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					                                                    Heart of Birmingham TPCT - Trust Board
                                                         11 December 2008 – Enclosure 10



     HEART OF BIRMINGHAM TEACHING PRIMARY CARE TRUST
            SUMMARY OF REPORT TO TRUST BOARD

SUBJECT:         ICT Update

REPORT BY:       Director of Finance

AUTHOR:          K. Ryatt, Associate Director of ICT

KEY ISSUES FOR BOARD CONSIDERATION AND DECISION:

RecommRe
To update the Board on the progress on the National Programme for IT and also
supporting ICT projects within the PCT.



IMPLICATIONS: ()
Financial:                    

Human Resources:              

Healthcare:                   

National                      
Policy/Legislation:
Annual Health Check:

Local Delivery Plan:          

Diversity Impact:

Patient and Public
Involvement/Consultation:
Other:


RECOMMENDATIONS:
The Trust Board notes progress made on ICT developments




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                                                       Heart of Birmingham Teaching Primary Care Trust
                                                                   Report to the Trust Board
                       Subject:                           Information Communications and Technology
                       Date:                              December 2008
                       Lead Director:                     David Melbourne
                       Author:                            Kam Ryatt
                       Recommendations:                   To Note Report

                       1.         Executive Summary


Project                                 Summary                                                         Plans                                                                 RAG
1. Connecting for Health:               Ongoing implementation of the C-PAS and prepare for             Agree with Service Leads when remaining services are to move
Community PAS/Lorenzo                   deployment of Lorenzo. Take on of remaining services.           onto C-PAS. Ongoing development of reporting capability.
                                                                                                        Preparation for Lorenzo deployment – discussions to take on
                                                                                                        Lorenzo Rel1/2 next year.                                             G
Issues: Delays from CSC/iSOFT to deliver Lorenzo Regional Care. Major impact on delivering clinical functionality and ‘joined up’ integrated health records within our
LHE, impacts full delivery/benefits of the 2010 care in the community programme.
Operational slowness of C-PAS system, major impact on users inputting data, recognised by CSC, plans are in place to upgrade servers which should improve response
times. Reporting system called ‘bluefish’ unavailable during upgrades – delays in reporting activity.
2. Choose and Book                         Electronic referral management system –                      Ongoing support to Practices, training, use of the Directory of
                                           Indirect bookings for Oct ’08 – 44%                          Services (DoS), shortcuts and tips to use system, bulletins on DoS
                                           Direct bookings for Oct ’08 – 26%                            changes, increase the number of services available on DoS.             A
Issues: Engagement from some GPs to use system, reluctance to change current referral processes within Practices usually within single handed Practices. The C&B team
have personally sat with Practices to help with refining the referral process however limited success. Local reward scheme not really having the desired effect to improve
performance.
3. GPtoGP, clinical record transfer        Electronic transfer of clinical record from one Practice to  Good progress has been made albeit with two of our GP system
                                           another (nationally)                                         suppliers’ EMIS and InPractice.
                                                                                                                                                                              G
Issues: Main challenge is improving the data quality within our GP systems, the work we are conducting around implementing the IM&T DES components 1to4 including
implementation of paperlight, data accreditation is helping however data quality is very variable.
 iSoft yet to deliver a stable system for GPtoGP.
4. Electronic transfer of                  This programme will be delivered in two phases.              Good progress has been made, Phase 1: 54 of our General Practices
Prescriptions eTP                          Phase 1: bar coded FP10’s                                    have implemented phase 1 and 76 Pharmacies within HOBs area
                                           Phase 2: fully electronic FP10 which will be available to are on the system                                                        G
                                           any Pharmacy connected to the system
Issues: Ongoing delays from NPfIT for Phase 2 and iSOFT system still having issues to deliver phase 1 bar codes. Phase one mainly benefits Pharmacies as the bar code
will give all the information required for dispensing drugs.
5. N3 Community of Interest                Implementation of a Pan-Birmingham wide data/voice Settling in period and then exploit the bandwidth for other
Network –Pan Birmingham                    broadband network. Fully managed service by BT – applications such as telemedicine, softphone, video conferencing
                                                                                                                                                                              G
                                           transfer of Risk from SSA(IT) to BT
Issues: Ensuring 99.9% uptime and developing contingency plans in case of major failure. Develop backup procedures and test. Technical issues around Firewall
management.
6. Telephony: Voice over Internet Deployment of VoIP using the N3, Coin system across all Ongoing plans to further extend the service into HOB premises.
Protocol (VoIP)                            our Health Centres
Issues: Lack of knowledge and resources to manage expectations and limitation currently on the N3/BT solutions. HOB is one of the first PCTs in the country to take            A
this service and we are pioneering functionality for BT/N3. Roadmap for emerging technologies to elongated.
7. General Practice Telephony              Review and upgrade General Practice telephony systems        A communications bulletins will shortly be sent to GPs outlining
                                           To migrate all 0845 and 0844 numbers onto ‘03’ numbers       the PCTs intentions around 0845 and 0844 numbers and
                                                                                                        engagement with GPs around deploying new telephony systems.            A
Issues: Complex requirements from General Practices, very bespoke for each Practice, GPs in long term contracts with suppliers.
8. Dentists                                Install N3 connections to Dental Practices, provide PCs      All Dentists who agreed to the scheme have had their N3
                                           and Printers.                                                connection and equipment installed. Working with Ros Hamburger
                                           Develop a web-portal for Dentists.                           in developing the new web-portal and migration to a single system     G
                                           Recommend a single system for Dentists
Issues: Dentists concerned about ongoing revenue costs for N3 data lines and maintenance. The ICT department is providing 1st line technical support for equipment but
not their clinical system.
9. Patient Texting – GP Practices          To reduce the number of DNAs, a mobile text reminding        Ongoing review of project – and extension into Community
                                           services has been implemented within General Practice,       Services
                                                                                                                                                                              G
                                           soon to be extended to services within the Provider
                                           Community Services
Issues: Review of DNAs and texted patient to be undertaken within the next 6 weeks
10. Graphnet Data Warehouse                Implementation of a data warehouse to support the local Contract agreed with suppliers, hardware and initial database
                                           health economy with its 2010 programme and also installed. 330,000 patient demographics loaded onto the database
                                           provide operational information to clinicians in all care and 1st GP has agreed to test loading of his clinical data. We are in
                                           settings                                                     discussions with SWBH to receive acute clinical data. The system is   G
                                                                                                        NOT accessible for anyone yet and is in test phase only.
                                                                                                        1st Programme Board meeting scheduled for December,
                                                                                                        membership from all partners in the LHE.




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2.1 Community Patient Administration (C-PAS)

Implementation

The implementation of CPAS will continue until the end of the financial year for the
following services:

      Intermediate Care – Bedded Unit
      Falls Prevention Service
      Palliative Care Heart Failure Nurses
      Cardiac Rehabilitation Nurses
      Sexual Health and Family Planning
      Intermediate Care – ICATT
      Stroke Service
      Parkinson’s Nurses
      Carers

Please note that all implementation schedules are dependent on the participation of the
services to go onto CPAS and the availability of resources to support the services
successfully.

Performance

The national system continues to be a proven and stable solution, although in the past
month there has seen a decline in response times after the upgrade to version LE2.2.
This is due to the system supplier confirming that server hardware required updating.
The updates to the infrastructure within CSC were completed on 18th November 2008
and all PAN Birmingham PCTs have confirmed that there has been a significant
performance increase.

Accessibility

The ICT department has continued to provide personal computers within our Health
centres to support services both existing and soon to use PAS. The mobile PAS laptop
solution is also being deployed with over one hundred units now in circulation amongst
Provider services staff. Furthermore in an effort to improve the accessibility and
performance, the ICT department as liaising with mobile data solution providers such as
Orange and O2 to procure and implement a direct access solution which will allow users
to access HOB network services more effectively.

Activity Recording

Activity recording onto CPAS has been generally consistent for the majority of services
although within the recent month we have seen a decline in timeliness, which may be a
direct result of the performance issues at CSC. The provider services directors continue
to promote the need for timely input within 48 hours which is a message that is being
filtered to all staff via the respective section heads and at point of training.

Data Quality




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Data Quality in regards to records unmatched against NHS numbers remains on target to
achieve 95%.

The statistics correct as of November 2008 are as follows:

        Records With NHS numbers                    Records without NHS numbers
                 142,562                                        9,936
                 93.03 %                                       6.97 %

The PAS team are currently revising the strategy to improve overall data quality in
regards to untraced NHS numbers, redundant referrals, system configuration, and many
other facets of the system and it is therefore envisaged that significant improvements
should be evident throughout all areas in the coming months.

2.2 Choose and Book

Choose and Book is a national electronic referral service which gives patients a choice of
place, date and time for their first outpatient appointment in a hospital or clinic.

System Upgrade

The Projects Team held two awareness sessions prior to the release 4.1 upgrade, and one
workshop after the upgrade. The awareness sessions focused on: user interface changes,
screen layout changes, support for attachment descriptions, changes to booking rejected
referrals, and alerts. The sessions were attended very well by all practices, and the
workshop provided practices with an opportunity to learn more about various changes
brought about by the upgrade.

Primary Care Services

The Respiratory Service have started to receive referrals via the C&B system. The
Projects Team is awaiting further information from the Physio Service lead regarding the
implementation of indirectly bookable C&B for their service. Currently liaising with
Diabetes and Heart Failure service to move them onto Choose and Book

Progress to date

Total booking performance for HoB is currently at 44% for October 2008, but since the
last report to Trust Board, Connecting for Health have now started to rate StHAs and
PCTs on Direct Bookings only. Heart of Birmingham DBS figure was 1,182 patients for
September 2008 and 1,233 patients for October 2008 which equates to about 26% of our
referrals to secondary care.

2.3 GP2GP

GP2GP is the NHS Connecting for Health project that is enabling patients' electronic
health records (EHRs) to be transferred directly from one practice to another. It starts
when a practice accepts a patient onto their practice list for primary health care and ends
when the EHR is transferred from the previous practice into the new GP clinical system.
Under the existing process the new practice often does not have the benefit of the old
record when the patient attends for the first consultation. GP2GP on the other hand,


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enables an almost instantaneous transfer of a patient’s EHR. As a result, GP’s and their
teams will be able to provide patients with a safer and more efficient service

Phase One:

To implement and support the GP2GP project to Emis LV and Vision Practices across
Heart of Birmingham This will include Clinical System upgrade, Business process
mapping workshops, staff training and data quality checks.

Progress to date:

Currently 47 practices (39 Emis LV and 8 Vision) have been trained and are live with
GP2GP, with 5 Practices pending training/Go-Live. Registration and summarisation
policies have been approved and communicated to all practices that are using the system.

So far 1,372 GP2GP requests have been made by HoB Practices and 1,715 extracts in
October 2008.

Due to some issues and concerns around Data Quality at General Practice for GP2GP,
the Data Quality Team are preparing to visit all practices to assist with improving usage
and maintain a standard approach to implementation.

2.4 Pharmacies Update – ETP

Electronic Transfer of Prescriptions will enable GP Practices to send prescriptions
electronically to any Pharmacy of the patient’s choice. This is being rolled out in two
phases:

Phase One: System Readiness

Installation and setup of GP Clinical Systems to print off bar-coded prescriptions
containing medication prescribed by the GP

Installation of ETP ready systems to Pharmacies to scan bar-coded prescriptions and
receive medication details.

Phase Two: System Deployment

GP surgeries will begin to send prescriptions electronically to all pharmacies with a
compliant ETP system. Pharmacies will also be able to send prescription claims
electronically to the PPD (Prescription Pricing Division).

Progress to date:

76 out of 83 Pharmacies (92%) now currently have a live ETP system installed and are
slowly beginning to process bar-coded prescriptions that arrive from any of the 54 of the
77 GP Practices that are producing the appropriate prescriptions from within their
surgery.

Isoft clinical Systems are still having trouble delivering their solution, despite being
accredited by CFH. The 6 outstanding practices have all received training and will be



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setup as soon as Isoft have resolved current issues. The remaining 11 practices have
some local issues that are in the process of being resolved with the aim for completion by
the end of March 2008.

Pilots for Phase Two across the country are still yet to commence but it is estimated that
these may begin by the end of 2008.

2.5    N3 – Community Of Interest Network Deployment (COIN)

The N3 Coin deployment was a PAN Birmingham project to upgrade the IT networks at
various Birmingham NHS locations. A total of 28 HOBtPCT sites were identified to
have a requirement for an upgrade to the new N3 Coin network. This project took 12
months to complete and all sites including Bartholomew House have now been
successfully migrated and commissioned to the new network. This project has now
completed and a final project closure report is being prepared.

       2.5.1 Telephony Services – Voice over Internet Protocol (VoIP)

       To exploit the new COIN, Heart of Birmingham tPCT has started to deploy
       telephony systems over the same infrastructure within our Health Centres via
       BT/N3 solution. The service is a fully managed hosted service provided by
       BT/N3. The benefits of this system have been well documented and essentially it
       is a move towards integration at a technical level for data and voice technologies.
       We have therefore deployed this service in all our new health centres (except
       SOHO) as the strategic platform for telephony services. ICT plan to extend this
       service to existing building in due course (Bartholomew House, Gee House and
       SOHO sites).

       In addition to the above service ICT have also started move our mobile
       telephones onto the O2 provider as they currently provide the best call rates and
       a direct gateway into the BT/N3 network, the solution also integrates with our
       email servers via the Blackberry devices.

       2.5.2 General Practice Telephony

       Within General Practice however, the telephony services are very diverse and of
       varying degrees of complexity. Nearly all systems within General Practice are
       what we call ‘local’ systems which provide functionality and there are many
       ‘carriers’ of the service into the public service telephony network (PSTN) these
       are typically Virgin, BT, Telewest, Cable and Wireless etc. (basically the cheapest
       deal at the time). All of these systems can handle out of hours messaging and is
       usually provided by a third party. Example of this functionality is when calls are
       re-routed to an alternative supplier giving the Patient various messages. (e.g. ‘in
       the event of a emergency please call PrimeCare/Badger etc, ‘our surgery is closed
       followed by a number of options).

       Most General Practices have incoming numbers prefixed with 0845 or 0844
       numbers these are ‘premium numbers’ and both have charges attached to the
       incoming caller. Some Practices have the standard 0121 prefix which again
       depending on the callers’ telephone package could be included in the package or




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          is chargeable, in any case if the caller is diverted to another 0845/0844 number
          the caller will pickup the additional cost.

As part of improving the telephone services within General Practice we are proposing to
offer the following schemes:-

         0844 and 0845 numbers: the PCT would like to move all these numbers to a
          ‘03’ number. These numbers are usually within ‘call packages’ and hence will not
          attract additional costs for Patients. The PCT will facilitate the implementation
          and communication to patients. The costs to implement the ‘03’ service will be
          met by the PCT for incoming calls only. In essence you will see no change to the
          current service you have. The benefits are directly for your patients.

         New Telephone Systems: we will review existing telephone systems within
          General Practice and where required offer assistance to upgrade systems as part
          of our agreed telephone strategy. Again the PCT will pick up all costs for
          deployment of ‘03’ numbers and depending on which new telephone system you
          opt for there maybe a contribution by the PCT.

The PCT will not pick up any costs for ‘outgoing’ calls from Practices, however as part
of the consultation we will advise of the best cost effective schemes and how we can
deliver improved site to site calls and reduced call rates to mobiles.

2.6       Dentists ICT Update:

There are a total of 39 Dental Practices of which 18 Dental Practices have signed up to
have new networking infrastructure and IT hardware at their practices.

In April 2008 the ICT department commenced Phase 1 which was the installation of new
BT network links, new updated PCs and printers for the 18 practices on the DPAS pilot.
Since then practices have gained access to the Internet, PCT Intranet and NHS Mail.

The 2nd phase of the scheme is to look at the possibility of developing a Dental
Information Portal for the service which aims to keep all dentists updated on specific
dental policies, procedures and news throughout the service.

There are also plans to review the existing range of dental clinical systems used
throughout the PCT and whether these can be standardised and centralised.

All information for moving the Dental Practices to a central clinical system has been
submitted to Mark Pulford in Commissioning. This has been taken to the Dental Board
and ICT are waiting for approval before proceeding with the next stage.

2.7 New Premises – ICT Commissioning

The Percy Road building redevelopment is due to be completed in March 2009.

The ICT team plan to install a new BT VoIP telephony system in the existing building in
December 2008. Once the new build phase has been handed over to the PCT next year
the telephony system will be extended to the rest of the building.



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ICT will make plans to work with all the new proposed services to provide the necessary
network infrastructure and IT systems before go live.

2.8 Boots ‘City Centre’ Health Floor

The Heart of Birmingham PCT in partnership with Boots, Aston University and other
local NHS Trusts developed the ‘City Centre Health Floor’ within the lower ground of
Boots. The new health floor initially opened in mid July 2008.

In Phase 1 of the project the ICT team ordered & installed a new BT N3 Coin network
and VoIP telephony system for various health services based within Boots.
Dr Nye’s GP clinical systems and associated IT hardware were relocated from Matthew
Boulton College. Various sexual health teams moved from St Patricks Centre and
Whittal Street GUM clinic to the new health floor and their IT systems were configured.

In October 2008, the Boots Walk in Centre changed provider from Badger to Chilvers
McCrea. HOB IT worked closely with Chilvers McCrea to introduce the new INPS
Vision clinical system, desktop hardware and new telephony system for the service.
An SLA is in place with the PCT IT department to provide ongoing IT support for this
service.

In December 2008 there are plans to help relocate Chlamydia Screening currently within
Boots to St Patricks Centre. South Birmingham PCT dental services will also move to
Boots and will utilise the new IT network infrastructure and telephony systems recently
installed.

2.9 Patient Mobile Texting – GP Practices

A new iPLATO patient mobile texting service has been introduced in HOBtPCT with an
aim to reduce non-attendance to appointments (DNAs).

All GPs and Practice Managers where contacted requesting their participation in the
scheme. The minimum criteria for practices were to ensure they regularly recorded up to
date mobile telephone numbers for patients.

A total of 38 practices agreed to participate and patient messaging software has been
installed on participating GP clinical servers. The patients of these GP practices are now
benefiting from receiving appointment reminders to their mobiles phones via text
message.

Progress to date:
    32 GP practices are currently live and sending out appointment reminders.
    Live practices have had accounts credited with text messages.
    Knowledge Sharing events and user training has been delivered to GP Practices
       through classroom training and on-site visits.
    iPlato Best Practice Guidelines have been approved by the ICT team and
       communicated to GP Practises.
    IT Support processes are in place for practices and an intranet page setup for
       further help.
    Patient Care Messaging awareness across the PCT has been communicated both
       internally via local IT newsletters to practices as well as externally in Your Guide.


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      6 practices are currently on hold due to clinical system changes or staff shortages.
      The ICT team is currently performing a DNA review across selected practices to
       assess the impact of appointment text reminders to patients. This involves both a
       quantitative and qualitative analysis from practice data and staff feedback. This is
       due to be completed by the end of December 2008. However, general feedback
       from practices to date is very positive.
      The iPlato system has been opened out to other practices who may be interested
       in signing up to text messaging at their practice. The PCT has agreed to support
       the costs for the first 12 months after which a review of usage will be undertaken.
      The PCT receives regular weekly reports on text messaging usage at live GP
       Practises. A random sample of system usage is shown below:-

        Practice              Practice Name                 Average number of
          Size                                              texts sent per week
         Small      Dr Sidhom                                        245
        Medium      Dr Walji                                         739
         Large      Dr Bathla (Main & Branch practice)              1,845

2.10 Graphnet Data Warehouse

The Graphnet Data Warehouse will link together patient records from acute and primary
care to produce a view only integrated electronic patient record for clinicians to access
across the PCT. This will support the local health economy with its 2010 programme and
also provide operational information to clinicians in all care settings.

Hardware Setup and Pilot

Hardware configuration of the servers has been completed and testing of configuration is
due to be completed by the end of November.

Patient demographic information from the Exeter system will need to be extracted to
populate the database with registered patients. There will also be a requirement to receive
information from neighbouring trusts to identify those patients that are residents within
their pct but are registered to HOB GP’s. Sharing Protocols with these organisations are
being drafted up to support this process.

GP engagement is due to begin at the end of November 2008 with a view to setup and
begin a data extract by the end of December 2008. The ICT team are working with Dr
Gaspar’s practice (St Clements surgery) to pilot the system, and develop sharing
protocols, configuration, testing and validation processes. Once the pilot phase has been
completed we will have the opportunity to demonstrate a working system to other GP’s.

Engagement with the acute services to setup a data extract will begin early 2009.



3. Information Governance

The Information Governance agenda continues to be a high priority, with a number of
mandates being issued to government offices and agencies following recent high profile



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data losses. The Trust is taking steps to ensure appropriate procedures and safeguards are
in place to ensure compliance.

3.1 IT Systems Usage Policy

The IT Systems Usage policy has been approved and is in the process of being published
and cascaded to staff. This policy outlines staff responsibilities when using IT systems,
and additionally sets out what is acceptable/ unacceptable use.

A recent report on internet usage has highlighted that many staff are regularly using
Social networking sites such as Facebook and radio streaming. The top websites visited
are to be monitored and access to certain sites may be blocked if they are considered
counterproductive or effect network performance.

3.2 Information Security

The rollout of encrypted USB memory sticks and Safeboot encryption on laptops
continues. Encrypted memory sticks have been ordered for all PEC Members, NEDS
and clinical advisors and are available for collection from IT.

To date approximately half of the Trusts laptops have Safeboot encryption installed. A
communication will be issued from the Director of Finance to advise that any staff
member that fails to arrange for their laptop to be protected with Safeboot by February
2009 will have the equipment taken from them.

All GPs have also been advised of their responsibility to encrypt patient identifiable data
held on practice owned portable equipment (memory sticks, laptops etc) to comply with
DoH mandate and the Data Protection Act 1998.

A number of recent incidents have highlighted that Information Security awareness
needs improving throughout the Trust; the Information Governance manager is liaising
with the Communications department to address this.

3.3 Data Quality

A new IM&T LES has been created to encourage more practices to participate and
achieve the data quality standards necessary for sharing data in the National Care
Records System.

This LES differs from the previous IM&T DES as it offers a financial incentive to
practices who achieve Paper light accreditation, in recognition of the significant effort
involved in meeting the requirements for Paper light.

Practices must subsequently gain Data Accreditation to ensure readiness for the National
Care Records System.




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