THE LEEDS TEACHING HOSPITALS NHS TRUST

Trust Board 30 August 2007 Report of Brian Derry Paper prepared by Alastair Cartwright Subject/Title Informatics Update Paper discussed at October 2006 Board (private section): “Update on Connecting for Health (CFH) and the National IT Programme (NPfIT)” To meet Board request for an update on informatics developments To note progress, risks and mitigation. Background papers Purpose of Paper Action/Decision required Link to:  NHS strategies and policy Link to:  Trust’s Strategic Direction  Corporate objectives National Programme for IT DH Operating Framework for Information Management & Technology Resource impact Consideration of legal issues Information and IT supports many Trust objectives, including financial balance, access targets and clinical quality. Already covered through business and capital planning processes. Have all relevant legal issues been considered fully during the preparation of this paper? Yes Defined the first time they appear in the paper. Acronyms and abbreviations D:\Docstoc\Working\pdf\a7ac39e0-0788-40ac-932e-91fcad7271c4.DOC 1 THE LEEDS TEACHING HOSPITALS NHS TRUST TRUST BOARD – 30th AUGUST 2007 INFORMATICS UPDATE Introduction 1. This paper notes significant recent informatics developments, outlines current plans, takes stock of future opportunities and assesses current risks and issues. 2. The Informatics Directorate continues to provide a wide range of core operational services [see Annex 1]. In addition, many major new systems and technologies have been implemented over the past year. National context 3. The departures have been announced of the Chief Executives both of NHS Connecting for Health (CFH), Richard Granger, and the Information Centre for Health and Social Care, Professor Denise Lievesley. The recent Government reshuffle has also seen the departure of the Minister responsible for the National Programme for IT (NPfIT), Lord Philip Hunt. The implications of these changes are as yet unclear but some re-organisation and reprioritisation may be expected. 4. Implementation continues of the NPfIT Local Ownership Programme (NLOP), whereby increased responsibility for delivering NPfIT passes to SHAs and local health communities. This has brought stronger roles for Strategic Health Authorities and Primary Care Trusts in leading local informatics strategies (see below). This includes formal responsibility for assessing and improving local informatics capability and capacity. The Trust is represented on the national steering group developing a framework and tools for this assessment. Governance and clinical engagement 5. Under the NHS Operating Framework for 2007/08 the Trust was required in April this year to produce an Information Management and Technology plan for formal approval by the Strategic Health Authority (SHA) and Leeds Primary Care Trust (PCT). It includes a forward-looking „roadmap‟ for major systems - see Annex 2. 6. The internal governance arrangements for Informatics continue to be strong, lead by the multi-disciplinary Informatics Strategy and Programme Board, chaired by the Medical Director. The Trust was assessed as „green‟ under the annual Department of Health (DH) Information Governance review, with significant improvements on last year. 7. Over 50 clinicians are working directly with Informatics staff as part of a Project Board or implementation team. In addition, 6 senior medical staff have just volunteered to act as (unpaid) Clinical Leads for Informatics, supporting and advising the Informatics Directorate. New and enhanced systems, technologies and services 8. Systems  The Dental Institute implementation of Trust‟s Patient Administration System (PAS) achieves the goal of having all Trust services on the same PAS.  The new multi-specialty Clinical Information System is now live in Orthopaedics.  New Theatre system is in use for scheduling trauma and acute sessions.  A new Radiology information system is in place, with some further work to do on service processes and integration with the digital x-ray “Picture Archiving and Communications System (PACS). D:\Docstoc\Working\pdf\a7ac39e0-0788-40ac-932e-91fcad7271c4.DOC 2       e-Learning has delivered training for 3000 staff in the new areas of Infection Control, cannulation, patient confidentiality and patient administration. Further enhancements to Emergency Care systems. New or enhanced clinical systems for: Retinal Screening, Results, Assisted Conception, Cleft lip and Palate, Dental, Chaplaincy, Wheelchairs. Redesign of the Trust intranet, with new “talkback” facility. Piloting of speech recognition technology for clinicians and managers. New performance reports to support LTHT and PCT on outpatient demand management, 18 weeks referral to treatment times, and Choose and Book. 9. Technologies Much essential investment is unseen by the majority of the Trust. Recent achievements include:  The Trust Paging system (pagers and transmitters) has been replaced and is now provided on the latest digital technology  The St.James‟s telephone exchange has been upgraded. This provides new call handling facilities for the Referral and Booking Service and extra capacity for the New Oncology Wing.  The data network, both within and between Trust sites, has been significantly upgraded, especially to cater for sending digital images around the Trust.  Automatic network monitoring and alerts now cover 160 servers and 200 databases.  Over 400 Smartcards have been issued to Trust staff. This is the approved access method for national systems and will also start to be used for access to Trust systems. 10. Services  Measurable improvements continue in the completeness, depth and timing of clinical coding.  PAS is now compliant with the technical requirements of Choose and Book.  LTHT has played a leading role nationally in the development of information systems to meet the requirements of the 18 weeks referral to treatment target.  The Trust Referral and Booking Service (RBS) and Medical Records were successfully transferred in May 2007 to the Clinical Support Directorate.  LTHT and the University of Leeds are developing a shared library service at St James‟s Hospital. The Library catalogue is now searchable over the internet, from work or home.  Following the recommendations from a Robson Rhodes audit, work is underway, starting with Pathology, to centralise some Trust Clinical Management Team (CMT) IT functions and staff under the Informatics Directorate. This will improve cover, efficiency and compliance with standards, and support the professional development of staff. Further delivery during 2007/08 11. Key priorities for the rest of this year include:  Installing the IT network and systems for the Now Oncology Wing. The Informatics Directorates technical solutions and approach has just been endorsed by an independent “due diligence” review.  Digital x-ray technology (PACS) will be implemented, first within the whole of Radiology and then the New Oncology Wing and associated services.  The multi-specialty Clinical Information System will be expanded within Orthopaedics and then implemented in Neurosciences.  The Theatre system will be used by all surgical specialties to produce theatre lists.  PAS will start to be used for occupational health, dietetics and physiotherapy.  The Trust will commence e-booking, in line with Choose and Book.  e-Learning will be used for junior doctor induction.  LTHT IT policies are being updated and integrated.  Developing the requirements for new Renal and Maternity systems.  The Emergency Care system will be rolled out to the Leeds Assessment Areas; it will also link to a Pharmacy robot. D:\Docstoc\Working\pdf\a7ac39e0-0788-40ac-932e-91fcad7271c4.DOC 3    A new Bed Request Module of the Emergency Care system will automate the links between emergency care / assessment departments and the bed board. Further developments to Results, including test ordering, primary care access, remote access and enhanced security. Out of hours 24x7 IT cover implemented. Where next? 12. Increasingly technology itself is less of an issue than the organisational „change‟ required to embed new processes in everyday practice. The Informatics Directorate has recently produced an analysis of potential „Invest to Save‟ opportunities from the improved use of technology. As an example, the real-time collection of admissions, transfers and discharges by ward staff would significantly improve the Trust‟s ability to manage its bed capacity. Without such it will be difficult to implement future improvements such as electronic prescribing. These initial, broad-based proposals will be refined to identify the specific strategy and investment plan that will maximise the return on investment either financially or by „futureproofing‟ the Trust and contributing to Foundation Trust status. A further paper will be brought back to the Trust Board. 13. National informatics strategy 14. The paper on informatics presented at the October 2006 Trust Board provided a progress report on the national IT programme and its impact upon the Trust. Our assessment still holds. The Trust continues to make good progress with three national systems: PACS, the Radiology Information System, and Choose and Book. The major systems „roadmap‟ [Annex 2] shows how local, tactical systems will migrate to national strategic systems. The implementation of NPfIT systems in secondary care is improving, with successful PAS and PACS implementations across the country. However, there is still some uncertainty around the availability of the new „Lorenzo‟ integrated electronic patient record system being developed by iSOFT. 15. Conclusion 16. Important progress has been made in mitigating risks identified in last report to the Board, and some new ones – see Annex 3. Experience from industry highlights the need to harness the opportunities created by IT to enable improvements in operational processes. There is significant potential to do this within the Trust, following significant investment in the Trust‟s core IT infrastructure and systems. However, technology-initiated change remains complex: the best prospects come with making sure such change is service-led, and integrated with the redesign of processes, roles and responsibilities. Brian Derry Director of Informatics August 2007 D:\Docstoc\Working\pdf\a7ac39e0-0788-40ac-932e-91fcad7271c4.DOC 4 Annex 1 Key Informatics measures: year 2006/7 (unless otherwise stated) IT infrastructure  7,000 Personal Computers (PCs) and 160 servers supported; nearly 2,000 other devices connected to the network, including medical devices and laboratory equipment. The number of network connections is growing at the rate of 1,000 new devices per annum.  LTHT network operates at 750 giga bits per second - about 3 million times the capacity of the average home broadband. It comprises about 2,500 kilometres of wiring.  10.2 Terra Bytes of computer storage is available (1TB = 1,000,000,000,000 bytes) enough for around 40 million Word documents.  Helpdesk calls - 32,000 Telephone infrastructure  Telephone extensions 9,500; mobiles 900; pagers 2,100  Incoming calls 15 million; internal calls per month 12million, pager calls 1.2 million Network security  Anti virus software installed on all known PCs  Major virus attacks on the Cookridge and Seacroft sites quarantined and cleared.  1 million emails blocked as junkmail (“Spam”) Systems  9,000 users of the GroupWise email and diary system; 2 million emails stored.  Results service supports 6000 users, with about 1-2 system “hits” every second. Information services  CMT Information: 1,000 ad hoc requests; 1,300 regular reports.  Central Returns: 270 daily, weekly, monthly, quarterly and annual returns to the Department of Health; 4,500 aggregate returns to PCTs (practically every PCT in England and Wales); 2,500 ad hoc PCT queries.  Commissioning Information: 135,000 rows of patient level information from 60 data feeds are analysed each month to produce reports for 350 commissioners.  Clinical Coding: 228,000 episodes coded - 100% within Payment by Results (PBR) deadlines; average number of diagnoses per episode increased from 3 to 3.4  Consultant Appraisal: almost 500 consultants sent tailored performance reports, comprising 4,000 reports from 12 different data sources  Integrated Performance Report: produced monthly at Trust, specialty and sub-specialty covering hospital activity, waiting times, clinical indicators, benchmarking data and analysis from over 20 local and national sources.  Libraries: 2,900 Trust staff registered with library service; 4,100 items borrowed from Trust libraries and 38,000 accesses to electronic resources Staff trained  Library staff delivered 270 hours of information skills training to library users  PAS training: over 2,000 staff attended PAS training courses in the last year, including 300 new users from the Dental Institute. PAS trainers provided over 1,540 hours of courses. Over 300 staff completed the PAS foundation e-learning module (implemented in November 2006). Some 100 staff completed the mandatory e-learning refresher training (started April 2007)  Access training: 12 half-day courses run for CMT business managers and patient admin staff. D:\Docstoc\Working\pdf\a7ac39e0-0788-40ac-932e-91fcad7271c4.DOC 5 Annex 2 D:\Docstoc\Working\pdf\a7ac39e0-0788-40ac-932e-91fcad7271c4.DOC 6 Annex 3 Informatics risks and mitigation Estate: there is an increasing dependence of information systems on the estates infrastructure (power, air-conditioning, asbestos etc). Service moves depend equally on the informatics infrastructure. Mitigation: close working between Facilities and Informatics; requiring a formal estates impact assessment in IT capital investment business cases; and a formal informatics impact assessment of service moves. Workforce: recruitment and retention of IT and network specialists, information analysts and clinical coders remains a challenge. Mitigation: investment in professional development; restructuring to enable career pathways; active identification of LTHT-based work development opportunities. 24x7 cover: progress has been made towards designing a workable solution, satisfying the requirements of both the EC working time directive and NHS employment contracts. The staff most affected have been actively engaged in the design process. A formal, costed proposal is being completed for approval. Technical capacity: competition for technical IT and information analysis skills continues to exceed supply. Mitigation: re-prioritisation of capital investments; investment in generic systems solutions; development of information systems to support CMTs and Leeds PCT; challenging new central demands. CMT capacity: new systems require disciplined use. Data quality remains a serious issue for financial, access and clinical governance. Mitigation: Managing Patient Pathway Programme being further developed to support redesign in CMTs; coders working closely with clinicians; review of the LTHT Waiting List Action Team mechanism for assuring waiting list management; use of data quality indicators to target remedial action, including as part of the Income and Profitability workstream led by the Director of Marketing and Communications; active support to CMTs, managed through the Trust‟s Activity Recording Panel. External information demands: the burden of DH, Healthcare Commission and audit requirements continue to spiral unchecked. New demands in relation to the 18 weeks waiting times target are especially onerous. Mitigation: challenging the case for new demands; meetings with the Healthcare Commission and DH, to highlight practical issues and propose resolutions; agreeing to join the formal review of DH approval processes for new central returns. 18 weeks referral to treatment times target: the “rules” continue to change and DH is still focused on central monitoring rather than on systems to support delivery. New monthly demands made mandatory from January and weekly returns recently introduced. Mitigation: active engagement with DH on 18 weeks principles and definitions; automation of central returns; development of a shared LTHT/PCT pathway management system and working with DH to promote this approach. Data Protection/Caldicott: there are significant information governance issues for new clinical pathways crossing organizational and professional boundaries. Mitigation: joint approach with Leeds PCT and Leeds City Council; formal Data Protection agreements with other organisations; updating Trust policies. D:\Docstoc\Working\pdf\a7ac39e0-0788-40ac-932e-91fcad7271c4.DOC 7