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NHS Highland Board 28 May 2019

Item 4.5 UPDATE ON eHEALTH

Report by Iain Ross, Head of eHealth on behalf of Deborah Jones, Director of Strategic Commissioning, Planning and Performance The Board asked to: Note the update on eHealth 1 BACKGROUND This is the fifth eHealth update to the NHS Highland Board and covers the period from November 2017 to date and will focus on the following four main areas:

• The Electronic Patient Record (EPR) • Cyber security (a request from the November Board meeting) • Other eHealth deliverables • National Programmes • Scotland’s Digital Health & Care Strategy

The current eHealth Delivery Plan (which is being developed in conjunction with the service and to allow flexibility to support the financial recovery Plans) is attached as an appendix. 2 STRATEGY The eHealth Strategy for 2019/20 remains unchanged from the previous year and is as follows:

Electronic Patient/Person Record Access to an electronic patient/person record that replaces the existing paper records integrated across NHS Highland (primary, secondary, community and social care) with access available as required regionally and thereafter nationally. This would also be available to the patient/person or appointed representative with appropriate access controls. Equity of Access to Systems and Services Integrate the different environments in use across NHS Highland and regionally to ensure that all users have access to similar services and systems, ensuring that NHS Highland is consistent with the emerging national and regional digital maturity models. Digital Infrastructure Delivery of a digital infrastructure that is appropriate to the needs of the service (primary, secondary, community and social care). Cyber AND Data Security

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Compliance with the cyber security, information governance and data security standards that are being mandated by the Scottish Government.

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3 ELECTRONIC PATIENT RECORD (EPR) NHS Highland has had the implementation of an EPR across health and social care as a strategic aim for a number of years. An EPR is a complex solution and consists of a number of deliverables.

3.1 Care Portal The regional Care Portal was formally launched on 14 February 2019 (the system went ‘live’ in December 2018) with access being provided to all clinicians across the four collaborating Boards (Highland, Shetland, Orkney and Grampian). The Care Portal is the foundation stone for all future EPR developments. The Care Portal brings together clinical information from the collaborating Boards including diagnostic results, clinical letters, hospital encounters, x-ray imaging and where appropriate GP summary information via the Emergency Care Summary (ECS). It also provides a link with NHS Greater Glasgow & Clyde’s clinical portal. 3.2 Scanning of Hospital Health Records

• Scanners now in place • Document store implemented (SCI Store linked to the Care Portal) • Policies drafted • Readiness assessment completed by Internal Audit to identify the

remaining areas where work is required before the scanning of hospital health records can commence. The tasks identified are being controlled via a formal project management framework

• Business case for the establishment of a scanning bureau being developed

3.3 Review of existing paper flows Work has commenced on identifying the existing paper flows and solutions are being implemented to transition these into a digital format, examples include:

• White letters (additional clinical information) from GP’s to Consultants, these will be scanned and viewable in the EPR

• No duplication day which will stop paper being produced and filed where a digital copy exists and is available via the Care Portal

• Review of the existing nursing forms • National early warning score (NEWS2)

3.4 The digitisation of paper forms A number of clinical pathways are supported by digital forms which now exist across NHS Highland. Work has commenced on developing a business case to support the fuller digitisation of clinical documentation including nursing, AHP and medical documentation. This work is being carried in partnership with the Golden Jubilee National Hospital and will be delivered via the Care Portal. Regionally, work has commenced on the development of a Major Trauma rehabilitation pathway that will allow clinical documentation to digitally flow across the North of Scotland.

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3.5 Community and Maternity EPR’s Argyll & Bute went ‘live’ with a community solution at the beginning of April based on CareFirst which allows Health and Social Care staff to share information. In North Highland the implementation of Phase 1 of the Morse solution is progressing and work on a business case for Phase 2 has commenced The implementation of the Badgernet Maternity EPR is still progressing across the whole of NHS Highland. 3.6 Future Plans The full plans for the EPR are documented within the draft eHealth Delivery Plan (Appendix) however this can be summarised as follows:

• Establish links with primary and social care systems (NHS Highland is leading on the link with primary care and NHS Grampian are leading on the link with social care)

• Establish links with other clinical portals (link with the Golden Jubilee National Hospital already under development)

• Establish links with other clinical systems (Emergency Department, Out of Hours service, Medical photography)

• Establish links with the National Digital Platform (Domain E of the Digital Health & Care Strategy)

• Commence the digitisation of clinical pathways eg. nursing forms

4 CYBER SECURITY One of the requests following the last update to the Board was for a focus on Cyber Security programme. Nationally there are six national cyber priorities:

A core component of the Cyber programme is compliance with the NIS (Network and Information System) Directive.

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So what is it?

• EU Directive - Security of Network and Information System Directive • UK law - the Network and Information Systems Regulations 2018 • Came into force 10 May 2018 • Regulated by a ‘Competent Authority’ similar to the Information Commissioner’s

Office (ICO) for GDPR • Non compliance can result in enforcement action similar to GDPR

What is its purpose?

“The Security of Network & Information Systems Regulations (NIS Regulations) provide legal measures aimed at boosting the overall level of security (both cyber and physical resilience) of network and information systems for the provision of essential services and digital services.”

Who does it apply to?

• Operators of Essential Services (OES) & Relevant Digital Service Providers

(RDSP) • All Health Boards are OES and compliance is a legal requirement

The NIS Compliance framework consists of 4 high level objectives with 14 underlying principles:

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NHS Highland, in common with all Boards, has a programme that complements the National priorities:

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5 OTHER eHEALTH DELIVERABLES

6 NATIONAL PROGRAMMES NHS Scotland has commenced three major national programmes these are as follows:

6.1 GP IT Re-Provisioning NHS Scotland has awarded a new framework contract to supply IT software to GP’s across Scotland. EMIS Health (Egton Medical Information Systems), Microtest and Vision have been tasked with developing an IT Managed Services Framework to meet the needs of Scottish GPs. Clinicians will then pick the system and supplier most suited to the needs of their practice. The new systems will be designed to be more user friendly and intuitive, focused on offering improved functionality specified in consultation with GPs including better online services for patients; improved monitoring and reporting; and remote and mobile access for primary care teams. 6.2 Replacement of the CHI and Child Health Systems The CHI & Child Health Transformation Programme is a NHS Scotland programme of work that is being undertaken because the current system that supports a number of essential IT systems within NHS Scotland is aging and expensive to maintain. NHS Scotland, therefore, needs a modern system that meets legislative requirements, delivers fast electronic communications and reduces the need for paper-based systems. Since 2015 NHS Scotland has been conducting a procurement programme and the following preferred supplies have been identified:

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Replacement of the CHI (including the GP Registration System (GPRS and the Pharmacy Registration System (PRS)) – the preferred supplier is Wipro Replacement of the Child Health Systems which includes the Scottish Immunisation & Recall System (SIRS), the Child Health Screening Programme – Pre School (CHSP-PS) and the Child Health Screening Programme – School (CHSP-S) – preferred supplier is Servelec.

6.3 Microsoft Windows 10 and Office 365 rollout This programme will see all devices (110,000) across NHS Scotland upgraded to the latest version of Windows 10 and all users (161,000) provided with access to a version of Office 365 which will include a new email system. Work has already started on the upgrading to windows 10 and the Office 365 programme is in the advanced planning stage.

All of the above national programmes will have an impact locally on NHS Highland who will need to allocate resources to support these programmes with the local financial impact currently awaited. 7 DIGITAL HEALTH & CARE STRATEGY Work is now progressing with the implementation of Scotland’s Digital Health & Care Strategy. The strategy has six domains:

Domain A - National Direction & Leadership Domain B - Information Governance, Assurance and Cyber Security Domain C - Service Transformation Domain D - Workforce Capability Domain E - National Digital Platform Domain F- Transition Process

Progress is being made across all the domains with the governance for each now in place and the delivery plans being defined. The Head of eHealth is involved in the transition group and progress with the strategy is reported back at national meetings. As the work on the strategy develops it will be included in future eHealth updates. 8 CONTRIBUTION TO NHS HIGHLAND BOARD OBJECTIVES The eHealth Delivery Plan is consistent with the aims of the Board’s Quality and Sustainability Plan. 9 GOVERNANCE IMPLICATIONS 9.1 Staff Governance

There are no particular staff governance issues around the eHealth Delivery Plan. Each individual project will have its own staff engagement plan.

9.2 Clinical Governance Each project will comply with clinical governance as part of the project delivery.

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9.3 Financial Impact

The financial impact of the eHealth Delivery Plan is being analysed and where required, business cases will be developed and presented to the appropriate governance groups.

10 RISK ASSESSMENT The individual projects will have their own risk assessments and risk governance arrangements. 11 GENERAL DATA PROTECTION PRINCIPLES COMPIANCE There are no risks to compliance with Data Protection Legislation. 12 PLANNING FOR FAIRNESS The eHealth Delivery Plan will ensure equity of access to patients by improving the access to clinical information across NHS Highland. 13 ENGAGEMENT AND COMMUNICATION Each project will develop its own communications plan which will include communications to staff and patients as required. 14 SUMMARY eHealth’s main function is to deliver a full support service to all users. In this coming year the department is evaluating the use of clinical floor walkers and secondary care facilitators with a view to improving the support provided to front line clinical staff and maximising the usage of the clinical systems in use across secondary care. For 2019/20 the eHealth department will also look to focus on upgrading some of the key clinical systems which are required to ensure we have systems that meet the needs of the clinical users in terms of improved functionality and speed of access. The eHealth department is also working with the financial recovery leads to ensure that eHealth is in a position to support the work emerging for each of the cross cutting themes. The eHealth function has a full agenda over the next 2-3 years as it balances ensuring the Board has appropriate cyber security in place and delivering on the new solutions that will enable transformational change within the healthcare system. This agenda could not be delivered without the support of the dedicated and committed staff in Inverness and the Argyll & Bute area. This report is a summarised version of the work being carried out within the eHealth function and the department would be happy to host visits from Board members where more detailed information and demonstrations can be provided. IAIN ROSS Head of eHealth 7 May 2019

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Appendix - eHealth Delivery Plan 2019/20 DELIVERABLE DESCRIPTION NATIONAL/REGIONAL/

LOCAL OBJECTIVE RESOURCE REQUIREMENT

FUNDING SOURCE (IF REQUIRED)

Cyber Security Continue the work to achieve compliance with the following: Cyber Essentials + Public Sector Action Plan on Cyber Resilience NIS Directive

National eHealth only (local and regional)

eHealth Strategy Funding

Continuation of the Electronic Patient Record (EPR)

• Support for Patient Pathways and Collaborative worklists

New modules of the Care Portal that will enable more advanced clinical use of the system

Regional and local

Supplier, Regional Programme plus some local eHealth resources

N/A

• Creation of links with Primary and social care

The linking of Care Portal with primary and social care data

Regional and local Suppliers and local eHealth resources

eHealth Strategy Funding

• Implementation of scanning for physical case records

The scanning and disposal of hospital case records with viewing via the Care Portal

Local Health Records staff Governance rules to be agreed

Business case being developed

• Community EPR Solution

Argyll & Bute HSCP – Implementation of CareFirst to replace MIDIS North HSCP completion of the implementation of Morse

Local HSCP Staff in Argyll & Bute and North eHealth Staff

If this deliverable is agreed then a Business Case for the N&W implementation to be developed

• Maternity EPR Solution

Implementation of the Badgernet Maternity EPR across NHS Highland

Local Maternity staff across NHS Highland (project midwives). eHealth staff

Funding already in place

• Discrete values to Primary Care

The ability to transfer labs results as discrete values rather than an image

Local eHealth staff Practice staff for testing

Funding already in place

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DELIVERABLE DESCRIPTION NATIONAL/REGIONAL/LOCAL OBJECTIVE

RESOURCE REQUIREMENT

FUNDING SOURCE (IF REQUIRED)

• Implementation of order communications to Primary Care

The ability to request and receive digitally lab tests and results

Local eHealth staff Practice staff for testing

Business Case being revisited.

• Continuation of eVetting

The ability to triage referrals via TrakCare PMS

Local eHealth staff (Clinical Apps) Service Managers

N/A

• Implementation of the TTG module of TrakCare PMS

Additional module to support management of patients via the TTG rules

Local eHealth staff Service Managers

N/A

• Continuation of recording clinical information at source

The transition from recording clinical information on paper into a digital format

Regional and Local Supplier Regional staff eHealth staff Clinical staff

Some funding being made available from regional funds Strategy funding Business case to be developed to support ECC and other new builds

• Other Care Portal Developments

o Links with other portals

o Link with ED

Additional links so that a user can see information on a patient from other boards and the NHS Highland Emergency Department (ED)

Regional and Local Supplier Regional staff eHealth staff

Part of a funding bid for regional funding

• Implementation of order communications to Secondary Care

The ability to request and receive digitally diagnostic tests and results

Local Supplier eHealth staff Diagnostic department staff

Business case to be developed

• Digitisation of internal clinical documents

Currently distribution of internal letters to clinicians and non-GPs is via paper, this deliverable is to convert this to a digital process

Local eHealth staff Operational unit staff

To be planned

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DELIVERABLE DESCRIPTION NATIONAL/REGIONAL/LOCAL OBJECTIVE

RESOURCE REQUIREMENT

FUNDING SOURCE (IF REQUIRED)

Supporting Patient Flows by implementation of

• Admission View • Ward View • Paediatric View • Community Hosp View • Clinical Bridge • Info View

The ability to see the status of a patient across the Healthcare system from integrated community teams through hospitals stays and back to the community. Real time information dashboard

Local eHealth staff Ward staff Integrated community teams Operation Unit staff

Funding already in place

Support for regional and national programmes

• Major Trauma • Upper GI • Scottish radiology

transformation programme (SRTP)

• Ongoing regional digital programme

• NPex

Variety of regional and national programmes that support transformational change and news ways of working.

National and regional eHealth staff Regional staff Operational staff

Funding via national and regional programmes

Support for New Builds • Skye • Aviemore • Elective Care Centre • Fort William

Infrastructure and digital transformation programme in preparation for new builds

Regional and local eHealth staff Estates staff Operation unit staff

Via building Business Cases

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CORE INFRASTRUCTURE PROGRAMMES

These are MUST DO programmes that are required to ensure system performance across the digital estate is optimised:

1. Windows 10

2. Office 365 (to be defined) 3. Upgrading of environment to support the move to EPR (Resilience) 4. Upgrading of the following systems:

a. Immediate Discharge Letter system b. The Emergency Department System (EDIS) c. The Theatre system (TriSoft)

5. Upgrading of the following core infrastructure environments:

a. The Interface management system (Ensemble) b. The central backup system (Commvault) c. Upgrading of the operating systems in a number of file servers (all

sectors) d. Design and upgrading of the Microsoft SQL environment

6. Phase 2 of the commissioning of Scottish Natural Heritage as a resilience site

7. Ongoing patching to TrakCare PMS 8. Completion of the implementation of WiFi in all NHS Highland hospitals

9. Integration of Active Directory (AD) domains into the NHS Highland domain

a. Primary Care b. Argyll & Bute