Informatics Strategy
&
2010-11 Plan
for
Norfolk Local Health Community
version 2-2
Shared care records supporting the patient journey
enabling safe, seamless & effective care
Version control
v0-3 / Working draft / Martin Bainton/Andrea Slater
v0-5 / Draft / MRB/AS / Keith Price
v0-6 / Amendments following comments / AS/MRB / KP/Alan Hough
v0-7 / Amendments following review / MRB / KP/AH
v1-0 / Final for submission following LHC Programme Board / MRB / KP/AH
V2-0 / Amendments following feedback from EoE – see annexes F, G, H & I / MRB/AS / KP/AH
V2-2 / Amendments following feedback from AH + adding EPS milestones – annex J / MRB
Contents
Section 1· Governance
· Whole system process
· LHC entities engaged in the process / Page 3
Section 2
· Timetable and alignment with local service development planning
· IM&T’s specific role in enabling delivery on NHS Norfolk’s 5 year strategic initiatives / Page 7
Section 3
· Progress in 2009-10
· Plans for 2010-11
· Mapping projects to National Expectations
· Record sharing / Page 10
Section 4
· Technical infrastructure supporting enabling systems and services / Page 22
Annexes
· A Terms of Reference for LHC IT Operations and Interfaces Committee and Strategic IM&T Programme Board
· B IM&T Programme Communication Plan
· C Risk escalation process
· D Pseudonymisation plan
· E TCS Plan
· F IM&T Programme Financials
· G Benefits Realisation
· H EPS Release 2 planned implementation stages
· I SCR deployment milestones
· J EPS R2 draft deployment plan / Page 25
Section 1
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Section 1
Section 1
Integrated Planning & Performance across the LHC
The purpose of the Local Health Community (LHC) programme is to deliver the strategic goal of an integrated care record for Norfolk and to inform planning which will move Commissioner and Providers towards its achievement of the goal. The LHC IM&T strategy will also define the enabling role for IM&T in business transformation plans developed by the Commissioning PCT and service development plans being formed by provider organisations in response to national, regional, local and organisational priorities.
It is intended to be used to inform construction of plans as well as to show how IM&T can deliver planned outcomes, so that technologies are fully exploited and the potential benefits of emerging functionalities are realised.
Norfolk Local Health Community (LHC) IM&T planning is a shared process across the organisations which make up the LHC, led by NHS Norfolk (NHSN) Chief Executive as Senior Responsible Owner of the strategic IM&T programme and Chair of the LHC IM&T Programme Board. IM&T Programme Board to oversee benefits realisation; optionally include comments on OIC to deliver the benefits and to validate plans
In summary,
The IM&T Programme Board:
· defines and agrees LHC IM&T strategy at annual meeting in January
· meets in June to check progress and consider ideas to investigate for the next January strategy meeting
· Oversees benefits realisation – owns the programme benefits
· The attendees will be a lead clinician and an executive member responsible for strategy from each organisation
· chaired by NHSN CEO
The IT Operations and Interfaces Committee:
· meets every other month
· ensures that the LHC programme is delivered, reporting progress to the Board
· ensures opportunities for collaboration on IT enabled service transformation are exploited
· attendees will be the IM&T leads
· responsible for delivery of benefits and validating plans
· chaired by NHS Norfolk’s CIO.
Full Terms of Reference and Membership for both groups are at Annex A
The programme brings together NHS funded providers (Trusts, Foundation Trusts, independent contractors and private sector organisations) to agree how information can best support patient care pathways, help prevent ill health and support health promotion activities. The strategic tool for this is the Programme Board with strategic membership from providers and all care settings, together with Norfolk County Council Children’s Services and Adult Social Care. The Board, chaired by NHSN CEO guides collaborative work by the LHC Operations and Interfaces Committee which delivers on the local IM&T development agenda making best use of the opportunities for transformational change offered by the national regional and locally procured systems and services.
The Strategic IM&T Programme Board membership includes patient and public representatives from the Norfolk Local Involvement Network (LINk) whose remit crosses health and social care and a General Medical Practice representative from Norfolk Local Medical Committee. Prison healthcare is represented through board representation by NCH&C senior management as they currently manage Prison Healthcare in the county. The Board membership includes clinical directors, General Medical Practitioners and other directors and senior managers responsible for service and strategic change and planning.
The Programme Board is responsible for sign off of LHC wide projects and programmes such as Summary Care Record Project and local programme boards apply to the Board for sign off of key documents relating to major IT projects they implement.
The Board is supported by the LHC IT Operations and Interfaces Committee to which are referred operational issues and which provides detailed technical review of projects. The committee also acts as a forum for the identification of threats and opportunities to join up working and for the agreement of plans to manage them. The Committee escalates risks to the Board as necessary. The Committee includes membership from Norfolk County Council and from providers outside the PCT area from whom significant services are commissioned (West Suffolk and James Paget hospitals)
The Board’s governance structure is shown in Figure 1.
The Board is accountable to the PCT Board through the PCT’s CIO who reports specifically to the PCT Board on IM&T. The PCT’s CEO, as SRO of the Programme is in a position to ensure alignment of IM&T with overall strategy. The CEO and CIO are members of the PCT’s Clinical and Management Executive boards.
As the provider market opens further, the guiding role of the Board will remain an essential facilitator of change, but the mechanism for ensuring adoption of systems and services that will form an integrated information resource for care provision in Norfolk will need to operate with increasing vigour through the broader commissioning process, through specification in contracts of the informatics context in which commissioned services must be delivered. NHSN’s CIO works closely with the contracting process to ensure embedding of informatics requirements that align with the LHC’s strategy. Programme Manager or delegate from the Programme Team attends Commissioning Programme Boards or Professional Executive to advise on opportunities to exploit IT enablers in achievement of healthcare improvements in each area.
Programme management
The PCT leads the Programme for the LHC following OGC principles and using a Programme Management Office and associated structure.
The PCT resources the PMO with a qualified Programme Manager and Programme Office Manager, Communications Lead and Programme Support Officer
Communications strategy is at Annex B
Risk management process is at Annex C
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Section 2
The table below gives examples of how enabling systems and services will support delivery of NHS Norfolk’s strategic initiatives in 2010-11 and over the life of the NHS Norfolk’s strategic plan 2009 – 14.
Initiative/Service priorities / 2010-11 / 2011-14 /Inequalities / Continuing roll out of advanced patient administration systems (TPP) across community and GP sites brings an increasingly integrated patient record which will support targeted prevention eg of cardiovascular disease and obesity. Introduction of the Summary Care Record will provide visibility of alerts and medication, including for hard to reach groups when accessing unscheduled care services
Advanced patient administration systems provide high quality information on which to base selections and integrated care records increase richness of information on which prevention and screening campaigns can be targeted / Completion of roll out of Summary Care Record extends safety and inclusion benefits to whole population, improving quality of treatment in unplanned care situations.
Universal adoption by providers of advanced patient administration systems and integrated detailed care record systems (TPP and Lorenzo), through specification in commissioning contracts, allows flexibility in provision of elements of care pathway to tackle inequalities of access. Improved quality of care through joined up, shared records will contribute to improved outcomes in terms of longevity and quality of lives.
Lifestyle / Integrated detailed care records (TPP) rolling out progressively through 2010-11 will enable joined up approaches to healthy lifestyle support and encouragement across care settings / Integrated detailed care records (TPP and Lorenzo) universally adopted through commissioning contracts will enable joined up approaches to lifestyle issues affecting healthcare, early detection of risk factors and high quality monitoring.
Empowering Communities / Continuing roll out of advanced patient administration systems (TPP) across community and GP sites brings an increasingly integrated patient record which will support targeted prevention eg of cardiovascular disease and obesity deprived communities and will enable joined up treatment of migrant workers and travellers.
Introduction of the Summary Care Record will provide visibility of alerts and medication, including for hard to reach groups. / Advanced Patient Systems Lorenzo and TPP become universal and interoperable delivering high quality information from secondary and primary care for whole population improving candidate selections.
Empowering high risk groups
Choice / Choose and Book functionality being added to TPP for community / Integrated Booking will empower patients and clinicians to join up care episodes and improve efficiency and effectiveness/improve patient experience
Older people / Stroke type identification through video conferencing linked to PACS leading to increased opportunity to deliver anticoagulant therapy / Summary Care Record will enable confident and informed response to emergency and out of hours calls for help and will remove need for patients to repeat the story at each consultation in settings not yet reached by integrated detailed records systems.
Prevention and maintain Independence / Advanced patient administration systems and integrated detailed and summary care records provide an improved ‘customer experience’ as need to repeat information is reduced, appointment schedules are shared and prescribing is optimized. PACS (electronic X-ray images service) speeds diagnosis, prevents unnecessary repetition of imaging.
Tele health technology continuing roll out increases independence for those with long term conditions enabling them to stay at home longer, whilst maintaining high level of monitoring / Integrated detailed care records (TPP and Lorenzo) enabling truly patient-centred care will be of particular benefit in rehabilitation as the same detailed record is available at all points in the care pathway irrespective of setting or provider and supporting integrated care teams as messaging to social care systems is enabled.
Summary Care Record will enable confident and informed response to emergency and out of hours calls for help.
Dedicated module of Advanced Patient System TPP integrating with GP and Acute systems will enable earlier identification of patients who could benefit from Preventative Treatment
Integrated Care closer to home / The Summary Care Record will provide information in all care settings about allergies, drug reactions and current medication, raising general levels of patient safety and identifying vulnerable patients before admission.
Advanced patient administration systems across care settings provide integrated scheduling so that patients can see clinic availability at point of referral, clinician can see complementary care bookings.
TPP GP and Community record sharing will be enabled in Integrated Care Pilots to support care teams apply a holistic approach preventing exacerbations.
Advanced Patient Administration Systems (TPP Palliative Care) will help ensure more patients have place of death wishes recorded and this information available in more settings through record sharing in Enhanced Data Sharing functionality / Integrated detailed care records (eg TPP and Lorenzo) universally adopted through commissioning contracts will enable joined up approaches to care delivery, enabling it to become truly patient-centred as the same detailed record is available at all points in the care pathway irrespective of setting or provider and supporting integrated care teams. The breakdown of barriers between primary and secondary care records enables out of hospital delivery of traditionally in-patient care.
Advanced Primary Care system (TPP) integrates with OOH module and with Summary Care Record to improve quality of information for initial contact, improving confidence in dealing with problem without referring to an emergency service.
Summary Care Record with enrichment will enable confident and informed response to emergency and out of hours calls for help and will remove need for patients to repeat the story at each consultation in settings not yet reached by integrated detailed records systems; enrichment will provide vehicle for coded clinical documents across care settings, improving safety, efficiency and effectiveness.
Continuing roll out of advanced patient administration systems and Integrated detailed care record will enable joined up approaches to end of life care delivery, enabling it to become truly patient-centred as the same detailed record is available to the whole end of life team irrespective of setting or provider and supporting integrated care teams.
Mobile Working functionality in TPP will save effort and increase efficiency in care of patient in their homes and in care homes by giving community staff and GPs access to full medical record away from clinic bases.
Fair and equal access / Completion of roll out of Summary Care Record Enrichment extends safety and inclusion benefits to whole population, improving quality of treatment in unplanned care situations. / Universal adoption by providers of advanced patient administration systems and integrated detailed care record systems (TPP and Lorenzo), through specification in commissioning contracts, allows flexibility in provision of elements of care pathway to tackle inequalities of access. Improved quality of care through joined up, shared records will contribute to improved outcomes in terms of longevity and quality of life.
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