APPENDIX 1
Highland NHS Board 3 April 2007 Item 9.1
NHS Highland Board – eHealth Strategy Progress March 2007
The Board is asked to note this quarterly report relating to the implementation of the NHS Highland eHealth Strategy. Background NHS Highland allocated £1.2M capital in the financial year 2006/07 to support the delivery of the eHealth Strategy in the managed sector. This was against an identified requirement of £3.1M. The initial allocation was reduced to £900k due to uncertainties about the overall capital position within the board. During the course of the year additional capital monies were received as follows: EHealth Allocation Video Conferencing Air Conditioning Additional Allocation SEHD Additional Pathology SEHD Additional Grouped Assets Additional CT/Radiography TOTAL £ 900k £ 173k £ 17k £ 459k £ 200k £ 50k £ 8k ------1,935K
In addition £198k specific capital funding was received in respect of general practice. The plan for utilisation of these funds has been devised and agreed by the eHealth Steering Group and formally approved on behalf of the Board by DHS Management Group. All proposals have been subjected to a formal risk based evaluation process but an additional principle has been applied in determining which of the £3.1M worth of proposals were to be progressed; this was to consider the revenue impact of the proposals and those with zero or minimal revenue impact were prioritised above those which were predicted to incur additional recurring costs. There are numerous initiatives in addition to those funded by the eHealth capital allocation which contribute to the achievement of the NHS Highland‟s strategic aims, as well as this the SEHD released additional eHealth capital during the year. The eHealth Steering Group has agreed capital schemes for these projects. For completeness these are included in this report. 1
Section A – Managed Sector Projects Funded by NHS Highland eHealth Capital Programme Project Title Pathology System Objective To replace the existing Pathology System before it becomes unsupported by the supplier. To replace the existing Radiology System with one that will support a modern Radiology service and to develop a business case to support the implementation of PACS in NHS Highland Status & Progress The project is now at the best and final stage with the two identified suppliers. The expectation is that a supplier will be identified during April/May allowing implementation to start early Summer. NHS Highland planning for the new National RIS is complete. Access agreement will be signed during the next week. Date for implementation to start will be agreed once the signed access agreement has been received by the SEHD. PACS business case has been developed and submitted to the asset management group for funding during 07/08 and 08/09. To procure and implement software that will enable more efficient and effective management of NHS Highland‟s websites Supplier has been identified for CMS consultancy (Storm-ID). Work is progressing well on the new Intranet and SHOW sites. Migration of current content has started however a great deal of information needs to be migrated to the new sites. Project Manager in post and has started the procurement via the OJEU process. The procurement has completed the Financial/Economic/Technical (FET) stage of the procurement. The operation requirements of the th project will be signed off by the project board on 19 March 07. This document will then be issued to the short listed suppliers. New software is currently being beta tested by NHS Highland. Once complete will be installed on the live system. The funding for this project was provided by the SEHD. More effective and efficient management of the Board‟s websites. Benefits Realised Replacement of obsolescent Pathology System. Replacement of obsolescent Radiology System in preparation for PACS (and eventual filmless environment).
Radiology System (RIS) and Picture Archiving and Communication System (PACS)
Content Management Software
Renal System
To procure and implement a system that will support the provision of Renal Medicine Services.
Better management of patients with renal disease.
New Ways of Measuring Waiting – PAS Development
To redevelop NHS Highland‟s Patient Administration System to fulfil the requirements of SEHD‟s “New Ways of Measuring Waiting” initiative.
To meet national directives in “New Ways” initiative.
2
Backup Silo and eMail Store
To procure and implement a system that will enable quicker and more comprehensive backup of NHS Highland‟s data; and to provide the facility to store all emails sent and received by NHS Highland staff.
This project is complete and NHS highland now has a robust managed backup regime. This means that peripheral servers are backed up to Inverness, Raigmore servers are backed up to Assynt House and visa versa. This not only provides confidence in the backups being carried out but meets the requirements of audit. A number of sites across NHS Highland have had their local area networks upgraded as part of this project as well as a laser link being implemented between Assynt House and Raigmore Hospital. Equipment to install wireless in key sites has also been purchased this year. This is ongoing and essential replacement/upgrading of NHS Highland technical infrastructure and included the creation of a fault tolerant laboratory system. A number of community bases across NHS Highland have now been upgraded to a permanent N3 connection, this allows community staff to make use of the same services as other NHS employees (Intranet/Internet, email, file & print). Work continues on surveying and upgrading community bases. Software and services from all companies has been ordered. Work continues on completing this project.
NHS Highland‟s clinical and managerial data will be secured and will be more readily retrievable.
Network Developments & UPS Replacement
To contribute to the ongoing replacement and upgrading of NHS Highland‟s data networks and uninterruptible power supply devices To contribute to the ongoing replacement and upgrading of NHS Highland‟s 120+ fileservers.
Replacement of key infrastructure components
Server Enhancements
CHP Infrastructure
To provide community staff with secure and reliable access to NHS Highland‟s IT systems as appropriate.
More robust and resilient servers will enhance service continuity and disaster recovery issues. The provision of access to clinical and other applications for staff based in the community
Haematology Anticoagulant Service
To unify and enhance the safety, efficacy and accessibility of the region‟s anticoagulant monitoring services by upgrading the software package supporting this service at Raigmore hospital and making it available at all sites delivering such a service in the region.
Increased patient safety with regard to the provision of regional anticoagulant services.
3
Section B – Managed Sector non-Capital Funded Projects
Project Title Advice and Guidance system Objective To provide a means of securely communicating and recording patient identifiable advice exchanged between primary and secondary care clinicians To provide technical capacity and e-learning support to staff in remote areas to enable and encourage use of the eLibrary service. Status & Progress Planning has started on the implementation of this application. Benefits Realised Has the potential to provide auditable clinical information exchanged between clinicians and may reduce the number of avoidable referrals. Increased learning opportunities for staff in remote areas.
“Building Capacity” Programme
NES has provided funding to deploy technology (£73k) and to provide an e-Learning facilitator to support the use of technology to access services such as the eLibrary in remote areas. This will be tied into the “CHP Infrastructure” project described above. System has been developed to meet user requirements. Work continues on improving the usability of the software including developing a number of reports from the system. Main focus of current work is in the analysis and implementation of cancer specific pathways within the software.
Cancer Tracking System
To develop and deploy a system that will support the tracking of patients with cancer and that will enable NHS Highland to meet the SE‟s targets to report on cancer waiting times each week. It is recognised that this system will provide a temporary solution pending the delivery of a national system. To ensure that all clinical communications identify patients using the Community Health Index number. To develop and deploy a system that facilitates the generation and storage of clinical correspondence.
This system will enable easier and more reliable tracking of the “patient journey” for patients with cancer, and will alleviate much of the effort expended on reporting waiting status to the Scottish Executive.
Universal Uptake of CHI
This initiative is one that is sponsored and supported nationally with targets set by the Directorate of Delivery at SEHD. To date NHS Highland has achieved the targets that have been agreed and further targets are anticipated. Roll out of system proceeding. Link with clinical repository (SCI Store) imminent.
The provision of reliable and secure patient identification across health and care sectors. Legible, semi-automated, auditable, storable & retrievable correspondence.
Final Discharge, Interim, Clinic and Miscellaneous letters
4
Videoconferencing
To provide comprehensive, accessible and supported videoconferencing facilities to NHS Highland.
8 new full video conferencing units have been delivered to sites. 4 are fully operational, the other 4 will be shortly. 2 Video Conferencing Advisors appointed. One takes up nd post 2 April, the other in May. Tenders for desktop video conferencing and web cast facilities concluded and orders placed. These products will be rolled out early next financial year. NHS Highland presently spends approximately £80kpa on commercial storage and retrieval of medical records. This figure is increasing by around £10k annually. Work has been initiated to develop a business case to test the financial viability of withdrawing from commercial storage and replacing with a scanning service for these records. This project has been halted due to conflicting demands for resources. 79% of all referrals are currently being made via Gateway. Further progress is inhibited due to the high proportion of non-GPASS practices in Highland.
Reduced need to, and cost of travel within the extended NHS Highland area.
Medical Records Storage
To develop a business case in support of scanning and archiving medical records which are currently stored in commercial premises. National initiative to assist the management of referrals. To provide the national standard referrals system for use by all NHS Highland GPs
More ready access to archived casenotes; reduced cost of storage.
Patient Focused Booking
Enhances patient choice.
SCI Gateway
Emergency Care Summary
To provide unscheduled care providers with a minimal clinical dataset for patients that they encounter. To provide the facility to automatically download laboratory results into General practice clinical records.
This project has now been completed. Further roll out to A&E departments and receiving wards has also been implemented.
Robust, reliable and auditable transmission of referral letters. Enables date stamping of “target” referrals. Clinical benefits for patients using unscheduled care services.
LabLinks
The necessary tailoring of the Raigmore Lab system was funded and completed in 2005/06. Developments of GPASS which will enable the receipt of results is still awaited and is considerably delayed. Representation has been made to SEHD in this regard Equipment and network access has been provided for pilot users in Nairn. System has been in pilot stage for a number of months. The SEHD is currently evaluating the user functionality of the software.
Will enable laboratory results to be available in GP systems thus avoiding re-keying by practice staff.
eCare
To provide mobile electronic means of recording Single Shared Assessment for elderly patients/clients.
Will potentially provide a robust and reliable means of sharing assessments for vulnerable groups.
5
GIRFEC
To provide a means of securely sharing data about children between agencies that have a responsibility for aspects of child welfare.
Endoscopy System
To provide a clinical system that supports the care of patients undergoing endoscopies.
NHS Highland has been designated a “pathfinder” site for GIRFEC (Getting it right for every child).There is an expectation that there will be an electronic solution applied to GIRFEC. However to date the requirement has not been specified, no solution appropriate to health has been identified and it is unclear what support capacity (network, human, equipment etc) will be required. System has been implemented in Raigmore Hospital. Issues identified when implemented in the peripheral hospitals, these have been passed to the supplier who is changing the software to deal with these issues.
Will potentially provide a robust and reliable means of sharing assessments for vulnerable children.
Will enable clinical data to be stored and retrieved for patients undergoing endoscopy.
6
Section C – Projects Carried forward into Argyll and Bute from 2005/06 Local Area Network Upgrades Laboratory System To upgrade and replace LANs in all of Argyll & Clyde‟s Acute and Community Hospitals To implement a single iLab (APEX) system to replace separate systems in RAH, IRH and VoL/Oban and to replace Pinnacle for Pathology, To implement the national A&E system Review of community hospital network infrastructure in progress. Requirements for some hardware upgrades have been identified and orders for replacement equipment have been placed. The single lab system iLab for Argyll and Clyde acute hospitals is now live at Lorn and Islands DGH
A&E System
The project for rollout of EDIS to hospitals in Argyll and Bute commenced February 07. Hardware requirements have been identified and orders have been placed. Development of a Project Initiation Document and project plan for implementation at Lorn and Islands DGH has started and is due for completion by end of March. Plan for rollout to Argyll and Bute is on hold while requirements are reviewed for all NHS Highland AHP services.
AHP System
Tiara has been in use for some years for Physiotherapists at Vale of Leven. This is to be extended to Physiotherapists in Argyll, then Dieticians, Podiatrists and others. Continuum (formerly Torex) is used extensively by Mental Health Teams and Community staff in Renfrewshire and Inverclyde and is being implemented in Lomond and Argyll. To provide common outpatient system at all hospitals to replace PCSMR or paper systems in preparation for implementation of „New Ways of Measuring Waiting Times‟ and electronic data transfer from SCI Gateway for referrals. To provide IT and Information services for the new hospital in Lochgilphead.
Mental Health
Continuum is now live in Helensburgh, Lochgilphead and Islay. Rothesay are about to go live and this will be followed by Dunoon, Kintyre and North Argyll where preparatory work has commenced.
SCI Outpatient System
A project to implement SCI Outpatient system at Campbeltown, Rothesay, Dunoon, and Islay hospitals commenced in September and work was completed by the end of January 2007. Work is currently in progress at Argyll and Bute Hospital with go-live date planned for April 2007.
Mid Argyll Hospital
This project is now complete.
7
Section D – Projects in Contractor Services Sector
Dental IT Services NHSMail
To roll out the national Dental System in Highland Implementation of NHS Mail across Highland in compliance with SEHD timescales.
New server for the dental (R4) system implemented, 2 practices have been migrated to the new system. NHS Mail is the only approved conduit for the transmission of clinical information. A Scottish Executive Health Department (SEHD) letter is about to be issued to the service advising of NHS Mail implementation timescales. It is believed that full implementation within General Practices will be required by 30 June 2007. Fifteen Docman implementations carried out during 2005/06. A further seven have been carried out to date in 2006/07 and the rollout process continues. All Highland practices are now operating on an acceptable hardware platform specification. In future the infrastructure project will concentrate on the cyclical replacement of equipment as it reaches the end of its useful life. Direct advice and support is provided to NHS Highland Pharmacy contractors by the eHealth Pharmacy Mentor. The post is centrally funded until March 2008. National NHS secure mail system in common use across NHS Highland (and the wider NHS). Safe and secure transmission of patient and other data Secure auditable document management within general practice Optimum and effective use of IM&T resource within general practice Optimum use of IM&T resource by the pharmacy contractor sector
DocMan
General Practice Infrastructure Pharmacy Contract Implementation
Implementation of document management system (Docman) to Highland General Practices Continuation of a major project to replace and develop IM&T Hardware within NHS Highland general practice To ensure that the IT aspects of the pharmacy contract are efficiently and effectively implemented
8