SCR Implementation Project Brief

Purpose of this document is:

  • To present to the SCR Project Team an overview of the implementation requirements of the SCR and what it would mean to the Health Community
  • To give an insight to the Programme Board of what is entailed in delivering the SCR
  • Upon approval, to be used as a communiqué in order to inform all Project Stakeholders of the extent and content of the Project – until such time aPID is compiled.

Distribution

Distribution: / Gary James / Dr Paxton / Manny Hussain / Vicki Hughes/ Dr Eames / Amy Mason / Bronya Glet
Further copies from: / Tina White

Document Control

Title: / SCR Implementation Project Brief
Reference:
Status: / Final Draft
Version: / 2
Date Issued: / 09/01/09
Originator: / Tina White

Change History

Date / Version / Author / Comments
031208 / V1 / Tina White / Original Draft
090109 / V2 / Tina White / Final Draft

Document Review and Approval

Role / Reviewer / Review Requirement
SRO / Gary James / Mandatory
Quality Assurance (QA) / Dr Adam Paxton / Mandatory
Senior Supplier (CFH) / M H / Mandatory
SHA (QA) / V H / Mandatory
Senior User / M E / Mandatory

1Executive Summary

1.3 Consent

2Project Definition

2.1Objectives

2.2Scope

2.2.1Business Process

2.2.2Organisations

2.2.3Locations

2.2.4Data

2.2.5Applications

2.2.6Technology and Statistics

2.3Excluded from Scope

2.4Project Deliverables

2.4.1Product Breakdown Structure (PBS)

2.5Constraints

2.6Communications and Interfaces

2.6.1NHS CfH Dependencies

3Outline Business Case

3.1Strategy – how this Project Supports NHS CfH

3.2Reasons why SCR ought to be implemented

4Project Tolerances

5Customer Quality Expectations

5.1.1Patient Safety

5.1.2Access & Responsiveness

5.1.3Clinical & Cost Effectiveness

5.1.4Patient Focus

5.2Benefit Realisation

6Acceptance Criteria

7Risks

1

Improving Health, Improving Services

1Executive Summary

  • The Summary Care Record (SCR) is a subset of a patient’s record with headline medical details (e.g. Medication, Allergies & Adverse Reactions) which can be accessed by clinicians using the Summary Care Record Application (SCRA) and by patients via ‘HealthSpace’
  • SHAs are required to ensure SCR is implemented to agreed national timescales
  • The “Care Record Guarantee” means patients can opt in or out of the use of SCR
  • Public Engagement and Communication are critical elements of implementing SCR
  • Data Quality is a critical consideration for implementation
  • A significant Management Resource will be needed at PCT level to prepare for and implement SCR county wide

1.1 Background

The Summary Care Record (SCR) is a subset of the NHS Care Record Service. Initially it will contain a data set of current medications, allergies and adverse reactions, uploaded from the GP System. The SCR will be available throughout England, giving secure access to those who need it to deliver care. Benefits of this service are widespread but primarily aimed at delivering major end user benefits to the patient, in circumstances where treatment occurs, in settings with no access to their GP record; for example A&E Departments, OOH, Walk-in Centres and Ambulance Service.

This Brief outlines the project requirements to deliver a sound, substantiated Project Initiation Document (PID) for the Implementation of the SCR across the PCT, the purpose of which is to seek Approval to Proceedfrom the project board

Its purpose is:

  • To ensure that the Project has a sound basis before asking the Project Board to make any major commitment to the Project
  • To act as an introductory document against which the Project Board and Project Manager can assess the scope, complexity and environment into which the Project will venture.

1.2 What is the Summary Care Record?

SCR will be created automatically from information available from detailed records kept by operational systems. It can be viewed by healthcare professionals and patients themselves:-

  • An extract of a patient’s GP summary record is submitted to a central database
  • It can then be viewed in a controlled manner by authorised healthcare staff wherever the Summary Care Record Application has been deployed
  • The initial record consists of medications, allergies and adverse reactions
  • With the patient’s consent, their record can be enhanced to include key clinical information, for example diagnoses
  • Patients have choices about whether to have a Summary Care Record and whether they want to share it with healthcare staff
  • Patients can change their minds at any time
  • Patients can view their own records via HealthSpace, a secure internet service, using an advanced HealthSpace account, obtained by completing the secure registration process.

SCR will be implemented at two levels. Level-1 will focus on information extracts from general practice clinical systems to include initial up-load and then information captured from primary care patient encounters, to then be used by Healthcare professionals and additionally by the patient themselves.

Level-2 will capture information from other care settings. This will begin to happen in the summer of 2009.

1.3 Consent

The NHS Care Record Guarantee provides a commitment that the patient’s records will be used in ways that respect their rights to secure, confidential and accurate records. A key element of the guarantee is that patients can limit how their information is shared and the consent model lays the basis for implementing patient choices, of which a Public Information Programme (PIP) is essential.

The SCR Early Adopter programme has undergone an evaluation by the University College London. Within their findings was a recommendation that the consent model for patients is reviewed with the aim of making it simpler, and providing added “governance” around access to records for those patients who were “apathetic” to the PIP at the time, but would be concerned around access when actually faced with an acute situation.

The key elements of the consent model for creating and accessing SCRs are based on the following principles:

  • Letter from the PCT to patients (over 15 years and 9 months) informing them of the intention to create SCRs
  • Providing opportunities for consultation with trained staff/clinicians
  • Recording the patient preference for those who choose to opt-out
  • Patient gives consent for SCR and their dormant SCR is activated
  • Patient dissents; the SCR remains dormant (not viewable to any user)
  • Ensuring explicit consent for patients to add additional data items
  • At point of access, ensuring patients agree their SCR can be viewed “ask me first”

This has resulted in changes to the SCR consent model, working processes and associated technology in order to additionally provide for a requirement of “permission to view”. The revised consent model was agreed by the national SCR Programme Board in September 2008, for implementation in the NHS.

2Project Definition

2.1Objectives

The overall objective of the project is the successfulimplementation of the SCR across the PCT, with one GP practice going through initial implementation in order to formulate the grounding for full deployment across NHS Lincolnshire. Thislocal healthcare community (LHC) consists of the following organisations:

  • NHS Lincolnshire (PCT)
  • Acute Services – United Lincolnshire Hospitals NHS Trust (ULHT)
  • Mental Health Services – Lincolnshire Partnership Foundation Trust (LPFT)
  • GP Services – (Market Rasen Surgery is the initial implementation site)
  • OOH services at LouthCountyHospital
  • EMAS – East Midlands Ambulance Services

Specifically the project aims:

  • To implement the Summary Care Record (SCR) delivering robust, practical and user friendly GP Summaries to be viewed by the LHC through the Summary Care Record Application (SCRa)
  • To work with the GP Practices to upload summary records to the National Spine Application (PSIS).
  • To develop a prioritised implementation plan to rollout the SCR over 2009/11.
  • To manage the relationship with third parties that provides necessary input, e.g. NHS Connecting for Health, Local Health Communities and GP System Suppliers
  • To detail expected and realised benefits and dis-benefits that all relevant stakeholders of the SCR programme may experience.
  • To develop and implement a detailed Communications Plan that ensures timely briefing to key stakeholders that effectively manages patient enquires so that the impact on the GP practice is minimised.
  • To develop and implement a detailed Business Change and Training Plan that ensures all persons affected in the new processes, and the use of the SCR, are trained as appropriate to gain maximum benefit.
  • To manage the implementation process through defined project management approaches.
  • To provide input into lessons learnt for use by other summary record implementers.
  • To evaluate outcomes to support improvements to the provision of safer Health Care through the wider deployment of the Summary Care Record Application.

2.2Scope

The scope for this project is

  • to deliver all necessary and relevant documentation/products, including benefits
  • to facilitate the approval of the Implementation of the SCR within the chosen area
  • To understand which organisations (and services) could or will be involved, along with an understanding of what processes, evaluations, strategies, plans and activities need to be initiated prior to the SCR Implementation

Such areas/bodies that need to be addressed for consideration are, but not limited to, detailed in sections 2.2.1 to 2.2.6. Further appraisal of these will be detailed in the Project Initiation Document.

2.2.1Business and Training Process

The business process area focuses on what the organisations do, how activities are carried out and in what sequence, what rules are followed and the type of results obtained.

  • Assessment of the current business process or known process changes that will occur during the lifetime of the project to determine the implications of moving to Summary Care Record service.
  • Identification of the processes that should be followed when the SCR is live e.g. Management of IG, Local Registration, Alerts and Audits; additional SCR content, patient population changes, etc.
  • Management of patient information concerning allergies, medications and adverse reactions.
  • Management of patient information should discrepancies be noted.
  • Training to ensure that staff have the appropriate knowledge, skills and ability to access and use the information within the SCR, to fully realise the benefits

2.2.2Organisations

The scope of this Project is limited to those Health Care Organisations contained within the Lincolnshirecommunity – detailed below.

Organisation / Service
PCT / OoH Service / LouthCountyHospital / LincolnCountyHospital
Minor Injuries Units / JohnCouplandHospital
GP Practice / Initially Market rasen Surgery, followed by additional GP Practices across Lincolnshire
Secondary Trusts (acute and mental health) / Emergency Departments / Louth and LincolnCountyHospitals
Mental Health Crisis Intervention Services / Lincoln & Louth
Acute Assessment Units / Louth and LincolnCountyHospitals
LPFT / Crisis intervention Team / Louth & Lincoln
EMAS / Paramedic Services / OOH services

2.2.3Locations

The location area focuses on where the Patients and End-users consult or administer/receive treatment – the SCR may not be employed or available in all locations. The locations this project will affect are listed below. However, should additional locations be identified as gaining benefit from this implementation then this will be managed through due change control processes.

NHS Acute Trust

  • Emergency Departments
  • Mental Health Crisis Intervention Services
  • Acute Assessment Units

Primary Care Trust

  • OoH Services
  • Walk In Centres
  • Minor Injuries Units
  • GP Practices

2.2.4Data

The data area focuses on the content, structure, relationships, and business rules for the data used in and by the different business processes, applications and health organisations.

For any system/service to be of use to the end user/client, the provision of correct, up to date data is mandatory. Without such, the end-user can not be expected to make an informed judgement should he or she have reservations over the quality of the data he/she is supplied with. With this in mind, it is imperative that any and all identified data is only uploaded from accredited sources. This could be in the form of many and varied Data Quality Pre-Reqs, Audits and Assessments (IM&T DES)

For the SCR programme, the IM&T DES is currently in place for the data quality accreditation requirement prior to the SCR Upload process. The risk of implementing an upload without adhering to such processes could impact the successful delivery of local implementation of the system.

With recent events publicised regarding the care of sensitive data, this project will deliver systems and processes that will ensure the capture, storage and accessibility of Patient data is of the highest standard possible. A high level of confidence, from all stakeholders, in the system/service is needed to ensure Patient Confidentiality is maintained at all times – a crucial area of the projects success criteria. GP’s must therefore ensure that their smart card is used at all times, when accessing their GP system, so that any alterations to the SCR and performed in ‘spine connect’ mode, ensuring local and spine records remain constant.

2.2.5Applications

It is assumed that the applications to be used in the delivery & use of the SCR have already been developed. As such this Project will not concern itself with the further enhancement of these apps/systems, except to treat them as external dependencies.

2.2.6Technology and Statistics

The technology area focuses on the hardware, system software and communications infrastructure used to enable and support the SCR service.

Community / Unscheduled / Emergency Care / System Supplier / No of PAS / PAS Supplier
ULHT / A&E departments
Medical Assessment Units / 1 / McKesson
LPFT / Crisis intervention Team / 1 / Marisiss
NHS Lincolnshire / Minor Injuries Units
OOH Services
Walk in centres / Adastra/ SystmOne / 1 / McKesson
EMAS / Paramedic Services
Ambulance services
OOH / Adastra / McKesson

2.3Excluded from Scope

Excluded from this project are any of the activities that would constitute as Service Management responsibilities, once the Go-Live activities have been achieved.

2.4Project Deliverables

The following set of Project Management Products (Product Breakdown Structure – PBS) will be delivered as part of this project. Spread across two stages – Start Up and Initiation – these products will define in total the approach, scope, process, organisation, responsibilities, structure and governance of how the project will be initiated. A brief definition of the aim for each product is included.

Start Up

Role definitions(for Programme Management Team (PMT)

Terms of Reference(ToR for Project Board)

Appointment of Senior Executive (SRO)(onto the Project Board)

Project Brief (provides a full and firm foundation for the initiation of the project)

Project Approach(i.e. how the project will be delivered, i.e. 3rd party development using local deployment teams)

Initiation Stage Plan(including planning and control methods to approve a move to project initiation)

Initiation

Quality Plan(Quality techniques and standards used; will form part of PID)

Project Plans(need not be MS Project but enable an overview of the project for the board)

Project Controls(i.e. definition of monitoring, review and authorisation methods)

Project Filemanagement system(this configuration management activity will be completed by the PMO)

Project Initiation Document for approval (the PID may be a collection of documents and is to be approved by the Project Board)

2.4.1Product Breakdown Structure (PBS)

The table below details the Products that will be produced across the Initiation and Start Up Stages of the Project.

Post successful start up and initiation of the Project, the production of further products/deliverables for the following stages (design, deployment, testing and hand over into service) will ensue. These will be detailed in the PID.

Key Product / Function
Role definitions / Defines the roles required to implement the project
Terms of Reference / Defines the responsibilities and accountabilities of the project team
Project Approach / Sets out the options considered, the chosen option and its rationale, along with identifying in which environments the project will affect
Initiation Stage Plan / Identifies the initial group of activities of where the project will start and how they will be implemented
Quality Plan / This will detail the quality process and checkpoints in the project
Project Plans / Used to plan and track the progress of the project
Project Controls / Details how the project will be governed
Project Initiation Document / Provides the basis for the management and assessment of the success of the project
Project Brief / Provides a summary of the project and what it is intended to deliver.
Communication Plan / This will set out who the stakeholders are and how they are to be communicated with.
Risk Register / Identification of risks and actions in place to mitigate them
Exception Reports / Gives early warning of deviation from timescale, cost or quality
Highlight Reports / Identification of progress against plan, future activities, risks and issues

2.5Constraints

The following constraints are expected in the successful implementation of the SCR across the selected Health Organisations.

  • Budget – should an overrun of budget become evident, it will be necessary to re-submit a revised costings, indicating the extra resources needed
  • Schedule – extensions/expeditions to the implementation schedule will need presentation to and approval from the Project Board. Whilst the high level understanding of the timeline will be depicted in the PID a more detailed view will not be available until such time the PID is signed off.
  • Resource – at the level of implication of this document, resource requirements are limited to roles and the level of effort expected. Members of the Project Board/Project team may well be known at this time, but not named.
  • Data – the provision data (in this case the GP Summary Record) is not directly a responsibility of this Project. The activities regarding the quality/readiness of Data fall within the IM&T DES remit. Whilst representation of the IM&T DES Team will be evident on the Project Team, the SCR Project Manager is not accountable for the timely delivery of this data.
  • Infrastructure/Applications – To reach Go-Live of the SCR other supporting Systems and Services need to be in place. The SCR Project Manager is not responsible for the rollout of - GP Systems Accreditation, SCRAPPLICATION availability, Smartcard Registration and N3 connectivity, but co-ordinating its availability as dependencies of the project will be critical to the success of this project.
  • Public Information Programme (PIP) - 16 week Appraisal. As part of the PIP, PCTs are required to write to all registered patients aged 16 and over informing them of the changes, the choices they have and a date by which the changes will happen. It is recommended that PCTs also include those patients who will have reached the age of 16 within the PIP period.

2.5.1Project Timeline

2.6Communications and Interfaces

Consultancy and communication with many interfaces will be required to deliver the SCR, these will include, but not be restricted to, NHS CfH, PCT Execs, Trust Execs, LMC Exec, Health Care Organisations Clinical Leads, Practice Managers, GP’s and The Public, all of which will have valuable viewpoints on the understanding and success of the Project.