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Document Details

Title IM&T Strategy

Trust Ref No 2053-34833Local Ref (optional)Main points the documentcovers

Community Trust Strategy for Information Managementand Technology services

Who is the documentaimed at? All Trust employees

Authors Andrew Crookes (Head of Informatics)

Approval processApproved by(Committee/Director) Resource and Performance Committee

Approval Date 26th January 2017

Initial Equality ImpactScreening

Yes

Full Equality ImpactAssessment Not required for this document

Lead Director Director of FinanceCategory GeneralSub Category IM&TReview date 31st January 2020DistributionWho the policy will bedistributed to Appropriate Staff

Method Publication on Trust websiteDocument LinksRequired by CQC NoRequired by NHLSA NoOtherAmendments HistoryNo Date Amendment

1.0 March 2012 Final version 1.0 - updated to reflect service developments, newNHS Information Strategy, and IBP V2.3

1.1 September 2012 Revised Version 1.1 – updated to reflect IBP and LTFMfeedback.

2.0 January 2014 2014 – 2016 New Version 1.0 – updated to reflect servicechanges and NHS wide digital programme

3.0 November 2014 Version 3.0 – to reflect 5 year plan

4.0 August 2015 Version 4.0 – to reflect Electronic Patient Record and ChildHealth Changes, and staff views

4.1 January 2016 Version 4.1 – minor updates to work programme

5.0 December 2016 Version 5.0 – reflects the STP and Digital Roadmap, and theimplementation of the RiO EPR

Information Management Technology Strategy

IMT Strategy 2015-2020 2053-34833_1B3043D.docx 1 December 2016

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Information ManagementTechnology Strategy

2015 - 2020

Author(s) Owner(s) Andrew Crookes

Version No. Version 5.0

Approval Date 26/01/2017

Review Date 31st January 2020



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Executive Summary

“One of the greatest opportunities of the 21st century is the potential to safely harness thepower of the technology revolution, which has transformed our society, to meet thechallenges of improving health and providing better, safer, sustainable care for all. Todate the health and care system has only begun to exploit the potential of using data andtechnology at a national or local level. Our ambition is for a health and care system thatenables people to make healthier choices, to be more resilient, to deal more effectivelywith illness and disability when it arises, and to have happier, longer lives in old age; ahealth and care system where technology can help tackle inequalities and improveaccess to services for the vulnerable.” Personalised Health and Care 2020(NationalInformation Board, November 2014)

Our Vision

To be the lead local provider of high quality innovative services near peoples’ homes,working closely with partners so people receive well-co-ordinated, effective care.

Our Strategic Objectives

High quality care – To exceed expectations in the quality of care delivered Care closer to home – To transform our services to offer more care closer to

home more productively, especially services for older people, those with longterm conditions, children and specialist services

Integrated care through working in partnership – To deliver well-co-ordinated effective care by working in partnership with others

The purpose of this document is to set out the contribution required from informationsystems to support the vision and strategic objectives of the Trust, including thosesystems and services provided under the existing infrastructure provided by NHSDigital.

The document sets out the strategic context and the vision for informationmanagement and technology for the Organisation and this is translated into a set ofpriorities, which leads to a programme of work for the Trust over the next 5 years. Thisstrategy is aligned to both the local Digital Roadmap and the Sustainability andTransformation Plan; and reflects the requirements of Neighbourhood working tosupport our service delivery.

The strategy considers the emergence of both Telecare and Telehealth; and how theTrust needs to deploy appropriate solutions and work in partnership with otheragencies to deliver these technologies to increase the efficiency and effectiveness ofthe organisation, but to also improve the experience and health outcomes of thepatient, delivering care closer to home.

The overarching strategic IM&T objective is to ensure that the right information isavailable to the right people, at the right time, regardless of the care setting.



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To meet the Trust objectives in providing care closer to home, mobile working; eitherwith real time connections or via disconnected working will become the norm foraccessing the various clinical systems that we will be using.

Given the dependence of these solutions on commercially provided mobile phonenetwork coverage (3 and 4G), the topology of Shropshire provides some significantchallenges; which means that disconnected mobile working is a pre-requisite for anyclinical system which is planned to be deployed within the Trust.

Mobile working is also heavily dependent upon the device(s) that will be utilised bystaff, , and as this market is still rapidly evolving this will pose a number of challenges,not the least of which will be managing people’s expectations in times of significantrestraints on NHS resources.

Telecommunications (including fixed, mobile and wireless communications) arediscussed in the context of delivering elements of this strategy; a unifiedcommunications strategy is being separately developed.

The Trust is currently dependent upon a range of legacy systems that will need to bereplaced over the period of the strategy. Currently the Trust spends around £750K onsystems.

The Information Governance issues associated with this type of working have to beclearly understood and managed across the whole organisation, both by the use oftechnology safeguards, but more importantly by the continual training and educationof staff in Information Governance risks and issues.

It is important that Information Governance concerns do not act as a barrier to patientcare and cross organisational working; but staff need to be aware of the potentialrisks, and the appropriate responses.

Over the next 5 years the Trust will:

Move to mobile working for a large proportion of its workforce Deploy wireless technology across its estate Deploy the new RiO Electronic Patient Record Invest in appropriate telehealth and telecare technologies Work with our partners through the Digital Enabling Group to create an

integrated care record at the point of care

The programme of work that is described in the strategy is aligned to the TrustsSustainability and Transformation Plan, and the various underpinning strategies(Workforce, Clinical, Quality, Financial etc..) and is subject to the financial planningas expressed in the Long Term Financial Model.



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Contents

1 BACKGROUND and INTRODUCTION................................................................... 52 STRATEGIC CONTEXT .......................................................................................... 63 THE VISION FOR INFORMATION MANAGEMENT AND TECHNOLOGY............ 7

Objectives ............................................................................................................... 7Outcomes ................................................................................................................ 8Deliver High Quality Care....................................................................................... 8Support people to live independently at home .................................................... 9Deliver integrated care and Develop Sustainable community services .......... 10Training ................................................................................................................. 10

4 ISSUES TO BE ADDRESSED ............................................................................. 13Trust 5 Year Plan .................................................................................................. 14Choice.................................................................................................................... 14The Legacy from the National Programme for IT............................................... 15A Patient-led NHS and The Power of Information.............................................. 15Clinical Governance ............................................................................................. 16White Paper – Equity and Excellence: Liberating the NHS ............................... 17NHS Improving Quality (NHS IQ) ......................................................................... 17National Infrastructure Maturity Model (NIMM) .................................................. 17Planning for system replacement ....................................................................... 19

5 OPERATIONAL PRIORITIES and BENEFITS...................................................... 26Provision of IM&T Support .................................................................................. 26Trust Technology Infrastructure ......................................................................... 27Information Governance and Data Quality ......................................................... 28Benefits Realisation ............................................................................................. 29

6 CURRENT WORK PROGRAM ............................................................................. 30Telecommunications............................................................................................... 30Telehealth and Telecare ......................................................................................... 31

7 DELIVERY PLAN .................................................................................................. 33



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1 BACKGROUND and INTRODUCTION

1.1 The Trust provides community health services to the resident population ofShropshire at every stage in their lives; in their homes and from a range of localfacilities; including four community hospitals with a total of circa.113 inpatientbeds. We also provide School Nursing services to 5 – 19 year old Children inDudley.

1.2 The services the Trust provides cover wide range of inpatient, outpatient andhome based health services, covering general care for adults and children andyoung people such as district nursing, school nursing and health visiting,alongside more specialist services such as the community respiratory service,and DAART service which provides urgent assessments to avoid acute hospitaladmission. Although these services are diverse, they share a common themein that they all occupy a pivotal place interfacing effectively with other partners.

1.3 The Trust approaches service provision in two distinct ways.

1.3.1 The first is on a locality basis; this is due to the large geographical areaserved and the different population make ups with their differing healthrequirement. This enables the Trust to provide a mix of communityhealth services from each locality.

1.3.2 The second is on a Trust-wide basis, where the Trust provides serviceswhich are specialised (e.g. Health visiting, Speech and LanguageTherapy) or can be better managed and delivered across a completepopulation group (e.g. Children’s Services).

1.4 Previously the NHS has adopted a National approach to IT deliveryprogrammes through the National Programme for Information Technology; thisprovided a number of the key building blocks for information management andtechnology infrastructure; some of these programmes were utilised by the Trustin 2005.

1.5 The Trust needs to respond to a number of challenges:

Internally the need for more information, in greater depth

Increasingly sophisticated information tools

Tactical information systems suited to specific functions

Greater collaboration and a widening of the user base and the associateduser support requirements, including increasingly sophisticated businessand financial modelling capabilities

The governments requirements that patients should be able to access andshare their clinical records electronically, as expressed in “The Power ofInformation”

The imperatives to empower a truly mobile clinical workforce withsophisticated clinical systems and robust infrastructure



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Maintaining an appropriate safe and secure technical infrastructure whilstoperating in a rapidly changing and challenging environment

Managing in an environment which is financially constrained; but hasincreasing demands

2 STRATEGIC CONTEXT2.1 The Trust has its services commissioned by a number of organisations

including Clinical Commissioning Groups (CCGs), Local Authorities and NHSEngland.

2.2 The Trust works closely with Shropshire Council and Telford and WrekinCouncil, the Local Authorities with whom we share a common boundary, on arange of issues relating to health and social care.The Trust actively engages with other NHS Trusts, independent and thirdsector service providers where this is appropriate for the care and wellbeing ofour patients.The Trust is one of the partner organisations in the Digital Enablement Group,which is responsible for developing the Local Health Economies DigitalRoadmap. This group is chaired by Shropshire CCG and has partners fromNHS, Local Authority, and Third Sector organisations from across the LocalHealth Economy.The Digital Roadmap is part of the Sustainability and Transformation Plan.

2.3 The Trust provides a number of services including:

Prison Health Services District Nursing Health Visiting Community Hospitals Minor Injuries Units DAART Advanced Primary Care Services Podiatry Specialist Childrens Services Universal Children’s Services Community Therapy Services Community Loan Stores Continence Service Specialist Community Nursing

2.4 Information systems in the Trust are required to support a number of strategicrequirements, including:

access to the appropriate elements of the care record

integration across multiple organisations

access to information at the point of care delivery



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ensuring that clinical records are accessible to all the relevantprofessionals as and when required

information should be captured once and then shared as appropriate

promote and enhance shared working across organisational boundaries

3 THE VISION FOR INFORMATION MANAGEMENT AND TECHNOLOGY

Objectives3.1 The strategic vision for IM&T development at the Trust is built around a number

of objectives:

all systems which are deployed by the Trust will encompass the appropriatefunctionality to enable information sharing, including secondary and primarycare, local authorities, citizen access and 3rd sector providers

any clinical systems which are deployed by the Trust will allow for fully mobileworking; and as a default they must allow for disconnected mobile working; andbe underpinned by safe and secure infrastructure

information systems should first and foremost be used to support the provisionof safe, effective care

management information should be derived not only as a by-product ofsupporting care delivery, but also should be generated explicitly to support thedecision making processes of the Trust, e.g. Service Line Management

information, including personal information, is managed securely andconfidentially and shared in ways which can be understood by all data subjects(Patients and Staff), and staff will be fully trained in their responsibilities withregard to Information Governance

staff should have access to the information technology hardware and skilldevelopment programmes that they need to be able to be productive in theirrole, whatever that may be in the healthcare system, regardless of where theywork. Staff need to have access to a learning and development environmentwhere they can identify and address their learning needs and improve theirindividual information management and technology skills and competencies

the Trust should promote the development of an information culture withinwhich staff are encouraged and supported to access and use information andknowledge to improve the quality of services that are being offered

staff should be able to use information technology to communicate reliably,efficiently and securely, and to access sources of evidence and knowledge.Staff at the Trust will need to communicate with all partner agencies (including

The overarching strategic IM&T objective is to ensure that the right information isavailable to the right people, at the right time, regardless of the care setting.



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General Practitioners, Pharmacists, Opticians, Dentists, Local Authorities,Other NHS Organisations, Independent and Third sector providers)

OutcomesDeliver High Quality Care3.1 The Trust recognises the importance of financial investment in order to

introduce new technologies that will change how the Trust provides services,ensuring that its service reform agenda is delivered, aided by the appropriatetechnologies. However it also recognises that the investment that may berequired will have to be viewed in the context of the wider financial andorganisational priorities that the Trust will face in the coming years, and thewider NHS resource constraints.The investments made in new or replacement systems will have to be basedon sound business cases, including full benefits analysis, which are thenappropriately prioritised alongside other developments.

3.2 The implementation of robust processes and systems will be a key factor inensuring success, and these will include: the deployment of integrated clinical system(s) across the Trust; the implementation of technologies coming out of national and other

workstreams where appropriate implementation of business tools which will surround our data warehouse

to provide rapid business analysis to aid effective management use of a secure network infrastructure, including the implementation of

wireless technologies, to ensure that appropriate patient information isavailable to whoever needs it, when it is needed

using accredited programme and project management methodologiesacross Trust services

adherence to current best practice around interoperability, including makingfull and effective use of the ITK (NHS Interoperability ToolKit); DigitalMaturity Assessment and Digital Roadmaps.

ensuring that at all times robust Information Governance procedures are inplace and being adhered to

3.3 The implementation of these technologies and processes will help to ensure: that patients receive faster, safer, more convenient care that care can be pre-booked and is of a high quality that the clinicians who are delivering the care have timely access to the

information they need3.4 By providing the knowledge that is necessary to help deliver safe and effective

patient care and more appropriate models of care, clinical information systemsare at the heart of the organisation e.g. electronic patient record

3.5 The Trust will continue to invest in appropriate technologies that support boththose that are providing and those that are receiving care with timely, accurateand appropriate information e.g. where appropriate patients should haveelectronic access to their clinical records; technology supported access toclinical services (Skype for Business etc…).



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3.6 Additionally, by making use of the available information technology andinformation systems, the Trust will be able to effectively and efficiently channelresources to ensure that the care models being delivered are appropriate to theneeds of the patients, and can be clearly demonstrated to the servicecommissioners e.g. Service Line Management

3.7 The Trust will ensure that it continues to develop a knowledge culture in whichinformation and knowledge is viewed as an important organisational asset; toaid the decision making process and thus help us to improve our standards ofcare.

Support people to live independently at home

3.8 As part of the Sustainability and Transformation Plan (STP) for Shropshire andTelford & Wrekin the Trust is looking at opportunities for working closely withrelated partners, including The Shrewsbury and Telford Hospital Trust and thethird sector, at local level in delivering pathways of care, at working jointly onsupporting systems such as electronic records systems that help rather thanhinder joint work, and at increasing use of technology including telehealth toextend the range of health care possible in the community.

3.9 Telehealth, often referred to as remote patient monitoring - refers to servicesthat use various point-of-care technologies to monitor a patient's physiologicalstatus and health conditions. When combined with personalised healtheducation within a chronic disease management programme, it can significantlyimprove an individual's health and quality of life.

3.10 Telecare is a service that enables people, especially older and more vulnerableindividuals, to live independently and securely in their own home. It includesservices that incorporate personal and environmental sensors in the home, andremotely, that enable people to remain safe and independent in their own homefor longer. 24 hour monitoring ensures that should an event occur, theinformation is acted upon immediately and the most appropriate response putin train.

3.11 Why telehealth and telecare?

Potential to make significant health improvements and quality of life impacts forpeople with a high dependency on the NHS, local GPs, social services andlocal hospitals.

A key component of the Neighbourhood model of service delivery across theSTP footprint, enabling people to look after themselves wherever possible andpractical.

Provides a means to increase the availability of NHS clinical support byallowing local practitioners to be in permanent contact with those people lessable to look after themselves.

Can help improve the reach of the services that the NHS provides, looking afterthose who are often 'invisible' from the main acute services.

Helps keep people out of hospital and avoids all the pressures this can put onthem and their families.



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Benefits for Individuals Promotes the concept of self-care Improves quality of life for carers Less travel and disruption for routine check-ups, but requires robust support

systems in place to provide services to people when required. Retention of a sense of independence and dignity Increased confidence to manage own health Fewer stressful, unplanned hospital admissions

Benefits for Health and Social Care Professionals

Through risk stratification, GP’s can identify those people in their practice whohave Long Term Conditions (LTCs) and could be better supported if telehealthwere adopted

Professionals can be better informed of the status of these people and see lessdemand on services, with fewer A&E events and unscheduled inpatientepisodes

Professionals see less impact on family members/carers of people with LongTerm Conditions (LTCs) as they start to take more control of their own health

More regular data means professionals can be better informed of a person'shealth status which leads to early intervention and proactive care

Deliver integrated care and Develop Sustainable community services3.12 The technological infrastructure that is already in place throughout the Trust as

a consequence of the National Programme for IT (e.g. N3 connectivity),together with locally specified and procured systems already offers somesignificant opportunities to enable a more efficient organisation and will supportthe more effective information flows described previously.

3.13 The majority of staff in the Trust, across its community domiciliary services,health centres and within the community hospitals routinely use informationtechnology to support their day-to-day activities; in the future this utilisation willincrease as new technologies become available e.g. tablet devices,smartphones.

3.14 Internal and external communication between organisations is carried outelectronically where currently feasible, this facilitates monitoring informationflows and ensuring secure, efficient and effective use of technology, whilstmaintaining information governance processes.In the future the use of integrated and interoperable systems will lead to analmost complete digital communication path with the attendant benefits.

3.15 Information technology is one of the primary supporting infrastructures for theTrust. The need to ensure that those who work within the Trust have theappropriate skills and competency levels to use the technologies they are beingasked to work with is crucial.

Training



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3.16 To enable all Trust staff to fully utilise IT systems a range of training options isrequired from start-up, rollout training on new systems to refresher training forexisting users. The IT trainers work within the Organisational Development andWorkforce team but maintain close links with IM&T. The team will continue tooffer a comprehensive range of courses to all staff including Trust specificsystems training, as well as generic Microsoft Office Training.The main priority for the team is to ensure that the workforce have the relevantknowledge and skills required to use existing and future clinical systemseffectively. Training is considered integral to successful implementation andongoing use of IT systems, it is therefore essential to involve the training teamat an early stage for all new systems within the organisation.The Trust has mandated that Information Governance forms part of its staffmandatory training curriculum in order to ensure that patient confidentiality isrigorously maintained.

3.17 It is acknowledged that the ways in which we deliver training will also change.More modern methods of learning will be incorporated with particular emphasison e-Learning. A blend of learning methods will make the service more flexible,customer focused and easier to deliver to a geographically wide population.The reliance on classroom-based instructor led training; which comes at a highcost in terms of administration, training charges, travel and associated costsand impacts on employee work time overall is being reduced as the utilisationof e-learning gathers momentum.The deployment of e-learning is a vehicle that can both support and offer analternative to classroom based training.

Convenience of availability and location of learning 24-hours a day, 7 daysa week, 365 days per year

Just-in-time training opportunities Reduced time away from job A mechanism to ensure staff are up-to-date with their training which

ultimately will have a positive impact on patient safetyAs an NHS organisation the Trust has access to the National LearningManagement System (NLMS) at no cost. This is a module of Electronic StaffRecord and can be used to host national and local e-Learning content. Trainingundertaken in this environment is automatically registered on the relevant staffrecord. The NLMS system will support the up-skilling of staff in line with theworkforce strategy. The system will also support compliance, performance andservice development. The use of the NLMS will help meet the requirements ofour mandatory training agenda. All of which will ultimately benefit our patients.

3.18 With both the local and National transformation agendas being enacted duringthe next few years they will bring an unprecedented degree of change. Thedeployment of new enabling information technology brings with it significantorganisational impact and varying degrees of insecurity among individual staffmembers and/or staff groups, these fears are well recognised from variousacademic studies and from evidence in other parts of public and private sectorindustries.The Trust recognises the need to support staff through these changes.



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3.19 Many of the clinical systems deployed through the National Programme forInformation Technology were standard solutions; this imposed limits on theability that the Trust has had to tailor them to local requirements.The lessons learnt from the National Programme for IT deployments will bebuilt into future procurement proposals, most significantly the recognition thatthere are significant differences between Acute and Community servicedelivery models; which must be addressed in any information technologydevelopments.

3.20 The Trust recognises the need to manage the impact of these issues and willensure that, through the use of modern change management techniques, theseissues will be mitigated.Furthermore the Trust recognises that the nature of health care provision in achallenging financial environment is leading to a landscape of continuouschange; rather than a traditional model of periodic change with relatively longintervening periods of stability.

3.21 With such a heavy dependence on technology, the impact of any technologyfailure can become significant. The Trust has recognised these risks and willwork to ensure that across all of its services, continuity plans are put in placeand tested; to ensure that any impact can be responded to, and that within aclinical governance framework, risk mitigation is maximised.The overarching requirement is that our services must be safe.

3.22 Systems to support the business of the Trust require reliable and robustinformation technology that is available to staff at any location that their jobrequires. The Trust has deployed appropriate technologies which provide staffwith the ability to gain remote access to these support systems; which is secureand complies with NHS requirements for remote users.Additionally, the Trust will continue to work to ensure that its informationtechnology disaster recovery plans are robust and fit for purpose.

3.23 The Trust will deploy clinical systems that meet industry best standards interms of availability, and will in principle favour using off site supplier hostedsolutions, where the supplier can demonstrate clear disaster recovery planningthat includes multiple data centres, and resilient infrastructure.This is especially important where 24/7 operation of clinical and businesscritical infrastructure is required.

3.24 The implementation of the RiO Electronic Patient Record is a milestone for theTrust and its staff on the journey to deploy modern, effective and safetechnology driven solutions to improve patient care.



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4 ISSUES TO BE ADDRESSED4.1 In setting the strategic direction of travel and the issues that are to be

addressed, the various drivers for change need to be considered.4.2. These drivers come from both national initiatives and local priorities; the NHS

Information Strategy “The Power of Information”1 makes it clear that one of theunderpinning principles in the future will be the rights of people to have simpleand easy access to their records, whether they are held in primary orsecondary care.Some of these drivers are illustrated in the following diagram.

The creation of digital records and the deployment of electronic access for patients totheir records; is a significant challenge to the Trust.1 The power of information: giving people control of the health and care information they need; Department ofHealth; May 2012



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Trust 5 Year Plan4.3Trust strategy is based on the huge potential for community health services to

deliver a substantial change to the overall pattern of care in the local healtheconomy, delivering the right care at the right level i.e. increasingly with home andcommunity settings ‘as normal’, and with integration, early intervention and supportfor self-management built strongly into care delivery services. The strategy strivesto improve patients’ experience and independence through services close tohome, and help to manage increasing demand.The Trust and its partners are developing a Neighbourhood model of servicedelivery as part of the STP; this way of working is still under development, but canencompass some or all of the following:

• New model for community hospitals (or other larger community healthbases), linked to community hubs (Future Fit clinical model) - Offeringco-location of community hubs with a strong connection to localcommunities/volunteers for prevention and supporting self-management,plus ambulatory services, urgent care centres, medium acuity beds,simple diagnostics and planned care consultations, assessment.

• Urgent care centres (Future Fit clinical model). Development of MinorInjury Units and Diagnostics, Assessment and Access to Rehabilitationand Treatment as part of new urgent care centres.

• ‘Teams around the practice’ for ‘maintenance’ case management and‘Teams around the patient’/ Integrated Community Services (ICS)/Expanded reablement teams for high intensity input – with alignmentbetween the two (Future Fit clinical model)

• Childrens’ Services – CAMHS and services for children with disabilitiesand special educational needs, plus maximising the benefit from the newhealth visitor model, and fully exploring the potential of the communitychildren’ nursing service and hospital at home concept

• Linked working with communities to harness community capacity/contribute to patient self-management

• Cross cutting themes include increased partnerships and integration, 7day working, workforce development and technology support

Choice4.4 The NHS aims to deliver a health service that is fit for the 21st Century with

services that are designed around the needs of the patient. The NHS aims toprovide prompt, convenient, safe, high quality services from a range of qualifiedproviders, from which patients will be able to choose. The Trusts own vision isclearly aligned to these concepts and this is clearly articulated within the TrustsIntegrated Business Plan, “Bringing Care Closer to Patients – A Strategy forTransforming Local Services”.

4.5 The NHS has set out its vision for developing clear standards for thedevelopment of care pathways the delivery of which are dependent on thedevelopment and use of systems like Map of Medicine. These pathways willalso include developments like Personal Health Budgets, which will enable



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patients with Long Term Conditions to exercise choice in how they want theircondition to be managed.The Trust will meet the challenges posed by these developments by ensuringthat it is fully engaged in any dialogue between and within the health economy;and by ensuring that its systems and services are capable of meeting theemerging requirements.

The Legacy from the National Programme for IT4.6 The National Strategic Programme for Information Technology identified the

importance of information technology as a key enabler to delivering the highquality services that the NHS must deliver. As the programme ended it leftbehind a mixed legacy; with some clear successes (N3, NHS Mail, PACS); lesssuccessful from a local perspective was the proposed Patient AdministrationSystem (PAS)/Electronic Patient Record (EPR) solution.With the Trust left in a position of requiring an integrated solution across itsmajor services which is not available through the existing contractualarrangements. The delivery of the successor RiO EPR is currently the singlemost significant IT challenge that the Trust faces.

4.7 The National Programme recognised the importance of creating an informationtechnology management capability that provided support to the NHSmodernisation agenda by setting out the capabilities of information technologyto: improve the patient experience and quality of care; support service reconfiguration with modern information technology; improve the capability of the NHS to deliver change and reform; change working and clinical practices; support front line clinicians in delivering improved patient-centred care.

4.8 The National Programme was delivered by Connecting for Health and focusedon the NHS and also proposed to take forward parallel developments in SocialCare information technology, so that the two service areas were technologicallyintegrated to support integrated services working at a local level.This was not successfully delivered at a national level; although locally theNHS and Local Authorities did work together and successfully deployed N3connectivity; which provides the underlying secure connectivity infrastructurefor NHS services which operate from Local Authority premises.

4.9 The outcome from the National Programme for the Trust is that we have robusttechnical infrastructure in terms of hardware and network connectivity; but weare left with a diverse range of clinical systems, some of which are suitable totake forward, and some are less well developed.

A Patient-led NHS and The Power of Information4.10 The implications of the white paper Equity and Excellence: Liberating the NHS

will require the Trust to respond to the information technology implications ofprogrammes such as: GP Commissioning Choice Digital Care Records



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Patients electronic access to their records E-prescribing in hospitals Paper-light

The main thrust of these initiatives will require the Trust to publish informationabout its services and outcomes in easily understandable formats and in atimely manner; including performance information and associated managementinformation being available as required, in the form and format that usersrequire.

Linked to this and following on from the both the Francis and Berwick reports,the accuracy and integrity of published information must be demonstrable andcan be subject to far greater scrutiny than has been the case previously. Thiswill mandate a significant degree of activity on ensuring that data quality iseffectively and robustly managed within all the services that the Trust provides.

4.11 The following are extracts from “The Power of Information: Putting all of usin control of the health and care information we need.”“To realise the enormous potential benefits of information to improve our careand our health outcomes, this strategy sets the following ambitions:

Information used to drive integrated care across the entire health and socialcare sector, both within and between organisations. Information regarded as ahealth and care service in its own right for us all – with appropriate support inusing information available for those who need it, so that information benefitseveryone and helps reduce inequalities;

Information recorded once, at our first contact with professional staff, andshared securely between those providing our care – supported by consistentuse of information standards that enable data to flow (interoperability) betweensystems whilst keeping our confidential information safe and secure;

A culture of transparency, where access to high-quality, evidence-basedinformation about services and the quality of care held by Government andhealth and care services is openly and easily available to us all;

If we can access, contribute to and choose to share our health and carerecords, it will support a culture of ‘no decision about me without me’.It depends on making the shift to give us more control of our health and careand on recognising that collecting and sharing good information is pivotal toimproving the quality, safety and effectiveness of our care, as well as our ownexperiences of care.“ (The Power of Information: Putting all of us in control of the healthand care information we need, DoH, May 2012)

Clinical Governance4.12 Supporting Clinical Governance across the Trust is fundamental to the

achievement of delivering quality improvements and ensuring our services aresafe.



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4.13 Examples of where information technology supports clinical governanceinclude:

provision of access to evidence based medicine to support best practice(the Map of Medicine project; the Royal Marsden Manual Online);

ensuring the integrity of data in clinical systems is maintained throughtraining in Information Governance including data quality and datamanagement;

training and development of staff in the appropriate use of clinical systems; establishing secure access to systems through the deployment of Smart

Card Technologies including single sign-on where appropriate

White Paper – Equity and Excellence: Liberating the NHS4.14 The long term aim of the White Paper is to realign the health and social care

system so that social care, primary care and community services are integratedand tailored to meet individual need.

4.15 The White Paper covers many areas of joint work undertaken by Trusts andlocal authorities and how they could be better integrated or co-ordinated toimprove the services delivered to patients, their carers and the public.

4.16 It is clearly recognised that in order to achieve this, health and social caresystems should not be divorced but should be joined to ensure that appropriateinformation is made available to carers and clinicians as needed.This does not mean they have to use the same systems, but that informationmust flow around and between them to meet the requirements of patients andcare providers.The Trust will continue to work with Local Authority and social care colleagues,and other service providers to improve this area of our services; and will ensurethat these considerations are factored into any of our procurement processeswhere joint working is required.

NHS Improving Quality (NHS IQ)4.17 A number of workstreams that have and are continuing to emerge from the

previous QIPP programme which has been subsumed within the NHS IQumbrella have already been reviewed by the Trust; these reviews included theuse of Digital Pens for Community Nurses and the potential for Single Sign onto the clinical systems.There are a number of other technology solutions that are being brought to theattention of the wider NHS by the NHS IQ programme and the Trust is fullyengaged with the IM&T aspects of the programme through NICE, which hastaken over the responsibilities of the former NTAC (NHS Technology AdoptionCentre).

National Infrastructure Maturity Model (NIMM)4.18 This Strategy recognises the fundamental part played by infrastructure in

underpinning all IM&T services and so has adopted the NHS InfrastructureMaturity Model (NIMM) designed by Connecting for Health and now managed



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by NHS Digital. The model shows the steps that the Trust needs to take todeliver all of the benefits available from a mature, comprehensive and strategicinfrastructure.The Trust is currently predominantly scoring 3.4 as an average across thevarious domains.During the lifetime of this strategy the Trust is planning to attain an average of4, with the possibility some individual areas achieving 5.The major developments that will lead to this attainment are not simplytechnical in nature, they also relate to a cultural move towards recognising howthe transformational nature of IT can enhance and develop the Trust. Thecultural change builds upon the deployment of new technologies which enablethe Trust to deliver its services differently.

The widespread deployment of wireless infrastructure, coupled with clinicalinformation systems that support mobile disconnected working will facilitatea mobile workforce.

The operation of an electronic patient record will enable the Trust tocontribute to a patient centred integrated clinical record, that is availablewhen and where it is required.

National Infrastructure Maturity Model 2

4.19 The Trust has commenced the deployment of SharePoint as a mechanism fordocument sharing and collaboration, working with discrete work groups todevelop the adoption and utilisation of the technology before moving to largerscale deployments across the Trust.The Trust completed the migration of its desktop IT estate to MicrosoftWindows 7 and Microsoft Office 2010 during 2015/16.The Trust has also invested in centralised IT management software to enablethe more effective and efficient use of resources when dealing with some ITissues, including IT support utilising “Live Chat” functionality.

% C

ompl

ete

Average Highest Lowest Average Highest Lowest Average Highest Lowest Average Highest Lowest Average Highest Lowest

Patterns & Practices 100% 3.7 4.0 3.0 3.7 4.0 3.0 3.3 4.0 3.0 3.5 4.0 3.0 3.3 4.0 3.0

End User Devices 100% 3.0 3.0 3.0 3.0 3.0 3.0 3.0 3.0 3.0 3.0 3.0 3.0 3.0 3.0 3.0

Common Applications &Services

100% 3.0 4.0 2.0 3.2 4.0 2.0 3.3 4.0 2.0 3.4 4.0 2.0 3.6 4.0 3.0

Operating Systems 80% 3.8 4.0 3.0 3.8 4.0 3.0 3.8 4.0 3.0 3.8 4.0 3.0 3.8 4.0 3.0

Infrastructure HardwarePlatforms

100% 3.5 4.0 3.0 3.2 4.0 3.0 3.5 4.0 3.0 3.5 4.0 3.0 3.5 4.0 3.0

Network Devices &Services

100% 3.7 4.0 3.0 3.5 4.0 3.0 3.5 4.0 3.0 3.5 4.0 3.0 3.7 4.0 3.0

IT Security &Information Governance

100% 3.6 4.0 3.0 3.7 4.0 3.0 3.6 4.0 3.0 3.6 4.0 3.0 3.6 4.0 3.0

InfrastructureGovernance

100% 3.2 4.0 2.0 3.4 4.0 3.0 3.4 4.0 3.0 3.6 4.0 3.0 3.6 4.0 3.0

Business Alignment 100% 3.7 4.0 3.0 3.7 4.0 3.0 3.0 3.0 3.0 3.7 4.0 3.0 3.7 4.0 3.0

Procurement 100% 3.3 4.0 3.0 3.7 4.0 3.0 3.3 4.0 3.0 3.0 4.0 2.0 3.3 4.0 3.0

People & Skills 100% 3.4 4.0 3.0 3.4 4.0 3.0 3.2 4.0 3.0 3.2 4.0 3.0 3.2 4.0 3.0

Financial Management 100% 3.0 3.0 3.0 3.0 3.0 3.0 3.0 3.0 3.0 3.0 3.0 3.0 3.0 3.0 3.0

PSPG 100% 3.2 4.0 3.0 3.2 4.0 3.0 3.2 4.0 3.0 3.2 4.0 3.0 3.2 4.0 3.0

Strategy Alignment & Business ValuePerspective

Process Perspective People & Organisation Perspective Technology Perspective IT Security & Info Gov Perspective

Ccurrent



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This process will continue, alongside a number of IT infrastructuredevelopments, including the implementation of wireless technologies inappropriate locations.

Planning for system replacement4.20 Shown below are illustrative planning timelines for the most significant

workstreams; there are resource constraints around the RiO/EPR programme.The RiO/EPR implementation requirement remains the greatest area offinancial risk to the Trust from an IM&T perspective.

4.21 The existing financial resources in terms of both Capital and Revenue cangenerally support the proposed development programme; with the exception ofthe RiO/EPR requirement which may require additional external support.

4.22 The end of central support for both iPM and HSW Child Health by July 2016provide the Trust with a clear start point for the RiO/EPR implementationprogramme; the resource constraints generally within the NHS and in particularwithin the Trust will make this process challenging.

4.23 The Trust will face a number of issues where systems and services come totheir end of life, as recently witnessed by the end of support for Windows XP byMicrosoft. The most significant potential issues are identified in the followingschematic, which shows the system / service, expected end of life and potentialreplacement / continuation option.

4.24 The Microsoft Licences including Windows Server 2008, Windows 7 & 8, Office2010, SharePoint 2010, SQL 2008 and other server client access licences willall require replacement during the period 2019 – 2021. This is when the historicNHS Enterprise Wide Agreement comes to an end.One of the potential options is to move to “cloud” services e.g. Office 365;products of this type are known as Software As A Service (SaaS); alternativelya joint venture with other organisations may allow us to initiate anotherEnterprise Wide type of agreement.

4.25 NHSmail2 will replace the existing “@shropcom.nhs.uk” email service and theexisting users will migrate to NHSmail2 by summer 2017.There are a range of additional services (top-up services) that can be procuredunder this agreement; increased mailbox storage, skype for business, mobiledevice management. All of these top-up services will incur additional revenuecharges.

4.26 The Health and Social Care Network (HSCN) is the replacement for theexisting N3 national NHS network service. The planned migration to HSCN isscheduled to take place by 2020, organisations will be able to select from adefined list of migration paths.The Trust will be “aggregated” alongside a number of other organisations eitheras a single STP locality, or groups of STP localities dependent upon themigration path that has been chosen, this is designed to deliver the greatesteconomies of scale nationally.



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Clinical Systems

System Options Risks CurrentStrategic

Solution/Plan

iPM – PatientAdministration System,including MIU,outpatientappointments,Community servicescontacts

Do nothing

Short term contract(Extended for 13months)Long term contract (3years extension)

Replace

No Service Q22016High cost and noadvantageHigh cost and notsuitable forpurpose

Detailed in RiOprogramme plan

RiO EPR –Full ElectronicPatientRecord,includingfunctionalityfor Bedmanagement,MIU,Outpatients,CommunityServices,clinicalmessagingetc..Core elementElectronicPrescribingand MedicinesManagement(EPMA)

GraphNet - PatientAdministration Systemfor CAMHS includingoutpatient appointmentsand communitycontacts

DonothingUpgrade to newversion

Replace

UnsupportedsystemIncreased costFragmentsserviceinformation andmakesintegration morecomplex.


SEMA Helix -- PatientAdministration Systemfor Community Hospitalsincluding bed utilisation,theatre bookings,outpatientappointments

Do nothing

Replace

Continue tofragment service,increasescomplexity ofintegration.Dependency onAcute Trust


e-Script – prescribingand dischargemanagement

Do nothing

Replace

SystembecomingunsupportedReplace as partof RiO (EPMA)



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programme plan

MESaLS – ManagesLoan Stores Equipmentservice

Do nothing

Replace

Product ceasesto exist 2016

Replace withCES360

BEST (Soft Options) –Manages WheelchairService

Do nothing

Replace

None

Unsupported

No Change

Meridian - Friends andFamily questionnaires

Do Nothing

Replace

None No Change

SOEL Health (SOE) –Community DentalServices, including X-Rays

Do nothing

Replace

TBA – PotentiallyReplace withCarestream CSR4

TBA

TPP SystmOne –Clinical record inPrisons

Do nothing

Replace

Chosen by theMinistry ofJustice

No Change

TWINKLE – clinicalrecording for Diabeticchildren

Do Nothing

Replace

None


Potentiallypart of RiO

WANDA – used byAdmiral Nurses forpeople with Dementia

Do Nothing

Replace

None


Potentiallypart of RiO

WinScribe – digitaldictation

Do Nothing

Replace

None Potentiallypart of RiO

PACS – imaging, thisservice is provided by anumber of Acute Trusts

Do nothing

Replace

Dependency onAcute Trusts butlow risk

No Change

Analytical and Corporate Systems



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System Options Risks CurrentStrategic

Solution/Plan

Data Warehouse –stores all activity andcontracting information

Do nothingReplace

No requirementto change

Renewedservice2016/17

InPhase – Businessintelligence product fordata analysis andpresentation

Do nothingReplace


No Change

ORACLE – FinancialServices, andProcurement

Do nothingReplace


No Change

SEL (Software Europe)– electronic staffexpenses

Do nothingReplace


No Change

ESR – Electronic StaffRecord

Do nothingReplace


No Change

Datix – RiskManagement

Do nothingReplace


No Change

CASS (OPAS) –Occupational Healthsystem

Do nothingReplace


No Change

SLR – Service LineReporting

Do nothingReplace


No Change

Infrastructure Systems

System Options Risks CurrentStrategicSolution/Plan

Windows 7 – OperatingSystem

Do nothingReplace

Avoidance oflicence costs

Windows 10

Windows Server 2003 –Obsolete OperatingSystem

Do nothingReplace

Unsupported Move toWindowsServer 2008



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Windows Server 2008 –Operating System

Do nothingReplace


No Change

Exchange 2010 - email Do nothingReplace

Cost avoidance Move toNHSmail2

NHSmail - email Do nothingReplace

Service ceasesduring 2016

Move toNHSmail2

NHSmail2 - email Do nothingReplace


No Change

Office 2010 –productivity tools

Do nothingReplace


No Change

Sharepoint 2010 –document management

Do nothingReplace


No Change

Sophos UTM – firewall Do nothingReplace


No Change

Sophos Suite – Anti-virus, content filteringetc..

Do nothingReplace


Renew2016/17

Sophos EmailEncryption

Do nothingReplace

Cost avoidance Move toNHSmail2

LANDesk – Informaticsservice desk

Do nothingReplace


No Change

Bomgar – IT serviceremote access

Do nothingReplace


No Change

SSL Certificates –security certificates

Do nothingReplace


Renewal2017/18

Symantec – backup Do nothingReplace


No Change

N3 Do nothingReplace

Unsupported Migrate toHSCN

Storage Area Network(SAN) and mail servers

Do nothingReplace

Elementsbecomeunsupported

TBA



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Health and Social Care Economy Systems

System Options Risks CurrentStrategicSolution/Plan

EMIS (GP Practices) –clinical system

Do nothingReplace


No Change

InPractice (GPPractices) – clinicalsystem

Do nothingReplace


No Change

SEMA Helix (SaTH) –clinical system

Do nothingReplace


No Change

Care First (Councils) –client records

Do nothingReplace


Change toReplacementSystem

Liquid Logic (TWCouncil – ChildrensServices) – clientrecords

Do nothingReplace


No Change

iPM / GraphNet (RJAH)– clinical system

Do nothing

Replace

iPM No Service2017Unsupported

Investigatingoptions

4.27 The telecommunications programme has already commenced, and willcontinue into the medium / long term.Mobile device deployment has commenced with the utilisation of smartphones,and tablet devices in some clinical areas.Telehealth / Telecare, has a number of schemes that are in the final planningstages prior to authorisation and deployment; this programme will continue asnew services / devices become available.As part of the NHS 5 Year Forward View2 the investment in, and utilisation ofthese technologies will form a potentially significant workstream; which has thepotential to deliver both significant organisational efficiencies, together with animprovement in service delivery for our patients. (2The NHS 5 Year Forward View,NHSE, October 2014)



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5 OPERATIONAL PRIORITIES and BENEFITS5.1 The Trust has to ensure that its services have information technology systems

that are fit for purpose and can support the staff in providing safe, high qualitypatient care. The Trust has had in place a rolling programme of hardwareupgrades for services to ensure their equipment remains at a high standard.

5.2 Changes to the way in which the organisation is required to work will requiremore technically challenging and innovative approaches; delivering care closerto home will require the deployment of mobile working solutions, which willhave to meet the requirements of staff when they are working in areas of low3/4G coverage e.g. mobile disconnected working.

5.3 Seamless links between organisations in caring for people with long termconditions e.g. Dementia, COPD, or those that move across organisationalboundaries will require the ability to send and receive secure information thatcan be electronically processed automatically into the relevant part of thepatient/client record regardless of the service provider.This will require the utilisation of digital records and the associatedtechnologies.

5.4 People will expect to be able to access virtually real time information about theservices that the Trust offers, there locations and details about outcomes andservice quality. This type of information will be crucial in enabling the Choiceagenda and it is important that the Trust starts from a high quality position inorder to maximise the market potential. This is especially true where clientswith personal health budgets become an increasing share of the clientpopulation, combined with commissioners that are looking for services fromany qualified provider (AQP).

5.5 An emerging trend across both public and private sector organisations is theuse of personally owned equipment being used to process the employers data;this is generically referred to as “Bring Your Own Device (BYOD)”.A number of Trusts within the NHS are testing elements of this approach.However the significant governance issues that are inherent in this way ofworking have yet to be fully tested. The marginal gain in not having to fund arelatively small outlay for a laptop or tablet could be outweighed by thetechnical infrastructure that will be required to ensure the personal deviceworks within a managed risk environment.The Trust will monitor developments in this area, although it is probable thatthe deployment of this way of working would be restricted to non-clinicalapplications due to the risk management issues that surround personalconfidential information.

Provision of IM&T Support5.6 Currently the information technology support for the Trust is provided by the

Informatics service based at William Farr House.5.7 There is a single IT Service Desk for all IM&T support for the Trust, which

utilises a free phone number for staff to contact the service desk with anyissues. It operates a comprehensive IT Service Desk management platform



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which enables the effective management of issues, including the ability toprovide updated information to IT support staff who are operating on a mobilebasis.All the IT Service Desk staff have undertaken ITIL training (The InformationTechnology Infrastructure Library (ITIL), is a set of practices that focuses onaligning IT services with the needs of business), this is an internationallyrecognised qualification for IT support staff.

5.8 The Informatics department provides project and programme managementsupport across the Trust as and when required; this specialist support isavailable for non-IM&T programmes and projects where the client requiressupport in using proven techniques from specialist qualified staff to effectivelymanage projects/programmes.

5.9 All the senior staff within the Informatics department are qualified in PRINCE2project management to at least Foundation level; and all IM&T projects withinthe Trust are managed on this basis.

5.10 The Informatics department also manages the:

Registration Authority for the Trust;

Data Protection and Information Governance management;

Information services (activity data for commissioning/planning/operational);

Performance reporting.

Trust Technology Infrastructure5.11 Internal E-mail is provided by a fully encrypted e-mail solution which is

delivered via Microsoft Exchange service for Trust staff, who can also utiliseNHSmail. This will be migrated to NHSmail 2 during 2017.

5.12 Local storage and backup servers are deployed in a number of locations.5.13 All locations are connected via N3 links, this will be migrated onto HSCN during

the coming years.5.14 Remote IT diagnostics, repair and patch management are in place across all

Trust locations; this includes the use of a “live chat” function to provideadditional support to users..

5.15 The Trust is operating an estate of Windows 7 desktops, this will be migrated toWindows 10

5.16 The Trust is operating Office 2010, and has sufficient legacy licences for theproduct until the end of the support provision for the product in autumn 2020.

5.17 The Trust is operating MS Server 2008 and SQL 2008 client access licencesuntil the end of the support provision for the products in 2019/2020

5.18 The Trust is in the process of deploying Phase 1and 2 of its wirelesstechnology programme into the Community Hospitals and is investigating thefurther deployment of wireless technologies on a wider scale whereappropriate; and as required by future clinical developments.



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Information Governance and Data Quality5.18 The purpose of information governance is to:

support the provision of safe high quality care by promoting the effectiveand appropriate use of information;

encourage staff to work closely together, preventing duplication of effort andenabling more efficient use of resources;

develop support arrangements and provide staff with appropriate tools andsupport to enable them to discharge their responsibilities to consistentlyhigh standards;

enable organisations to understand their own performance and manageimprovement in a systematic and effective way.

5.19 The Information Governance Toolkit is a tool with which organisations canassess their compliance with current legislation, Government directives andother national guidance. It has been approved by Health Ministers, the reviewof Central Returns (ROCR) team and NHSI.It is a requirement that the Trust completes the Information Governance toolkiton an annual basis.To demonstrate the delivery of information governance, the Trust is required tocomplete the NHS web-based Information Governance Toolkit. This covers sixwork areas:

Information Governance Management; Confidentiality and Data Protection Assurance:

* Confidentiality NHS Code of Practice;* Data Protection Act 1998;

Information Security Assurance:* Information Security Management NHS Code of Practice;

Clinical Information Assurance:* Health Records Management;* Records Management NHS Code of Practice;

Secondary Uses Assurance:* Information Quality;* Payment by Results;

Corporate Information Assurance:* Freedom of Information Act 2000;* Corporate Records Management:* Records Management NHS Code of Practice.

The Trust is required to attain at least level 2 status in order to meet theStatement of Compliance requirements, this has been achieved historically and



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the commitment and expectation is that the Trust will improve on this positionand will attain Level 3.The Trust is externally audited on its compliance with the IG Toolkit on anannual basis.

Benefits Realisation5.20 Benefits realisation is a system, or a number of steps, that offers a way of

identifying benefits from an investment and ensures that those benefits arerealised.

5.21 In the NHS, any investment in information technology must be driven by thebenefits that the investment will bring to improving patient care. Identifiedbenefits may include:

• increasing the quality of care;• reducing costs;• providing alternative or innovative ways of delivering patient care.

5.22 In addition, investment in information technology must be able to stand up torigorous scrutiny and provide assurance that it is fit for purpose in a modernNHS and meets the requirements of Data Protection and CaldicottGuardianship.

5.23 Expenditure on information technology has been growing substantially in recentyears and it is therefore unsurprising that an increasing focus is being placedon realising the benefits of investment in information technology.The increasingly challenging financial environment makes it even moreessential that any investment in IM&T is recognised as delivering tangiblebenefits to the Trust and our patients.

5.24 It is a Trust requirement that any programme or project which involvessignificant expenditure on IM&T services will be managed under a structuredprogramme or project management methodology (e.g. PRINCE2). Thisapproach ensures appropriate levels of governance and also encompassesBenefits Realisation as an integral part of the evaluation process.



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6 CURRENT WORK PROGRAM6.1 Some of the key areas of work being currently being undertaken include the

following:

Supporting the monitoring and achievement of agreed performance criteria(e.g. RTT, Infection Prevention & Control, etc..)

Continue providing information technology training around improving dataquality

Continue interim support for the legacy clinical system “iPM/ Lorenzo” andother National and local programmes e.g. TPP SystmOne etc..

Continue to develop the business support and information systems of theTrust, e.g. Service Line Management, and robust Information Governanceprocedures (Pseudonymisation)

Continue to develop and enhance the data warehouse; including dashboarddevelopment and expansion of reporting sources

Continue to monitor NHS IQ developments, and ensure that appropriatedevelopmental opportunities within the Trust are taken advantage of (e.g.virtual meetings / virtual classrooms video technologies)

A rolling hardware replacement programme Deployment of encryption technologies Deployment and migration plans for Windows 10 Deployment and Migration from a local Exchange email service onto

NHSmail 2 SharePoint deployment Continue to support the Trusts transformational working agenda Continue the support and delivery of the RA and Information Governance

services Delivery of Trust Website and associated process management Supporting where appropriate the delivery of Telehealth and Telecare

solutions through the Digital Enablement Group inc. Digital Roadmap anduniversal capabilities.

Actively engaged in the STP digital agenda Monitoring and testing of mobile solutions as they come to market Deployment of wireless technologies Reviewing remote tele-metrics solutions e.g. near field technologies,

wireless enabled vital statistics devices Supporting the RiO EPR implementation processDetailed work plans supporting the above areas of work will continue to bedeveloped as appropriate within the programmes they support.

Telecommunications6.2 A cohesive and comprehensive telecommunications strategy will need to be

commissioned, which will articulate the future telecommunicationsinfrastructure that the Trust will require to adopt during the coming years toenable it to deliver the clinical and support services in the most efficient andeffective ways possible.



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This strategy looks at both fixed and mobile telecommunications technologiesand delivered a number of recommendations which included:

Develop or procure clinical applications which can supportsynchronisation with mobile devices, at various time frames.

Adopt appropriate technology to support mobile working, e.g. laptops,tablets, smartphones

Use appropriate telecommunications technology to update mobiledevices as appropriate to the data, for example:

o daily synchronisation using fixed communications;o ad-hoc synchronisation using fixed or mobile;o using 3/4G network to provide live access (if available).

For sites with occupants from multiple organisations, seek to reduce thenumber of network links to a site, by working in partnership with otherpublic sector users adopting an approach of ‘sharing’ links as the norm.

Extend the video conferencing system to additional meeting rooms andlocations within the Trust, and following investigation on the impact onthe network, to certain desktops. Consider the use of the N3 Videobridge to link to provide connectivity to other Trusts.

Expand the use of fully-featured virtual classroom technology and in theshort-term implement a full trial of Cisco WebEX to determine itssuitability. Also consider specialised online learning environments suchas Moodle and Elluminate.

Use a converged voice and data network supporting VoIP whereverpossible.

Take steps where possible to enhance mobile phone reception.Potential actions include:

o use of 1picocells and/or 2femtocells to locally enhance coveragein buildings;

o in exceptional circumstances consider roaming SIM cards orSatellite phones.

1Picocells are operated and managed more closely by the network operator.2Femtocells are semi-autonomous and often user installed, sensing from their immediateenvironment the best frequency and radio parameters to use.

Telehealth and Telecare6.3 The NHS has committed to extend Telehealth and Telecare solutions across

the population; concentrating initially on people with Long Term Conditions(LTCs).Telehealth - generally refers to services that use various point-of-caretechnologies to monitor a patient's physiological status and health conditions.Typically, it involves electronic sensors or equipment that monitors vital healthsigns remotely from home or while on the move.



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Telecare - services incorporate personal and environmental sensors in thehome, and remotely, that enable people to remain safe and independent intheir own home for longer.

6.4 This message is re-enforced in the “Power of Information”; with clearrequirements to rapidly expand the delivery of services closer to people’shomes by utilising all the available technology channels.

6.5 The Trust has a small capital programme available for the acquisition anddeployment of Telehealth / Telecare products; this programme is formallymanaged by the Operations Directorate.

6.6 The deployment of solutions in this area are a key part of the Trustsdevelopment programme and the STP Neighbourhood programme forsupporting people at home. The STP recognises the requirement to increasethe management and care of individuals with Long Term Conditions in theirown home to avoid admissions into the acute sector is a challenge across theNHS. Telehealth and Telecare services are seen as one of the cornerstones toachieving this objective.

6.7 The Trust will work with partner organisations to deliver and where appropriateto manage solutions providers as an increasing range of products and servicescome to market.

6.8 The use of patient wearable vital signs monitoring equipment in bothcommunity hospital and domiciliary settings is an area which can deliversignificant patient, carer and organisational benefits. These products aredeveloping rapidly across both Health and Social Care settings, and aregaining acceptance within the citizen groups that they are helping to support.



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7 DELIVERY PLAN

By 2020 we will:

be using RiO Electronic Patient Record across all services

have clinical staff working on a predominantly Mobile basis

have a Wireless Infrastructure in place for staff and patients

be using Patient wearable vital signs monitoring (home and hospital)

have Patients accessing their clinical record electronically

be contributing to a STP wide Integrated Digital Care Record



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Personalised Health and Care 2020Using Data and Technology to Transform Outcomes for Patients and CitizensA Framework for Action (National Information Board, November 2014)

Overview Timeline of NIB Framework Milestones

20142015

• From March 2015, all citizens will have online access to their GP records.• By March 2015, proposals will be set out for the enhancement and extension of

the MyNHS service on NHS Choices.• By March 2015, NIB will publish a roadmap for alignment of existing national

programmes with the outcomes of this framework.• By 1st April 2015, HSCIC to publish the roadmap and standards care

organisations will be required to meet to be able to access core transactionssystems.

• From April 2015, use of NHS number as primary identifier in clinicalcorrespondence and for identifying all patient activity will be mandated in healthand care.

• By April 2015, the NIB and partners will coordinate agreement on nationaltechnical and professional data standards required to achieve digital real-timeand interoperable care records.

• By April 2015, NHS England to publish new “Insight Strategy” for making betteruse of patient outcome and experience data.

• By June 2015, the NIB will publish proposals on the regulation, accreditation andkitemarking of technology and data-enabled services, including apps.

• By June 2015, NHS England to develop proposals for ‘Code 4 Health’.• By June 2015, the HSCIC will develop proposals with industry for personal data

usage reporting.• By September 2015, proposals will be published for linking 111 with NHS

Choices.• By October 2015, HSCIC, CQC, Monitor and NHS TDA will publish data quality

standards for all NHS care providers.• By October 2015, the HSCIC will publish enhanced data security standards and

requirements and will re-launch the Information Governance Toolkit.• By October 2015, Digital Maturity Index key indicators for NHS Trusts will be

published via NHS Choices.

2016

• By April 2016, the NIB will agree a core ‘secondary uses’ dataset that all NHS-funded providers will have to make available.

• From April 2016, the CQC to take performance against the data quality standardsinto consideration as part of its regulatory regime.



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• By April 2016, HEE will introduce a new knowledge and skills framework for alllevels of the health, care and social care workforce.

2017

• By 2017, 100,000 individual genomes will have been sequenced.• By April 2017, core curriculum and associated knowledge frameworks will

contain the relevant knowledge, skills and characteristics to enable the workforceto embrace information and technology.

2018

• By 2018, clinicians in primary care, urgent and emergency care and other keytransitions of care contexts will be operating without the use of paper records.

• From March 2018, all individuals will be able to record their own comments andpreferences on their care record.

• Until April 2018, procurements under GP System of Choice will be used tostimulate the supply of new and innovative systems for out-of-hospital services.

2019

2020

• By 2020, all care records will be digital real-time and interoperable.• By April 2020, the entire health system will adopt SNOMED clinical terminology.

Notes :

HSCIC has been renamed NHS Digital

NHS Improvement (NHSI) is the operational name for the organisation thatbrings together Monitor, NHS Trust Development Authority (TDA), PatientSafety, the National Reporting and Learning System, the Advancing Changeteam and the Intensive Support Teams

To deliver high quality care

Trust Goals

To support people to live independently

at home

To deliver integrated

care

To deliver sustainable community

services

Corporate Objectives

xxx Priorities Safe

Caring

Effective

Responsive

Well-Led

Designed around the patient

Increased range of services

Making best use of technology

Delivered in sustainable environments

Financial Sustainability

Information Management and Technology Strategy 2015-2020 “Ensuring that the right information is available to the right people, at the right time, regardless of the care setting”

Priorities: Programme of Work Implement mobile working across Community Health Services Deploy wireless technology across the Trust premises Deploy the new RiO Electronic Patient Record and associated training programme Invest in appropriate IT equipment, telehealth and telecare technologies Work with our partners through the Digital Enabling Group to create an integrated care record at the point of care

Improving Lives in Our Communities

Plan on a Page

Development of an information and knowledge culture

Supporting the provision of safe and effective care

Outcomes Deployment of integrated clinical systems that can accommodate Trust goals Implementation of appropriate technologies and business tools for rapid data

analysis Use of wireless and communications technology for mobile working Management of projects using industry standard methodologies Adoption of current best practice Effective use of toolkits and frameworks including ITK and NIB Adherence to robust Information Governance processes and procedures

Delivery and Benefits Collaborative partnerships for successful joint working Remote patient monitoring and self management of long term conditions Telecare systems to enable patients to stay safe and independent in their homes Support of the development of local enhanced community services in rural areas Integrated care and sustainable services Provide the secure information, where and when it is needed

Collaborative partnerships for successful joint working

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