TRUST BOARD – 3 NOVEMBER 2005


   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

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
   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


   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

            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
Network failure (Red       Upgrading IT network.
Telecommunications failure Upgrading telephone switchboards and bleeper
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.

                                  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
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.
           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
                             Theatres - Surgical Pathways Improvement
                             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.

            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.
           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
                           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

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