DIGITAL STRATEGY 2018 2021 - WHATDOTHEYKNOW
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Digital Strategy 2018 - 2021
DIGITAL STRATEGY 2018-2021 Foreword As one of the five strategic objectives of the overall Trust strategy, this document sets out the Digital Strategy in detail. It aims to achieve the following: • Establish the framework for the decisions made • Articulate the future • Ensure priorities are clear and founded • Communicate the plan of action • State the current position We describe our ambition to build upon our proven delivery capability and how we aim to position ourselves as a leading digital enabler within the Surrey Heartlands Sustainability and Transformation Partnership(STP) and as part of the Thames Valley and Surrey Local Health and Care Record Exemplar project. The document is structured into three main sections with an appendix providing further reading. Section One: Introduction – presents the context for the strategy in terms of influences, both internal and external Section Two: Digital Vision – outlines the vision and anchors it across principles and themes Section Three: Transformation Roadmap – sets out the programme of work to deliver the future vision Appendix: Current Status – describes our current status and highlights key areas for focus
DIGITAL STRATEGY 2018-2021 Executive Summary The digital strategy is written in the context of the overall Trust strategy and has been developed very much with our wider vision in mind. It builds upon the one-page digital strategy of 2015-2021 and is also influenced by guidelines and parameters set by NHS Digital (NHSD) and NHS England (NHSE). The rhetoric is based on key elements highlighted in the 2016 Wachter Report and the 2014 Five Year Forward View. The aims and objectives of the wider Integrated Care System (ICS) are reflected, but this document focuses specifically on the Trust’s own priorities. Five key themes have been adapted from NHSD and interpreted from a Trust perspective: Empower the person Manage the system safely and effectively This is part of having a patient-centric strategy and describes our We will continue to focus on funding opportunities to accelerate commitment to assisting our patients in self-management by our digital progress, and we will strengthen the resource facilitating a patient portal, health apps and appointment supporting the services. We will consider cloud-based services, management. We are also committed to harnessing existing keeping business continuity at the forefront of any decisions in technologies to provide virtual clinics and the ability to this area. Finally, we will prioritise cyber security and ensure communicate with us via chat bots. General Data Protection Regulations (GDPR) are followed. Support the clinician Enable a digitally smarter future The aim is to move away from a “push” approach and create a We will build on our successes and confidence in our ability to “pull” environment. This will be done via clinically-led initiatives, implement large systems and effect change. We will think big, pathway-led initiatives, the development of a clinical digital continue to expand our already well established mobile device engagement forum, supplier roadshows and a focus on the strategy, and ensure we are agile in our approach so that we can Surrey-wide approach. embrace new ideas and technologies quickly. We will explore Integrate services artificial intelligence and other emerging concepts. We will We aim to develop a partnership approach with our main ePR further develop in supporting clinical research, and we will supplier, who will provide us with a flexible modular hybrid ePR automise transactions wherever possible, and move further in which is already proven in its integration and interoperability self-service to data for operational staff. capabilities.
DIGITAL STRATEGY 2018-2021
Executive Summary continued
Digital Vision Shared Care Record
Using digital technology and innovations to improve clinical We will pursue this goal with the STP community, and the Trust
pathways, safety and efficiency, and empower patients. will continue to play a leading role in supporting the delivery of
this project. The strategy describes the Trust’s aspirations of what
Automate and Innovate a shared care record will look like.
This principle is integral to the Trust’s overall strategy and this
document describes some of the areas we will focus on, such as Other areas
clinical admin, clinical coding, appointments booking, patient Other areas such as a digital workforce, open standards, and
flow and corporate systems. governance are described. These each play an important part of
Hybrid ePR achieving the goals.
This is the big ticket project of the strategy and will be procured
in 2018/19. Our primary focus is on working with a long-term Investment Opportunities
partner who is flexible and has proven ability to integrate with Getting the funding for the strategy will be key, and the Trust will
key systems in our existing estate, such as PACs, Bluespier, ICE ensure that there is funding to back some of the initiatives.
and across the health system. It will replace our current PAS and However, external funding will have to be sought in order to
discharge planning solutions, and will also have an electronic make this affordable. Readiness is key and so the development of
prescribing and medicines administration (ePMA module), and an the procurement documentation of the hybrid ePR will
A&E module. commence immediately and be accelerated.
Digital Transformation
Benefits and Timelines
The hybrid ePR will be the major deliverable, and will support the
The benefits to patients and staff are articulated, and the
automation and innovation principle as well as the key themes
timelines for delivery have been set out.
described above. It will have a clinical portal which will be the
clinician’s main landing page for all their work, moving away from
The benefits are very much a reflection of the Empower the
logging into disparate systems. The solution will in use in a similar
person and Support the clinician key themes, focusing on an
setting to our own and the supplier will be well established in
increased ability to use technology to improve outcomes.
NHS trusts.
DIGITAL STRATEGY 2018-2021
Section One
INTRODUCTION
Presenting the context
for the digital strategy
INTRODUCTION
Local Context and National Alignment
There are two key documents which provide the context and influence the direction of
travel for the digital strategy.
The Five Year Forward View (2014) provides the overall context and challenge, and more specifically, the findings of the Wachter Review
(Making IT Work, 2016) heavily steer the investments of NHS Digital and NHS England. As a result, there are several initiatives to
consider.
Global Digital Exemplar (GDE) Programme Approximately 15 Local Health and Care Record Exemplar (LHCRE) Programme
acute and five mental health trusts across England have been The Trust is part of the Thames Valley and Surrey consortium
identified as worth of significant investment to provide blueprints which successfully bid to receive £7.5m of national money from
for successful digital procurement and delivery. There are none NHS England. The aim of this wide-reaching project is to
geographically co-located, which diminishes the opportunity to accelerate shared records development and adoption of tools like
become a so-called “Fast Follower” within this programme. population health management.
Sustainability and Transformation Partnership (STP) Every NHS
NHS England, NHS Improvements, NHS Digital
Trust in England is now part of a local STP programme, whose
The leadership and guidance provided by these three bodies
plans include a Digital Roadmap. The Trust is a key partner in the
have significant impact on the Trust’s approach to its digital
Surrey Heartlands STP, with our Director of Finance taking the
strategy. For example, NHS Digital have organised their strategy
SRO role for the Digital Workstream.
into 10 domains, all of which have a bearing on the Trust’s
Integrated Care System/Partnership (ICS/ICP) These models strategy. The domains are driven by discrete teams within NHS
build on the STP vision and seeks to empower localities to own Digital, who each have their own objectives to achieve. Some are
their investments and plans as a local health economy rather initiatives which complement our strategy and enable us to take
than at individual organisational level. advantage of the progress.
INTRODUCTION
Ongoing Policy Shift
The digital journey is framed by national
policies and guidelines which are emerging NHS Providers’ Head of Strategy,
and evolving. There is a need to be agile in Miriam Deakin, writes in NHE (Jan
our approach. 2018) of the potential themes her
“Dealing with uncertainty is at the heart of strategy
organisation would like to see as a
development” (Strategy Development Toolkit, Monitor 2014) result of emerging accountable care
With the models of working of STPs and ICPs, and now the
models
introduction of the LHCRE project, all still very much under
development, it is important that the Trust develops a strategy
with this in mind. Surrey health and social care organisations are
• A clearer public narrative around
also on the brink of devolution, which gives local control of the STPs and ACOs
funding streams. • Learning from new approaches to
In addition to the shifting context, our digital strategy needs to be strategic commissioning
able to take into consideration emerging technologies, which may
impact the direction of travel.
• Testing out a new balance of
regulation and oversight
For this reason, it is common for a digital strategy to be
continually under review and completely refreshed after two or
• Trusts investing in ‘the art of the
three years, even if the original plan projects further initially. possible’
As the STP, the Integrated Care Partnership and devolution
• The pace of change will vary – but
become more established, the Trust will adapt and adopt this everyone needs support
strategy accordingly.
DIGITAL STRATEGY 2018-2021
Section Two
DIGITAL VISION
Presenting the vision
and its influencers
DIGITAL VISION Digital Vision Simon Eccles, CCIO at NHS England, stated in his opening tweet in his new role that one of the priorities for NHS IT is to recognise that ‘going digital’ is a core part of our business. At Ashford and St. Peter’s we recognise the importance of digital and including it as a foundation in our strategy is not new. Our previous Trust strategy placed the digitisation of our paper records as a key enabler. The newly refreshed strategy sets Digital as one of our key objectives. We will provide a stable and agile digital platform which will improve clinical pathways, and move the safety and efficiency agenda forward. We will support change, best practice, sharing of information and innovation by investing in people to help us transform the way we work as an organisation, and in turn we will empower patients to manage their own healthcare. We will invest in technologies which will enable the Trust’s priorities and our digital decisions will be informed by these.
DIGITAL VISION
Principles
Taking the principles we identified in the
2015-2020 Digital Strategy, we can see that Educate
Learn &
there is alignment, but that these principles Improve
need to be updated to reflect the Trust’s
vision. Listen
Empower
The original principles are not contradictory, but do not go far & Value
enough to ensure the strategy is focused on people and benefits.
Taking this on board, we re-examined the Trust’s objectives and
also looked outside the organisation to ensure we are not
operating in a vacuum.
Standardise &
Optimise
The digital network of Chief Information Officers and Chief
Clinical Information Officers is reaching a stage of maturity where
Automate
we are more able to keep up with each other’s plans, focus and
& Innovate
challenges. We used this to influence our strategy and over time
it became clear that NHSD is becoming more involved in projects
and decisions, and so we looked to them for further input.
Sustain &
ThriveDIGITAL VISION
Key Themes
We have adopted and adapted the NHS
Digital themes, ensuring we are not taking
a siloed approach. Our strategy must be Adopted Key Themes from NHSD
recognisable and strike a chord with our
neighbouring care systems. Empower the Person
The principles of this strategy link nicely with NHSD themes and
demonstrate how our own strategy fits the national picture,
whilst still encouraging us to explore our own interpretation. Support the clinician
In addition, the Trust is keen to build its digital capabilities within
the context of the wider care system (STP/ACS/LHCRE), and also
wants to pursue funding opportunities where possible. Whilst the Integrate services
principles are a reflection of our internal requirements, it is
important to ensure our strategy is aligned to themes which are
understood and acknowledged by our stakeholders.
Manage the system
The sections below discuss each theme in detail.
Enable the futureDIGITAL VISION
Empower the person
The concept of providing digital services The means to readily respond. This will be achieved by increasing
which hand over increased control and our “virtual clinic” services, introducing “chat bot” opportunities,
and by having improved digital access to our own information,
access to patients is expected of us. thus enabling staff to respond quickly and fully.
With the successful digitisation our medical records into the
Information in the format preferred by the patient, for example
Kainos Evolve solution, we are well-placed to extend this to a
in a web portal, an app, email, text, letter or phonecall .
full suite of tools to ensure our patients are provided with
access to the information they need and want to manage their
own healthcare/ Transform the statistic We will play our part in contributing to an
increase on the 2% in the figure below
Our delivery plan will include:
An electronic patient record (ePR) providing a structured
format for the recording of patient information, which we will
be able to securely share, when and where appropriate, with
our health partners and with patients themselves.
A patient portal, where patients can manage their
appointments, access their own patient record, letters and
results, record their own observations and access appropriate
advice and guidance. We aim to deliver this as part of an STP-
wide initiative to ensure citizens are not presented with multiple
logins and a mixed offering.
A suite of health apps, some national, others locally built, with
the aim of increasing the level of self-management
Improved access to wifi across the estateDIGITAL VISION
Support the clinician
So-called “clinical engagement” should not be a challenge with Build on nursing leadership in IT We have had significant success
the right digital strategy in place. The aim is to create “pull” from with harnessing the leadership of nursing staff to lead digital
both doctors and nursing staff, whereby they are making the solutions to improve best practice. Champions are identified and
suggestions for the next steps, are actively involved in the the nursing staff take ownership of their areas. We will build on
decision-making, are willing champions of change, and embrace this success model and recognise it as a key enabler.
and create opportunities.
The means to readily respond. This will be achieved by increasing
our “virtual clinic” services, introducing “chat bot” opportunities,
Prioritise patient-safety initiatives Those projects which
and by having improved digital access to our own information,
articulate significant benefits from a patient-safety perspective
thus enabling staff to respond quickly and fully.
will be given priority and will receive an accelerated timeline
where possible.
Clinically-led initiatives will be encouraged and supported. There
will be improved, transparent opportunities for these to be given
due consideration and funding.
Pathway-led initiatives will provide a focus for an end-to-end
approach to care, and will also present opportunities for dividing
large projects into smaller, manageable chunks. Delivery will be
more meaningful for the key stakeholders..
Increased interoperability across care systems Clinicians are too
often expected to work with disjointed silos of information, at
best sparse, at worst contradictory.
STP-wide delivery By taking a leading role in the digital
workstream of the STP, we will take forward the interoperability
agenda to provide better access to information and a multi-
agency approach to patient care.DIGITAL VISION
Integrate services
Many processes are not fit for purpose in the face of 21st century Information is available & accessed when needed, not
expectations. dependent upon “send and receive” technology This requires a
Lead and shape the STP vision and delivery model The Trust is completely different approach to information flows. Current
already taking a lead role in the digital workstream of the STP and practice is for patient documentation to be received into the
the aim is to forge ahead with this approach. By being fully organisation and sent out. This is based on historical processes
informed of potential opportunities and able to identify synergies defined by postal services. We still send and receive
and clinical priorities, we will be a leading and key partner in the documentation, albeit much of it digitally. However, with regard
STP. Our delivery capability will allow us to influence and drive to communication with patients, this is still very much paper-
forward procurement and implementation of key deliverables. based. A strategy which makes information available to be
We will be outcome focused. accessed as and when required, rather than sending it from
Prioritise our vulnerable patients We will focus our efforts on system to system, will further the patient safety agenda and
integrating with those providers where we have high numbers of create efficiencies across the care system.
shared care or transfers of care and where patient needs are Single source of the truth All staff, whether clinical, operational
complex. or administrative, need to be able to rely on the data and know
Focus on interoperability We will take forward the that there is just one version of the truth. With a large number of
interoperability agenda to provide better access to information disparate systems across the Trust, many of them stand-alone,
and foster a multi-agency approach to patient care. As well as our we are not always sure which version is the latest or most
local GPs, we also work closely with the Surrey and Borders accurate. A hybrid ePR will go some way to addressing this if
Partnership Mental Health who use the System One TPP solution implemented with appropriate business processes. This will
and Social Services who use Liquid Logic. There are the “Hub” require a change to working practices and will form a key
partnerships, e.g. the Bedser Hub in Woking where a fully shared element of the digital transformation work.
care model is active but poorly supported by digital integration Suppliers as partners We will actively seek partnerships with our
and capability. These will be priority areas for integration. supplier base who are open to the concept of open APIs and who
make integration an easy ask, rather than a tricky and expensive
piece of work. Suppliers with solid evidence of integration will be
favoured.DIGITAL VISION
Manage the system safely and effectively
The resources surrounding the strategy must keep apace with the
enhancements. Not only from a cost perspective, but from a
recruitment/resource angle. Newer solutions require large
Focus on funding This means securing the required funding, both numbers of servers and storage solutions, and data centres are
internally from a revenue and capital perspective, and externally becoming increasingly power-hungry. The cost of externally
in terms of readiness to take advantage of funding opportunities. hosted, managed services has decreased significantly over recent
The aim is to focus on making timely decisions regarding key times and suppliers are now able to offer support at scale to a
elements of the strategy, preparing the requisite procurement large customer base. It is time to challenge our previous
and project documentation and taking forward those initiatives approach of hosting solutions locally and seriously consider the
where we believe funding can be successfully accessed. The advantages of both cloud and managed services, whilst being
timing for funding is key and therefore tender documentation for continually mindful of the risk of not being able to access the
the larger investments must commence immediately. record. This will mean robust business continuity and disaster
Strengthened provision Resource management will be key to the recovery plans. Not all solutions are fit for cloud hosting (e.g.
success of the strategy. The aim is to continue with the low staff legacy systems), but new projects should be evaluated on their
turnover currently enjoyed by the IT teams. There is a committed suitability. This approach will also be a consideration within our
workforce in place and it will be important to consolidate this. overall approach to cyber security.
There is an identified need to increase some aspects of the Cyber security We will continue to seek to identify and address
resource. Some of this will be permanent, and other areas will be our vulnerabilities, but with more rigour and interest from a Trust
stepped up and stepped down in accordance with need. Where executive level than previously. This is an area of national focus
possible, resources will be shared across the STP. In addition, we and we have already taken advantage of several NHSD support
will seek to identify services which may provide a solid business initiatives, which have highlighted some key areas to focus on.
case for merging fully explore such opportunities. The WannaCry attack was a sobering and timely jolt for all trusts,
Cloud-based services We have started to move into the arena of and made us reconsider our approach to downtime for upgrades
off-premise, hosted services with our recent procurement of the to clinical systems. We will also seek opportunities with
Clevermed maternity solution and the Careflow Connect for neighbouring trusts to share the knowledge and guidance of
clinical communications. As we increase our reliance on digital subject matter experts in this area.
solutions, we will find the overhead of locally hosting these
solutions a challenge.DIGITAL VISION
Create the future
Think big – we know we have to work within our financial means,
App development – this is an area we need to consider in the
not just in terms of affordability, but also value for money within
coming months. The demand for app development is growing,
the scale of our capability. However, this should not prevent us
but our staff resource is not in place to meet this demand. We
from considering initiatives which at first glance may seem too
need to consider whether to meet the requirement with a small
ambitious for us. We pride ourselves on our ability to implement,
in-house development team, to outsource to a preferred supplier,
and we should capitalise on this to move forward at pace.
to outsource to a range of suppliers as each request is generated,
Clinicians are often exposed to innovative solutions through their
or to create an STP-wide development approach.
own networks and we will develop a forum where they can
present these. However, rather than be separate from the Agility – we need to position ourselves so that we are able to
strategy, they will form part of it, and be considered in light of its scale up and scale down implementation teams quickly and
priorities and focus. efficiently. We have achieved this in the past by using
secondments from within the Trust to create an implementation
Clinical Research – we need to work with clinical teams to
team. This worked well, but does need good organisation and
identify their research requirements, create good links between
planning as it takes about four months to recruit and backfill
them and the CIO/CCIO leads within Health Informatics. This is an
internally, where agencies can provide staff at very short notice.
area which can tie in with the point above, and has the potential
However, by recruiting internally we are able to deploy staff who
to enhance the Trust’s reputation as an innovator.
already have good insight into the workings of the Trust, and it
Mobile strategy – we were early adopters of iPad and other also trains those staff and arms them with new skills and further
Apple devices, which means we are in the strong position of their opportunities. Agency and contract staff are used rarely
already having several hundred mobile devices in use across the within the health informatics teams, a model we intend to
hospital. Going forward, this gives us an advantage when taking continue.
on new solutions, as we are likely to already have the devices in
Analysing the data – accessing the data you want, when you
place, or can easily scale up without the need for significant
want it, by means of a sophisticated but simple tool. Automation,
additional funding. We need to ensure our mobile strategy is
in-depth analysis of data we can trust. The information team aim
flexible enough to adapt to the fast-paced environment inhabited
to take a proactive approach and lead the way in providing a high
by mobile devices, and that we ensure annual investment is
quality service.
available to refresh both the devices and the management
software. Explore AI potential – this is an attractive and current topic, an
area we will explore and find ways to exploit.DIGITAL VISION Automate One of the stated principles of the overall Trust strategy refers directly to digitisation. Clinical Admin This is an area where end-to-end automisation of tasks such as flow of clinical documents can have significant impact on efficiencies and free up both clinical and administrative staff to focus on the patient experience. Bookings Scheduling systems need to be smarter and less reliant in human intervention to ensure modern patient expectations are met and utilisation is optimised. Records Management The medical record is digitised, but is not fully electronic. The development of the hybrid ePR needs to be a key deliverable of this strategy. Ordering Ensuring diagnostics are ordered without duplication in a timely manner and easily acknowledged with minimum room for error. Coding By purchasing modern solutions where coding is captured and automated at point of care, income will be more secure. Patient Flow & Coordination We need to build upon digital opportunities to ensure our staff are able to locate and move patients using up-to-the-minute information. We need reliable predictors and the tools and capability to use them. Informatics Better access to self-service dashboards by operational staff who are able to interpret and probe. Corporate systems Continue to exploit national solutions and ensure important “behind-the-scenes” workflow are automated where possible.
DIGITAL VISION
Innovate
Another of the stated principles of the
overall Trust strategy refers to innovative
technologies. It is the responsibility of the Some thematic examples of innovation:
digital team to tease out what this means in • Self-care tools
• Pathway management
real terms. • Communication Tools
Innovation technologies are of interest and can help us with • Artificial Intelligence, supporting:
meeting the many challenges faced by teams across the Trust. • image reporting
However, the benefits are often unproven or exaggerated, and the
• scheduling
success rate is often limited by other factors, including people-
related. • triaging
• theatre efficiency
This does not mean shying away from innovation, but the • Bots supporting human system interactions
governance around the decision-making processes need to be • Telemedicine
robust and implemented at scale. The resources need to be • Virtual clinics
identified ahead of the decision to purchase – often the cost of the
• Chatbot helpdesks/callback
solution is low, but the change costs are high and the obstacles to
realising the benefits are not met head on. • Informatics for quality improvement
• Technology changing clinical practice
The examples on the right provide a idea of where innovation is • Technology supporting the workforce
starting to have an impact. Several are attracting a lot of media • Disruptive market entrants, i.e. into providing
coverage and will soon become accepted projects. The Trust is keen patient-owned health records (e.g. Google
to explore and implement.
and Apple)DIGITAL VISION
Patient-centric Digital Model
By recognising the patient perspective as a
key influencer, we can see how the patient
Side panel
needs to be at the heart of the digital
strategy.
The diagram from the Nuffield Trust demonstrates why we must
end the current organisational digital boundaries which prevent
the development of a culture of empowering the patient to
manage their own care.
• At the centre of the diagram, the patient is harnessing
technologies for self-care.
• The middle circle describes the technologies required for
clinical support and decision-making
• The outer circle details the operational and financial
requirements which enable the organisation to be a highly
functioning trust
A patient-centric approach will guide us to moving from solutions
which produce data about a patient to solutions which create
data for the patient.
“Overview of the future digital landscape”
(Delivering the Benefits of Digital Health Care, Nuffield Trust 2016)DIGITAL VISION Service Provision The discussions around local provision versus outsourcing to a managed service are always worth considering for a ….that is the question corporate service. Whilst there are no current plans for outsourcing services, we continue to remain open to opportunities in this vein. Going forward, as the organisations within the STP become more aligned, it will be easier to identify shared goals and efficiencies. This may lead to joining teams or to outsourcing collectively. There are some areas which lend themselves more easily to this kind of set-up, but each proposal will be considered against its own merits. The ongoing debate of the advantages and disadvantages of cloud-based, hosted services will also influence our strategy. In time there will be some difficult decisions to make but it is not yet sufficiently clear how the market and solutions will develop. The digital strategy principles call for an agile & resilient service SHARED SERVICE and this will be an important criteria when considering this type of change. In reality this might happen by stealth.
CURRENT STATUS
GDPR
The General Data Protection Regulation
requires organisations which process
personal data to demonstrate compliance Information Commissioner’s Office Advice
with its provisions; it is our responsibility to
ensure that the data we hold is secure. • Raise awareness across the organisation
• Document the personal data we hold
In terms of GDPR, the Trust’s appointed Data Protection Officer • Review privacy notices
will play a key role in providing an objective view of the state of
the security. The new Data Protection and Security Toolkit
• Ensure individuals’ rights are protected
provided by NHSD, which replaces the IG Toolkit, gives good • Update Subject Access procedures
guidance in this area and has been redesigned with GDPR in • Identify legal basis for processing
mind.
personal data
In addition, we will follow the advice and guidance of the ICO to • Review consent regarding use of personal
ensure we are GDPR compliant. data
• Review process for gathering parental
consent
• Review data breach procedures
• Review Data Protection Impact
AssessmentsCURRENT STATUS Cyber Security “GDPR compliance and effective cyber resilience are clearly two sides of the same coin and it makes sense to take an integrated approach to developing a single roadmap towards compliance and protection.”1 Cyber security has become a buzzword in the workplace and this has had a positive impact welcomed by the health informatics department. It has enabled the development of plans for upgrading systems and for investment in security solutions which previously found it difficult to get onto the list of priorities. However, information security as a whole has always been a focus for the Trust, and this renewed interest at board level can only serve to strengthen the provision. Following on from its commitment to GDPR, the toolkit provides a good audit for security, and the Trust will use this and other measures to secure its interests. A primary focus will be on education of users, equipping them with the tools to identify and avoid hazards. 1Roadmap to GDPR and Cybersecurity, Digital Health article by Cazz Ward, Assistant Director ICT and Digital at The Big Life group
DIGITAL STRATEGY 2018-2021
Section THREE
TRANSFORMATION ROADMAP
Describing the deliverables
and the means of
achievementDIGITAL TRANSFORMATION
Hybrid ePR
The Trust will seek a partnership with a
supplier to provide a hybrid ePR.
We will select a supplier with an ePR with a modular approach
but which enables us to keep those departmental solutions we Hybrid ePR
currently have and favour.
Why hybrid and not best of breed?
A hybrid approach will allow us to focus on the key elements we
are missing and to procure these simultaneously rather than one
by one . Integration will be a key element, and we will be seeking
a supplier with a strong reputation for integration and flexibility.
A hybrid ePR approach will allow us to seek a strong partnership
alliance with a supplier in the acute digital record market. It
replaces the previous “best of breed” strategy by focusing on the
partnership and by reducing the number of disparate systems.
We will seek to procure a replacement for our PAS with
ePrescribing, an A&E module and patient flow/bed management
capability. We will replace the following solutions:
PAS/PatientCentre; RealTime; InPatient Lists (IPL).
Legend
In place Complete in 2019/20
Complete in 2018/19 Complete in 2020/21DIGITAL TRANSFORMATION Clinical Portal The hybrid ePR will provide a one-stop clinical portal. The clinician will log into the main clinical system and from here clinical portal examples will be able to access each aspect of the patient record. This will happen seamlessly, within patient context and will contain windows for each aspect. The “landing page” will be configurable for each clinician and they will able to view most if not all of the information they require in one place. The example on the right shows a typical portal layout, where each box is a widget containing a summary of the information available. If the clinician wishes additional information, or perhaps in the case of a PACs image, for example, they click on the example and follow the patient through to the background information or integrated system. In selecting our hybrid ePR partner, the ability to create a landing page which is flexible and easily integrated will be key. The solution will provide a clinical workspace which will enable the clinician to easily input their clinical data, without the need to access the back-office PAS/administrative modules.
DIGITAL TRANSFORMATION Local Health Care Record Surrey Heartlands is now working with other STPs as part of the Local Health Care Record Exemplar (LHCRE) initiative. This is a nationally funded project with the long term aim of joining up health records across England. The Trust is committed to working with the local health community to deliver a shared care record, for the benefit of its patients and to enable clinicians across the whole care setting to provide great care. The digital workstream of Surrey Heartlands STP, of which the Trust has a leading role, is currently developing the architecture, integration and information security requirements. Building on this, we are now in in the initial planning stages of integration with a wider geographical remit. Golden standard requirements: Clinicians will seamlessly (using patient context) access information across care settings. The information will be accessed via a clinical portal in each setting and where applicable functionality for bilateral data input will be available. There will be opportunities to develop a single care plan. Business Intelligence will be securely managed in a data warehouse.
DIGITAL TRANSFORMATION
Open Standards
With goals such as the provision of a
patient portal and a shared care record,
open standards and interoperability are
key.
The Trust will actively seek to work with suppliers who see
interoperability as a key recipe for success. The hybrid EPR will
already support a wide range of recognized interoperability
standards, and our suppliers will be committed to supporting
upcoming standards and requirements, e.g. FHIR, Transfer-of-care
standards. The hybrid approach will ensure a rich dataset and will
be able to share both structured and unstructured data .
Interoperability within context will be key; i.e each clinician is
able to view the shared information as an integral part of their
own clinical information system without having to log in
separately and without having to search for the patient again
Acute
Care
Commu
Primary
nity
Care
Care
Shared Care
Record
Patient Social
Portal ServicesDIGITAL TRANSFORMATION Digital Workforce The introduction of new digital technologies requires a workforce who are technically capable and culturally committed to changing their practice. The department has a strong IT Training Team who are well- known and sought out by the organisation. We have recently relocated their main training room to a more central location and it is hoped that this will attract staff in greater numbers to make use of this service. Training in basic skills has moved on recently with the explosion in the use of smartphones. Frontline staff struggle less than they used to with the basics, but at the sametime, workplace expectations have moved on and staff are expected to be au fait with Word, Excel and clinical systems. The training team offer several courses which address the gaps, but managers need to be more proactive in signing up their staff. Job Descriptions need to be more specific and the organisation has already put in place some minimal requirements regarding computer skills. These will be further developed and consideration will be given to a basic IT skills entry-level test. Where this is not met, it will be possible to put a training plan in place.
DIGITAL TRANSFORMATION
Identifying Outcomes for the benefit of patients
The starting point for any health strategy
should be from a patient perspective. Patient Benefits
There is much discussion around the “I want to tell my story My clinician has a
once” vision, which means that the message behind this can get I feel part of a
good all-round
tired and lost. The modern patient expects clinicians in each care modern healthcare
understanding of my
setting to be part of the wider system, to be joined-up in both system
background
their approach and knowledge of the patient’s needs and history.
The patient expects us to be able to deliver services using
I can book
modern systems, even if they then choose to use more Improved alerts
appointments online
traditional methods of communication. strategy – I tell my
and feel empowered
story once
Yes, we must make sure that patients who don’t use the internet to amend them
are able to access our services and make appointments. However,
that will not be used as an excuse to delay modernisation and
expoit digital transformation opportunities. I know everything I
need to about my
I can access self-care
We will embrace our principle of Empower the Person, and own healthcare and
deliver the benefits our patients expect. We will actively engage history
with patients via our patient panel and other feedback channels,
such as “I want great care”.
We will deliver a patient portal as an integral element of our ePR I can use the devices
My care is joined up
and as part of our work with the Surrey Heartlands STP. Patients I want to
will be able to access key aspects of their medical record.DIGITAL TRANSFORMATION
Identifying Outcomes for the benefit of staff
“Digital technology can underpin and drive
care that is truly integrated around the Staff Benefits
needs of people”.1
I feel the systems and
The principle of Support the Clinician is aimed at delivering the I feel part of a modern
devices I use help me
benefits which staff can relate to. To achieve this we will deploy a healthcare system
in my job
communications plan. By using the existing Your eMR Twitter and
Facebook accounts, we can build momentum with the staff who
are already engaged and who are keen to try out new
technologies. There is an established list of clinical and
Improved alerts
administrative digital champions who are primed for the next Reduces DNAs and
strategy – I don’t have
large-scale initiative. We will capitalise on this existing wastage in system
to keep asking
engagement and invite other staff to join in, ensuring their
opinions are heard early in the decision-making process.
A programme of pre-market engagement around the hybrid ePR I can easily access
project has already begun. We will build on this to develop and I know everything
technical expert
track the desired outcomes for staff. relevant about my
support to improve
patients’ history
my working practices
I am easily able to
I can use the devices I
hand over care
want to, where I want
appropriately and
to
1 Ella
efficiently
Jackson, Harnessed Technology article in NHE Nov/Dec 2017DIGITAL TRANSFORMATION
Governance
We will build upon a strong governance
framework to monitor the delivery of the
strategy and provide a digital forum to
Trust Board
encourage innovation.
The Integrated Digital Committee, with delegated authority from
Trust Board, will provide the over-arching governance. It will set
the priorities in the context of the strategy, be accountable for Integrated
and oversee the delivery, address the issues and control the Clinical Risk Digital
funding. Scrutiny Committee
Committee
It will have a dotted line to the Clinical Risk Scrutiny Committee
to ensure all implementations are assessed for quality and safety.
It will also have a dotted line to the Information governance Information
ePR
steering group to satisfy data protection and security measures Governance
Project Board
are in place. Steering Group
The Digital Strategy Forum will also receive applications from
departments for the consideration of projects which contribute
to the strategy. Clinical
Project Team Engagement
Finally, it will consist of members who are curious about the Workshops
digital world and will seek to learn and innovate.DIGITAL TRANSFORMATION
Investment Opportunities
If we get the funding models correct, we
will invest to save, in terms of lives, time Case for Investment
and money.
The Trust is committed to ensuring funding is available for digital
transformation and will explore every avenue to ensure
opportunities are fully exploited. We will commit revenue and
capital funding of our own and seek funding from technology
funds as opportunities arise. We will work with our suppliers to
identify innovative models to the sharing of risks and benefits.
Enhancing Addressing
With the investment made in the eMR/Evolve programme, we Reputation Risk
were able to identify and realise cash-releasing savings early in
the implementation. We plan to use a similar approach but it
does involve rigorous commitment to the principles of the initial
investment case
Benefit
Strategic fit Realisation
Not every aspect of the business case is about achieving benefits;
there are other good arguments which sustain the case for a
modern ePR. The model on the right identifies our priorities for
investment.DIGITAL TRANSFORMATION
High Level Timeline of ePR implementations
The projects currently in hand are: Careflow; Order Comms; Maternity solution; wifi replacement; eForms development; Bluespier
exploitation (mobile, referrals, scheduling). These projects will be delivered in 2018/19, and at the same time the procurement will
progress at pace for the hybrid ePR. This will put us in a good position to pursue funding opportunities as they arise. The following slides
detail the timelines and a more specific benefits schedule.
2018/19 2018/19 2019/20 2019/20 2020/21 2020/21
Q1/2 Q3/4 Q1/2 Q3/4 Q1/2 Q3/4
Careflow Connect
Maternity system
eForms development
Ophthalmology
Order Comms Patient Portal system
Digital
Dictation/Transcription
GDPR/Security focus
Hybrid ePR procurement Core ePR implementation
Bluespier
exploitation A&E module Patient Flow
UTC system
ePMA implementation
Wireless upgrade
Shared Care Record
Focus on cyber security, resilience, future-ready infrastructureDIGITAL STRATEGY 2018-2021
Section FOUR
CURRENT STATUS
Describing the presentCURRENT STATUS
Current Services
The teams supporting the digital strategy
are generally recognised across the Trust
for providing a good service. 95 information systems
The varying departments within the health informatics
department provide a vital support service to ensure frontline Desktop & Mobile Devices (laptops iPads or iPods)
staff are able to provide their patient services. In addition, they
also support every other member of staff in some way with
regard to their daily working life: using a computer, pager or 3,500 users to support
mobile device; deploying a new system; learning how to use
technology: accessing emails, information systems or monthly 450 Mobile Phones & 2,500 telephone extensions
reports; using the wi-fi.
The Trust has a streamlined team supporting an ever-expanding 1,400 Pagers
number of devices and technologies within a tight financial
envelope. This leads to an element of risk tolerance which needs 480 Wireless Access Points
to be carefully monitored on an ongoing basis. However, on the
whole it is a model which works.
180 monthly information reports 1.5% of
Trust
2.5m revenue
1.5m capital
Approximately 55 Digital Support StaffCURRENT STATUS Team Structure The team structure follows a relatively traditional model, and also includes the Medical Records department. There are four main workstreams within the department and there are no current plans to change this. The team is streamlined and in general we have a smaller establishment that in other similar trusts. However, commitment is strong and staff retention is high, resulting in a reputation for delivery, and a strong support provision. There are several identified “single points of failure” where key roles are taken by just one member of staff and where a minimum of two would in itself be no more than adequate. This in areas such as network management, integration, and complex database administration (DBA). Recruitment is challenging not just from a cost perspective but also in terms of available, suitable candidates. To counter this risk we have elements of mitigation in place, such as occasional support from external suppliers to provide holiday cover or to assist with specialised pieces of work. In general, we manage this risk, but it is important to recognise it and actively improve the situation as opportunities arise. Having Medical Records within the structure has enabled large- scale projects to deliver on time as decision-makers are already working together to achieve the desired outcomes.
CURRENT STATUS
Digital Maturity Indices
There are several Digital Maturity Indices
available to assess the current status of our
services. They all show the Trust to have
some degree of optimism from a digital
perspective.
1. The Digital Maturity Assessment (DMA) is a self assessment
tool managed by NHS England to measure the effective use of
digital technology against three key themes: organisational
readiness, capability and infrastructure.
2. The Clinical Digital Maturity Index (CDMI) is a benchmarking
tool managed by Digital Health Intelligence to assess digital
maturity by measuring the implementation of a number of
core and advanced modules.
3. The Universal Capabilities have been set by NHS England as a
target for the STP digital roadmaps.
.CURRENT STATUS Digital Maturity Accelerated progress in the Digital Maturity Assessment for NHS Digital is required to achieve the paperless agenda. Digital Maturity Assessment Approximately every 18 months we are required to fill in a self- assessment tool for NHSD. This involves IT and clinical leaders evaluating and agreeing on our digital maturity by answering a lengthy set of questions around areas which have been identified as pre-requisites for achieving the 5-year Forward Plan and the paperless agenda. The figure on the right show our progress from Jan 2016 to September 2017 in some key areas of the assessment. Much of the progress is due to the implementations of the eMR solution, and the vital signs project. There are projects ongoing to target Order Comms, maternity and infrastructure, but we need to address the issues around Transfers of Care and ePrescribing and Medicines Administration to make the next big step of improvement.
CURRENT STATUS Clinical Digital Maturity Index (CDMI) This CDMI matrix, again from self- assessment, shows specific solutions we need to deploy in order to achieve maturity. The green coding denotes we have achieved digital maturity in 17/34 clinical functions and gone some way to address a further seven. The proposed hybrid ePR procurement will go some way to addressing several of the red areas (e.g. prescribing, and clinical portal), and will also improve a number of amber sections, particular clinical noting, A&E and scheduling. The areas of order comms and results to GPs are covered by the current Order Comms project.
DIGITAL TRANSFORMATION Roadmap to 2020
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