Betsi Cadwaladr University Health Board Committee Paper 11 ... IOPlan.pdf · Betsi Cadwaladr...

Betsi Cadwaladr University Health Board Committee Paper 11.10.12 Item IGC/007

Name of Committee:

Information Governance Committee

Subject: Informatics Operational Plan 2012/3

Summary or Issues of Significance

The draft Informatics Operational plan was presented to the IGC in April 2012. However the IGC were unable to approve the plan as there was a) uncertainty about the national programme delivery and b) the Informatics Budget was not forecast to balance for the year.

Strategic Theme / Priority / Values addressed by this paper

This plan addresses the budget issues and forecasts a balanced budget for this year but there remains uncertainty about the national programme delivery

Healthcare Standard addressed

Equality Impact Assessment (EqIA)

Recommendations: Committee is requested to action as follows:

Approve the Informatics Operational Plan for 2012/3

Author(s) Mike Lugg and Dylan Williams

Presented by Dylan Williams Date of report 02.10.2012 Date of meeting 11.10.2012 BCUHB Committee Coversheet v5.02 Disclosure: Betsi Cadwaladr University Health Board is the operational name of Betsi Cadwaladr University Local Health Board

1

INFORMATION MANAGEMENT & TECHNOLOGY

OPERATIONAL PLAN 2012/13

Final for Approval

Dylan Williams, Assistant Director of Informatics

Revised & Updated Sept 2012

2

4. Contents

1. Purpose of document ................................................................................................................................... 3

2. The objective of the plan ............................................................................................................................. 3

4. Capacity plans .............................................................................................................................................. 3

5. Strategic Milestones..................................................................................................................................... 3

6. Local Priorities .............................................................................................................................................. 8

7. National drivers - NHS Wales Informatics Service ..................................................................................... 9

8. Development of a single service across BCU ............................................................................................. 10

9. Business Planning Principles ...................................................................................................................... 11

10. Financial Revenue Planning ....................................................................................................................... 13

11. Departmental priorities ............................................................................................................................. 18

8. High level three year plan and constituent projects .................................................................................. 30

9. Financial Capital Planning .......................................................................................................................... 35

10. Workforce .................................................................................................................................................. 37

11. Risks............................................................................................................................................................ 38

12. Glossary ...................................................................................................................................................... 38

Appendix A – Significant Risks to Informatics .................................................................................................... 41

3

DRAFT IM&T Business Planning 2012/13

1. Purpose of document The aim of this document is to summarise the main informatics business priorities for the Betsi

Cadwaladr University Health Board (BCU) for 2012 and beyond. The document details the main drivers

for change and how the service aims to meet these requirements with the allocated resources.

2. The objective of the plan The main objective of the Informatics Service is to enable the organisation to be an information led

business, where clinicians and management know their data and information better than anyone else.

Information should be available that is defined by the business, for the business and is provided in the

most useful, relevant and appropriate way to provide the best care possible to patients. Every element

of this plan should contribute towards this objective through the provision of services, support and

information from across the whole of Informatics.

5. Capacity plans The Informatics department’s plans have been developed at a time when its organisational structure is

still developing through the OCP. The impact of the organisational restructuring within the department

and the rest of the Health Board mean that existing resources have to focus on core programmes of

work as defined and prioritised by the Clinical Programme Groups (CPG).

The main areas of concern are reflective of the whole Health Board i.e. the challenge of meeting

increasing demand within the existing resources. Whilst some of the demand increases will be managed

via the Organisational restructuring, any major projects will only proceed on the basis of an approved

and funded business case.

6. Strategic Milestones The drive for an efficient clinical system where outlined in the 2011/12 Operational Plan and comprise

of a number of programmes of work. The critical strategic issues for consideration by the Health Board

are summarised below.

6.1. Information and Measurement Strategy.

Work on the Measurement Strategy has been switched to focus on rationalisation of existing

reporting from an Information Department perspective. This has enabled the department to

streamline its work, as well as reduce the volume and format of reports being issued to the

organisation.

This process will continue in 2012/13, with all standard reports being linked to an organisational

and/or national priority, with a nominated sponsor.

6.2. Rollout of key National Systems. Although many of the national products have been a long

time in the development and pilot the first phase major products were implemented at the

end of the 2011/12. Each of these projects are now gradually contributing towards the

development of a organisational wide single electronic patient record which will comprise

the following key components

4

Welsh Clinical Portal (WCP)

Laboratory Information Management System (LIMS)

Welsh Clinical Communications Gateway (WCCG)

Individual Health Record

Electronic Master Patient Index

PACS – Radiology lead on a successful All-Wales procurement which will

focus in 2012/13 on implementation

6.3. Digitisation of the paper record

During 2011/12 the focus was on the development and approval of a business case for an Electronic

Document Management System (EDRMS). The business case was shared with Clinial Programme

Groups, and approved by the Board of Directors in August 2011 and by the Information Governance

Committee in November 2011. As detailed in the business case, significant capital investment is

required to procure, implement and manage an EDRMS. It also highlights that revenue savings

‘required to pay’ for a solution would need to be realised in a number of Clinical Programme Groups.

Despite the capital outlay required, and a failure to gain ‘sign up’ to savings in all Clinical Programme

Groups, operational pressures , the problems inherent in the management of paper records,

growing demand for multi-site patient care and the suggested Return on Investment require this

Project to remain a priority.

In March 2012, a scoping/verification bid for Invest to Save monies was drafted to support the

EDRMS business case and undertake pre procurement activities, this was not submitted following

advice that the bid would not be successful. There is broad agreement that this is a real service

enabler and should be submitted as an Invest to Save scheme which could transform services to

patients and improve patient safety.

During 2012/13 the focus will be on engaging with the ‘Welsh Care Records Service’ that is being

established by NWIS to ensure a ‘once for Wales approach’ and setting up a local project board.

NWIS have agreed a competitive Dialogue approach to procurement and BCU have advised of its

desire to lead the procurement (in a similar fashion to PACS). No Indicative timescales have been

documented by NWIS yet but it is hoped that a procurement can commence during 2012 with

contract award anticipated towards the end of 2012/13.

Capital has been allocated for this work, this capital may also be used to fund a ‘scanning trial’ i.e.

set up a scanning bureau, begin to prepare and scan records to learn lessons and create a prototype

record that clinicians etc. can become engaged with.

In addition, there is enough evidence that the deployment of digital pen technologies could have a

dramatic impact on the way peripatetic work handle and store patient information. Capital allocated

for a pilot was deferred due to the orthopaedic work but we are still keen to pilot this technology in

some form this coming year. Therapy Manager software already has interfaces built for this

technology and could be a potential pilot area

6.4. Upgrade and replacement of existing patient administration system.

5

National policy and financial constraints dictate that the Myrddin system will be the default system

and we therefore need to plan and to urgently implement a single instance of a PAS across the whole

organisation.

During 2011/12 Myrddin has been deployed in ABMU & ABHB and there will be a period of a few months to pause and rationalise so that all Health Boards will be on the latest version.

We will be pushing for BCU to be the next implementation so that we standardise on a single system by the end of 2014 at the latest. Although the local rollout strategy has yet to be finalised we will aim to have started the mobilisation during late 2012/13. Realistically the rationalisation to a single PAS system across BCU will take up to two years and in the interim we need the technical solutions and resource in place to support the safety, performance and quality agenda. Initial discussions over national support to this timescale have not been promising and considerable effort will be required to change their priorities.

The three main hospitals’ patient recording and scheduling processes run on different patient administration systems.

The East has already implemented the national system which is Myrddin. The system has been in operation for over four years but development support from the Myrddin Team needs to be secured in order that specific functionality improvements can be addressed to make the system more effective and efficient. This upgrade has been planned for the Autumn 2012 and resources have been scheduled by all stakeholders. Currently all reporting is handled outside of the system, including Referral to Treatment.

Both Central and West are using commercial PAS supplied by iSoft. Both sites use different products and there is an urgent need to rationalise the systems before support is withdrawn in Central [supplier rationalisation].

The success criteria for this programme of work will be: a single, robust Myrddin system implemented across each site; allowing scheduling of appointments; access to clinical information; and electronic communications between primary and secondary care.

6.5. Community and Mental Health

Historically the provision of information and clinical system in community has been poor to non existent and in order to understand and improve services across BCU there needs to be a clear strategy.

The Mental Health service in the Centre uses Myrddin to administer patients. However the new Mental Health Measures legislation is highlighting the shortfall in functionality and this still needs to be addressed in partnership with NWIS.

The District Nurse teams throughout Central use Myrddin to manage their caseloads and access to information requirements to support operational and management reporting. Paper diaries have been replaced and all national and local reporting requirements are met by Myrddin.

Outline future plans include extension of this service into the West. The system does need revision in the light of the latest Mental Health legislation and the “usability” of the system in the community and mental health context. This highlights again the constraint upon progress where support from the national team is subject to prioritisation across Wales.

6

6.6. Departmental system strategy

In addition to the challenge of rationalising the PAS systems across BCU there is a pressing need to rationalise other clinical and departmental systems. Many systems are at the end of their operational life and departments lack a consistent system to operate their services efficiently. The section below is not an exhaustive list but highlights those critical systems that the CPGs have prioritised. One challenge will be to agree a pragmatic way forward in the context of the financial climate and adopting nationally developed or procured systems. The overriding challenge for Informatics last year was that most informatics resource was focused on delivery of the WCP and LIMS with very little delivered over and above this in terms of departmental solutions due to this lack of resource. As further national functionality and services are made available in 2012/13 then this position will prevail. The focus will therefore continue to be on helping CPGs develop their understanding of the benefit of rationalising systems; focus weeks to kick start the business case & requirements; interdependency management of selected suppliers with the BCU infrastructure; and advice around appropriate project governance documentation.

A&E – The East uses a commercial system which has the benefit of being focused on ED and clinical functionality but is limited in terms of lack on integration with the main hospital systems and compliance with data standards. Central and West manage the A&E through modules within the PAS systems – they do benefit from integration with the hospital PAS system. Each site still uses paper casualty cards. Primary, Community & Specialist Medicine CPG is keen to deploy a commercial system across each site which will conflict with the national approach which is to adopt the Myrddin A&E module for the administration of department. Nationally it has been agreed that the clinical functionality will not reside in Myrddin but will be delivered via the Welsh Clinical Portal. However the requisite clinical functionality for emergency medicine has not yet been developed.

Cancer prescribing – There is a need to standardise the electronic prescribing systems for cancer. BCU has two different systems and there is no national programme in place to look at this specific prescribing issue. During 2011/12 the CPG has developed a specification and business case to test the market and procure a single system which must be able to interface with national solutions such as PAS and eMPI. The CPG need to be mindful that although there is an existing system in place – the full benefit of the system is not being realised in a large part due to the lack of resources and process to ensure benefits realisation– this must be concluded prior to the procurement.

Discharge communications – Eventually all clinical documentation, including discharge letters will be done in the WCP and transmitted via the WCCG. Good progress has been made with WCCG in the areas where suppliers have made their product available. However, the relevant functionality required in the WCP will not be available for national rollout until later in 2012/13 at the earliest. In the interim the organisation needs to decide whether to implement local systems as an interim solution. In the East a system referred to as EPOC (Electronic Point Of Care) has been developed over the past ten years and has been successful in Medicine in particular and is an effective mechanism to capture clinical information and create structured electronic discharge information. It also has the ability to transfer the letter electronically to a limited number of practices. The CPG will have to decide on the balance the effort to change the ways of working to capture data at the point of care, the cost of the system, the risk of supplier support not being available and the timescale for the WCP rollout in deciding on a suitable way forward.

7

Theatres – Each of the main hospitals have a different solution in place. A renegotiation of a support contract for the system in use in the East has given some temporary reduction in the risk that the solution will no longer be supported by the supplier. The preferred solution will be to adopt the Myrddin Theatres module. An assessment will be undertaken following the major upgrade in the autumn as to whether further development is required. If this is the case the timescale for those developments are unclear at the time of writing. BCU has made an offer to NWIS to undertake some of the necessary configuration work but the necessary skills transfer and access has not been concluded.

6.7. Data Warehouse Development

The development of a single data warehouse for BCU remains a key strategic priority for 2012/13.

During 2011/12 the department completed the development of the following datasets within the

data warehouse:

o Outpatient Activity

o Admitted Patient Care (Inpatients)

o Emergency Department

The task of transitioning all reporting from these datasets is underway. The priorities for

2012/13 are:

o Leverage value from completed developments – transition adhoc and standard reporting

to the new datasets

o Develop the following datasets:

Referrals

Outpatient Additions & Removals

Inpatient Additions

o Undertake a hardware capacity planning exercise for future warehouse requirements

o Upgrade to the latest version of the warehouse software

o Pilot the web based reporting tools (Casius/Vision)

6.8. Improved use of communications and collaborative technologies.

The merging of the former organisations has left a legacy of technology and ways of working which are no longer sustainable. Many staff now need to be able to work from any location and need to easily access and share their information and files. Current methods such as shared folders can no longer work effectively at the outer edges of the organisation network and we will have to exploit web and portal technologies in a much more effective manner. Whilst various SharePoint sites have been developed in the past they have tended to be focused on a particular department or issue and a longer term strategy is required. The Informatics Department will lead an option appraisal of the existing technologies and work with stakeholders to define the requirements for collaboration and information sharing across the Health Board. This will include the feasibility of including the corporate record [subject to discussions with Corporate Communications] and development of a

8

business portal. Underpinning this appraisal will be a review of usage and needs for video conferencing technology and how this technology could be exploited further.

6.9. Speech recognition and digital dictation technology

The Board of Directors have agreed that speech recognition and digital dictation technology SRDD has the potential to transform the efficiency of the service and has developed the business case during the 2011/12 financial year with a view to embarking on a procurement and contract award during 2012/13.

6.10. Information and Communication Technologies (ICT) Infrastructure

The size of the ICT estate has grown unabated for well over a decade based predominantly on Microsoft/Intel based computing and IP/Ethernet networking standards. The end user computing model has up until now been based upon a standard suite of software delivered to the desktop, be this a thin client device, a personal computer or a laptop. Access to remote services and systems has been via a private NHS network to guarantee the security of highly confidential data and to protect NHS ICT assets from inappropriate access or malicious attack.

However, in the present economic climate an ICT infrastructure based on giving everyone access to the same level of technology whether they need it or not is no longer affordable. BCUHB owns some £15 million worth of ICT assets yet only receives £1.7 million pounds in discretionary capital each year to service this a figure and, which in the financial forecasts provided

to the Department, reduce significantly over the next years.In the last two financial years very few desktop devices have been replaced, the budget being used to either replace ageing critical core equipment or add new equipment to the estate. The result is an ageing BCUHB desktop that is starting to fail and is limiting the ability to embrace some of the latest systems and services. The traditional infrastructure model and the means by which it is funded are therefore clearly unsustainable. And it is not just the financial situation that requires not only BCUHB, but also the rest of the NHS to undertake a radical review of its ICT infrastructure.

The growing need to collaborate and communicate with non-NHS organisations, the patient and the public requires a rethink of networking and communication strategies. In 2012/13 the ICT Service will undertake a strategic review of the ICT infrastructure, the key objectives of which will be to develop an ICT Infrastructure Strategy that maximises user access and productivity whilst reducing the cost of ownership. The key principle being to provide ‘an appropriate tool for the job’ rather than a standard desktop.

The Informtics Service will look to collaborate wherever possible with Local Authotities across Wales through the North Wales Heads of IT and Chief Information Offices (CIO) Council for Wales.

7. Local Priorities Like all public services there is a real need to focus on the efficiency yet maintain quality of services. BCU

has a well developed five year plan which is designed to balance the challenges of the burden of disease,

workforce and financial constraints. The backdrop to the five year plan is the strategic themes

9

summarised in the document “Bringing people and services together for North Wales” which was

approved by the Health Board in October 2009 and focuses on five local strategic themes;

1. Marking it safe

2. Making it better

3. Making it sound

4. Making it work

5. Making it happen

The BCU Health Board will embed sustainable service improvements which support the delivery of both

National and Local requirements. Through our local planning processes we have identified detailed

service priorities which will become the focus of CPGs and the Health Board.

The 14 high value identified by NHS Wales opportunities (also embedded in the Health Board’s 5 Year

Plan); these include

Develop new settings of care and improve long-term care pathways.

Improve quality of continuing care through health and social care integration.

Implement cross-system patient information and informatics.

Develop improved unscheduled care pathways.

Stop wasteful clinical interventions.

Improve acute care performance and decrease length of stay.

Improve primary and community care performance.

Improve mental health service provision.

Manage medicines more effectively.

Improve procurement and supply chain.

Drive highest-value prevention campaigns.

Streamline and refocus the centre.

Establish service line management and patient level costing.

Modernise the workforce.

Clearly Informatics is a critical component in its own right but informatics has a role to play in each of

the 14 themes by providing information to the right people at the right time and implementing

technology that will enable service transformation. It is therefore essential that the informatics

programme is aligned with these core strategies together with the regional and national informatics

policy where it benefits the organisation.

8. National drivers - NHS Wales Informatics Service The NHS Wales’ Informatics Service was established on 1 April, 2010, as part of the healthcare reform programme. It brings together the strategic development of Information Communications Technology (ICT), the delivery of operational ICT services and information management. The new organisation has a national remit to support the transformation of NHS Wales and make better use of scarce skills and resources. It was formed by merging Informing Healthcare, Health Solutions Wales, the Business Services Centre IM&T element, the Corporate Health Information Programme and the Primary Care Informatics Programme.

10

The new arrangements will allow ICT resources to work together more closely to support a consistent approach to health informatics and the implementation of common national systems. The organisation will also be an exemplar for health informatics professional development. Set out in the corporate requirements within the NHS Wales – Annual Quality Framework 2011/2012

are requests to NHS bodies to clearly demonstrate how they plan to change systems and resource

allocation. Organisations should pool resources and work collectively to deliver the shared

implementation plan for the following common all-Wales information services:

Enterprise patient master index (EMPI) - to identify the right patient at every contact and their information;

National directory and email service (NADEX) - to identify each member of staff uniquely on the electronic information systems and provide them with the information services they individually need;

Individual Health Record (IHR) - to see the key parts of the GP record in an emergency;

Welsh Clinical Portal (WCP) - to order a pathology or radiology investigation and see the results and to manage medicines in the hospital;

My Health On Line (MHOL) - to enable patients to order repeat prescriptions, book an appointment, and later, with appropriate safeguards, use their own record to self-manage their own care;

Welsh Clinical Communications Gateway (WCCG) - to enable electronic referrals and discharges to be delivered to any location in health and social care.

Responsibility for data quality rests with the provider of the information and the objectives must be to make sure that all information is fit to be used both internally and externally. Additionally, organisations should contribute to the development and use of national standard reporting tools and systems for efficient collection and reporting. Organisations should also work with clinical teams to make sure that common ICT systems are used to improve delivery of high quality clinical services and the benefits to patients and staff are identified, realised and reported.

All of the National Solutions have been developed with representative Stakeholders and put through a rigorous Governance process which includes Patient Safety, Technical Architectural compliance and adherence to Information Governance standards. This has, along with development and delivery issues, delayed the availability of such solutions in some cases by over 2/3 years.

9. Development of a single service across BCU The Information Governance Committee and its sub groups will be responsible for developing the long

term informatics strategy as well as the assurance against the business as usual of the Informatics

departments. The balance between national and health board priorities will be managed within the

forum.

Economic pressures vs. Quality

Last year the Health Board continued to innovate and achieve more with fewer resources. Informatics

clearly continues to play a crucial role in enabling the Health Board to become a more efficient

organisation whilst maintaining and improving quality of services. The forecast funding and investment

position over the next three years suggests prioritisation and the necessary criteria will be a key strand

of Informatics Governance.

11

Whilst pockets of innovation exist throughout the organisation, the current financial situation means

that a step change in the use of technology is required – both in terms of maximising the use of existing

systems as well as the procurement and development of technologies to enable and drive change. It is

essential that these programmes are not “technology driven” and that they are based on the needs of

the Health Board.

The main benefit areas to focus on will be;

A move towards a paper free clinical record system which allows access to legacy records as well

as providing a simple way to capture clinical and activity information in an efficient and safe

manner. This will involve the implementation of next generation user friendly patient

administration and clinical systems, the digitisation of existing paper records and an overall

portal view of all information.

Ensuring that any new systems that enable the capturing of clinical and business information are

designed and deployed in a way that the information is easy to extract and re-present to the

relevant staff within the organisation to continuously monitor and improve service provision.

This will be achieved through a balance of Myrddin, the Welsh Clinical Portal and the

development of Business Intelligence systems and supporting processes.

The technologies used will enable greater efficiency and will allow better collaboration between staff

and other organisations. The underpinning network and operating system infrastructure will be

developed to take advantage of emerging collaborative technologies such as SharePoint.

10. Business Planning Principles In order to make sure that the business plan meets the strategic and operational needs of the Health

Board each initiative which merits a place on the plan will have to satisfy specific criteria which are

detailed below.

There is a clear project brief detailing the sponsor, the objectives, products, timelines and

benefits of the work.

Any additional funding, both capital and revenue has been sourced and approved by the

sponsor and the Finance department prior to the implementation of the project.

The project must be aligned with or have a specific requirement from the following;

Is on the CPG priority and operational plan

Cost Reduction Strategy

Statutory or mandatory requirements

Strategic Compliance or agreed convergence path

Any innovation needs to be of direct benefit to the patients and the Organisation.

Principles for IM&T Projects/Programmes In order to assist with prioritisation the following criteria has been drawn up to assist CPG's and Corporate services to review their requirements within a structurally different environment. It is hoped that this will assist with Strategic alignment of ICT with business objectives. Strategic fit

12

Resources will only be provided for projects or programmes that can demonstrate support for the strategic objectives of Clinical Programme Groups (CPG), Betsi Cadwaladr University Local Health Board (BCULHB) and or the NHS Wales Informatics Service (NWIS).

Where requested projects or programmes do not meet the strategic objectives of the CPGs, BCULHB and or NWIS but are required for business continuity, plans must be submitted to align the project or programme with the relevant strategy.

Where multiple projects have been requested by CPGs they should provide the priority for implementation based on resources and service need.

To ensure strategic fit there will be one integrated plan for National and local projects. Demands for national and local projects, the priority of their implementation and the resources that

they require will be considered in light of business needs and available local resources* by the Information Governance Committee.

*Note local resources mean Informatics and committed CPG/LHB resources

Equity

Projects and Programmes must be designed to provide equity across BCULHB, phasing of technology is permitted to avoid ‘big bangs’ BUT project and programme plans must be designed to provide services which are equitable

Where a replacement or new system is required common agreement on solutions must be achieved across BCULHB

Where there is a service need to procure an interim solution for one site to ensure business continuity, plans for strategic alignment must be provided to ensure equity of services and governance for the future

Where a pilot is undertaken to provide evidence for fulfilling a business need, it must be scalable and or the learning and benefits must be transferable for the future if deemed a success

Change Management

Where IT is being used to assist with merger of services, or deliver service redesign CPGs must provide Business Change Managers [BCM] to work alongside IT project managers

Where appropriate, the CPG must provide relevant resources to support the project to ensure ownership and project delivery, resources must be evidenced and timelines for projects must be committed to

Projects must evidence a future state i.e. how IT can assist future working and what manual processes will need to change before and after the introduction of the IT (CPG led by a BCM)

The relevant CPGs must sponsor any project or programme that is undertaken at their request

Benefits

The benefits of projects and programmes must demonstrably outweigh the costs (note this is not just financial) e.g. increased efficiency, reduced costs, improved patient care, quality or innovation

13

Governance

Informatics Projects/Programmes will only be undertaken if they have passed the relevant Governance stages i.e.:

1. They must fit the principles above 2. They must be signed off and sponsored by the relevant CPG with clearly identified business

sponsor and business change manager 3. They must evidence appropriate available resource for the project and its ongoing support i.e.

project team members, revenue etc 4. A Business Case must be produced which will be reviewed for Strategic Alignment and Benefits

by both Senior Clinicians and Informatics representatives [representatives to be confirmed] 5. They must have received the support of the Clinical Informatics Group [ proven requirement]

and Informatics Strategy Sub Committee [consistency with 5 Year IM&T Clinical Plan]

6. The submission of requests for projects must adhere to the planning cycle for IM&T projects [to be confirmed]

11. Financial Revenue Planning The Financial Outturn of the Year ending 31st March 2011 showed an overspend of £1,678,665 [14.5% of

Allocation] and is set out in Table 1. This identifies an overspending across all aspects of Pay/Non Pay &

over recovery on Income due to Non Recurring items when set against the accumulated Informatics

allocations from the previous host departments and organisations.

Table 1

Some of these historic factors include:

Historical transfers of expenditure to capital for funding of projects through capital leading to

the removal or absence of on going revenue funding

Establishment of additional ICT solutions implemented without funding for Informatics Support

of Third Party Maintenance contracts

Informatics Budget & Expenditure y/e March 2012

Allocated

Budget

Expenditure

/Income

Variance

[+Over/-

Under]10/11

Outturn

Pay 9,184,707 9,620,737 436,029 694,436

Non Pay 3,882,597 4,053,873 171,275 865,998

Sub Total 13,067,304 13,674,610 607,304 1,560,434

Income -556,955 -619,573 -62,618 118,231

Total 12,510,349 13,055,037 544,686 1,678,665

14

Service expansion in clinical areas which have no funding in place for the ‘back office’ functions

such as Health records and coding which are directly affected by changes e.g. Additional Clinics,

episodes

A failure to realise benefits from investment with no recourse to re-cycle some of the cash

savings into Informatics support

Overall cost improvements and Price inflation shortfalls levied on the Health Board with a

proportion delegated to the Associate Director of Informatics

Informatics Expenditure

From a subjective point of view this is split between Staffing [Pay – 70% [68%in 10/11]] and Non Staffing

[Non Pay – 30% [32%in 10/11]] Table 2.

Table 2 – Subjective Split – Pay/Non Pay

This can however be analysed into a more detailed picture

Staffing Expenditure

Table 3

4053873

9620737

Informatics Pay & Non Pay Expenditure

2011/12

Non Pay

Pay

Pay Expenditure & WTE Actual y/e 31st March 2012

Pay Band Range

WTE

Actual

Cost

Actual

A&C Bands 1-6 315.65 7,943,162

A&C Bands 7-8d 29.77 1,601,799

Other 0.00 75,776

Total 345.42 9,620,737

15

Non –Staffing

Table 4

Anticipated Income

The major element of income [nominal] is the delegated budget to the Informatics Directorate. In

addition are anticipated non recurring incomes from NHS Wales Informatics Service and legacy incomes

from Telephone incomes, Health Records copy request etc. Over time as events have changed a number

of expected income levels have dropped although no adjustments have been made resulting in an

allocated shortfall. A number of these streams are Health Board wide and were lodged on the

informatics books as a result of legacy actions.The NWIS contributions are expected to drop further in

12/13.

The analysis of Income Areas is set out in Table 5 below:

Non Pay Expenditure 2011/12 2010/11

Y/E 31st March Subjective Total Total

Non Pay 35570 Computer Maintenance 900131

33310 Telephone Rental 688908

33320 Telephone Call Charges 379092

35560 Computer Network Costs 323833

33340 Mobile Phones 187443

35550 Computer Software/Licen 185733

37330 Comps Ex Gratia 147096

36500 External Consultancy Fe 145855

33010 Stationery 116457

33300 Telephone Installation 77828

33350 Staff Location Systems 76455

35300 Contract : Photocopying 75524

37910 General Reserves 67289

38350 SLA : Other NHS Organis 64339

33610 Travel & Subsistence 63947

34200 Training Expenses 63847

33040 Microfilming/ Archive t 55383

32240 Hotel Services - Extern 47881

35700 External Data Contracts 47530

33000 Printing Costs 47272

36510 Staff Consultancy & Sup 43680

35510 Office Equipment & Mate 25775

37470 Miscellaneous Expenditu 20760

32810 Other General Supplies 20413

Non Pay Total > £20,000 3872471 4199473

Misc < £20,000 181402 125079

Total Non Pay 4053873 4324552

16

The above summarised analysis of expenditure must be compared with the delegated income [budget]

provided by the Health Board to the Associate Director of Informatics. The Health Board element has

been a reducing figure since 2009 although considerable investment into Health Records, Coding and

Programme Management was subsequently made in 2011/12. The ability to fully establish this

investment has been against a backcloth of Organisational Change Programme and financial austerity.

Therefore the initial forecast of the outturn year ending 31st March 2013 indicated an overspend of

£550,000. This is based on the following assumptions:

The investment of £1m into Coding, Health Records, ERDMS and Programmes is allocated

A direct link to the future strategy which is dependant upon ICT tools being more widely

available but to be supported by reducing ICT complement

Continuous rationalisation of estates which require infrastructure changes and user movements

and deployments

Any cost pressures around Pay or employer on-cost will be devolved to the Informatics Services

However in year CIP schemes and non recurring actions should reduce this forecast to £13,000 at

year end. Therefore by careful planning the year end position can managed to achieve a balanced

position which is consistent with the objectives set out by the BCU Delivery Board.

Table 6 below sets out the financial flows.

Informatics Underlying Deficit Reduction Plan 2011/12 - 2015/16

Subjective

Annual

Budget

Annual

Actual Note:

01400 Support Services/ Staff -120000 -53144 Capital Recharge

01900 Local Authorities Income 0 -818

02000 Overseas Visitors Incom 0 0

02600 Private Patients Income 0 -560

03600 Joint Working With Others 0 -7225

04500 Research & Development 0 -10275 One off payment R&D

06000 Inc Gen - Training 0 -79600 ADAPT Funding

06200 Inc Gen - Sale Of Equip -258 0

08100 Leased Car : Private Dedctns -3844 -100

09010 Course Income 0 -212

09030 Case Notes Income -96155 -75965

09360 Telephone Income -73149 -12034

09400 VAT Recovered Income 0 -9193

09440 Other Income -263549 -370447 Additional Capital Recharge, NRec -NWIS Funding

Income Totals -556955 -619573

17

Informatics Memorandum 2011/12 Only

2012/13 Forecast

2013/14 Forecast

2014/15 Forecast

2015/16 Forecast

Description of Change Over/ (Under)

Over/ (Under)

Over/ (Under)

Over/ (Under)

Over/ (Under)

£000 £000 £000 £000 £000

Underlying Recurring Deficit B/F 873 658 570 310

Add: CRES Allocation Reductions 1,166 0 0 0

Add: Cost Pressures 12/13 50 47 0 0

Add: Inflation 250 0 0 0

Add: Transformation Projects 0 0 0 0

Less: Saving Schemes

11/12 (265) 0 0 0

12/13 (230) (94) (50) (44)

13/14 0 (41) (210) (20)

14/15 0 0 0 (25)

Less: Cost Pressure Funding (1,172) 0 0 0

Less: Service/CPG Funding (14) 0 0 0

Recurring Deficit 873 658 570 310 221

NON RECURRING EVENTS

Income (333) (194) (194) (130)

Transfers to Capital (112) (100) (85) (75)

Expenditure (213) (276) (31) (16)

Forecast Outturn at 31st March 550 0 0 0 0

Version number : 12

18

Actions taken to mitigate

Recharges to capital

Currently Informatics staff time spent on schemes are identified and considered for recharging to

capital where they can be amortised over the life of the asset being deployed. In 2012/13 a figure of

£112,000 has been identified and this has been set to one side in the Informatics Discretionary

capital.

As a result of changes to definitions a number of items previously charged to revenue are also

eligible for capitalisation and this has had the effect of marginally reducing the expenditure on the

non capital accounts.

Recharges against other Sources

Wherever possible recharges to alternative sources of funding will be made thereby reducing the

expenditure.

CIP – current year

The current and full year effect of previous year schemes which set out to address the shortfall and

planned initiatives will save £ 495,000 in year.

CIP - Future

The 2012/13, 2013/14 & 2014/15 year schemes will save, subject to available investment capital, a

further Full Year Effect of £ 484,000.

Summary and Outlook

The anticipated outturn for 2012/13 will be at break even position.

The break even forecast for 2012/13 requires expenditurer reduction or income increase of

£1,200,000 in year which will be achieved by a combination of the above, an aggressive cost

improvement programme and delays in essential but not mandatory expenditure. It is essential

therefore that the strategic milestones which will release significant recurring savings are enacted as

soon as possible with the impact therefore in 2012/13 & 2013/14 being managed in these

alternative ways.

12. Departmental priorities A review of last year’s progress and a look ahead into 2012/13 is provided for each of the Informatics

departments.

Information Management

2011/12 Review

While acknowledging the need to press ahead with formal appointments, the decision to appoint an

interim assistant head of service and leads for strategic themes has been well received. In addition the

19

allocation of CPG Account Managers has proven beneficial to key CPG contacts, with a growing depth of

understanding of service needs developing.

On specific issues identified in the 2011/12 plan:

2011/12 Priorities Progress

Improve engagement with CPG – presentation of performance information at management meetings.

All CPGs have been assigned an Information Analyst as an account

manager. Interaction, and joint meetings have begun, but will be

dependent on the new structures freeing up time to undertake

proactive analysis. Initial feedback has been very positive.

Develop working links and share best practice with Public Health

The Informatics Department has established an Information

Development Group, with Public Health Membership. The

department has also worked on a number of projects in conjunction

with Public Health colleagues.

Develop a Measurement Strategy which defines all key indicators for the Health Board and provide a framework for how they will be processed and monitored

The draft Measurement Strategy has been developed, with progress

on completion. The introduction of Tier 1 and 2 measures has

provided more focus to the work.

Market review and implementation of a Data Warehouse to support the organisation’s information requirements.

The Department has opted to develop the existing Central area data

warehouse, due to the data loading and quality checking available.

three key datasets (OPA, APC and EDDS) have been developed, with

routine and ad-hoc reporting reducing duplication.

Produce a BCU wide standard set of Information resources – “produce and publish once”.

The department has produced a service directory of key reports,

which is also being used to support the measurement framework.

Work is ongoing standardising these into single reports, both in

terms of production and distribution, as well as develop them via

the warehouse.

Increased use of Myrddin: Introduce robust validation processes. Utilise pathway manager waiting list view as the tracking and validation tool for CPG’s in East. Produce RTT information from Myrddin instead of manual process.

All specialties except Cardiology are now managed via Pathway

Management within Myrddin. Cardiology will follow in January

2012. However, the reatime management of pathways has not been

implemented in Myrddin, due to the lack of Stage information, and

key data quality issues.

Baseline data quality across BCU, and plan equalisation – in support of national performance reporting, and Myrddin implementations.

The organisation continues to improve against the national data

quality targets highlighted in the NHS ICT Progress Report, with

marked improvement against the previous year.

The department has also begun a regular RTT process audit via case

notes across all sites.

On-going support for Strategic Reviews and Redevelopment plans.

The department has continued to support the Information

requirements of the strategic reviews.

CLIP Reports to be provided for each Consultant on a six monthly basis

This was undertaken, and highlighted the need for more up to date

information being circulated to clinicians, as questions raised from

20

the reports were up to 12 months in the past.

Promote and expand the use of CHKS Signpost at CPG level to improve the quality of care, patient safety and the data quality of clinical information.

A national review of benchmarking services is currently being

undertaken. It is hoped that an enhanced service will be developed,

with a key requirement being to deliver on patient safety indicators

in a flexible user defined way.

The department continues to utilise CHKS to support the “Focus

On” reports, answer FOI requests, and provide ad-hoc analysis to

stakeholders.

Engage with CPG’s to develop their regular clinical information reporting requirements providing analysis and benchmarking information to improve the quality and safety of patient care and clinical outcomes.

Develop further the support provided to1000 Lives Plus workstreams to assist the development of data collection methods, analysis and reporting locally, pan BCU HB and nationally.

While the department is actively involved in supporting 1000Lives+,

with staff involved at all levels, this continues to be an area of

concern, due to the number of measures which are not recorded

utilising core systems.

2012/13 Priorities

Implement agreed OCP structure as a priority.

Implement KPIs for Information Standards across the department, and exceed all national targets.

Implement Referrals, and Additions/Removals in the Data Warehouse.

Standardise reporting suite for CPGs.

Participate in the National Re-procurement of Benchmarking service.

Develop closer working relationships with Primary Care support staff.

Complete the development of a BCU wide Data Quality Plan.

Work with primary and secondary care colleagues to improve key demographic, and patient activity data, as identified in the data quality plan.

Clinical Coding

In 2010 BCUHB allocated additional revenue to support the Clinical Coding process, with a view to

improving the 12 week target, which in turn would support improved data quality, clinical engagement,

performance and financial information.

During 2011/12 the following has been achieved:

2011/12 Review


Appoint 3 WTE Band 5 Clinical

Coders/Auditors

On hold due to OCP process

Appoint 2 WTE Band 4 Clinical Coders

In post. National Coding courses being undertaken, and contributing

to Coding.

Appoint 5.5 WTE Clerical Support staff In post, and supporting the improvement in coding timeliness.

21

Utilise Agency Coders to reduce backlog Agency Coders have worked weekends in both the Maelor and Glan

Clwyd, reducing the backlog. During September 2011 to March

2012, approximately 140 days Coding have been procured to reduce

the backlog in Ysbyty Gwynedd.

Achieve 98% Coding within 1 month by

March 2012

Achieved. The department were achieving the national 95% target

in real time at the end of the financial year (the target is 12 weeks).

In addition, the internal target of 98% coded in 1 month was also

achieved. The department were also awarded the CHKS Data

Quality Award (Scotland, Wales & Northern Ireland) for 2012.

2012/13 Priorities

Implement agreed OCP structure as a priority.

Implement Medicode software in Ysbyty Gwynedd

Implement Key Performance Indicators across all sites (quality, timeliness, depth, breadth)

Maintain the 98% target, subject to process change for the movement of case notes across the organisation.

Implement a robust staff development scheme, with a view to achievement of ACC qualifications for all trainee coders where possible.

Establish an internal and external audit programme for clinical coding across all sites.

Establish processes to ensure the timely coding of all deaths.

Health Records

2011/12 Review

Despite continued pressures the Health Records Service it managed to progress all of its main priorities for 2011/12, as detailed below. Progress was achived despite increasing operational pressures which include increased demand for orthopaedic activity and the continued problem of CPGs arranging extra clinics to deliver core activity. Whilst there is no extra money for this activity for the CPG, this increased activity results in a real cost increase to the Health Records Service. Storage continued to be a pressure and additional scanning of records was required during the year. In the Centre the closure of HMS and reduced storage at other locations will continue to cause pressure on the service. In the West some capital was invested to increase storage in the mail file library following health and safety risk assessments and recommendations.


A business case to procure an electronic document management system EDRMS – the investment in this technology could create huge efficiencies across the health board whilst also making clinical records available at the point of care.

The business case was approved by the Board of Directors and the Information Governance Committee.

Implementing Rapid Filing in the Central Records Library – this will be adopting latest warehouse technology to

The project progressed to the testing stage, resource constraints and operational pressures prevented project

22

file and retrieve case notes and will hopefully free up resource to concentrate on improving the quality of the records service.

completion.

Reviewing all patient letter and other medical record related printing across the organisation – there are different processes in place at each location and there are real opportunities to standardise work and reduce costs.

A pilot to divert printing from Myrddin in the East to the central print room in YGC was successful. However before diverting all printing – a resources analysis and contingency/ business continuity plan needs to be developed. It proved challenging to gather all the relevant information regarding responsibilities for mail and its budgets. There are real savings opportunities to be had through optimizing printing and linking through to mail – however, dedicated resource will be required to manage this process.

Working to establish a BCU wide Health Records Committee and recommending options for reducing the reliance on paper – in particular creation and storage of paper test results.

The committee or the Health Records Group has been established and terms of reference have been ratified by the Information Governance Committee.

Establish new ways of ensuring individuals are trained in the standards of Health Records and ensure we monitor how we are delivering the service.

Training documentation have been agreed and a basic web site is being developed as a repositrory of all training materials.

Work with Programme Office to deliver national products like the Welsh Clinical Portal and the Master Patient Index and understand the impact of these systems on working practice and data quality.

Despite delays in the delivery of the national products the Health Records service has played a vital role in the testing and implementation of the MPI and WCP.

We will ensure that there is a clear understanding of new service developments. Last year was hampered by not being involved in planning schemes which lead to additional workload for the records service without the requisite funding which lead to an unacceptable workload.

The process for requesting additional health records resources will be formalized across BCU and an analysis of the repatriation of work from England and cost implication will be discussed with Planning and CPGs

2012/13 Priorities

Trends suggest that pressure on the Health Records Service due to increasing activity and service needs

predicted for 2011-12, will become a feature of coming years. “Future Impacts” on the health records

service will continue to be identified and examined to ensure that the service is able to meet future

needs.

Initial investigations into the impact of projected repatriation for 2012-2013 indicates that if all schemes

go ahead, at maximum projected activity additional transactions/activity contacts (e.g. pull case notes,

prep case notes, reception patient, and re-file case notes) may be in the range of 20,000 from this area

of activity alone. Therefore the need to do more for the same or more for less persists; in turn this

presses the need to increase the current pace of standardisation and modernisation within Health

Records. However in what seems like a vicious circle, the resource available to concentrate efforts in

this area is constrained and likely to reduce; this results in a slower than desired pace of change.

To implement a new Health Records Organisational Structure

To review the storage facilities for current and archive (acute) medical records

23

To investigate and define a storage strategy for Health Records; work with Estates to identify additional storage space with BCU, or alternative options e.g. external storage / scanning.

Agree and define the most effective and efficient use of resource in relation to case note storage e.g. most cost effective solutions for storing records with time bands

For Health Records Managers to use the strategy to create yearly action plans that mange case note storage effectively and efficiently whilst complying with agreed retention and destruction guidelines

To lead on the procurement of an EDRMS and start the implementation at one of the main hospital sites

Implement formalized ways to access the Health Records service to evidence changing service demand e.g. repatriation. This will lead to a more formal reporting of activity and issues

To identify and agree Key Performance Indicators and targets for the Health Records Service

Use KPI’s to audit records management systems, identifying and implementing improvments required.

To create and or standardize Health Records policies, procedures and processes where possible

To agree and deliver standard induction and training programmes for own staff

To agree and deliver organisational wide training prgrammes for Health Board Staff on records management that will highlight required record keeping practice and advise of laws, policies and procedures

To identify opertunities for delivering organisational wide training within existing resources (e.g Bid for funds to deliver training via Video, provide key messgaes to be inbedded in IG training etc).

Service Management / IT Service Desk

2011/12 Review

A working group was established to develop a plan for integrating the three existing IT Service desks. A single telephone number was introduced on 25th June 2012 allowing for the establishment of a single virtual IT Service desk. At the same time an Informatics Web Portal was introduced allowing end users to log fault calls and service requests online.


Implement Information Technology Infrastructure Library (ITIL) best practice. This will ensure IT processes are aligned with organisational need leading to enhanced IT service delivery and consumer experience.

Much progress has been made in introducing ITIL incident management best practice with standard service catalogues established and a BCU service and fault knowledge base introduced.

As a first priority use ITIL practices to stream, prioritise and manage the requests coming in each day

The introduction of a single virtual IT Service Desk and Web Portal has facilitated the introduction of standard incident management processes and service requests.

Embark upon a continuous improvement cycle to proactively reduce call volumes and improve response times

The working group continues to meet regularly to monitor the IT Service Desk performance as well as to plan the next phase, the introduction of Problem Management best practice.

Undertake early adopter work to develop Organisation Service Level agreements (OLA’s) and Key Performance Indicators (KPI’s) to better measure and publish performance

No progress made on OLA development and only minimal progress on the development of KPI’s.

Following a detailed review of demand provide Good progress has been made with the development of

24

Self service facility to undertake simple call resolutions using automated facilities

Supported Frequently Asked Question FAQ section on the internet

Automated facilities to log requests for non urgent equipment requests which integrate with the Health Board’s ICT approval and ordering processes

An end user self service for registering requests for assistance and other problem resolution

A single outfacing technical service for consumers

the Web Informatics Portal for logging fault calls and service requests..

2012/13 Priorities

Priorities for 2012/13 will be less ambitious. Key is to establish a service management organizational structure that pulls together the existing service management and service desk resources into a single coordinated and cohesive service offering the end user a consistent and effective experience. Key priorities will be:-

Single service management organizational structure

Single IT Service Desk with a single telephone number

Robust and cost effective on-call arrangements based on clinical service need

Development of a Organisational Service Level Agreement (OLA) with a number of clearly identified and published key performance indicators

Clinical Systems and Front Line Support

2011/12 Review

A series of changes in timescales in respect of the program for the delivery of national projects such as

WCP, Myrddin and eMPI has impacted on the planned priorities for the period 2011/12. This review

reflects those changes and how the resource implications have affected other timescales.


Business process review – benefits analysis for national solutions, WCCG – clinical prioritisation, PAS flows in central & west, community, maternity

Benefits analysis for national solutions, WCCG – clinical prioritization were completed

Process mapping for medical records

Review & consultation regarding ED, (Emergency Department), business case

Delayed: -

PAS flows in central & west, community, maternity

Requirements – readiness work for Myrddin into acute services in west and central, feasibility of STARR/Therapy man interface, WCCG – PAS interface, health record scanning, digital pen

Initial digital pen pilot planning undertaken for maternity

Review & consultation regarding OPMAS, (Oncology Patient Management Audit System), replacement

Delayed: -

25

Discussions around the strategic way forward and ongoing negotiations with national Myrddin management team on timescales for deployment.

Myrddin – planning and readiness

STARR/ Therapyman Interface

WCCG/Therapyman Interface

Development – build order requests Development of Order sets – WCP, (Welsh Clinical Portal)

Development and pilot of software to support generic discharge documentation

Development of STARR , (Services, Tests & Results Reporting), admin tool

Development of interface for Filefast into medical records YGC

Development and deployment of medical records workload planner

STARR stapling

Development and deployment of equipment management software for disability centre

Development and deployment of discharge summary solution for AMU, (Acute Medicine Unit) and medicine

Procurement – health record scanning, digital pen Postponed till at least 2012/13 due to in year 2011/12 capital restrictions

Deployment – WCP requesting & reporting into all acute areas, STARR into central [non pathology & radiology], eMPI into all areas linked to existing PAS,WCCG- electronic referrals, IHR, GPTRRR

Testing of WCP application in readiness for deployment

WCCG- electronic referrals Delayed: -

Deployment – WCP requesting & reporting into all acute areas, STARR into central

Ongoing support – as 2010/11 plus STARR, deployed national solutions

Diamond upgrade – diabetes software

Order comms rolled out to Holywell community hospital

Movement of services to support YGC redevelopment – ABH , (Abergele Hospital) to the new Ivor Lewis outpatient building, POAC, (Pre op assessment), to YGC etc

Ongoing support for applications such as GPOOH, iExpress PAS, PIMs, Myrddin, WCP/STARR, eMPI, Interfacing etc

Delayed: -

The ongoing implementation of eMPI into all

areas linked to existing PAS.

2012/13 Priorities The priorities for this period are linked closely to some major national projects such as the ongoing work to rollout WCP across BCU, eMPI and Myrddin. Timely and accurate data quality will form most of the priorities for the training team and a review service provision of ECDL is urgently required to identify its suitability for the future strategic context.

Stabilize support following the rollout of WCP Reporting in West

26

Complete upgrade to 305 [East], review & plan implementation of Myrddin across rest of BCU Review feasibility of replacing Theatreman [East] with Myrddin Theatre module Handover requirements and processes for ED to enable CPG to commence procurement Review options and plan way forward for a replacement of OPMAS Support developing National Systems and the continuing deployment of eMPI Continuing support for movement of services in line with the YGC rebuild Supporting CPGs [Focus Weeks] in the development of IT related business cases and associated

documentation - areas include Renal, Diabetes, Occupational Health Undertake significant scale upgrades to PAS's in Central & West

ICT Infrastructure

2011/12 Review

In 2011/12, whilst much of the work of the ICT services was in support of the National ICT and Local Estates programmes, key ICT infrastructure projects were undertaken to start standardising on the provision and management of core ICT services and to build resilience into the existing assets.


Further upgrade and enhancements to the physical and wireless networks to facilitate greater mobile access to systems and services and to support the development of a unified communication strategy that will deliver integrated data, voice and video services.

Phase 1 of the Ysbyty Gwynedd core network upgrade completed. Ysbyty Gwynedd Pathology Department network upgraded. Minor upgrades to Ysbyty Glan Clwyd and Wrexham Maelor networks. Installation of additional PSBA circuits together with upgraded Intrusion Prevention Systems to the three DGH’s to provide additional redundancy and security in readiness for LIMS and WCP

Further reduction in the number of physical servers in favour of virtual servers to maximise the performance and cost effectiveness of server assets and to reduce the overall IT carbon footprint.

Continued expansion in server virtualization across the three main datacenters.

Enhance data and email archiving facilities. Email archiving implemented in Ysbyty Glan Clwyd and Wrexham Maelor datacenters. Pre-existing in Ysbyty Gwynedd datacenter.

Support business intelligence, knowledge management, improve internal communication and help deliver a paperless environment.

Support provided as required.

Define, approve and begin phased implementation of a standard desktop suite of software.

No progress. A complete fundamental review of the desktop is now scheduled for 2012/13.

Undertake a review of potential measures to reduce overall carbon footprint and inform the green agenda.

Options for better power management of the desktop being considered with a view to possibly submitting a business case for spend to save money.

Implement nationally procured software to allow all removable media (CDs, memory sticks) to be encrypted

Rollout of encryption software to all laptops and personal computers deemed at risk on target for completion by end of 2011/12.

27

Review demand and prioritise technology services to support the wider infrastructure outside of core activities e.g. Broadband to residential accommodation.

The demand for access to corporate services from home has increased considerably. There is a particular corporate priority to give staff access to the electronic rostering system. The ICT Service is currently discussing possible options with NWIS.

Contribute to the prioritised, and agreed, level of support to the capital build programme/ CPG & Corporate “moves and changes”, identify skills & resource costs required for inclusion into additional scheme business cases.

Demand has been far greater than previous years although this was to be expected. Ysbyty Glan Clwyd Asbestos Removal Project and the closure of HM Stanley Hospital has been particularly challenging to the ICT service.

2012/13 Priorities

As in 2011/12, a number of ICT infrastructure projects will be undertaken standardise on the provision and management of core ICT services and to build resilience into the existing assets. Key amongst these are:-

Phase 2 of the Ysbyty Gwynedd core network upgrade.

Installation of a wireless network to the Wrexham Maelor Hospital Campus

Extension and upgrade of wireless network to the Bryn y Neuadd Hospital campus

Completion of the data archiving.

Completion of server virtualisation.

Review of network maintenance arrangements with the view to establishing a single network maintenance contract.

However, the key priorities for 2012/13 will be a strategic review of the ICT Infrastructure through four distinct but interrelated workstreams:-

Desktop and end user devices

Networking and Communications

Server and Storage

Datacentre. The strategic review will also enable

A review of current business continuity and risk assessments of key systems which will feed into appropriate comprehensive ICT Disaster Recovery Plan at a later date.

Telecommunications

2011/12 Review

Progress on Telecommunications was also hampered by a lack of progress in Organizational Change Process. However, a number of projects have been delivered that have increased the resilience of the DGH switchboards and the Out of Hours Contact Centre whilst also delivering on the first phase of a project to integrate call handling across the three DGH switchboards and implement a common BCUHB telephone directory.


Prepare a Telecommunications Strategy for BCU to encompass the delivery of unified communications at

The Telecommunications Strategy was deferred until the second half of 2012/13 in order to address a

28

the desktop. number of operational and practical issues. A number of projects were started to mitigate areas of risk. Chief amongst these were the installation of additional hardware to Ysbyty Gwynedd and Wrexham Maelor Hospital switchboards and Ysbyty Glan Clwyd Contact Centre to increase resilience.

Rationalisation of switchboard technologies and services.

A review of all switchboard technologies is near completion with a view to the rationalization of existing assets and proceeding to tender for a single support contract in 2012/13.

Rationalisation of call logging administration. The replacement of the call logging system in the West has been deferred until the last quarter of 2012/13.

Implement a mobile call traffic gateway to reduce call costs between land line and mobile phones.

Options being reviewed.

Contribute technology support in order for the organisation to identify, design and implement a common telephone directory.

Phased approach to a fully integrated switchboard service with a single common telephone directory has been determined with the 1

st phase included

within the projects to increase switchboard resilience. 2

nd phase and completion planned for

2012/13.

Contribute to the prioritised, and agreed, level of support to the capital build programme/ CPG & Corporate “moves and changes”, identify skills & resource costs required for inclusion into additional scheme business cases.

Demand has been particularly high in 2011/12 due to the number of site closures and the subsequent relocation of staff.

2012/13 Priorities

Priority for 2012/13 is to establish a telecommunications organizational structure that pulls together the existing resources into a single coordinated and cohesive service offering the end user a consistent and effective experience. Because of ever closer divergence of data, voice and video technologies to form the new and emerging unified communication technologies, telecommunications will initially be considered within the four ICT Infrastructure strategic work streams and only if this becomes operationally or strategically impractical will a separate work stream be established to progress a telecommunications strategy.

Single telecommunications organizational structure

Implementation of common operator/switchboard software. This would enable calls to be routed and handled according to switchboard resource availability

Negotiate and agree new duty rotas to maximize staffing levels and take advantage of new call routing functionality.

Review telecommunication maintenance arrangements with a view to establishing a single telecommunication maintenance contract.

Review all call charges with a view to establishing more effective call handling services and call tariffs.

29

Education, Training and Development

Ensuring our staff have the knowledge and skills they require to deliver the service. The OCP process and

inevitable

2011/12 Review

Providing training to IT users across BCU presents many challenges, there are currently 5 training

resources, 3 based in east and 2 in central. Reorganisation will help with the development of a pan BCU

training strategy which should make available some resource to support staff in west.

The team take a mixed approach to training by offering classroom based and workplace training.

Although resources have been stretched to support the WCP project there are other activities are still

being undertaken.


Local Clinical & Administrative Systems

Myrddin/iExpress/ Pims/EPOC/WDS/TPath/RadIS

The provision of this service has been restricted as a result of a bias towards the National Solution Training.

Microsoft Office, ECDL, Essential IT Skills

Word/Excel/Access/PowerPoint

First Click/File Management/Internet & Email/

CDL Advanced/ECDL Essentials/ECDL Extra

These have progressed over the year mainly centered in the East which has test centre status. With the advent of changing requirements the provision of this service will need to be reviewed.

National Clinical & Administrative Systems

Welsh Clinical Portal [inc retraining all current OCS consumers], WCCG, IHR and MHOL in primary Care, eMPI

This has been a challenging year supporting a changing and iterative timescale particularly in support of the Welsh Clinical Portal. As a result early adopters have been trained more than twice which is a drain of resources overall.

e-Learning

There has been limited use of e-learning this year being restricted to aspects around the WCP.

2012/13 Priorities The provision of IT training will need to evolve into one that is more of an informatics focused service which will support the interactions of clinical and administrative process improvements in all areas of the Health Board rather than one which solely teaches the functionality provided by the solution with limited reference to the detailed working context. The recently produced ‘Enhanced Learning Through Technology At BCUHB’ will require a review leading to, potentially, a re-alignment of training services.

Impact Assessment of the vision articulated in ‘Enhanced Learning Through Technology At BCUHB’

Impact assessment resulting in the change of national solutions provision to the Health Board Outline strategy for the Informatics Training objectives, requirements, capacity and capability

with the EDT services Rebalancing of training support across the geographically dispersed Health Board Undertake training in support of Myrddin Upgrade [East], Real Time Data Entry [Surgical CPG],

PIMS & Homer PAS.

30

8. High level three year plan and constituent projects

Betsi Cadwaladr University Health Board has been at the forefront of selection and development of

future national solutions opting to ‘go first’ in a number of areas. This has a consequential impact on the

prioritisation of projects within the Health Board due to the dependency and readiness work which

require completion as pre-requisites. As a result the project work undertaken over the three year

planning period is inevitably skewed in favour of these implementation objectives.

In addition, the design and architecture of the national solutions narrow options and room for

manoeuvre when developing or extending local solutions. Whilst in the short term [18months] if may be

possible to move forward on local issues the future convergence with national architecture is narrowly

defined and in effect ‘locks out’ some options. In other words they would become obsolete with any

investment wasted. Balanced against this is the ability of the national programme to deliver to time,

something which to date has been challenging, although recent deployment timescales have improved.

These are just some of the challenges that the Health Informatics Group will need to process whilst

prioritising the Health Board programme.

The following pages provide a summary of the key deliverables for the next three years. The plan

outlines the stages of each project and the key strategic and financial milestones. These include;

1. National and Local Relationships – Figure 1

2. Enterprise, Proof of Concept & Infrastructure, and Other BCU Wide Projects – Figure 2

Each project on the plan has a detailed supporting project brief and, in addition, there are many projects

which need to be delivered over and above those detailed in this plan. Each of components will be

tracked through the business plan and the workload monitoring system and reported to the Information

Governance Committee through HIG.

The follow key identifies the various project stages and decision points on the plan.

Decision Point/investment required/business case

Strategic Decision

Planning, Readiness, Teams establishment, Mobilisation

Planning Assumption

Implementation

Go Live

Re-Scheduled [Previous] [Additional]

Halted

31

IM&T Strategic Plan 2012-2014

National & Local Relationships Q Eff M

A M J J A S O N D J F M A M J J A S O N D J F M A M J J A S O N D J F M

Central Order Communications Closure

Welsh Clinical Portal-Pathology Test Reporting √ √ √ Option 1 To Service Support

Welsh Clinical Portal-Radiology Result Reporting √ √ √ Option 1 To Service Support

Welsh Clinical Portal-Pathology Test Requesting √ √ √ Option 1 To Service Support

Welsh Clinical Portal-Radiology Services Request √ √ √ Option 2

Welsh Clinical Portal-Order Set Requesting √ √ √ Option 2

Services, Tests, Results Reporting [STARR] √ √ Option 1 To Service Support

Homer PAS √ √ Acute Migration

Maternity Solution √ √ Acute Migration

Accident & Emergency √ √ To Service Support

Laboratory Information Management System [LIMS] √ √ To Service Support

National Pathology Handbook √ √ To Service Support

GP Test Requesting and Results Reporting [GPTRRR] √ √ To Service Support

Cancer Histology Information Reporting Project [CHIRP] √ √

West

Welsh Clinical Portal-Pathology Test Reporting √ √ √ W To Service Support

Welsh Clinical Portal-Radiology Result Reporting √ √ √

Welsh Clinical Portal-Pathology Test Requesting √ √ √

Welsh Clinical Portal-Radiology Services Request √ √ √

Welsh Clinical Portal-Order Set Requesting √ √ √

PIMS PAS √ √ Acute Migration

Maternity Solution √ √ Acute Migration

Accident & Emergency √ √ To Service Support



Anti-Coagulation √ √ To Service Support


Cancer Histology Information Reporting Project [CHIRP] √ √ To Service Support

East

Welsh Clinical Portal-Pathology Test Reporting √ √ √

Welsh Clinical Portal-Radiology Result Reporting √ √ √

Welsh Clinical Portal-Pathology Test Requesting √ √ √

Welsh Clinical Portal-Radiology Services Request √ √ √

Welsh Clinical Portal-Order Set Requesting √ √ √

Myrddin - 305 √ √

Maternity Solution √ √

Accident & Emergency √ √

Theatres √



Anti-Coagulation √ √ To Service Support


Cancer Histology Information Reporting Project [CHIRP] √ √ To Service Support

Apr-Jun Jul-Sep Oct-Dec Jan-MarOct-Dec Jan-Mar Apr-Jun Jul-Sep Oct-Dec Jan-Mar

2012/13 2013/14 2014/15

Apr-Jun Jul-Sep

Figure 1

32


Enterprise Systems Q Eff M


Myrddin - Enterprise Acute Migration Merge To Service Support

Myrddin - Central - Mental Health Merge To Service Support

Myrddin - Central - Community Merge To Service Support

Enterprise Master Patient Index [eMPI] √ √ To Service Support

Individual Health Record [IHR] √ √ To Service Support

My Health On Line [MHOL] √ √ To Service Support

Radiology System Consolidation √ To Service Support

Welsh Clin Com Gtwy-Electronic Prmy Care Refls √ √ To Service Support

Welsh Clin Com Gtwy-Electronic Tfr of Refls to PAS √

Welsh Clin Com Gtwy-Electronic Clin Mangmt of Refls √


Q Eff M

Proof of Concept A M J J A S O N D J F M A M J J A S O N D J F M A M J J A S O N D J F M

Medical Records Scanning [EDRMS]-Pilot √ √

Random Filing Health Records √ √ To Service Support

Proof of Concept-Digital Pens √ √

Proof of Concept-Self Registration Touch Screens √ √

Text Messaging √ √

Business Intelligence-Consolidation of Warehouses √

Business Intelligence-Referral to Treatment Information √ √

Infrastructure

Video Conferencing √ √

Serv Mangmt & Sup-Service Desk Software √ √

Serv Mangmt & Sup-Service Desk - ITIL √ √ √

Serv Mangmt & Sup-Profile Management [Clinl Systms] √

Core Network Upgrade √ √ P2

Telecommunications Review √ √

Encryption - Mobile Media Encryption √

Desktop Replacement and standardisation √ √


Other Health Board Projects [ Informatics assisting] Q Eff M


PACS Re-procurement and RadIS integration √

Therapy Manager

Speech Recognition √ √

Estate Capital Schemes √

HSDU √ TBC

EBME √

Apr-Jun Jul-Sep Oct-Dec Jan-MarOct-Dec Jan-Mar Apr-Jun Jul-Sep Oct-Dec Jan-MarApr-Jun Jul-Sep

Apr-Jun Jul-Sep Oct-Dec Jan-Mar

2012/13 2013/14 2014/15

Oct-Dec Jan-Mar Apr-Jun Jul-Sep Oct-Dec Jan-MarApr-Jun Jul-Sep

Apr-Jun Jul-Sep Oct-Dec Jan-Mar

2012/13 2013/14 2014/15

Oct-Dec Jan-Mar Apr-Jun Jul-Sep Oct-Dec Jan-MarApr-Jun Jul-Sep

2012/13 2013/14 2014/15

Figure 2

33

National & Local Relatonships Solutions

A number of these solutions have been described earlier and are not repeated; however the scope is

defined in more detail.

In central to move away from aging technology it is necessary to decouple a number of

services from each other e.g. Homer PAS and its Order Communicatuions System. With a

migratoiion to National products this prcess is proving vastly complicated at a time when the

delivery timescales and sequence are key to the migration process.

Cancer Histology Reporting System - to be implemented post new LIMS across all the

Pathology CPG to improve data recording, reporting locally and national screening services.

GP Test Requesting and Result Reporting - this functionality will enable GP’s to order services

from Pathology Departments [using the new LIMS] and will be similar to the Welsh Clinical

Portal. However it will require the following applications to be implemented: WCCG; WCP

TRRR Services; and Welsh Pathology Handbook. Ultimately it will replace the existing legacy

solution in the East.

LIMS - the new national solution will enable the modernisation of the CPG –Pathology once

implemented. This is a complex project which is led by the CPG but has support from

Informatics

Anti-Coagulation Software - this is a pre-requisite for the replacement of LIMS. This is in the

final stages of implementation replacing functionality within the old system which was as part

of the LIMS Programme.

National Pathology Handbook - current testing work is based around a local derivative of the

handbook which provides details around test names, ranges, equipment. It will be

transformed into a national handbook during the LIMS implementation.

WCP - the functionality to support Pathology Requesting & Reporting in Acute sites across

North Wales will be deployed in phases. Issues with functionality in Central have significantly

jeapordised the implementation timescales. This will be still be required in order to support

the end to end processes coupled to the LIMS implementation.

Enterprise Programme

The prioritisation of these schemes is subject to approval through the Informatics Governance Structure

and in some cases by the National Programme. The main impact areas to be considered are as follows:

Myrddin -Early discussions have commenced over the feasibility of advancing the

consolidation of the current legacy PAS solutions. Following the review proposals will be

brought forward to achieve the objective as early as possible. This transformation, although

providing longer term benefits, will be a major impact to the organisation.

34

Mental Health Review - This will require early direction due to impending legislation with the

likely solution being Myrddin dependent, albeit after further development work.

Community Solutions -A pilot of new technology previously described but likely to be Myrddin

dependant will be undertaken in this area following a requirements review

eMPI -this initially will contain demographic information from the current PAS systems in the

HB in a uni-direction manner i.e. PAS to MPI. This will then be linked through service requests

with the new LIMS which requires one source for the HB

WCCG - the first phase of this deployment is underway and was largely completed across all

primary care in north Wales by the beginning of Feb 2012. This will enable transmission of

generic electronic referrals and also provide a ‘carrier’ to support the GPTRRR functionality

later in the year.

IHR - Currently live in North West Wales approval has been given to roll out the solution to

all Out-of hours services across North Wales

Radiology System Consolidation - As part of the legacy system review the consolidation of the

current three local systems has been identified. However progress can only be maintained

with the agreement of the supplier, NWIS, who currently are planning an indicative date

commencing Post PACS Contract.

MHOL -no formal approval at a local level has yet been given for this ministerial imperative but

plans to commence Early Adopter work has been requested by NWIS.

Proof of Concept & Infrastructure Projects To limit exposure and rsik of ringing new ways of

working into the service environment some proof of concept projects are being run with CPG

support and corporate support. These include Medical Records Scanning which has been

described earlier and will impact across the entire organisation bringing record access benefits

and Digital pen technology which would appear to bring support to the peripaetetic worker.

Business Intelligence -This has been described earlier and the scope is currently being

determined prior to submission for approval

Discharges - A number of options are available to pursue the objective of timely and concise

discharge summaries. However the solutions available appear to be in conflict with the stated

national strategy and are therefore being reviewed prior to approval to proceed

Additional Infrastructure projects form part of the business as usual and technical statutory work that

needs to be carried out by the Informatics department.

Other BCU Wide Projects

Historically ICT has assisted projects within the organisation where the technology has been part of a

wider initiative on a best endeavours basis i.e. after the main ICT Programme has been resourced.

However recent Estate Rationalisations have brought an urgency and presenting demand in order to

ensure Business Continuity of Clinical Services. Such assistance will continue subject to initial reviews of

work scope requests through the Informatics Governance structure.

35

9. Financial Capital Planning

ICT Capital Allocation for BCUHB

The Capital Allocation required to support the ICT programme for BCUHB will be prioritised by the Health Informatics Group. The following sections outline the challenges to be addressed; the principles which need to be applied to prioritise investment; the allocation themes; an outline approach to programme management; risks to managed [including financial accounting] and concludes with a draft apportionment of a capital programme. In support of the new ICT National Directive this paper brings together all the ICT components (national implementations and local priorities) into one programme.

Summary of Implementation Challenges It is anticipated that the capital allocation available to Informatics will be reduced by 15% [7%+7%] for the next two years at least. This follows 11/12 where a one off reduction in year of £500,000 was levied to support clinical services and reinstated at the end of the year limiting flexibility around priorities [some having long lead times]. A number of factors need to go right to maintain momentum and these include:

ICT Leadership and Communication Architectural plan for legacy & national solutions, focused dependency management, clear decision structure, comprehensive alignment with BCUHB Objectives and consequent revisions to working practices

Programme Prioritisation Service representatives understand the capabilities and deployment speed of ICT, confirmation of the ICT capital allocation, identification of the programme costs [project costs], its ongoing support costs[ revenue and capital charges] and how this will be paid for over the assets life [benefits realisation].

Project Management Capacity Project managers within the ICT structure are partly funded by NHS Wales Informatics Service [NWIS] who will be issuing SLA's to ensure their capacity will be focused on alignment with national projects. This will require a prioritisation of capacity in local Project Management or additional funded capacity built into any new schemes seeking approval.

Sustainability Informatics within BCU will provide services in line with the operational plan which enable the working practices of clinicians to achieve continuous improvement into the future

Failure to identify mitigations to these factors will delay programme/ project initiation and deployment.

Capital Allocation The capital allocation for 2012/13 is outlined below having been reviewed by the Health Informatics Group and submitted to the Information Governance and Finance & Performance Committee respectively. Since that submission the 2012/13 priority list has been evaluated and prioritised.

Title: Capital Programme 2012/13

36

10.

Scheme Expenditure Proposals

ID

Project Proposed

2012/13

Capital

Allocation

£

Stage

Start

Stage

end

Comments Priority Status

GP Requesting - National 45,000 Apr-11 Apr-12 Sunquest – National Funding B/F 1 Ordered

Anti -Coagulant Software 50,000 Apr-11 tbc Procurement completed, readiness work

advanced, pending confi rmation of LIMS

dates to fina l i se implementation 1 Ordered

Estate Schemes 15,000 Apr-12 Mar-13 12/13 YG work not finished in 2012/13 1 Ordered

Medicode /Software - West 32,500 Jan-12 Mar-12 Ordered but not completed in 2011/12 1 Ordered

PAS Real i ty Licences 60,000 B/F whi ls t Enterprise discuss ions continued

1 Ordered

Network Infrastructure Upgrade

Phase 2 - WEST

300,000 Jan-12 Jul -12 Work deferred due to re-profi l ing of capita l

programme for Orthopaedics Plan.Deta i led

des ign work completed. Formal

procurement of hardware commenced with

tender to be completed before the end

March 2012 to enable award of contract in

Apri l 2012. 1 Ordered

Bringing Assets into use 112,856 Apr-12 Mar-13 Al located s taff time to National & Local

schemes inc Estate & Bus iness Moves – In

l ine with 2011/12 1 Ordered

Video Conf – Phase 1&2 100,000 Jan-12 Mar-12 Procurement commenced for implementation

by end of March 2012. 1 Ordered

NEW

Case Note Scanning 38,200 Apr-12 Aug-12 HM Stanley Closure requires removal of

records , digi ta l scan rather than s tore in NW

Wales 1 Ordered

Ongoing Hardware Replacement

12/13

200,000 Apr-12 Sep-12 Phase 1

1 Ordered - Monthly

Ongoing Hardware Replacement

12/13

200,000 Oct-12 Mar-13 Phase 2

1 Ordered - Monthly

National Implementation – Local 53,480 Apr-12 Mar-13 inc Sunquest Orders ra ised at request of the

National team.[8207981 & 8228498] 1 Ordered - Part

WiFi/Cabl ing - EAST 20,000 Aug-12 Dec-12 Cabl ing & Implementation 1 Ordered

Storage Expans ion – EAST & WEST 75000 Bus iness continuity mitigation whi ls t

s torage s trategy fina l i sed 3 CAF Issued

Operator Consul Software

Upgrade - BCU

100,000 Jun-12 Dec-12 Enables s tandardisation and load balancing

of switchboard services resulting in an

overa l l reduction in the number of

switchboard operators 3 CAF Issued

AMEND

VMWARE Expans ion – WEST 5,000 tbc Increase capaci ty whi ls t awaiting the

outcome of the infrastructure s trategic

review 3 CAF Issued

YGC Redevelopement Network

Decant – CENTRAL

30,000 Aug-12 Sep-12 Network Equipment required for bus ines

continuity during ward moves . 3 CAF Issued

Telecoms Strategy 30,000 Apr-12 Sep-12 Work deferred due to re-profi l ing of capita l

programme for Orthopaedics Plan. 3 CAF Issued

Infrastructure Strategy 30,000 Nov-12 Mar-13 Review desktop and infrastructure s trategy 5 In Principle

DC Switch Upgrades – CENTRAL &

EAST

150,000 tbc Upgrade of DC switches to provide a

necessary increase in capaci ty and improve

DC centra l management 5 In Principle

NEW

VM Ware Licencing 50,000 tbc Expans ion of exis ting VM environments to

enable on-going consol idation of exis ting

servers . 5 In Principle

NEWCore Switch Res i l ience (East) 15,000 tbc Core IP Switch requires extra hardware to

provide greater level of res i l iance 5 In Principle

NEWCore Switch Res i l ience (West) 53,000 tbc Core IP Switch requires extra hardware to

provide greater level of res i l iance 5 In Principle

SharePoint Strategy 30,000 Apr-12 tbc Review Document/Sharepoint Strategy 7 Awaiting Deta i l s

SAN Strategy 30,000 Sep-12 Mar-13 Review Document/Storage Strategy 7 Awaiting Deta i l s

Digi ta l Pen Early Adopter 24,946 tbc Work deferred due to re-profi l ing of capita l

programme for Orthopaedics Plan. 7 Awaiting Deta i l s

AMENDElectronic Digi ta l Medica l Record

Solution - Pi lot

70,000 tbc Bus iness Case Approved – Proposal for Pi lot

Phase - East 7 Awaiting Deta i l s

AMEND Provis ion 2011/12 Rol l Over 0

TOTAL PROGRAMME 1,919,982

Likely Allocation

Base Allocation 1,669,000

Brought Forward 172,500

NWIS 13,440

Revised 1,854,940

37

Workforce

Overview

Consideration of the organisational change policy and a review of requirements to develop a structure to meet the

needs of the organization have been completed. This is within a context of addressing the financial constraints

placed on Informatics and all other departments within the Health Board.

The operational demands on the service means that interim heads of service for Information, IT and Programmes

for the next six months have been appointed and are as follows

Head of Information – Richard Walker [based in Centre]

Head of ICT – Jeff Pye [based in the West]

Head of Programme & Clinical System Services – Mike Lugg [Based in the East]

They will spend time at each of the sites to support everyone but also act as senior manager for each location for

general day to day issues.

This should assist in cross departmental communications and help to focus on delivering and improving the

service. Their main focus will be on the delivery of the operational plan and ensuring the personal development

and management support of the Informatics staff.

Staffing Numbers

The Head count [Table 7] at the end of March 12 was 345.42 and this is planned to reduce slightly as a consequent

of reductions due to VERS offset by increases in Programme, Health record & Coding staff.

Organisation Change Process

A number of discussions have taken place where the expected structure was shared with staff. Following submissions to Finance and Executives the department has now been given the go ahead and

WTE Actual y/e 31st March 2012

Pay Band

Range

WTE

Actual

11/12

WTE

Actual

10/11

A&C Bands 1-6 315.65 320.72

A&C Bands 7-8d 29.77 29.56

Other 0.00 0.00

Total 345.42 350.28

Table 7

38

has undertaken aformal consultation. The document was published by the normal corporate routes and follow on session with representation from WOD and Staff-side. Health Informatics Professional and Workforce Development

National

Nationally there is a continued focus on Informatics professional development. We will be working with

NWIS and local WOD teams to influence the national agenda for the training and development of staff

in an effort to mainstream the Informatics profession.

Because the main focus of the Informatics service has been on the implementation of major national

systems there have been a number of opportunities for staff development which could easily be

overlooked and it is important that the staff contribution to the projects be recognized. The challenge of

implementing systems that will impact all health care workers coupled with the need to understand

new technologies and manage competing projects at national and local level has given many Informatics

staff an incredible opportunity to develop new skills and adapt to working in a unique environment. Few

people have the opportunity to work at the interface of operational staff ( Laboratories, clinicians,

admin staff), new technology and 3rd suppliers at such a large scale. There is no doubt that the learning

from these projects will help the Informatics staff support CPGs with future local projects.

Local developments

We have worked with WOD to implement Oracle Manager and Employee Self Service and have implemented the CARE approach with Occupational Health Services. In addition we have been supporting the technology to support the establishment of the CARE project.

11. Risks Informatics maintains an actively maintained risk register which includes all aspects of the service

provision. The top risks, and changes in the period, are reported to the Health Informatics Group as

part of the bi-monthly update. The top risks outlined in the March 2012 HIG report are reproduced in

Appendix A.

12. Glossary A&E system An A&E system is used to record attendances in both major

and minor emergency settings. BCU has three different

systems in operation across the HEALTH board. Whilst some

record only attendances others follows the journey of the

patient recording clinical details and flagging the time they

have spent within the department.

CHIRP Cancer

Histopathology

Reporting Project

A service improvement project to streamline and improve

the quality, completeness and availability of cancer

histopathology information across Wales.

39

Digital Dictation This allows clinicians [and others] to dictate to a digital file

which can be accessed from anywhere within the Health

Board for transcription.

Digital Pens A new technology which facilitates digital recording of

information as part of a paper-based workflow particularly in

the areas of peripatetic working and of shared care.

EDM Electronic

Document

Management

This solution provides clinical benefits by facilitating instant

access to digital records and reduces costs through the

release of storage, maintenance, filing, retrieval and

transport and transportation of paper-based patient notes.

EDS Electronic

Dispensing

System

All Wales Pharmacy dispensing system

Encryption A framework contract of standard encryption products and

services, which can be used to help organisations protect

sensitive information

Endpoint The Endpoint solution provides a hard disk encryption

solution for desktop and laptop PC’s so that information can

be protected in otherwise unsecure environments

EPOC Electronic point

of care

EPOC is a solution which provides an effective mechanism to

capture clinical information and create structured electronic

discharge information.

GPTRRR GP test

requesting and

resorts reporting

This nationally developed solution provides GP's with the

ability to request tests and received results for pathology and

radiology electronically utilising the Welsh Clinical

Communications Gateway.

IHR Individual Health

Record

The IHR provides an electronic bridge between urgent and

primary care settings by providing access to the GP record

which gives doctors and nurses the information they need to

help them make important decisions about how a patient is

treated. This is limited in the first instance to the Out of

Hours service in North West Wales.

LIMS Laboratory

Information

Management

System

LIMS is used in pathology for recording and exchanging

information such as blood test results. The systems also link

to the machines which conduct the tests and analyse the

samples.

MHOL My Health Online My Health Online will give patients the opportunity to book

GP appointments, order repeat prescriptions, update their

40

general details such as change of address, keep a health diary

and make it easier to organise their healthcare, all from the

convenience of their own home.

41

13. Appendix A – Significant Risks to Informatics

Extract from Informatics Risk Log

Further Action

proposed/

controls required

Description Status Consequence Likelihood Description Status Description Consequence Likelihood

INF01

Delivery

through third

parties 17.05.11

We may face lack of clarity on delivery of

the National Informatics Programme

Proximity = On-going

Mitigated by a

clear plan from

NWIS and

ourselves Red 4 5 Red

Continued

engagement with

NWIS. Documented

commitment to

timescales from

NWIS, monitoring of

timescales by local

staff. Escalation of

concerns/timescale

breaches 4 4

A clear and

achievable plan,

which confirms

that key

milestones have

been met

INF03 Operational 17.05.11

a lack of a formal departmental structure

may result in service delivery delays,

staff retention issues and contribute

towards lowered productivity/staff moral

Proximity = current timeOrganisational

change programme Amber 4 3

Staff appraisals

Complaint reports

Staff satisfaction

surveys/service

user surveys Amber

Progress with OCP

and engage with all

staff groups/ service

heads 4 2

INF06 Operational 17.05.11

The demands being placed upon the

informatics Service continue to grow, while

the resource available to meet these

demands diminish or remain the same.

There is a risk that service demands may

not continue to be met

Proximity = Current time

Service review

Processes for

additional work

requests Red 4 4 Red

Baseline current

service provision

Use 'best practice'

across all sites

Modernise service

to release

efficiencies

Agree available 4 3

Creation of

additional capacity

with current or

less resource

INF14

Delivery

through third

parties 20.05.11

Projects which depend on the resources

from the NWIS integration team may be at

risk due to resource constraints within the

team or due to the 'make up' of the largely

based contractor team'

Proximity = Immediate

Monitor risk and

any project

slippage via local

project boards. Red 4 4 Red 4 3

Delivery against

plan and to agreed

specification

INF 24 Operational 10.10.11

That staff may be injured or suffer from

health and Safety related issues due to

insufficient space within Health Record

Libraries. E.g there is not enough shelf

space to accommodate all notes so notes

are stacked on floor (overspill area),

crammed in shelves, put in cages and other

'temporary' places ie boxes. This increases

the risk of injury and hazard for staff

Safe system of

work

Red 3 4

Risk Assessments,

boxes to be

replaced with bags

to limit weight in line

with load handling

guidance. Staff to

attend load handling

course 3 2 Health and Safety

INF29 Strategic 29.11.11

The reputation of the HIG and the Informatics

department may be adversely affected if

sufficient capital is not available to support IT

implementations (that are supported and

required by the organisation and that have

the required revenue funds available) Red

Risk DescriptionTarget RiskExisting Controls Current Residual Risk

Risk Type

Performance/

Outcome

Measures

Sources of AssuranceRisk Ref.

Date

Opened

Betsi Cadwaladr University Health Board Committee Paper 11 ... IOPlan.pdf · Betsi Cadwaladr...

Documents

Transcript of Betsi Cadwaladr University Health Board Committee Paper 11 ... IOPlan.pdf · Betsi Cadwaladr...