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THE LEEDS TEACHING HOSPITALS NHS TRUST TRUST BOARD – 3 NOVEMBER 2005 INFORMATICS RISKS 1. IT, information systems and information – “informatics” - are essential to the efficient and effective delivery of Trust objectives. Direct patient care in particular is increasingly reliant on IT. This paper reviews current informatics risks and mitigating actions. 2. The information in this paper is a product of the Trust’s structured formal risk assessment and controls assurance processes. These are informed by internal and external audit reports. Mitigation activities include the development of formal business continuity plans by all service areas, including the mandatory emergency preparation requirements of the new Civil Contingencies Act. Areas of risk 3. Sources of risks may be categorised under the following headings: Infrastructure – including the IT network, telecommunications, computer hardware, medical records and staff libraries. IT Systems - such as PAS, Theatres, A&E, GroupWise, clinical systems (e.g. pathology, radiology, pharmacy) and business systems (e.g. supplies, estates, finance, workforce). Processes – such as patient administration and clinical coding. People – including waiting list managers, patient admin staff, and informatics specialists in IT, information systems, information analysis, project management, clinical coding and library services. 4. Current risks and mitigations under these headings are summarised at Annex A. Areas identified as Red Risks on the Trust Risk register are highlighted. Outstanding issues 5. LTHT current devotes 1.4% of its turnover to informatics, compared to the Wanless recommendation of 4% (source: Connecting for Health). A fifth of LTHT’s expenditure is outside the Informatics Directorate, notably by Pathology, Radiology, Pharmacy, Supplies and Estates. 6. Connecting for Health (CfH) brings both opportunities and challenges. Its development of a secure national NHS Broadband network and IT infrastructure is fundamental to the development of informatics across the NHS. 7. However, the very scale of the national agenda constrains CfH’s ability to respond quickly to changes in the delivery of healthcare, in NHS policy and in operational processes. Moreover, as the pressures on national funding grow, costs will increasingly fall on the NHS: “implementation” has already been deemed a local responsibility. The central performance management of NHS preparedness for CfH is apparently to be escalated from the beginning of next year. 8. The Trust remains committed to the goals of CfH and to supporting their delivery, while ensuring that local implementation takes full account of local circumstances and requirements. LTHT will also continue to address local needs not yet covered by the national programme. 9. In addition to the risks from getting existing informatics wrong, there are the risks from falling behind in improving services through failing to exploit new technological opportunities. A step change in informatics development is needed to meet the combined challenges of Choice, practice-based commissioning, 18 weeks waiting times target, plurality of provision, Payment by Results and Making Leeds Better. 10. In particular: PAS needs to be transformed from a consultant-centric, hospital only, retrospective, paper-driven patient administration system, to become a patient-centred, health community-wide, real-time, care scheduling and patient pathway management system. Internet technology needs to be exploited beyond providing an information repository, to give active “e-commerce” support to the day-to-day activities of patients, GPs, commissioners and Trust staff. Information systems and information analysis must break free of the all- consuming demands of central-requirements and audit, to focus on the systematic measurement, analysis and improvement of service quality. The IT infrastructure should be “state-of-the-art” and be supported 24/7. 11. Such an agenda requires substantial additional investment. Capital is not really the issue, as we are unable to spend current allocations; the need is for people with skills in systems development and support, and project management. Conclusion 12. The Board is invited to comment on the risks and mitigation actions in Annex A and on the future strategic priorities. Brian Derry Director of Informatics Annex A Informatics risks and mitigation Infrastructure Risk Mitigation Casenotes not accessible Medical Records Strategy: or complete (Red Risk) single set of notes for each patient single 24/7 Medical Records library optical disk storage and retrieval casenote tracking via PAS audited standards for content and structure of notes. Network failure (Red Upgrading IT network. Risk) Telecommunications failure Upgrading telephone switchboards and bleeper systems Computer viruses Enhanced virus and spam checking software Server failure Server backups and increased capacity. Estates/environmental Back-up electrical supply for switchboards. problems (e.g. asbestos, IT infrastructure covered in estates condition flooding, power failure). surveys. Integrate IT planning with service/estates planning. Inadequate technical Business case being developed for 24/7 IT support. support. IT Systems Risk Mitigation System failures Systematic backups. More robust testing before implementation. Structured business continuity planning. Outdated functionality or Updating core systems: PAS, A&E, Theatres. gaps in system provision New clinical information system. Developing shared systems for primary care: results, PACS, diabetes, waiting lists. Application of internet technology to support Trust business processes and communications, including links to primary care. “Digital A&E” programme, assessing technological opportunities for supporting emergency care processes. Lack of system and Strengthening LTHT IT helpdesk. technical support. Internal Audit reviews of CMT support, security and business continuity arrangements for their systems, e.g. in Pathology, Radiology, Pharmacy, Cancer, Cardiac and Renal. Processes Risk Mitigation Inadequate or Interlocking programme of process improvement, inconsistent processes standardisation and documentation, covering: (Red Risk) Patient administration and waiting list management - Managing Patient Pathways programme Theatres - Surgical Pathways Improvement Programme A&E - new system implementation Medical records - Medical Records Strategy Clinical coding - Clinical Coding Strategy. Support from expert advisory groups - Waiting List Action Team and Activity Recording Panel. Internal Audit rolling programme of CMT data quality reviews. People Risk Mitigation Inadequate or outdated Mandatory training and accreditation of ADOps and skills (Red Risk) Business Managers in waiting list management. Mandatory annual PAS refresher training. Development of e-learning systems for patient admin and waiting list management. Investment in pan-Leeds library services. Promotion of national skills accreditation and qualifications, e.g. ITIL for IT service managers, clinical coding qualifications, data protection. Emphasis on continuing professional development for informatics specialists (e.g. via national professional associations). Helping lead the West Yorkshire Chief Information Officer development programme. Supporting professional regulation for informatics specialists (United Kingdom Council for Health Informatics Professions). Capacity to cope with Additional staffing for IT networks, medical records increased IT and and clinical coding. information demands; Supporting the new Health and Social Care public and private sector Information Centre in its mission to reduce the competition for scarce burden of central returns. skills; Challenging poorly designed or disproportionate demands, notably from the Audit Commission. People Risk Mitigation Agenda for Change Working with national professional groups and DH on developing national job profiles, Knowledge and Skills Frameworks, and on a survey to evaluate AfC outcomes for informatics staff and the case for recruitment and retention premia. Breaches of Data Development of e-learning system (TIGER). Protection Act/Caldicott Monitoring and support by Trust Data Protection Officer. Engagement with national Patient Information Advisory Group. Trying to establish formal data sharing agreement with Leeds University. Implementation of formal Information Sharing Agreements with external public and private sector agencies.
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