
3. Cash benefits reflect the true cost of existing EDS maintenance contract (07/08 budget currently £45k overspent)
1.2 Strategic Case Overview
The RDEFT Pathology Department serves a large geographical area in the middle of Devon. As well as providing local secondary acute services, the Royal Devon & Exeter NHS Foundation Trust (RDEFT) accepts tertiary referrals from a number of other trusts for orthopaedics, radiotherapy, thoracic surgery, plastic surgery, rheumatology, ophthalmology, cardiology and renal medicine
The RDEH (Wonford) site is currently supported by a 1Gb fibreoptic backbone with 100 Mb to the desktop. An upgrade to the network on the Heavitree site is planned for 2008/9. There is also a rolling replacement programme for desktop hardware over three years old. The trust currently has data transfer links for pathology to North Devon and currently working on links to Torbay for the transfer of first trimester Downs syndrome screening programme via the Viewpoint system.
The current Integrated Pathology System (IPS), supported by EDS, was installed in 1994/5 with the addition of Histopathology in 1999 and Microbiology in 2005. The weaknesses of IPS can be summarised as follows:
· No longer being developed by the supplier, thus:
o a gradual decline from currently accepted requirements, such as integration with NPfIT systems;
o unable to provide comprehensive service management information, demand management functionality or costing data;
o unable to transfer cancer datasets electronically to the Cancer Intelligence Unit;
o has no image handling, & is unable to adequately support long textual reports, such as required by histopathology
o support for the system is only on a rolling year by year basis.
· Because each laboratory system across the SW Peninsula has been setup & maintained separately, no transfer of patient data between laboratories is possible.
The RDEFT had been notified that EDS support for IPS would cease in December 2007. This has now been extended to December 2008 and proposed support costs for extended use of the EDS IPS in 2009 have been received by the trust. In view of the uncertainty this Business Case has been developed for the procurement of a modern Laboratory Information Management System (LIMS) that will meet present and foreseeable future requirements. This business case provides a comparative analysis of the potential pathology solutions available to the RDEFT and is designed to advise the Trust Board on the best option to pursue. Local resources and funding in the form of cash savings and other funding sources will be required to implement it and to achieve efficiency gains across the health community.
The RDEFT has identified a number of IMT investment objectives related to the development of pathology services which are summarised in the table below:
Table 1B
Overall Investment ObjectiveImprove health care provision within the Trust with improved turnaround time for tests in order to reduce delays in referral, improve pre-referral work up and enable more effective management of chronic disease (e.g. diabetes)
Enable the use of electronic test requesting (Order Communications) and results reporting for all acute hospital and GPs users.
Support service improvement and Pathology modernisation
Enable improved management reporting and business intelligence
Enable optimisation of processes and resources
Provide efficiency savings and release funds for clinical service delivery by reducing the average cost per test
Provide a single approach to service improvement covering people, process and technology with a common set of benchmarks and measures which are presented as part of a single IT and communications strategy
Deliver significant improvements in quality and value for money
More Specific ‘SMART’ Objectives
Reduce the potential for human error through the automation of pre analytical recording processes and reduced inappropriate testing with the associated risk/ distress to patients
Reduce clerical input and scientist recording time associated with sample and result handling
Improve and simplify the management of Pathology Services, through the production of integrated management information
Increase the Pathology Service’s ability to respond to developments emanating from the local Acute Services Reviews
Enhance Pathology support for the development of screening programmes for particular disease prevention/treatment programmes within the context of the National Service Frameworks (NSFs) and local Health Improvement Programmes.
Enhance Pathology’s strategic fit with wider clinical networking in such areas as cancer services
Ensure strategic alignment with the Connecting for Health (CfH) Programme and Pathology Modernisation
1.3 Economic Case Overview
The economic case is intended to confirm the preferred option, to establish the preferred scope of the local option and to demonstrate Value for Money in terms of costs, risks and benefits.